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Comparative Accuracy of Mammography and Ultrasound in Women with Breast Symptoms According to Age and Breast Density
Abstract
Breast cancer is the most common cancer and the second most common cause of death from cancer in women.The aim of this studywas to determine which is more accurate imaging test mammography or ultrasound for diagnosis of breast cancer based on the women's age and breast density. We examined 546 patients with breast symptoms, by clinical breast examination, mammography and ultrasound. A total of 546 breast lesions were examined by histopathology analyses. Histopathology results revealed the presence of 259 invasive cancers, and 287 benign lesions. Sensitivity varied significantly with age and breast density. In the 259 women who had both tests, ultrasound had a higher sensitivity than mammography in women younger than 45 years, whereas mammography had a higher sensitivity than ultrasound in women older than 60 years. The sensitivity according to age was 52,1% for mammography and 72,6% for ultrasound. The specificity according to age was 88, 5% for ultrasound and 73, 9% for mammography. Comparing the sensitivity of mammography and ultrasound according to the breast density indicates that mammographic sensitivity was 82,2% among women with predominantly fatty breast, but 23.7% in women with heterogeneous dense breasts, with the increase of fibro glandular density the level of sensitivity with mammography decreases, while ultrasonographic sensitivity was 71,1% among women with predominantly fatty breast and 57,0% for heterogeneous dense breasts. Our data indicate that sensitivity and specificity of ultrasound was statistically significantly greater than mammography in patients with breast symptoms for the detection of breast cancer and benign lesions particularly in dense breast and in young women.
... 8 The criteria for differentiating between benign and malignant lesions from gray scale sonography are widely accepted. 9 The accuracy of clinical diagnosis, mammography and breast ultrasonography in the preoperative assessment of breast cancer is necessary for early diagnosis. It is also to allow accurate pre-treatment planning to allow neoadjuvant chemotherapy or a single surgical intervention with clear surgical margins to reduce the incidence of tumor recurrence as patients usually abscond after the first surgical intervention. ...
... 8 In 2009 another study reported that sensitivity of US was 72.6% specificity of US was 73.9%. 9 We find no local study in this subject and published international data approved role of ultrasonography in dense breasts. 8,9 Mammography is known to be the best breast cancer screening test with a sensitivity of 85-95%; this test can help with the diagnosis of symptomatic or asymptomatic breast diseases. ...
... 9 We find no local study in this subject and published international data approved role of ultrasonography in dense breasts. 8,9 Mammography is known to be the best breast cancer screening test with a sensitivity of 85-95%; this test can help with the diagnosis of symptomatic or asymptomatic breast diseases. However, there are certain limitations to this technique such as the relatively high rate of false-negative mammograms. ...
Objective: To evaluate the diagnostic accuracy of ultrasonography (US) in the diagnosis of breast cancer in women with mammographically dense breasts. Methodology: This cross-sectional validation study was conducted from March 24th, 2021, to September 23rd, 2021, utilizing a non-probability consecutive sampling technique. A prospective study of 140 women with mammographically dense breasts (BIRADS 3 and 4) aged 25-60 years was conducted. All women underwent US and histopathology for the evaluation of breast lesions. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of US were compared to histopathology. SPSS version 24 was employed for data entry and analysis, calculating mean ± SD for quantitative data such as female age, and using frequency and percentage for categorical data like diagnosis on ultrasonography and histopathology. Results: The sensitivity of US was 91.67%, the specificity was 83.93%, the PPV was 89.53%, the NPV was 87.04%, and the diagnostic accuracy was 88.57%. Conclusion: US is a highly accurate modality for the diagnosis of breast cancer in women with mammographically dense breasts. It is a valuable tool for the early detection of breast cancer in these women.
... Our findings are in general in concordance with previously published literature. For example, a study in Kosovo that compared the accuracy of mammography and ultrasound among 546 women with breast symptoms, reported that ultrasound had a higher sensitivity than mammography in younger women (<45 years) whereas mammography's sensitivity was superior to ultrasound in women older than 60 years [12]. In Kosovo the sensitivity of ultrasound and mammography was 72.6% and 52.1%, respectively [12], findings that are similar to our figures (87.4% and 59.3%, respectively). ...
... For example, a study in Kosovo that compared the accuracy of mammography and ultrasound among 546 women with breast symptoms, reported that ultrasound had a higher sensitivity than mammography in younger women (<45 years) whereas mammography's sensitivity was superior to ultrasound in women older than 60 years [12]. In Kosovo the sensitivity of ultrasound and mammography was 72.6% and 52.1%, respectively [12], findings that are similar to our figures (87.4% and 59.3%, respectively). However, the specificity of ultrasound and mammography in the Kosovo study was 88.5% and 73.9%, respectively [12], whereas the corresponding figures in our study were lower: 50% and 71.2%, respectively. ...
... In Kosovo the sensitivity of ultrasound and mammography was 72.6% and 52.1%, respectively [12], findings that are similar to our figures (87.4% and 59.3%, respectively). However, the specificity of ultrasound and mammography in the Kosovo study was 88.5% and 73.9%, respectively [12], whereas the corresponding figures in our study were lower: 50% and 71.2%, respectively. ...
Early detection of breast cancer is essential for improving patient survival. However, non-invasive imaging test have different diagnostic value. This study aimed to assess the diagnostic accuracy of mammography and ultrasound to detect breast malignancy in Albania. The 234 patients suspected with breast lesions in Albania during 2018-2022 were subjected to both mammograph and ultrasound and then to core needle biopsy (CNB). The BI-RADS classification was used to evaluate breast lesions. The diagnostic value of ultrasound, mammography and their combination were assessed. Mean age of participants was 55.97 years (96.2% females). Ultrasound detected higher proportions of high-risk patients compared to mammography (79.1% vs. 52.6%, respectively) but the combination of the two increased this figure even further (88.9%). The sensitivity of mammography increased quickly with age, peaking to 93.2% among patients >60 years old, whereas ultrasound has better sensitivity among younger participants (<45 years and 45-60 years); overall, the combined tests had the highest sensitivity (95.1%), followed by ultrasound (87.4%) and mammography (59.3%). In conclusion, the sensitivity of mammography is best among older patients whereas ultrasound seems to be more accurate among younger patients. The combination of mammography and ultrasound seems to increase the diagnostic accuracy of breast tumors among Albanian patients.
... Furthermore, compared to MRI, this analysis has intriguingly identified radiomic assessment in USS as a strong predictor in characterizing benign and malignant breast lesions. Breast density and age are important factors in determining the accuracy of USS [55]. Notably, USS has been found to be more accurate than MMG in symptomatic women under the age of 45 [55]. ...
... Breast density and age are important factors in determining the accuracy of USS [55]. Notably, USS has been found to be more accurate than MMG in symptomatic women under the age of 45 [55]. The integration of radiomics into diagnostic USS could further enhance the speed of diagnosis and treatment decision-making. ...
Breast cancer is a prevalent global health concern, necessitating accurate diagnostic tools for effective management. Diagnostic imaging plays a pivotal role in breast cancer diagnosis, staging, treatment planning, and outcome evaluation. Radiomics is an emerging field of study in medical imaging that contains a broad set of computational methods to extract quantitative features from radiographic images. This can be utilized to guide diagnosis, treatment response, and prognosis in clinical settings. A systematic review was performed in concordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Quality was assessed using the radiomics quality score. Diagnostic sensitivity and specificity of radiomics analysis, with 95% confidence intervals (CIs), were included for meta-analysis. The area under the curve analysis was recorded. An extensive statistical analysis was performed following the Cochrane guidelines. Statistical significance was determined if p-values were less than 0.05. Statistical analyses were conducted using Review Manager (RevMan), Version 5.4.1. A total of 31 manuscripts involving 8,773 patients were included, with 17 contributing to the meta-analysis. The cohort comprised 56.2% malignant breast cancers and 43.8% benign breast lesions. MRI demonstrated a sensitivity of 0.91 (95% CI: 0.89-0.92) and a specificity of 0.84 (95% CI: 0.82-0.86) in differentiating between benign and malignant breast cancers. Mammography-based radiomic features predicted breast cancer subtype with a sensitivity of 0.79 (95% CI: 0.76-0.82) and a specificity of 0.81 (95% CI: 0.79-0.84). Ultrasound-based analysis yielded a sensitivity of 0.92 (95% CI: 0.90-0.94) and a specificity of 0.85 (95% CI: 0.83-0.88). Only one study reported the results of radiomic evaluation from CT, which had a sensitivity of 0.95 (95% CI: 0.88-0.99) and a specificity of 0.56 (95% CI: 0.45-0.67). Across different imaging modalities, radiomics exhibited robust diagnostic accuracy in differentiating benign and malignant breast lesions. The results underscore the potential of radiomic assessment as a minimally invasive alternative or adjunctive diagnostic tool for breast cancer. This is pioneering data that reports on a novel diagnostic approach that is understudied and underreported. However, due to study limitations, the complexity of this technology, and the need for future development, biopsy still remains the current gold standard method of determining breast cancer type.
... Computers 2023, 12, 220 2 of 21 and BUS images due to the presence of densely compacted fibro-glandular tissue in the breast. This limitation emerges due to the reliance on two-dimensional (2D) imaging modalities in these contexts [3]. ...
... To construct this dataset, we identified the top three IBTD models, those with the highest accuracy. For each image in the training set, we calculated the detection accuracy of each IBTD model and assigned an IBTD label (1), (2), or (3), corresponding to the model with the highest accuracy. Subsequent to the ensemble model's training phase, each DBT image was inputted into the ensemble model to determine the optimal IBTD for detecting breast tumors. ...
Digital breast tomosynthesis (DBT) stands out as a highly robust screening technique capable of enhancing the rate at which breast cancer is detected. It also addresses certain limitations that are inherent to mammography. Nonetheless, the process of manually examining numerous DBT slices per case is notably time-intensive. To address this, computer-aided detection (CAD) systems based on deep learning have emerged, aiming to automatically identify breast tumors within DBT images. However, the current CAD systems are hindered by a variety of challenges. These challenges encompass the diversity observed in breast density, as well as the varied shapes, sizes, and locations of breast lesions. To counteract these limitations, we propose a novel method for detecting breast tumors within DBT images. This method relies on a potent dynamic ensemble technique, along with robust individual breast tumor detectors (IBTDs). The proposed dynamic ensemble technique utilizes a deep neural network to select the optimal IBTD for detecting breast tumors, based on the characteristics of the input DBT image. The developed individual breast tumor detectors hinge on resilient deep-learning architectures and inventive data augmentation methods. This study introduces two data augmentation strategies, namely channel replication and channel concatenation. These data augmentation methods are employed to surmount the scarcity of available data and to replicate diverse scenarios encompassing variations in breast density, as well as the shapes, sizes, and locations of breast lesions. This enhances the detection capabilities of each IBTD. The effectiveness of the proposed method is evaluated against two state-of-the-art ensemble techniques, namely non-maximum suppression (NMS) and weighted boxes fusion (WBF), finding that the proposed ensemble method achieves the best results with an F1-score of 84.96% when tested on a publicly accessible DBT dataset. When evaluated across different modalities such as breast mammography, the proposed method consistently attains superior tumor detection outcomes.
... As was established in a study by Devolli-Disha et al., [30] sensitivity in a study population will improve with images showing predominantly fatty tissue, i.e., ACR_BIRADS "a" breast composition (almost entirely fatty breasts) and "b" (there are scattered areas of fibroglandular density) breast composition, which was not the case in this study in which 63% of the participants had a breast composition that could obscure underlying lesions and affect negatively the sensitivity as well as the overall accuracy of mammography. As stated by Barlow et al. [20] and authors from some other studies, [30,31] a dense breast is a major limitation in the sensitivity of mammography; hence, breast composition can affect positively or negatively the sensitivity of mammography. ...
... As was established in a study by Devolli-Disha et al., [30] sensitivity in a study population will improve with images showing predominantly fatty tissue, i.e., ACR_BIRADS "a" breast composition (almost entirely fatty breasts) and "b" (there are scattered areas of fibroglandular density) breast composition, which was not the case in this study in which 63% of the participants had a breast composition that could obscure underlying lesions and affect negatively the sensitivity as well as the overall accuracy of mammography. As stated by Barlow et al. [20] and authors from some other studies, [30,31] a dense breast is a major limitation in the sensitivity of mammography; hence, breast composition can affect positively or negatively the sensitivity of mammography. ...
Background: Breast cancer is one of the leading causes of cancer-related deaths among women worldwide. Mammography was recently introduced at the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria for breast cancer screening and diagnosis at the institution. Objective: The objective of this study is to determine the diagnostic accuracy of mammography in the assessment of palpable malignant breast lump among adult females referred from the NAUTH outpatient clinics using histopathology as gold standard. Materials and Methods: This prospective cross sectional study involved recruitment of consenting adult females with palpable breast lump referred for mammography between October 2017 and November 2019 at NAUTH, Nnewi, Nigeria. Two standard views—cranio-caudal (CC) and medio-lateral oblique (MLO)—were done for each patient. Spot magnification or other supplementary views were only done when indicated. Data analysis was done using Statistical Package for the Social Sciences (SPSS) version 21.0 for Windows software. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of malignant breast lesions were 41.4%, 98%, 96.7%, 54.4%, and 65%, respectively. The most common features of malignancy were mammographic opacity with an irregular outline (86.7%) and architectural distortion (80%), whereas asymmetric density (10%) was the least common feature. Conclusion: Mammography has a fairly high overall diagnostic accuracy in breast cancer diagnosis. However, an alternative imaging modality is required for dense breasts. This study’s reported specificity (98%) suggests that the test has a very high ability to correctly identify non-cancerous breast lumps. This is particularly relevant in breast cancer screening with an objective to rule out the presence of the disease among adult females in the population.
... Handheld (HH) US is used as a diagnostic adjunct to breast cancer screening mammography, which has been shown to be an effective imaging method in women with dense breasts. [14][15][16] While examining suspicious regions identified on screening mammography, US has been proven effective for the accurate detection of small, early-stage, and invasive breast cancers. [14][15][16][17] However, HHUS is still highly operator-dependent and time-consuming, which limits its reproducibility to relocate the position anatomical landmarks at the same location, which is important for monitoring changes (temporal assessment) of suspicious breast lesions. ...
... [14][15][16] While examining suspicious regions identified on screening mammography, US has been proven effective for the accurate detection of small, early-stage, and invasive breast cancers. [14][15][16][17] However, HHUS is still highly operator-dependent and time-consuming, which limits its reproducibility to relocate the position anatomical landmarks at the same location, which is important for monitoring changes (temporal assessment) of suspicious breast lesions. 18 Furthermore, US images are inherently visualized in two dimensions (2D), do not permit (coronal) viewing planes parallel to the skin, and are unable to display the surrounding anatomy in three dimensions (3D), which precludes its utility for whole-breast imaging and assessment. ...
Background
Mammographic screening has reduced mortality in women through the early detection of breast cancer. However, the sensitivity for breast cancer detection is significantly reduced in women with dense breasts, in addition to being an independent risk factor. Ultrasound (US) has been proven effective in detecting small, early‐stage, and invasive cancers in women with dense breasts.
Purpose
To develop an alternative, versatile, and cost‐effective spatially tracked three‐dimensional (3D) US system for whole‐breast imaging. This paper describes the design, development, and validation of the spatially tracked 3DUS system, including its components for spatial tracking, multi‐image registration and fusion, feasibility for whole‐breast 3DUS imaging and multi‐planar visualization in tissue‐mimicking phantoms, and a proof‐of‐concept healthy volunteer study.
Methods
The spatially tracked 3DUS system contains (a) a six‐axis manipulator and counterbalanced stabilizer, (b) an in‐house quick‐release 3DUS scanner, adaptable to any commercially available US system, and removable, allowing for handheld 3DUS acquisition and two‐dimensional US imaging, and (c) custom software for 3D tracking, 3DUS reconstruction, visualization, and spatial‐based multi‐image registration and fusion of 3DUS images for whole‐breast imaging. Spatial tracking of the 3D position and orientation of the system and its joints (J1–6) were evaluated in a clinically accessible workspace for bedside point‐of‐care (POC) imaging. Multi‐image registration and fusion of acquired 3DUS images were assessed with a quadrants‐based protocol in tissue‐mimicking phantoms and the target registration error (TRE) was quantified. Whole‐breast 3DUS imaging and multi‐planar visualization were evaluated with a tissue‐mimicking breast phantom. Feasibility for spatially tracked whole‐breast 3DUS imaging was assessed in a proof‐of‐concept healthy male and female volunteer study.
Results
Mean tracking errors were 0.87 ± 0.52, 0.70 ± 0.46, 0.53 ± 0.48, 0.34 ± 0.32, 0.43 ± 0.28, and 0.78 ± 0.54 mm for joints J1–6, respectively. Lookup table (LUT) corrections minimized the error in joints J1, J2, and J5. Compound motions exercising all joints simultaneously resulted in a mean tracking error of 1.08 ± 0.88 mm (N = 20) within the overall workspace for bedside 3DUS imaging. Multi‐image registration and fusion of two acquired 3DUS images resulted in a mean TRE of 1.28 ± 0.10 mm. Whole‐breast 3DUS imaging and multi‐planar visualization in axial, sagittal, and coronal views were demonstrated with the tissue‐mimicking breast phantom. The feasibility of the whole‐breast 3DUS approach was demonstrated in healthy male and female volunteers. In the male volunteer, the high‐resolution whole‐breast 3DUS acquisition protocol was optimized without the added complexities of curvature and tissue deformations. With small post‐acquisition corrections for motion, whole‐breast 3DUS imaging was performed on the healthy female volunteer showing relevant anatomical structures and details.
Conclusions
Our spatially tracked 3DUS system shows potential utility as an alternative, accurate, and feasible whole‐breast approach with the capability for bedside POC imaging. Future work is focused on reducing misregistration errors due to motion and tissue deformations, to develop a robust spatially tracked whole‐breast 3DUS acquisition protocol, then exploring its clinical utility for screening high‐risk women with dense breasts.
... Obesity is known to impede the majority of ultrasound applications [65]. A hypothesis could be that obese women are more likely to have large and adipose breasts, limiting ultrasound evaluation [66][67][68]. Large and fatty breasts are more difficult to evaluate by sonoelastography [21] due to issues related to the penetration depth of ultrasound waves, especially for nodules, which are located in the deeper layers [69]. ...
Background and Objectives: Breast cancer is one of the most widespread cancers among the female population around the world and is curable if diagnosed in an early stage. Consequently, breast cancer screening imaging techniques have greatly evolved and adjusted over the last decades. Alongside mammography, sonoelastography became an important tool for breast cancer detection. However, sonoelastography still has its limitations, namely, there is still a high occurrence of false positive results in the BIRADS 4 category. The aim of our study is to identify potential false positive predictors and to ascertain the factors influencing the quality of strain ultrasound elastography for the evaluation of suspicious solid breast lesions categorized as BIRADS 4B, 4C, and 5. Materials and Methods: We conducted a retrospective study in a single private medical center in Timisoara between January 2017 and January 2022 analyzing 1625 solid breast lesions by the sonoelastography strain using a standardized BIRADS-US lexicon. Results: Our study showed that most sonoelastography factors linked to incorrect and overdiagnosis were due to a nodule dimension (OR = 1.02 per unit increase), posterior acoustic shadowing (OR = 12.26), reactive adenopathy (OR = 6.35), and an increased TES score (TES3 OR = 6.60; TES4 OR = 23.02; TES5 OR = 108.24). Regarding patient characteristics, age (OR = 1.09 per unit increase), BMI, (OR = 1.09 per unit increase), and breastfeeding history (OR = 3.00) were observed to increase the likelihood of false positive results. On the other hand, the nodules less likely to be part of the false positive group exhibited the following characteristics: a regular shape (OR = 0.27), homogenous consistency (OR = 0.42), and avascularity (OR = 0.22). Conclusions: Older age, high BMI, patients with a breastfeeding history, and those who exhibit the following specific nodule characteristics were most often linked to false positive results: large tumors with posterior acoustic shadowing and high elasticity scores, accompanied by reactive adenopathy. On the other hand, homogenous, avascular nodules with regular shapes were less likely to be misdiagnosed.
... US out-performs mammography in some patients (i.e., those with dense breast tissue). 9 Breast magnetic resonance imaging (MRI) can be a valuable supplement to mammography and US, particularly among women with dense breasts. 16 Several studies report MRI provides considerable increased detection in high-risk women than mammography or US. ...
in cases of dense breast parenchyma (common among young women) 9 or when radiation should be avoided (e.g., pregnancy). US has good sensitivity and specificity for detecting breast lesions, including those with high-likelihood of being cancer, such as enlarged axillary lymph nodes. 10 A study conducted by Gonzaga MA found the sensitivity for detecting breast lumps to be 92.5%. Additionally, the sensitivity and specificity to detect the breast cancer was 57.1% and 62.8% respectively (positive and negative predictive value was found out to be 68.1% and 99.5%). 11 Due to technological advancements, US sensitivity in detecting benign and malignant breast lesions is improving. 12 As Nepal is a low-to medium-income country, US is a feasible tool for evaluating symptomatic or palpable breast lesions, 13 owing to reasonable cost and portability to remote areas. Our present study evaluated the prevalence of breast cancer among patients undergoing ultrasonography in a major public hospital in Nepal. We also evaluated the sensitivity, specificity, positive and negative predictive values, and accuracy of US with respect to histopathology (gold standard) to detect malignant breast masses. DATA AND METHODS A cross-sectional study was conducted at B.P. Koirala Memorial Cancer Hospital (BPKMCH), a tertiary-level public cancer hospital in the Chitwan district of Nepal. Established in 1992, the hospital has 500 inpatient beds, 9 surgical oncology departments, adult and pediatric medical ABSTRACT Background Ultrasonography (US) is an important modality for investigating breast lesions, as it lacks radiation exposure, differentiates between solid tumor and fluid-filled cysts, and is particularly-useful for young females with dense breast tissue. This study aimed to determine test characteristics (sensitivity, specificity, positive and negative predictive values, and accuracy), and the prevalence of breast cancer, among patients undergoing diagnostic breast US for clinically-detected abnormalities in a tertiary care cancer hospital in Nepal, comparing US findings with histopathology and cytopathology. Data and Methods A cross-sectional study was conducted among a convenience sample of 418 female patients who underwent diagnostic breast US between April 15 and September 10, 2022. Data were entered and analyzed on SPSS 25.0. Prevalence of cancer was determined among US patients who were referred for tissue diagnosis on the basis of clinical or US findings. Sensitivity, specificity, positive and negative predictive values, and accuracy of US in detecting breast lesions in comparison to histopathology and cytopathology findings were calculated. Results The study respondents' age ranged from 13 to 75 (±11.8) years. Among 97 patients who underwent fine needle aspiration or biopsy based on US findings, 52 (12.4% of total) were diagnosed with breast carcinoma. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of US to detect breast cancer were 94%, 100%, 93.7%, 100%, and 96.9%, respectively. Conclusion Among women with breast complaints or physical examination findings, diagnostic US revealed a high prevalence in the population investigated and demonstrated very good sensitivity, specificity, and accuracy to detect breast cancer. This study confirms the important role of ultrasound in the evaluation of breast lesions, particularly in underdeveloped countries.
... Ultrasound has better sensitivity for dense breasts and can be better for differentiating solid tumors from cysts than mammography [33]. Ultrasound technology is less expensive than mammography and may detect changes that are not visible in mammograms [34][35][36]. Radiologists can distinguish between various tissues. Segmenting breast ultrasound images may be valuable for tumor localization and breast cancer diagnosis [37]. ...
Introduction
Breast cancer stands as the second most deadly form of cancer among women worldwide. Early diagnosis and treatment can significantly mitigate mortality rates.
Purpose
The study aims to classify breast ultrasound images into benign and malignant tumors. This approach involves segmenting the breast's region of interest (ROI) employing an optimized UNet architecture and classifying the ROIs through an optimized shallow CNN model utilizing an ablation study.
Method
Several image processing techniques are utilized to improve image quality by removing text, artifacts, and speckle noise, and statistical analysis is done to check the enhanced image quality is satisfactory. With the processed dataset, the segmentation of breast tumor ROI is carried out, optimizing the UNet model through an ablation study where the architectural configuration and hyperparameters are altered. After obtaining the tumor ROIs from the fine-tuned UNet model (RKO-UNet), an optimized CNN model is employed to classify the tumor into benign and malignant classes. To enhance the CNN model's performance, an ablation study is conducted, coupled with the integration of an attention unit. The model's performance is further assessed by classifying breast cancer with mammogram images.
Result
The proposed classification model (RKONet-13) results in an accuracy of 98.41 %. The performance of the proposed model is further compared with five transfer learning models for both pre-segmented and post-segmented datasets. K-fold cross-validation is done to assess the proposed RKONet-13 model's performance stability. Furthermore, the performance of the proposed model is compared with previous literature, where the proposed model outperforms existing methods, demonstrating its effectiveness in breast cancer diagnosis. Lastly, the model demonstrates its robustness for breast cancer classification, delivering an exceptional performance of 96.21 % on a mammogram dataset.
Conclusion
The efficacy of this study relies on image pre-processing, segmentation with hybrid attention UNet, and classification with fine-tuned robust CNN model. This comprehensive approach aims to determine an effective technique for detecting breast cancer within ultrasound images.
... For instance, mammography poses risks to human health and has a high false positive rate in dense breasts [3,4]. Ultrasound is a low-cost option but is less effective in deeper breast tissue [5,6]. MRI has excellent resolution and sensitivity, but its high cost and time-consuming nature make it unsuitable for early diagnosis [7][8][9]. ...
In recent years, photoacoustic (PA) imaging has rapidly grown as a non-invasive screening technique for breast cancer detection using three-dimensional (3D) hemispherical arrays due to their large field of view. However, the development of breast imaging systems is hindered by a lack of patients and ground truth samples, as well as under-sampling problems caused by high costs. Most research related to solving these problems in the PA field were based on 2D transducer arrays or simple regular shape phantoms for 3D transducer arrays or images from other modalities. Therefore, we demonstrate an effective method for removing under-sampling artifacts based on deep neural network (DNN) to reconstruct high-quality PA images using numerical digital breast simulations. We constructed 3D digital breast phantoms based on human anatomical structures and physical properties, which were then subjected to 3D Monte-Carlo and K-wave acoustic simulations to mimic acoustic propagation for hemispherical transducer arrays. Finally, we applied a 3D delay-and-sum reconstruction algorithm and a Res-UNet network to achieve higher resolution on sparsely-sampled data. Our results indicate that when using a 757 nm laser with uniform intensity distribution illuminated on a numerical digital breast, the imaging depth can reach 3 cm with 0.25 mm spatial resolution. In addition, the proposed DNN can significantly enhance image quality by up to 78.4%, as measured by MS-SSIM, and reduce background artifacts by up to 19.0%, as measured by PSNR, even at an under-sampling ratio of 10%. The post-processing time for these improvements is only 0.6 s. This paper suggests a new 3D real time DNN method addressing the sparse sampling problem based on numerical digital breast simulations, this approach can also be applied to clinical data and accelerate the development of 3D photoacoustic hemispherical transducer arrays for early breast cancer diagnosis.
... Even though the meta-analysis data showed lower sensitivity and higher specificity in lowand middle-income countries [11], in our study in Albania, as a middle-income country, there was evidence of high diagnostic US sensitivity, along with lower US specificity. In a similar study, in a country with similar demographic features, such as Kosovo, with diagnostic purposes, the US sensitivity value is lower, whereas the US specificity value is higher, at 72.6% and 88.5%, respectively [23]. Our study found that all magnitudes of diagnostic accuracy in the US are slightly higher in small tumors 1-10 mm compared to tumors larger than 10 mm. ...
Aim: This study was aimed at assessing the diagnostic accuracy of ultrasound (US) in patients suspected of having breast cancer and confronting diagnosis by US imaging with histopathological diagnosis in patients of different ages. Methods: We performed a prospective case series of 280 patients suspected of having breast cancer, and referred to the tertiary University Hospital of Tirana ("Mother Teresa") for further evaluation, during January 2021-December 2021. These patients were diagnosed with US imaging, using the Breast Imaging Reporting and Data System (BI-RADS) as a tool for evaluating cancer risk. Subsequently, histopathology was carried out (used as a gold standard for diagnosis). The accuracy of US was evaluated by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV); the performance of US was evaluated by Receiver Operator Curve (ROC), and different associations between variables were assessed by conducting a chi-square test and binary logistic regression. Results: With increased age, BI-RADS 2 or 3 cases decreased [48.1% (15-40 years) vs 35.6% (40-49 years) vs 21.4% (50-59 years) vs 9.2% (60-69 years) vs 6.3% (over 70 years)], (p<0.001), while BI-RADS 4 or 5 increased (51.9% vs 64.5% vs 78.6% vs 80.8% vs 93.8%), (p<0.001), respectively in the above-mentioned age groups. Similarly, with increased age, benign diagnosed cases in histopathology decreased (72.2% vs 57.6% vs 44.3% vs 43.1% vs 21.9%), (p<0.001). There was an increase in malignancies according to histopathology amongst older patients, (27.8% vs 42.4% vs 55.7% vs 56.9% vs 78.1%, (p<0.001), respectively. In terms of US cancer diagnosis accuracy, our findings showed high sensitivity and NPV (97.9%, 95.7%), not very high specificity (48.2%), and satisfactory PPV and accuracy (65.7%, 73.2%). Meanwhile, the ROC curve showed an Area under the Curve value of 0.81, p<0.01. Conclusion: The US, using BI-RADS, is a good tool for detecting malignant breast cancer in patients of all ages. The accuracy of US is satisfactory for tertiary diagnostic service, nonetheless, all components must be considered to ensure that the US diagnosis always coincides with the histopathological diagnosis of malignant breast cancer.
... Ultrasonography (US) is an important and major tool for breast cancer screening in China that can better detect mammographically occult breast cancer in Chinese women with a high mammary parenchymal density [8]. In women with predominantly fatty breasts, the sensitivity of mammography and US are 82.2% and 71.1%, respectively, while in women with heterogeneously dense breasts they are 23.7% and 57.0%, respectively [9]. In predominantly fatty breasts or dense glandular structures, US can detect breast lesions from multiple planes with a high resolution [10][11][12]. ...
Purpose
Ultrasonography is one of the most effective methods for diagnosing breast diseases, especially among Asian women. The Breast Imaging Reporting and Data System (BI-RADS) is widely used independently of age in diagnosing breast cancer via ultrasonography. This study aimed to develop a model that integrates age with the BI-RADS lexicon to improve the diagnostic accuracy of ultrasonography in diagnosing breast cancer among the Chinese population.
Methods
This study comprised two cohorts: the training cohort, including 975 women from the Renmin Hospital of Wuhan University, and the validation cohort, including 500 women from the Maternal and Child Health Hospital of Hubei Province. Logistic regression was used to construct a model combining BI-RADS scores with age and to determine the age-based prevalence of breast cancer to predict a cut-off age. The area under the curve (AUC) was used to determine the model’s diagnostic efficacy.
Results
The age with BI-RADS scores model had the best performance compared to the age-only model and BI-RADS scores-only model with an AUC of 0.872 (95% CI: 0.850–0.894, p < 0.001). Moreover, among participants aged < 30 years, the prevalence of breast cancer was lower than the lower limit of the reference range (2%) for the BI-RADS subcategory 4A lesions but within the reference range for BI-RADS category 3 lesions according to the linear regression analysis.
Conclusions
The integrated assessment model based on age and BI-RADS may improve the accuracy of ultrasonography in diagnosing breast lesions. Young patients with BI-RADS subcategory 4A lesions may be excluded from biopsy.
... The findings are in line with previous studies showing high sensitivity of ultrasonography and mammography in detecting breast cancer (19)(20)(21). These studies included asymptomatic patients with or without a family risk of breast cancer coming for screening. ...
Background:
To evaluate the feasibility of a same day breast cancer diagnosis and management protocol, consequently decreasing time to treatment and immediately reassuring patients with benign diagnosis.
Materials and methods:
A total of 60 women underwent breast exam during SENODAY in our cancer center between January 2020 and December 2022. Patients are first seen by a breast surgeon who mentions whether the patient's history and physical exam are suspicious of malignancy. Patients are then sent to the radiologist who performs a complete radiologic assessment, classifies the lesions, and performs a biopsy when necessary. The specimen is sent to the pathologist who uses the imprint cytology technique to obtain a preliminary diagnosis. Effective counseling is established in case of breast cancer diagnosis.
Results:
Among 60 women, 25 patients were reassured by breast imaging and 35 underwent histopathological analysis (17 patients with a 1-day protocol and 18 with the standard definitive technique). Clinical examination was found to have a sensitivity of 100% and a specificity of 89.47%. The positive predictive value was 80 % and the negative predictive value was 100%. However, we did not find a strong correlation between imaging and definitive pathology. Moreover, on imprint cytology, sensitivity, specificity, PPV, and NPV were 100%. Finally, the mean time-to-treat was 28.6 days.
Conclusions:
SENODAY reassured 68.3% of patients. It also offered effective counseling and a treatment plan to newly diagnosed breast cancer patients within 1 day. Same day histological diagnosis by imprint cytology is effective and feasible with an excellent accuracy.
... Different imaging modalities are being used in the diagnosis and assessment of multicentricity. Ultrasonography showed higher specificity and sensitivity compared to mammography in the younger age groups <40 years [38][39][40]. However, MRI showed a higher detection rate of MF/MCBC when compared with other imaging modalities [41,42] (up to 16% of women showing additional lesions) [42]. ...
Background:
Multifocal (MFBC)/multicentric (MCBC) breast cancer is being more recognized due to the improved imaging modalities and the greater orientation with this form of breast cancer, however, optimal surgical treatment, still poses a challenge. The standard surgical treatment is mastectomy, however, breast-conserving surgeries (BCS) may be appropriate in certain situations.
Methods:
A total of 464 cases of MF/MCBC out of 4798 cases of breast cancer were retrospectively analyzed from the database of the Oncology Center, Mansoura University (OCMU), between January 2008 and December 2019.
Results:
Radiologic involvement of multiple quadrants was reported in 27.9% by ultrasonography, 19% by mammography, and 59.1% by magnetic resonance imaging. BCS was performed in 32 cases (6.9%) while 432 cases underwent a mastectomy. Postoperative pathology revealed infiltration of other quadrants grossly in 23.5%, and under the microscope in 63.6% of the examined cases. Mean disease-free and overall survival were 95.5 and 164.6 months, respectively. When compared with MFBC, MCBC showed higher pathologic tumor size (p < 0.001), higher stages (p < 0.001), higher recurrence rates (p = 0.006), and lower DFS (P = 0.009) but with similar OS (P = 0.8).
Conclusion:
Mastectomy is still the primary treatment option for MCBC with higher recurrence rates compared with MFBC. However, BCS for properly selected MFBC is considered oncologically safe, following the same rules of breast conservation for unifocal disease.
... The selective elderly patient underwent a digital mammogram. This was consistent with the study by Devolli Disha et al., [11] which proved that for detecting malignant and benign This patient underwent tissue diagnosis, which showed the lesion to be tubercular mastitis. The patient underwent antitubercular treatment, and the lesion was significantly reduced in size on follow-up scans breast lesions, the sensitivity and specificity of ultrasound are higher than mammography in females with breast complaints, mainly in young women with dense breasts. ...
Background: Breast Imaging Reporting and Data System (BI-RADS) classification for breast lesions was proposed for uniformity in categorizing breast lesions. While BI-RADS 1, 2 and 4–6 categories are straightforward, BI-RADS 3 is an intermediate category lesion with significantly different meanings and findings for mammography, ultrasound, and magnetic resonance imaging and is diagnostically challenging. Our study aims to determine the frequency and the malignancy rate of BI-RADS category 3 lesions detected on ultrasound breast and digital X-ray mammography by doing follow-ups at 6, 12, and 24 months of imaging. Materials and Methods: This ambispective study was conducted in the Department of Radiodiagnosis, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, from October 2020 to October 2022, which included 55 patients referred for digital X-ray and breast ultrasound. All BI-RADS category 3 in the initial sonomammography and digital X-ray mammography were included in the study and were followed up for final diagnosis and outcome either by pathological analysis or follow-up using sonomammography and digital X-ray mammography for a maximum of 24 months. Results: Fifty-five patients were categorized into the benign or malignant category from the results of tissue diagnosis or via follow-up. Fifty-four patients (98.18%) showed benign lesions, and one (1.82%) got malignant lesions. In the majority, 31 (56.36%) patients, the mean follow-up time was 6 months, followed by 12 months 10 (18.18%). Follow-up was 24 months in only 1 out of 55 patients (1.82%). The mean value of time to follow-up (months) of study subjects was 6 ± 4.6 with a median (25th–75th percentile) of 6. Conclusion: Short-term interval follow-up in BI-RADS category: three patients are enough to detect early breast malignancy, and this will avoid unnecessary tissue diagnosis (invasive procedure) in benign lesions. In our study, the malignancy yield in the follow-up of BI-RADS 3 was 1.82% (
... Emine et al. reported sensitivity and specificity for sonomammography as 72.6 and 88.5% respectively. 18 The results of this study were lower compared to our findings. Keeping in view the statistics of previous studies, it is evident that integrating BI-RADS guidelines in breast ultrasound technique results in achieving high diagnostic accuracy for diagnosing malignant breast lesions as most of these international studies are in concordance with our study. ...
Objective: To determine the diagnostic accuracy of Ultrasound BI-RADS classification in diagnosing breast lesions utilizing the core needle biopsy method keeping histopathology as a gold standard. Materials and Methods: A cross-sectional study was conducted in the Radiology department of CMH Peshawar incorporating 51 patients having breast lesions as presenting complaints. After performing ultrasonography, lesions were categorized as benign and malignant according to BI-RADS scoring. A core needle Biopsy of lesions was done and histopathology reports were collected. Diagnostic accuracy, Sensitivity, Specificity, Positive predictive value, and Negative predictive value of “BI-RADS classification were calculated by analyzing data. Results: The mean age was calculated as 45.63+ 16.83 years. According to the BI-RADS score, 17 cases (33.3%) were categorized as benign and 35 cases (66.7%) as malignant while Histopathology reported 20 cases (39.2%) as benign while 31 cases (60.8%) as malignant. Diagnostic accuracy, Sensitivity, Specificity, Positive predictive value, and Negative predictive value for ultrasound BI-RADS turned out to be 90.19%, 96.77 %, 80.00%, 88.23%, and 94.11% and respectively. Conclusion: Ultrasound BI-RADS classification has high diagnostic accuracy in differentiating benign from malignant lesions. Universal application of ultrasound BI-RADS guidelines will help in the early diagnosis of malignant breast lesions while avoiding unnecessary biopsies in benign lesions. Keywords: Breast imaging, Core needle biopsy, Diagnostic accuracy
... 20,23 Lehman et al. 23 reported that ultrasound has a sensitivity of 95% compared to mammography of (61%). Also, Devolli-Disha et al. 24 demonstrated that ultrasound had a higher sensitivity for women under 45 compared to mammography (73.5% vs 38.5%). However, mammography had a higher sensitivity for women older than 60 years old (73.5% vs 63.5%). ...
... 20,23 Lehman et al. 23 reported that ultrasound has a sensitivity of 95% compared to mammography of (61%). Also, Devolli-Disha et al. 24 demonstrated that ultrasound had a higher sensitivity for women under 45 compared to mammography (73.5% vs 38.5%). However, mammography had a higher sensitivity for women older than 60 years old (73.5% vs 63.5%). ...
The most common type of cancer among the female population is breast cancer. The most common site for the occurrence of breast cancer is the upper outer quadrant; the upper inner quadrant is the second site, and both the lower outer and the lower inner quadrants are in the third place. This problem is rarely seen in the central portion. Intermammary metastasis due to breast cancer is an infrequent finding. This article presents a 62-year-old lady who presented to the surgical ward with intermammary swelling that appeared suddenly 3 months ago. Ultrasound examination showed a hypoechoic micro-lobulated mass with internal vascularity on the chest wall. Although core needle biopsy suspected invasive ductal carcinoma, both right and left axillary lymph nodes were normal and free. The patient was consulted by an oncologist who recommended radiotherapy before surgery and chemotherapy before and after surgery. This study aims to report and discuss a rare case of intermammary cancer with the origin of breast cells without breast and axillary lymph node involvement. Although the intermammary region is an extremely rare location where breast cancer could occur, its management strategy is the same as other breast cancers.
... There is also a lack of information about disease staging [56]. Currently, several methods or tests are commonly used for breast cancer screening, including mammography, breast self-examination, clinical breast examination, and ultrasound [27,48,55]. ...
Background—Non-communicable diseases (NCDs) affect a growing share of the population in Kosovo. The country faces challenges with NCDs management, specifically detecting, screening, and treating people with NCDs. Objective—To assess the management of NCDs, including the inputs that influence the provision of NCDs and outcomes of NCD management. Eligibility criteria—Studies had to report NCD management in Kosovo. Sources of evidence—We systematically searched Google Scholar, PubMed, Scopus, and Web of Science. Charting methods—The data were charted by two researchers. In addition, we extracted data on general study details and design and information on the management and outcomes of NCDs in Kosovo. Synthesis of results—For the mix of studies that were included in the review, thematic narrative synthesis was used. We developed a conceptual framework based on health production core components to analyze the data. Results—Kosovo’s health care system is available to provide basic care for patients with NCDs. However, there are serious limitations in the availability of key inputs providing care, i.e., funding, medicines, supplies, and medical staff. Additionally, in terms of the management of NCDs, there are areas for improvement, such as limited application of clinical pathways and guidelines and issues with referrals of patients among levels and sectors of care. Finally, it is worth noting that there is overall limited information on NCD management and outcomes. Conclusions—Kosovo provides only basic services and treatment of NCDs. The data reporting the existing situation on NCD management are limited. The inputs from this review are helpful for existing policy efforts by the government aimed to enhance NCD care in Kosovo. Funding—This study was funded by World Bank Grant. WeBa NCD Trust Fund (P170638).
... Ultrasonography is also non-invasive and more portable and more sensitive to the disease than mammography [17,18]. There exist both ML-and DL-based methods for the classification of BC from ultrasound images. ...
Breast cancer (BC) is one of the deadly forms of cancer, causing mortality worldwide in the female population. The standard imaging procedures for screening BC involve mammography and ultrasonography. However, these imaging procedures cannot differentiate subtypes of benign and malignant cancers. Here, histopathology images could provide better sensitivity toward benign and malignant cancer subtypes. Recently, vision transformers have been gaining attention in medical imaging due to their success in various computer vision tasks. Swin transformer (SwinT) is a variant of vision transformer that works on the concept of non-overlapping shifted windows and is a proven method for various vision detection tasks. Thus, in this study, we investigated the ability of an ensemble of SwinTs in the two-class classification of benign vs. malignant and eight-class classification of four benign and four malignant subtypes, using an openly available BreaKHis dataset containing 7909 histopathology images acquired at different zoom factors of 40×, 100×, 200×, and 400×. The ensemble of SwinTs (including tiny, small, base, and large) demonstrated an average test accuracy of 96.0% for the eight-class and 99.6% for the two-class classification, outperforming all the previous works. Thus, an ensemble of SwinTs could identify BC subtypes using histopathological images and may lead to pathologist relief.
... Values for both dense and non-dense breasts were used when studies distinguished between the two, based on approximately 50% of women having dense breasts (8). Average sensitivity of the ten studies assessed was 60% (40%-78% range) and average specificity was 80% (46%-99% range) (31)(32)(33)(34)(35)(36)(37)(38)(39)(40). These accuracy values are more suitable for comparing mammography to other breast screening modalities. ...
This paper presents a computationally simple diagnostic algorithm for breast cancer using a non-invasive Digital Image Elasto Tomography (DIET) system. N=14 women (28 breasts, 13 cancerous) underwent a clinical trial using the DIET system following mammography diagnosis. The screening involves steady state sinusoidal vibrations applied to the free hanging breast with cameras used to capture tissue motion. Image reconstruction methods provide surface displacement data for approximately 14,000 reference points on the breast surface. The breast surface was segmented into four radial and four vertical segments. Frequency decomposition of reference point motion in each segment were compared. Segments on the same vertical band were hypothesised to have similar frequency content in healthy breasts, with significant differences indicating a tumor, based on the stiffness dependence of frequency and tumors being 4~10 times stiffer than healthy tissue. Twelve breast configurations were used to test robustness of the method. Optimal breast configuration for the 26 breasts analysed (13 cancerous, 13 healthy) resulted in 85% sensitivity and 77% specificity. Combining two opposite configurations resulted in correct diagnosis of all cancerous breasts with 100% sensitivity and 69% specificity. Bootstrapping was used to fit a smooth receiver operator characteristic (ROC) curve to compare breast configuration performance with optimal area under the curve (AUC) of 0.85. Diagnostic results show diagnostic accuracy is comparable or better than mammography, with the added benefits of DIET screening, including portability, non-invasive screening, and no breast compression, with potential to increase screening participation and equity, improving outcomes for women.
... [9] When it comes to screening for breast cancer, mammography and sonograms are by far the most common tools used. [10] Since it is important not to overlook a malignant tumour in its early stages of sickness, aggressive biopsy is commonly used even if mammography and sonograms have limitations. This means that between seventy and ninety percent of breast biopsies are performed for noncancerous reasons, causing the patient unnecessary suffering and money. ...
Objective: Using histology as the gold standard, this study aims to determine whether or not magnetic resonance spectroscopy can reliably diagnose malignant breast lesions. Study Design: Cross-sectional Place and Duration: Conducted at department of Radiology Central Park Medical College, Lahore. Duration was 6 months from October 2021 to March 2022. Methods: This research included 75 females. Malignancy-suspicious palpable lesions were included. Patients completed a consent form admitting the hazards before any data was gathered. The kinematics and morphology of dynamically enhanced magnetic resonance (MRS) images were studied. MRS's choline peak (Cho) was utilized to detect cancer. Single-voxel technique was employed to evaluate MRS' diagnostic accuracy in cancer. MRS and biopsies were compared. Data was analyzed using SPSS 24.0. Results: Malignant lesions were found in 65 (86.7%) of the patients by MRS, and in 58 (77.3%) of the cases according to the histological findings. Malignant lesions by MRS most frequently showed a ductal enhancement or a peripheral enhancement morphology. The results of MRS showed a 78% specificity, 85% accuracy, 90% sensitivity, 75% NPV, and 91% PPV. Conclusion: MRS must be employed because of its better specificity, sensitivity, and accuracy in characterizing breast lumps. MRS is a specific, sensitive, and effective diagnostic technique for breast cancer. Keywords: Accuracy, Magnetic resonance spectroscopy (MRS), Malignant breast lesion, Histopathology
... 17,18 A number of studies have shown that the sensitivity and specificity of ultrasound in younger females is superior to that of mammography in patients presenting with breast symptoms. 19 Fibroadenomas are characteristically seen as well-defined ovoid masses with posterior acoustic enhancement. ...
Fibroadenomas and phyllodes tumours are fibroepithelial lesions of the breast. Fibroadenomas are common benign breast masses encountered both symptomatically and incidentally. Phyllodes tumours are uncommon and usually present symptomatically. Management of fibroadenomas focuses on reducing biopsies without missing cancers while radiological management of phyllodes tumours should focus on predicting the need for surgical excision with or without margins.
... Several trials have shown survival in women older than 50 years but screening at a younger age and meta-analysis in the 40À50 age range is advantageous [50,51]. p0195 Mammography is also the most significant diagnostic method and best technique for detecting small, nonpalpable lesions after menopause [52]. In this case, a low dose of X-rays is used for the detection of early breast cancers. ...
Breast cancer is a life-threatening cancer and a leading cause of death among women. Breast cancer cases are increasing constantly due to the risk factors including age, menopause, obesity, use of hormone replacement therapy, family history, along with the environment and lifestyle factors. The increased awareness and newer diagnosis techniques help in the early diagnosis of cancer, thus allowing the best timely treatment, resulting in an increased survival rate. This chapter includes descriptions of the anatomy, hormonal physiology, types of breast cancers, classification, stages, imaging techniques, treatment options, and barriers for tumor-directed drug delivery to breast cancer.
... It can be detected either by pathological testing or by assessing with minimally invasive methods, the latter is preferable as it takes less time and resources than the former one. Regular physical assessment and imaging procedures such as sonography, MRI, and mammography are effective ways of breast mass diagnosis [1,2,3]. Fibroadenoma is a type of benign mass in the breast. ...
Fibroadenomas are quite common benign lesions in the adolescent age group, but it is a cause of concern for the individual and the family. These may remain asymptomatic or may present with pain. Aesthetic distortion of the breast symmetry may lead to psychosocial morbidity in adolescent females. The diagnosis is initially made by ultrasound. Magnetic Resonance Imaging is done in some cases where the underlying pathology is doubtful. A 13-year-old female patient presented to the Radiology department with the complaint of pain in the left breast for the past 10-13 days. The patient had no family history of breast cancer and drug intake. Her unilateral mammography (owing to age) and ultrasound of the breast was performed. After examination and ultrasound Surgical removal of this tumor was decided and the patient was referred to the surgery department for excision. Proper diagnosis and treatment at an early stage are necessary as it can lead to the progression of mass and can be turned into cancer.
... [9] Mammograms and sonograms are the two most often utilised methods for detecting breast cancer. [10] Even though mammograms and sonograms have their limits, aggressive biopsy is common because of the goal not to miss a malignant tumour in the early stages of illness. This indicates that 70% to 90% of breast biopsies are conducted for benign conditions, resulting in needless patient pain and worry, as well as an increase in the patient's medical expenses. ...
Objective: The present research seeks to examine the diagnostic accuracy of magnetic resonance spectroscopy in the diagnosis of malignant breast lesions using histopathology as the gold standard. Study Design: Cross-sectional Place and Duration: Sadiq Abassi Hospital Bahawalpur. July-21 to Dec-21 Methods: There were 110 females were presented in this study. Patients had with suspicious palpable lesions for malignancy were included. Before any patient data was collected, they signed a permission form acknowledging they understood the risks. The kinetics and morphology of magnetic resonance spectroscopy (MRS) dynamically enhanced pictures acquired with contrast on 1.5 Tesla MRI equipment were evaluated. The choline peak (Cho) permitted by MRS was used to determine a malignancy biomarker.. Single-voxel approach was used to examine MRS' diagnostic performance in breast lesions malignancy. Comparing MRS and biopsy results was done. This version of SPSS 22.0 was used to analyse all the data. Results: Majority of the patients 50 (45.5%) were from age group 41-60years, 35 (31.8%) patients had age > 60 years and 25 (22.7%) were from age group 20-40 years. Frequency of malignant lesion by MRS was found among 92 (83.6%) cases and by histopathological results its frequency was 81 (73.6%). Ductal enhancement and peripheral enhancement were the most common morphology among patients of malignant lesion by MRS. According to MRS findings, 75% specificity,86.7% accuracy, 91%sensitivty, 79% negative predictive value (NPV) and 92.3% positive predictive value were found. Conclusion: As a main imaging tool for the diagnosis of breast lesion malignancy, MRS must be used because of its superior specificity, sensitivity, and accuracy in the characterisation of breast lumps. It has been discovered that MRS is a very specific, sensitive, and reliable diagnostic tool for detecting malignant breast cancers. Keywords: Malignant breast lesion, Histopathology, Magnetic resonance spectroscopy (MRS)
... 18 In a study that Emine D and colleagues conducted on 546 breast lesions and analysed using histopathology, they found that the sensitivity and specificity of sonomammograms were, respectively, 72.6 and 88.5 percent. 19 Using the BIRADS lexicon system, we were able to achieve comparable results in this study, with a sensitivity of 87.5 percent, specificity of 88.3 percent, PPV of 83.3 percent, and NPV of 91.4 percent in differentiating benign from malignant masses in sonomammography. ...
Objective: To determine the diagnostic accuracy of BIRADS in diagnosing malignant breast lesions in patients with palpable breast lump. Patients and Methods: A total number of 100 patients presenting with Palpable breast lump were included in this study. The study was conducted in radiology unit of Lahore General Hospital Lahore from August-2021 to April-2022. Data regarding baseline study variables such as age, living area and socioeconomic status was collected for each patient. Ultrasound examination of the breast masses was done by an expert radiologist for calculation of BI-RADS score. Diagnosis of malignancy on histopathological findings was also made. Results: Mean age of patients was 41.04±11.00 years. There were 43 (43.0%) from rural areas and 57 (57%) from urban areas. Malignancy on BI-RADS was found in 42 (42%) patients. On evaluation of diagnostic accuracy of BI-RADS, BI-RADS was 92.5.0% sensitive, 88.3% specific having 84.1% PPV and 94.6% NPV (Table 1). Conclusion: When compared to histopathologic diagnosis, the findings of our study demonstrated that BIRADS is an accurate and trustworthy method for diagnosing breast lumps. Key Words: Palpable breast lump, BI-RADs Scoring, Histopathology.
... On the other hand, in symptomatic women, the frequency of diagnostic mammography performed is higher due to the abnormality in the breast. Diagnostic mammography enables doctors to determine the exact size, location, and the shape of the lump or other pathological finding, exactly [13]. ...
Breast Imaging Reporting and Data System, also known as BI-RADS is a universal system used by radiologists and doctors. It constructs a comprehensive language for the diagnosis of breast cancer. BI-RADS 4 category has a wide range of cancer risk since it is divided into 3 categories. Mathematical models play an important role in the diagnosis and treatment of cancer. In this study, data of 42 BI-RADS 4 patients taken from the Center for Breast Health, Near East University Hospital is utilized. Regarding the analysis, a mathematical model is constructed by dividing the population into 4 compartments. Sensitivity analysis is applied to the parameters with the desired outcome of a reduced range of cancer risk. Numerical simulations of the parameters are demonstrated. The results of the model have revealed that an increase in the lactation rate and early menopause have a negative correlation with the chance of being diagnosed with BI-RADS 4 whereas a positive correlation increase in age, the palpable mass, and family history is distinctive. Furthermore, the negative effects of smoking and late menopause on BI-RADS 4C diagnosis are vehemently outlined. Consequently, the model showed that the percentages of parameters play an important role in the diagnosis of BI-RADS 4 subcategories. All things considered, with the assistance of the most effective parameters, the range of cancer risks in BI-RADS 4 subcategories will decrease.
... With the increase of fibro glandular density the level of sensitivity with mammography decreases, while ultrasonographic sensitivity was 71.1% among women with predominantly fatty breast and 57 % for heterogeneous dense breasts. 17 Findings of our study were similar to these literatures. ...
Background:
Mammography, ultrasound and Magnetic Resonance Imaging are the available modalities for the evaluation of breast masses. Advances and ongoing improvements in imaging technologies have improved the sensitivity of breast cancer detection and diagnosis, but each modality is most beneficial when utilized according to individual traits such as age, risk factors, and breast density. However, pathological diagnosis is most crucial for the treatment of breast masses.
Methods:
A cross-sectional study were conducted from January 2017 to April 2018. There were total of 50 patients with clinically diagnosed palpable breast lumps who attended Gynaecological OPD/surgical OPD/medicine OPD in the study period. The patients above 30 years were evaluated by mammography and ultrasound in Department of Radiology, National Academy of Medical Sciences, Bir Hospital. The patients were then send for FNAC/biopsy and histopathology examination. Data were collected and analyzed using SPSS version 16. Specificity and sensitivity of MG and USG individually and in combination to determine the nature of breast lump in relation to histopathological findings were calculated.
Results:
Ultrasound had 88.90% sensitivity and 68.80% specificity whereas mammogram had 94.40% and 87.50% sensitivity and specificity respectively. When combined, both sensitivity of diagnosing malignant lesions increases up to 94.4% and specificity decreases up to 31.2%. Most of the variables of ultrasound and mammography (except density of the lesion) had significance in predicting nature of the lesion (p< 0.05).
Conclusions:
Combined Mammography and Ultrasound had higher sensitivity than sensitivity rate observed for either single modality. A combined Mammography and Ultrasound approach to detect breast diseases was significantly more helpful in accurate evaluation of breast pathologies.
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This book of proceedings gathers the contributions presented at the 7th URV Doctoral Workshop in Computer Science and Mathematics. The main aim of this workshop is to promote the dissemination of the ideas, methods and results that are developed in the Doctoral Thesis of the students of this doctorate program, and to promote the knowledge sharing, collaboration and discussion between their respective research groups.
Introduction:
Breast cancer is the most common malignancy among women, and subtypes are mainly defined based on hormone receptors such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). The relationship between breast cancer subtypes and imaging features in mammography and sonography has been studied but the results are controversial. The purpose of this study was to determine the relationship between the hormonal receptor status of breast tumors and the radiologic feature of the tumors on mammography and sonography.
Methods:
Eighty patients with breast cancer enrolled in this cross-sectional study. ER, PR, and HER2 determined by immunohistochemistry. Every patient underwent mammography and sonography before the biopsy. We evaluated the relationship between the hormonal receptor status and radiographic features of tumors on breast sonography and mammography.
Results:
The majority of the patients (n=75 (93.8%)) were diagnosed with invasive ductal carcinoma (IDC). The mean and standard deviation of the age was 49 ± 9 years. There was no significant relationship between the hormonal receptor status and the sonographic margin and shape (P>0.05). However, PR (P=0.002) and ER (P=0.001) status were significantly correlated with posterior features on sonography. ER-positive patients were more likely to have indistinct or speculated masses on mammography (P=0.017). Irregular or oval masses on mammography were higher in patients with ER (p=0.032).
Conclusion:
There was a significant correlation between PR and ER status and posterior features on sonography. Positive ER was associated with indistinct or speculated masses on mammography, as well as irregular or oval masses.
Medical thermography is an imaging test used to monitor skin surface temperature. Although it is not a recent technique, significant advances have been made since the 2000s with the equipment modernization, leading to its popularization. In cancer diagnosis, the application of thermography is supported by the difference in thermal distribution between neoplastic processes and adjacent healthy tissue. The mechanisms involved in heat production by cancer cells include neoangiogenesis, increased metabolic rate, vasodilation, and the release of nitric oxide and pro-inflammatory substances. Currently, thermography has been widely studied in humans as a screening tool for skin and breast cancer, with positive results. In veterinary medicine, the technique has shown promise and has been described for skin and soft tissue tumors in felines, mammary gland tumors, osteosarcoma, mast cell tumors, and perianal tumors in dogs. This review discusses the fundamentals of the technique, monitoring conditions, and the role of thermography as a complementary diagnostic tool for cancer in veterinary medicine, as well as future perspectives for improvement.
PurposeThe purpose of this study was to assess the diagnostic performance of mammography (MMG) and ultrasound (US) imaging for detecting breast cancer.Methods
Comprehensive searches of PubMed, Scopus and EMBASE from 2008 to 2021 were performed. A summary receiver operating characteristic curve (SROC) was constructed to summarize the overall test performance of MMG and US. Histopathologic analysis and/or close clinical and imaging follow-up for at least 6 months were used as golden reference.ResultsAnalysis of the studies revealed that the overall validity estimates of MMG and US in detecting breast cancer were as follows: pooled sensitivity per-patient were 0.82 (95% CI 0.76–0.87) and 0.83 (95% CI 0.71–0.91) respectively, The pooled specificities for detection of breast cancer using MMG, and US were 0.84 (95% CI 0.73–0.92) and 0.84 (95% CI 0.74–0.91) respectively. AUC of MMG, and US were 0.8933 and 0.8310 respectively. Pooled sensitivity and specificity per-lesion was 76% (95% CI 0.62–0.86) and 82% (95% CI 0.66–0.91) for MMG and 94% (95% CI 0.87–0.97) and 84% (95% CI 0.74–0.91) for US.Conclusions
The meta-analysis found that, US and MMG has similar diagnostic performance in detecting breast cancer on per-patient basis after corrected threshold effect. However, on a per-lesion basis US was found to have a better diagnostic accuracy than MMG.
Paget's disease of the breast typically affects postmenopausal women and is associated with an underlying malignancy. Skin changes are a common presenting symptom, as well as a lump, nipple discharge, pain and changes to the nipple shape. Imaging options include ultrasound for women under the age of 35 years or mammogram and ultrasound for women over the age of 40 years. The definitive diagnostic investigation is a tissue core biopsy. Cases are discussed by a multidisciplinary team to decide on the optimal management strategy. Management options are typically surgical and include breast-conserving surgery or mastectomy in addition to oncoplastic techniques. Sentinel lymph node biopsy is performed in all patients undergoing surgery. Adjuvant chemotherapy, radiotherapy or endocrine therapy can be used to treat concomitant invasive disease or ductal carcinoma in situ.
Background: The high diagnostic performance of modern breast ultrasound (US) opens the possibility to shift toward targeted US as initial imaging test in women with breast complaints. This comparative cohort study investigates the effects of starting with US followed by digital breast tomosynthesis (DBT), as practiced in the breast ultrasound study (BUST), on women's health-related quality of life (QoL). Methods: Fifty BUST participants and 50 "controls" who underwent DBT and US in regular order filled out the EQ-5D-3L three times during their visit: BUST participants before US (T1), after US (T2), and after DBT (T3) and non-BUST participants before DBT (T1), after DBT (T2), and after US (T3). Changes in QoL from baseline to T2 and T3 were assessed using generalized least squares, also taking into account the effects of biopsy, age, and complaint type. Results: Participants' mean age was 50.6 years (BUST: SD = 12.1, controls: SD = 11.5). At T2 the overall QoL was higher [t(102.9) = 2.4, p = 0.017] and anxiety levels were lower [t(98.7) = -2.4, p = 0.020] in BUST participants compared with controls. However, from T2 to T3 these effects equalize, resulting in similar performances in QoL and anxiety at T3, respectively [t(97.6) = -2.3, p = 0.023] and [t(97.2) = 3.1, p = 0.002]. Compared with BUST participants, controls show a clear decrease in pain after US [t(106.5) = -2.8, p = 0.006]. Women undergoing biopsy had lower QoL [t(167.1) = -2.4, p = 0.017] and pain [t(154.1) = -2.1, p = 0.038], and more anxiety [t(187.4) = 4.3, p = 0.000]. Conclusions: The results suggest that changing the radiological order by starting with US has a short-term positive effect on overall QoL, anxiety, and DBT pain experience in symptomatic women. Owing to its negative impact, biopsies should be performed cautiously. In conclusion, the moment of reassurance for women advances by reversing the radiological order according to the BUST, showing the high importance of human interaction in diagnostic care in addition to the clinical performance of imaging modalities.
Recent non-linear ultrasound imaging methods estimate acoustic tissue properties, such as speed-of-sound (SOS), density, and compressibility, among others. These methods can be used to generate 2D reconstructions of the properties of inner structures of the breast for further analysis. Due to differences in the acoustic properties between cancerous and normal tissues, these reconstructions are particularly attractive for computerized analysis. In this work, we explored the feasibility of using radiomic analysis on SOS images for breast lesion detection. We performed an in-silico analysis of SOS slices extracted from 120 3D virtual breast phantoms and built a system based on radiomic features extracted from SOS images for the detection of breast masses. We measured the performance of the system in terms of the area under the ROC curve (AUC) with 95% confidence intervals (CI). We also compared the performance of lesion detection from SOS images against a model trained with synthetic mammograms generated from the same breast phantoms. Radiomic analysis on SOS images yielded statistically significant results with AUCs of 0.73 (CI: 0.64–0.82), 0.89 (CI: 0.83–0.95), and 0.94 (CI: 0.89–0.98) at pixel-size of 1.5, 2.0 and 2.5 mm respectively. Radiomic analysis on mammograms showed lower performance with an AUC of 0.62 (CI: 0.52–0.72). Our evidence suggests that the use of SOS images, paired with radiomic analysis, could aid on the detection of breast masses that are hard to recognise using digital mammography. Further investigation on ultrasound-based reconstruction of SOS images of the breast is warranted.KeywordsUltrasoundMammographyFull waveform inversionBreast cancerLesion detectionRadiomic analysis
Breast density is known to increase breast cancer risk and decrease mammography screening sensitivity. Breast density notification laws require physicians to inform women with high breast density of these potential risks. The laws usually require healthcare providers to notify patients of the possibility of using more sensitive supplemental screening tests (i.e., ultrasound and MRI). Since the enactment of the laws, there have been controversial debates over (i) their implementations due to the potential radiologists’ bias in breast density classification of mammogram images and (ii) the necessity of supplemental screenings for all patients with high breast density. In this study, we formulate a finite-horizon, discrete-time partially observable Markov chain to investigate the effectiveness of supplemental screening and the impact of radiologists’ misclassification bias on patients’ outcomes. We consider the conditional probability of eventually detecting breast cancer in early states given that the patient develops breast cancer in her lifetime as the primary and the expected number of supplemental tests as the secondary patient’s outcome. Our results indicate that referring patients to a supplemental test solely based on their breast density may not necessarily improve their health outcomes and other risk factors need to be considered when making such referrals. Additionally, average-skilled radiologists’ performances are shown to be comparable with the performance of a perfect radiologist (i.e., 100% accuracy in breast density classification). However, a significant bias in breast density classification (i.e., consistent upgrading or downgrading of breast density classes) can negatively impact a patient’s health outcomes.
Background: Ultrasound Breast Imaging-Reporting and Data System (BI-RADS) classification may underestimate ductal carcinoma in situ (DCIS). Currently, there is a lack of research on ultrasound BI-RADS underestimating DCIS. Objectives: To improve the diagnosis of DCIS, this study aimed to investigate factors associated with the underestimation of DCIS, based on ultrasound BI-RADS assessments. Methods: In this cross-sectional study, consecutive patients with breast ultrasound BI-RADS classification and biopsy results were retrospectively examined. DCIS was found in the pathology reports of all patients. DCIS cases classified as BI-RADS 4A or lower were considered as underestimations of DCIS, while DCIS cases classified as BI-RADS 4B or higher were considered as non-underestimation of DCIS. The demographics, clinical manifestations, features of breast images, BI-RADS classification, and pathological results of the two groups were compared to explore possible associated factors. A stepwise logistic regression analysis was also carried out based on the significance of factors associated with the underestimation of DCIS according to the BI-RADS assessment. Results: Between January 2015 and May 2017, a total of 296 breast DCIS lesions were diagnosed in 294 female patients. Overall, 65 lesions (22.0%) were underestimated DCIS, and 231 lesions (78.0%) were non-underestimated DCIS; no significant differences were found between their clinical presentations. The univariate analysis showed that the age of the patients, presence of microinvasions, maximum lesion diameter, shape, margin, orientation, echo pattern, posterior acoustic features, ultrasound pattern, and vascularity of lesions were possibly associated factors, which could lead to the underestimation of DCIS. The logistic regression analysis showed that age above 50 years, maximum lesion diameter < 10 mm, lack of microinvasion, and circumscribed margins were associated with the underestimation of DCIS. Conclusion: In this study, 22% of DCIS lesions was underestimated by the BI-RADS assessment. The patient’s age, maximum lesion diameter, microinvasion, and lesion margin were associated with the underestimation of DCIS.
Ultrasonic technique became an indispensable imaging modality for diagnosis of breast
cancer due to its ability to efficiently capture the tissue properties, decrease the wrong
negative recognition rate observed and the number of non-essential biopsies
approximately by 40% in other modalities such as mammogram as well as its ability to
diagnose young women. Despite this, ultrasound images are corrupted with speckle noise,
which produces fine-false structures that decrease contrast of images and wraps the actual
boundaries of the tissue. In addition, it causes problems in the next stages of image
processing system such as edge detection, automatic segmentation, feature extraction and
classification. Even though there are many efforts made by researchers to formulate
various speckle reduction methods in ultrasound images, the methods have drawbacks
like removing finer edge details, being unable to balance effectively enhancing edges and
small structures while reducing noise, especially when quality of image is poor and
consume more processing time during calculations. This study developed a better despeckling technique called ‘Nonlocal Means Method Using Clustering Pre-classification
and Rotational Invariant Block Matching (RIBM) for De-speckling of breast
Ultrasound Images’ using Matlab. Effectiveness of the method is demonstrated by
comparing with three established state of the art de-speckling techniques the switching
bilateral filter (SBF), the NL-means filter (NLMF), and the optimized non-local means
filter (ONLMF) on 12 B-mode ultrasound breast images which include 6 database
and 6 clinical images collected from Black Lion Specialized Hospital based on visual
and numerical evaluation parameters, Self Similarity, Peak Signal to Noise Ratio and
Mean Square Error.
Clinical oncology can benefit substantially from imaging technologies that reveal physiological characteristics with multiscale observations. Complementing conventional imaging modalities, photoacoustic imaging (PAI) offers rapid imaging (for example, cross-sectional imaging in real time or whole-breast scanning in 10-15 s), scalably high levels of spatial resolution, safe operation and adaptable configurations. Most importantly, this novel imaging modality provides informative optical contrast that reveals details on anatomical, functional, molecular and histological features. In this Review, we describe the current state of development of PAI and the emerging roles of this technology in cancer screening, diagnosis and therapy. We comment on the performance of cutting-edge photoacoustic platforms, and discuss their clinical applications and utility in various clinical studies. Notably, the clinical translation of PAI is accelerating in the areas of macroscopic and mesoscopic imaging for patients with breast or skin cancers, as well as in microscopic imaging for histopathology. We also highlight the potential of future developments in technological capabilities and their clinical implications, which we anticipate will lead to PAI becoming a desirable and widely used imaging modality in oncological research and practice.
Breast cancer is the most common cancer in females which is associated with significant morbidity and mortality, if not detected in early stages. Triple assessment is the key to approach breast diseases, and it includes clinical examination, imaging evaluation and pathological assessment. Role of imaging is crucial in detection and staging of such patients so as to provide appropriate treatment to them. This chapter aims to provide an overall insight about various imaging modalities involved in evaluation of breast pathologies.KeywordsBreast cancerBreast imagingMammographyTomosynthesisBreast ultrasoundMRI
Mammographically dense breast tissue has been reported both as a cause of false-negative findings on mammography and as an indicator of increased breast cancer risk. We conducted this study to evaluate the role of breast sonography as a second-line screening test in women with mammographically dense breast tissue.
Between January 2000 and January 2002, 1517 asymptomatic women with dense breasts and normal mammography and physical examination findings underwent physician-performed breast sonography as an adjunct screening test. Within the study group, 318 women had a first-degree family history or personal history of breast cancer. The high-risk subgroup comprised these women. The detection rate of breast cancer in this subgroup was compared with the detection rate in the remaining study population with baseline risk.
Of 1517 women examined, seven breast cancers were diagnosed (cancer-detection rate, 0.46%). Four carcinomas were detected in high-risk women and three in women with baseline risk. The cancer-detection rate in the subgroup of high-risk women was 1.3%, significantly higher (p < 0.04) than the cancer-detection rate of 0.25% in the baseline risk subgroup. All cancers were T1 (range, 4-12 mm; mean, 9.6 mm). Sentinel lymph nodes were negative for cancer in six of seven carcinomas.
Screening breast sonography in the population of women with dense breast tissue is useful in detecting small breast cancers that are not detected on mammography or clinical breast examination. The use of sonography as an adjunct to screening mammography in women with increased risk of breast cancer and dense breasts may be especially beneficial.
Mammography is the standard imaging modality for breast cancer diagnosis. However, the value of mammographic diagnosis in breast cancer patients aged less than 40 years old has not been well assessed. The goal of our study was to determine the diagnostic efficacy of mammography for the detection of breast cancer in women under 40 years of age in a single medical center in Taiwan.
Of 1766 women diagnosed with breast cancer in one medical center between 1999 and 2005, 227 (12.9%) who were younger than 40 years of age were enrolled, and 105 of these 227 patients had pre-biopsy mammograms available for analysis. The sensitivities for mammography at first (prospective) and second (retrospective) readings and for corresponding ultrasound were calculated. The distribution of different breast composition between the mammographic true-positive (TP) and false-negative (FN) lesions at the first and second readings was analyzed.
Of the 105 patients, 104 presented with a palpable mass and the other one was asymptomatic. There were 109 pathologically proven breast cancers from the 105 patients; 92 of 109 cancerous lesions were detected at the first mammographic reading (sensitivity 84.4%), and the most common mammographic sign was microcalcifications (40.2%). The second reading detected seven additional cancers (99 of 109 lesions; sensitivity 90.8%). There was no significant difference between mammographic TP and FN lesions for the different breast composition on first and second readings. Ninety patients also had ultrasound available for correlation with 94 cancers diagnosed from them. The diagnostic sensitivity of ultrasound was 94.7% (89 of 94 lesions).
Mammography has an acceptable sensitivity for the detection of breast cancer in women aged less than 40 years, regardless of different breast composition. Breast ultrasound can offer a higher sensitivity for such a population.
The degree of adherence with evidence-based guidelines for the use of breast ultrasonography was determined in clinical practice of radiologists in six hospitals. Additional ultrasonography was performed in 2,272 (53%) of all 4,257 patients referred for mammography. High adherence rates (mean: 95%) were observed for guidelines recommending ultrasonography in patients referred for palpable breast masses and abnormal screening and diagnostic mammograms. Lower adherence rates (mean: 81%, Pearson correlation coefficient= -0.57; p=0.001) were found for guidelines advising against additional ultrasonography in patients referred for breast symptoms, a known benign abnormality, a family history or anxiety of breast cancer. The overuse of ultrasonography in 442 patients and underuse in 95 patients led to five additional false-positive results. It was concluded that the guidelines seem workable and feasible in clinical practice and that the current daily routine of diagnostic breast imaging corresponded to a great extent to the guidelines proposed.
The sensitivity of mammography with respect to age in women with symptomatic palpable invasive breast cancers has been assessed. The mammogram reports of 257 women less than 50 years old were compared with those of 143 women between 50 and 70 years old. The reports were classified as malignant, indeterminate, or normal/benign. Mammography demonstrated a lesion classified as suspicious of malignancy in 83% of women over-50 compared to 65% of those under 50 (p = < 0.001). There was a steady increase in the number of suspicious lesions seen on mammography with increasing age of the patient, ranging from 57% in women under 40 years to 87% in women aged 60-70 years. In 348 cases (87%) the mammograms were available for review and the parenchymal patterns were graded according to Wolfe's classification. There was a significant increase in the DY/P2 patterns with decreasing age of the woman (p = < 0.001). The sensitivity of mammography for the diagnosis of malignancy was decreased in women with DY/P2 patterns when compared to those with P1/N1 patterns (93% vs 66%; p = < 0.001). This study confirms that mammography is less sensitive in detecting breast cancers in women less than 50 years old. The increased density of the breast parenchyma in younger women appears to be an important factor. It is likely to be a major reason for the reduced efficacy of mammographic breast cancer screening programmes in women under 50 years of age.
Studienziel: Neubewertung der Mammasonographie nach Sichtung der neueren vergleichenden Literatur. Methode: Darstellung der Ergebnisse neuerer die bildgebende Diagnostik der Mamma vergleichender Studien. Ergebnisse: Bei der symptomatischen Patientin stellt die Sonographie das geeignetere und primär einzusetzende bildgebende Verfahren dar. Bei der asymptomatischen Patientin (Screening) wird der Sonographie eine höhere Sensitivität als der Mammographie zur Entdeckung des Mammakarzinoms in Kollektiven mit dichten Brüsten, bei Frauen unter 50 Jahren und in Hochrisikokollektiven zugeschrieben. Mammographisch okkulte Karzinome können sonographisch - abhängig vom Kollektiv - zwischen 10 und 40 % dargestellt werden. Die Tumorgröße ist bei Diagnose im Median nicht unterschiedlich zu derjenigen der Mammographie. Die Prävalenz der sonographisch entdeckten Karzinome ist im Gesamtkollekiv nicht geringer als die Prävalenz der mammographisch gefundenen. Schlussfolgerung: Die Sonographie sollte als primäres bildgebendes Verfahren nach der klinischen Untersuchung bei der symptomatischen Patientin eingesetzt werden und kann oft allein oder mit angeschlossener Stanzbiopsie zur gesicherten Diagnose führen. Bei der asymptomatischen Patientin sollte die Sonographie grundsätzlich ab einem Dichtegrad II (BI-RADS) komplementär zur Mammographie eingesetzt werden. Ein primärer oder zur Mammographie alternativer Einsatz der Sonographie ist bislang nicht prospektiv evaluiert, erscheint aber bei Frauen unter 50, bei Frauen mit dichten Brüsten und in Hochrisikokollektiven plausibel und sollte in aufzulegenden Studien abgesichert werden.
To determine whether sonography could help accurately distinguish benign solid breast nodules from indeterminate or malignant nodules and whether this distinction could be definite enough to obviate biopsy.
Seven hundred fifty sonographically solid breast nodules were prospectively classified as benign, indeterminate, or malignant. Benign nodules had no malignant characteristics and had either intense homogeneous hyperechogenicity or a thin echogenic pseudocapsule with an ellipsoid shape or fewer than four gentle lobulations. Sonographic classifications were compared with biopsy results. The sensitivity, specificity, and negative and positive predictive values of the classifications were calculated.
Benign histologic features were found in 625 (83%) lesions; malignant histologic features, in 125 (17%). Of benign lesions, 424 had been prospectively classified as benign. Two lesions classified as benign were found to be malignant at biopsy. Thus, the classification scheme had a negative predictive value of 99.5%. Of 125 malignant lesions, 123 were correctly classified as indeterminate or malignant (98.4% sensitivity).
Sonography can be used to accurately classify some solid lesions as benign, allowing imaging follow-up rather than biopsy.
Overall consecutive breast abnormalities (259 carcinomas, 1820 benign) examined with breast ultrasonography (US) are reported. US sensitivity, specificity and positive predictive value were 67.6, 97.7 and 81.0%, resp. (the corresponding values were 57.9, 97.9 and 77.2% for palpation, 79.9, 93.5 and 73.7% for mammography, and 97.6, 92.6 and 87.6% for cytology). US sensitivity was unaffected by age, whereas it was strongly influenced by tumor size (pT1-76.1%; pT2-87.1%) and histologic type (intraductal-7.4%; invasive ductal/lobular-83.4%; invasive special types-64.1%). The features of the lesions at US were significantly associated with cancer (irregular margins, posterior acoustic shadowing) or benign lesions (anechoic structure, lateral shadowing, posterior acoustic enhancement) but had a limited diagnostic accuracy. Overall, US visualized 174 (benign-24, suspicious-150) of 188 palpable, and 32 (benign-7, suspicious-25) of 71 nonpalpable cancers. US contribution was determinant to final diagnosis in 4 of 7 cancers, missed at palpation and mammography, but was at least partially responsible for 8 unnecessary biopsies of benign lesions. A negative/benign US report contributed to avoid unnecessary biopsy in 71 suspicious cases at palpation/mammography. Routine US examination of clinical/mammographic abnormalities is recommended for the advantages of US-guided aspiration and to reduce the frequency of unnecessary biopsies.
This study was undertaken to determine the frequency and distribution of dense mammograms. Factors that may affect parenchymal density of breasts among the diverse age groups of women who undergo mammography were also studied.
Mammograms of 1353 women between 25 and 79 years old who were grouped in 5-year age cohorts were reviewed. Breast density and the presence of benign calcifications were analyzed.
Parenchymal density on mammograms decreased progressively in the patient cohorts 25-29 years old through 75-79 years old (Spearman correlation, p < .01). In the cohort of 25- through 29-year-old patients, 38% had predominantly (> 50%) fatty breasts. In the cohort of 75- through 79-year-old patients, 76% had predominantly fatty breasts. Increased parenchymal density mammograms were more common in women who had smaller breasts, had had fewer than two pregnancies, and underwent hormone replacement (p < .01). Forty-nine percent of women 50-79 years old undergoing hormone replacement had predominantly dense breasts, a percentage similar to that (48%) of the patient cohort of women 40-44 years old. Prevalence of benign calcifications also increased with age, from 8% at ages 25-29 to 86% at ages 75-79 (p < .01).
In our study, a significant percentage (38%) of women who were 25-39 years old had predominantly fatty breast tissue that should not impede selective mammographic screening or diagnostic efforts in this age group.
To determine the value of ultrasonography (US) as an adjunct to mammography for the diagnosis of breast cancer.
In a 2-year prospective study, 4,811 mammograms were classified according to level of suspicion of malignancy. Targeted US was performed to analyze (a) circumscribed lesions, possibly cysts; (b) palpable lesions visible at mammography; (c) palpable lesions not visible at mammography; and (d) nonpalpable lesions visible at mammography. After US was performed in 1,103 cases (23%), cases were reclassified for level of suspicion.
In 338 cases, breast cancer was diagnosed. The sensitivity of mammography for all 4,811 cases was 83%; the specificity was 97%. After US, the combined sensitivity increased to 91%, with a specificity of 98%. The increase was significant (P < .001). The increase in sensitivity was highest among women younger than 50 years. The positive predictive value for mammography was high (72%), which reflects a high threshold for biopsy; this may have augmented the yield of US.
The use of US as an adjunct to mammography resulted in an increase in diagnostic accuracy. Its contribution to the diagnosis of breast cancer in this study was 7.4%.
Ultrasonography (US) of the breast is not applied to its optimal capacity if it is restricted to the differentiation between cystic and solid lesions and evaluation of dense breasts. It can play a major role in the detection of breast cancer; not only because of detection of mammographically occult lesions but also because of more accurate identification of lesion characteristics suspicious of malignancy. Its yield is highest among women younger than 50 years. However, one should keep in mind that the profit obtained by US shows not only the diagnostic accuracy of US but also that of mammography. Further improvement can be achieved by refinement in US diagnosis, especially with respect to the US characteristics of diffusely growing cancers.
We studied which, age of the patient or density of the breast accounts for the sensitivity of mammography and ultrasonography (US). Furthermore we studied whether the overall impression on the density of the breast or the density in tumour area accounts for the sensitivity of mammography and ultrasonography.
The material consisted of 572 consecutive histologically and 5 cytologically verified breast cancer cases. Mammography and US examinations were performed immediately before breast cancer operations and information on the findings were received from the original patient files and classified as malignant or benign. The density of breast parenchyma to fatty, mixed or dense in total breast and separately in tumour area was defined by a radiologist group from the original mammograms by comparing to model mammograms. The sensitivity (Se) of mammography and US was compared in 3 age groups (26-49, 50-59 and 60-92) and in the different density classes.
Sensitivity of mammography increased by age (density-adjusted OR = 0.2, 95%, CI 0.1-0.5) in age group 26-49 compared to age group 60-92) and with fattiness of the breast (age-adjusted OR= 0.4, 95%, CI 0.1-1.0 for dense breast parenchyma in tumour area compared to fatty breast). Sensitivity of US was inversely related to age (density-adjusted OR = 2.3, 95%, CI 1.0-5.2 in age group 26-49 compared to age group 60-92) and directly related with fattiness of breast (age-adjusted OR = 0.5, 95%, CI 0.2-0.9 by dense breast parenchyma in tumour area compared to fatty breast). Density in the tumour area compared to total breast density was related only mariginally better sensitivity both of mammography (0.4 vs. 0.6) and of US (0.5 vs. 0.6).
Sensitivity of both mammography and sensitivity of US are independently related both to the age of the patient and to the density of the breast. The effect of age is inverse and that of density parallel between mammography and US on sensitivity. The effect of overall breast density was close to the effect of density at the site of the tumour on the sensitivity of both mammography and US.
To evaluate the clinical utility of bilateral whole-breast ultrasonography (US) as an adjunct examination to mammography in asymptomatic women with dense (Breast Imaging Reporting and Data System [BI-RADS] density category 3 or 4) breast tissue.
Between July 1998 and April 2000, 1,862 patients with negative findings at clinical examinations, negative mammographic results, and breast tissue with BI-RADS category 3 or 4 density were evaluated with bilateral whole-breast US for occult cystic and solid masses, areas of architectural distortion, and acoustic shadowing. Suggestive findings were compared with tissue diagnoses from US-guided core biopsy specimens. US was initially performed by a US or a mammography technologist. The average time to perform the examination was approximately 10 minutes. Abnormal findings were corroborated by a fellowship-trained breast-imaging radiologist.
In the 1,862 women examined with bilateral whole-breast US, 57 biopsies were recommended in 56 patients; follow-up data were available in 51 of the 56 patients. Six breast cancers were detected (cancer detection rate, 0.3%).
Bilateral whole-breast US, when performed in patients with dense (BI-RADS category 3 or 4 density) breast tissue, is useful in detecting breast cancer not discovered with mammography or clinical breast examination. The 0.3% cancer detection rate compares favorably with that of screening mammography and with that in previously published studies involving bilateral whole-breast US.
To determine the number of patients who received a diagnosis of breast cancer after having an area of clinical concern at presentation and combined negative mammographic and ultrasonographic (US) findings.
During a 4-year period, 829 patients with a palpable abnormality at presentation and combined negative mammographic and US findings were identified. The number of women who went on to receive a diagnosis of breast cancer was determined retrospectively. The authors searched the breast imaging database and the pathology database, sent a contact letter to the referring physicians, and linked their data to the State Cancer Registry. They also analyzed the breast parenchymal density among all patients who had more than 2 years of follow-up.
Of the 829 women, 374 had follow-up information. Two-hundred thirty-three patients had negative imaging findings with more than 2 years of follow-up. The other 141 women were presumed to be cancer free, as they were not identified by the State Cancer Registry. Six (2.6%) of the 233 women had a diagnosis of breast cancer in the area of the palpable abnormality. The six cancers were diagnosed among the 156 women who had radiographically dense breast tissue (Breast Imaging Reporting and Data System category 3 or 4). Among the 77 women with predominantly fatty tissues, no cancers were diagnosed.
A negative mammographic and US finding of a palpable abnormality does not exclude breast cancer, but the likelihood of breast cancer is low, approximately 2.6%-2.7%. It may be higher if the breast tissues are dense and lower if they are predominantly fatty.
To (a) determine the performance of screening mammography, ultrasonography (US), and physical examination (PE); (b) analyze the influence of age, hormonal status, and breast density; (c) compare the size and stage of tumors detected with each modality; and (d) determine which modality or combination of modalities optimize cancer detection.
A total of 11,130 asymptomatic women underwent 27,825 screening sessions, (mammography and subsequent PE). Women with dense breasts subsequently underwent screening US. Abnormalities were deemed positive if biopsy findings revealed malignancy and negative if findings from biopsy or all screening examinations were negative.
In 221 women, 246 cancers were found. Sensitivity, specificity, negative and positive predictive values, and accuracy of mammography were 77.6%, 98.8%, 99.8%, 35.8%, and 98.6%, respectively; those of PE, 27.6%, 99.4%, 99.4%, 28.9%, and 98.8%, respectively; and those of US, 75.3%, 96.8%, 99.7%, 20.5%, and 96.6%, respectively. Screening breast US increased the number of women diagnosed with nonpalpable invasive cancers by 42% (30 of 71). Mammographic sensitivity declined significantly with increasing breast density (P <.01) (48% for the densest breasts) and in younger women with dense breasts (P =.02); the effects were independent. Mammography and US together had significantly higher sensitivity (97%) than did mammography and PE together (74%) (P <.001). Tumors detected at mammography and/or US were significantly smaller (P =.01) and of lower stage (P =.01) than those detected at PE.
Mammographic sensitivity for breast cancer declines significantly with increasing breast density and is independently higher in older women with dense breasts. Addition of screening US significantly increases detection of small cancers and depicts significantly more cancers and at smaller size and lower stage than does PE, which detects independently extremely few cancers. Hormonal status has no significant effect on effectiveness of screening independent of breast density.
The relationships among breast density, age, and use of hormone replacement therapy (HRT) in breast cancer detection have not been fully evaluated.
To determine how breast density, age, and use of HRT individually and in combination affect the accuracy of screening mammography.
Prospective cohort study.
7 population-based mammography registries in North Carolina; New Mexico; New Hampshire; Vermont; Colorado; Seattle, Washington; and San Francisco, California.
329 495 women 40 to 89 years of age who had 463 372 screening mammograms from 1996 to 1998; 2223 women received a diagnosis of breast cancer.
Breast density, age, HRT use, rate of breast cancer occurrence, and sensitivity and specificity of screening mammography.
Adjusted sensitivity ranged from 62.9% in women with extremely dense breasts to 87.0% in women with almost entirely fatty breasts; adjusted sensitivity increased with age from 68.6% in women 40 to 44 years of age to 83.3% in women 80 to 89 years of age. Adjusted specificity increased from 89.1% in women with extremely dense breasts to 96.9% in women with almost entirely fatty breasts. In women who did not use HRT, adjusted specificity increased from 91.4% in women 40 to 44 years of age to 94.4% in women 80 to 89 years of age. In women who used HRT, adjusted specificity was about 91.7% for all ages.
Mammographic breast density and age are important predictors of the accuracy of screening mammography. Although HRT use is not an independent predictor of accuracy, it probably affects accuracy by increasing breast density.
New evaluation of breast ultrasound based upon review of new literature comparing ultrasound and mammography.
Description and discussion of the published trials regarding breast imaging methods.
Breast ultrasound is the preferable method in the case of a symptomatic patient (after clinical examination). In the case of a patient without symptoms (screening), breast ultrasound is ascribed a higher sensitivity for detecting breast cancer in women with dense breast tissue, women under the age of 50 and high-risk women. Mammographically occult cancers can be detected by sonography in 10 to 40 % of the cases depending on the patient's breast density and age. The mean size of cancers detected only by ultrasound is not significantly different to that only detected by mammography. The prevalence of breast cancers detected by ultrasound is approximately equal to the one detected by mammography, regarding the total number of examined patients.
Breast ultrasound should be the preferred imaging procedure in the case of a palpable lump, leading to a definitive diagnosis itself or with an additional consecutive core needle biopsy. For women without symptoms, breast sonography should be mandatory and complementary to mammography in the case of breast density grade II (BI-RADS) or more. Application of breast ultrasound as a primary method or an alternative to mammography has not yet been evaluated sufficiently. It seems advisable in the case of women with dense breast tissue grade III and IV, women under the age of 50 and high-risk women. The implementation of breast ultrasound in this manner has to be checked by future trials.
Breast ultrasound is generally interpreted with knowledge of the mammographic examination. This study examined the influence of knowledge of mammography findings on the accuracy of ultrasound in women with breast symptoms. Subjects were sampled from all women 25-55 years of age consecutively attending a breast clinic. This included all 240 women shown to have breast cancer and 240 age-matched women shown not to have cancer. Ultrasound films were prospectively reviewed and reported by two radiologists independent of each other and in a blinded manner. A two-phase design was used. In the first phase, the radiologists provided an opinion on the ultrasound films. In the second phase, the ultrasound films were reread with consideration of the corresponding mammographic examination. The accuracy of reading the ultrasound with and without knowledge of the findings on mammography was compared using sensitivity and specificity, and receiver operating characteristics (ROC) curves. Reporting the ultrasound with knowledge of mammography (compared to without mammography) improved sensitivity and reduced specificity for both radiologists. For one reader, sensitivity increased from 77.5% to 86.7% (p = 0.0002) and specificity decreased from 89.7% to 85.4% (p = 0.04). For the other reader, sensitivity increased from 81.3% to 87.5% (p = 0.0023) and specificity decreased from 87.1% to 85.0% (p = 0.27). ROC curves for both radiologists showed that reporting ultrasound with knowledge of mammography resulted in small (about 3%), but significant improvement in the area under the ROC curve. Our study indicates that knowledge of the findings of mammography improves the interpretation of breast ultrasound in symptomatic women.
The amount of radiologically dense breast-tissue appearing on a mammogram varies between women because of differences in the composition of breast tissue, and is referred to here as mammographic density. This review presents evidence that mammographic density is a strong risk factor for breast cancer, and that risk of breast cancer is four to five times greater in women with density in more than 75% of the breast than in women with little or no density in the breast. Density in more than 50% of the breast could account for about a third of breast cancers. The epidemiology of mammographic density is consistent with its being a marker of susceptibility to breast cancer. Twin studies have shown that the proportion of the breast occupied by density, at a given age, is highly heritable, and inherited factors explain 63% of the variance. Mammographic breast density has the characteristics of a quantitative trait and might be determined by genes that are easier to identify than those for breast cancer itself. The genes that determine breast density might also be associated with risk of breast cancer, and their identification is also likely to provide insights into the biology of the breast and identify potential targets for preventive strategies.
Despite uncertain benefit, many women over age 80 (oldest-old) receive screening mammography.
To explore decision-making and physician counseling of oldest-old women around mammography screening.
Qualitative research using in-depth semi-structured interviews.
Twenty-three women aged 80 or older who received care at a large academic primary care practice (13 had undergone mammography screening in the past 2 years) and 16 physicians at the same center.
We asked patients and physicians to describe factors influencing mammography screening decisions of oldest-old women. We asked physicians to describe their counseling about screening to the oldest-old.
Patients and/or physicians identified the importance of physician influence, patient preferences, system factors, and social influences on screening decisions. Although physicians felt that patient's health affected screening decisions, few patients felt that health mattered. Three types of elderly patients were identified: (1) women enthusiastic about screening mammography; (2) women opposed to screening mammography; and (3) women without a preference who followed their physician's recommendation. However, physician counseling about mammography screening to elderly women varies; some individualize discussions; others encourage screening; few discourage screening. Physicians report that discussions about stopping screening can be uncomfortable and time consuming. Physicians suggest that more data could facilitate these discussions.
Some oldest-old women have strong opinions about screening mammography while others are influenced by physicians. Discussions about stopping screening are challenging for physicians. More data about the benefits and risks of mammography screening for women aged 80 or older could inform patients and improve provider counseling to lead to more rational use of mammography.
Screening mammography guidelines for patients age 80 years and older are variable. We determined the effect of mammography use on stage at breast cancer diagnosis and survival among women of this age range.
We used the linked Surveillance, Epidemiology, and End Results-Medicare database to evaluate 12,358 women >or= 80 years of age diagnosed with breast cancer between 1996 and 2002. Patients were grouped according to number of mammograms during the 60 months before diagnosis: nonusers (0 mammograms), irregular users (one to two mammograms), and regular users (three or more mammograms). Effects of mammography on disease stage (I to IIa v IIb to IV) and survival were determined by logistic regression and Cox proportional hazards analyses.
Percentages of women with nonuse, irregular use, and regular use of mammography during the 5 years preceding diagnosis were 49%, 29%, and 22%, respectively. On multivariate analysis, patients were 0.37 times less likely to present with late-stage cancer for each mammogram obtained (odds ratio, 0.63; 95% CI, 0.63 to 0.67). Breast cancer-specific 5-year survival among nonusers was 82%, that among irregular users was 88%, and that among regular users was 94%. However, survival from causes other than breast cancer was also associated with mammography use, suggesting a bias for healthier patients to undergo mammography.
Regular mammography among women >or= 80 years of age was associated with earlier disease stage, although improved survival remains difficult to demonstrate. Health care providers should consider discussing the potential benefits of screening mammography with their older patients, particularly for those without significant comorbidity.
Illustrated Breast Imaging Reporting and Data System (BI-RADS) rd ed. Reston, V.A: American College of Radiology
- American College
- Radiology
American College of Radiology. Illustrated Breast Imaging Reporting and Data System (BI-RADS) rd ed. Reston, V.A: American College of Radiology, .
Specifi city of mammography and ultrasound in the evaluation of a palpable abnormality: retrospective review
- L Moy
- J Slanetzp
- R Moore
Moy L., SlanetzP.J., Moore R. et al. Specifi city of mammography
and ultrasound in the evaluation of a palpable abnormality: retrospective review. Radiology ; :-.
Th e specifi city of combined mammographic and ultrasonographic evaluation of palpable lumps and palpable thickening
- D B Kopans
- R H Moore
- P J Slanetz
- E D Yeh
- D A Hall
- K A Mccarthy
Kopans D.B., Moore R.H., Slanetz P.J., Yeh E.D., Hall D.A., McCarthy K.A. Th e specifi city of combined mammographic and ultrasonographic evaluation of palpable lumps and palpable thickening. Radiology ; (P): .