Immediate postoperative mammogram for failed surgical excision of breast lesions

In a series of 200 consecutive preoperative needle localizations of non-palpable breast lesions, 128 lesions (64%) were calcified and 72 lesions (36%) were noncalcified on preoperative mammograms. Radiographs of the surgical specimen failed to confirm excision of 11 lesions (5.5%), seven calcified and four noncalcified. These 11 patients were taken directly from the surgical suite to the radiology suite, where an immediate postoperative mammogram was obtained. In five patients (2.5%), immediate postoperative mammograms showed surgical failure with the lesion still present. In six patients (3.0%), immediate postoperative mammograms showed that the lesion had been removed, even though the lesion had not been identified on surgical-specimen radiographs. No errors occurred in the interpretation of immediate postoperative mammograms, a fact corroborated by examination of surgical specimens obtained at repeat surgery in three patients and identification of skin calcifications in two patients, and with follow-up mammograms in six patients. Whenever a discrepancy between preoperative localization radiographs and surgical-specimen radiographs exists, the authors suggest immediate postoperative mammography to improve the diagnostic process.     

Mammographic detection of breast cancer in women under the age of 35

There have been few studies of the radiographic findings of breast cancer in young women. We report our series of 42 cancers in 39 women under the age of 35 who had a mammogram prior to biopsy. Abnormal findings were present on 86% of the mammograms with 94% of the abnormalities classified as high or intermediate suspicion. Mammographic findings were: mass in 50%, calcifications in 31%, diffuse inflammatory changes in 11%, and an asymmetric density in 8%. Six of the mammograms were normal. While young women are usually expected to have dense breasts, 23 mammograms showed either entirely fatty or mixed fatty/glandular tissue. Dense parenchyma infrequently obscured a palpable malignancy. We conclude that mammography can provide important diagnostic information in young women with breast cancer.     

Focal breast lesions with benign appearances. Review of eight breast cancers with initial features of intramammary lymph node

PURPOSE: The aim of this study was to evaluate whether certain histological types of early breast cancer may share radiographic features with intramammary lymph nodes. MATERIALS AND METHODS: The previous mammograms of patients with histologically proven breast cancer and lesions displaying the morphological features of intramammary lymph nodes were retrospectively reviewed. RESULTS: Retrospective evaluation demonstrated eight breast cancers of varying histological nature--mostly ductal carcinomas not otherwise specified (NOS)--whose early radiographic features were similar to intramammary lymph nodes. CONCLUSIONS: Although uncommon, a lesion with the radiographic features of an intramammary lymph node may hide an early breast cancer. No significant relationship exists between histological type and the presence of such features.     

Mammographic screening of TRAM flap breast reconstructions for detection of nonpalpable recurrent cancer

PURPOSE: To evaluate findings from routine mammographic screenings in patients with transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions. MATERIALS AND METHODS: During a 25-month study period, 214 consecutive screening mammograms in 113 asymptomatic women (mean age, 51 years) with TRAM flap reconstructions were obtained. Mastectomies were performed for cancer in 106 (94%) of the 113 women and for prophylaxis in seven (6%). Prospectively, a Breast Imaging Reporting and Data System (BI-RADS) assessment category 1-5 was assigned to each mammogram. Surgical, medical, pathologic, and radiographic records were retrospectively reviewed. CIs were determined by the normal approximation to the binomial distribution. RESULTS: Seven (3%) of 214 examinations were BI-RADS category 4 or 5. Six (86%) of seven patients underwent biopsy. Two (33%) of these six biopsies demonstrated invasive ductal carcinoma. Cancer detection rate for mammography was 1.9% (two of 106) (95% CI: 0.33%, 7.32%) for women with reconstruction for breast cancer during the 2-year period. One (6%) of 16 BI-RADS category 3 examinations later proved to be invasive ductal carcinoma at follow-up. No interval cancer was discovered in 171 cases of BI-RADS category 1 or 2 examinations with 1-year follow-up. No cancers occurred in women who underwent prophylactic mastectomy. A biopsy positive predictive value of 33% (95% CI: 6%, 76%) was observed. CONCLUSION: Screening mammography of TRAM flap-reconstructed breasts enables detection of nonpalpable cancer before clinical examination.     

Screening mammography-detected cancers: sensitivity of a computer-aided detection system applied to full-field digital mammograms

PURPOSE: To retrospectively evaluate the sensitivity of the performance of a computer-aided detection (CAD) system applied to full-field digital mammograms for detection of breast cancers in a screening group, with histologic findings as the reference standard. MATERIALS AND METHODS: This study had institutional review board approval, and patient informed consent was waived. A commercially available CAD system was applied to the digital mammograms of 103 women (mean age, 51 years; range, 35-69 years) with 103 breast cancers detected with screening. Sensitivity values of the CAD system according to mammographic appearance, breast composition, and histologic findings were analyzed. Normal mammograms from 100 women (mean age, 54 years; age range, 35-75 years) with no mammographic and clinical abnormality during 2-year follow-up were used to determine false-positive CAD system marks. Differences between the cancer detection rates in fatty and dense breasts for the CAD system were compared by using the chi(2) test. RESULTS: The CAD system correctly marked 99 (96.1%) of 103 breast cancers. The CAD system marked all 44 breast cancers that manifested as microcalcifications only, all 23 breast cancers that manifested as a mass with microcalcifications, and 32 (89%) of 36 lesions that appeared as a mass only. The sensitivity of the CAD system in the fatty breast group was 95% (59 of 62) and in the dense breast group was 98% (40 of 41) (P = .537). The CAD system correctly marked all 31 lesions of ductal carcinoma in situ (DCIS), all 22 lesions of invasive ductal carcinoma with DCIS, the single invasive lobular carcinoma lesion, and 45 (92%) of 49 lesions of invasive ductal carcinoma. On normal mammograms, the mean number of false-positive marks per patient was 1.80 (range, 0-10 marks; median, 1 mark). CONCLUSION: The CAD system can correctly mark most (96.1%) asymptomatic breast cancers detected with digital mammographic screening, with acceptable false-positive marks (1.80 per patient).     

Lobular carcinoma in situ of the breast: clinical, pathologic, and mammographic features

Lobular carcinoma in situ (LCIS) was diagnosed in 165 surgical specimens (119 patients) at our institution between 1974 and 1987. LCIS was seen more often in younger women (mean age, 49 years) than other breast carcinomas were (mean age, 58 years). Sampling of a single breast revealed multifocal disease in 70% (96/138). When both breasts were sampled, bilateral foci were found in 50% (41/82). Of 165 breasts with foci of LCIS, 37% (61/165) had simultaneously occurring invasive cancers in the same breast. Direct mammographic-pathologic correlation of foci of LCIS was possible in 73 breasts (67 patients). Microcalcifications were an indication for biopsy in 49% (20/41) of breasts with a mammographic abnormality, but were a nonspecific finding often found in tissues adjacent to foci of LCIS. The mammogram was normal in 44% (32/73) of breasts with foci of LCIS. The mammograms of patients with LCIS and those from a group of age-matched control subjects were compared by using a modified form of Wolfe's criteria and the percentage of fibroglandular elements. LCIS was seldom found in an N1 breast (1% vs 29%) or in a breast with less than 25% of its parenchymal area occupied by fibroglandular density (3% vs 33%). Compared with the control group, breasts with LCIS had more than 50% fibroglandular density (85% vs 45%) and a much higher frequency of the DY pattern (56% vs 36%). More fibroglandular density was seen in the LCIS group at all ages. Postmenopausally, the frequencies of the DY pattern and fibroglandular density greater than 50% in LCIS patients were nearly double those in the control group. LCIS patients have disease of the entire breast parenchyma, characterized by multifocality and bilaterality of various forms of lobular disease. Their mammograms reveal a higher rate of the DY pattern and higher percentages of fibroglandular or parenchymal density than those of age-matched controls. In LCIS patients, persistence of the DY pattern, or large amounts of fibroglandular density postmenopausally supports the concept that mammographically dense breasts are a marker for increased cancer risk in women 50 years old and older.     

Risk factors for breast cancer in women undergoing mammography.

To determine risk factors for carcinoma of the breast, we compared women with cancer on screening and diagnostic mammography with those in whom cancer was not detected. For 39 months, medical histories were collected by mammography technologists on 3492 women having routine screenings or diagnostic mammograms at our institution. Potential risk factors of women with biopsy-proved breast cancer were compared with those in women who had normal findings on mammograms or negative biopsy results (control subjects). Of the 3492 women, 49 had biopsy-proved breast cancer. There were 3361 patients in the control group, including those women with normal findings on mammograms (3294) and those with negative biopsy results (67). Eighty-two women had incomplete questionnaires or were lost to follow up. Nearly all of the patients with breast cancer were postmenopausal compared with 68% of the control subjects. The mean length of lactation for breast cancer patients was significantly less than for control subjects: 5.6 vs 7.5 weeks (p = .015). This was true also for the postmenopausal patients: 8.1 vs 6.1 weeks (p = .041). Postmenopausal breast cancer patients had menstruated significantly more years (p = .016) than the postmenopausal control subjects: 34 vs 31 years, although the mean age at menarche was not different. When corrected for age, there was no significant difference in the total duration of menstruation in the postmenopausal cancer patients compared with the postmenopausal control subjects. Postmenopausal breast cancer patients had a significantly greater (p = .021) average body weight than postmenopausal control subjects: 71.7 vs 66.7 kg, although body weight was the same when all patients were considered. Similar results were found when Quetelet's index for obesity (weight in kg/height in cm2) (p = .004) was calculated for postmenopausal patients: 28 for cancer patients and 26 for control subjects. There was no significant difference in height between the cancer patients and control subjects when all patients or just the postmenopausal patients were considered. History of oral contraceptive use was significantly less common among postmenopausal breast cancer patients than among postmenopausal control subjects: 9% vs 20%. Patients with breast cancer had lower parity than the control subjects. In our series of patients, women in whom breast cancer was detected on mammography lactated less, showed no significant difference in years of menstruation when corrected for age, had a greater average body weight, used oral contraceptives less often, and had fewer children than women in whom no cancer was detected on mammography.     

Mammographic findings after breast cancer treatment with local excision and definitive irradiation

Following local excision and definitive irradiation of 163 breast cancers in 160 women, alterations in mammographic patterns were observed for up to 7 years. Skin thickening was observed in 96% of mammograms obtained within 1 year of completing therapy and was most pronounced in women treated with iridium implant, chemotherapy, or axillary dissection. In 76% of mammograms, alterations in the parenchymal pattern, including coarsening of stroma and increased breast density, were seen at 1 year. Neither skin nor parenchymal changes progressed after 1 year. Within 3 years of treatment the parenchymal density, which usually regressed, did not change in all patients. At 3 years skin thickness and the parenchymal pattern had returned to normal in less than 50% of the breasts of these women. Scars developed in approximately one-quarter of women. They were present on the initial post-treatment mammogram and remained unchanged on serial studies. Coarse, benign calcifications also developed in the breasts of about one-quarter of women. Microcalcifications developed in 11 breasts; biopsy specimens of six were benign. Benign microcalcifications may be related to therapy.     

Sensitivity of noncommercial computer-aided detection system for mammographic breast cancer detection: pilot clinical trial

PURPOSE: To evaluate a noncommercial computer-aided detection (CAD) program for breast cancer detection with screening mammography. MATERIALS AND METHODS: A CAD program was developed for mammographic breast cancer detection. The program was applied to 2,389 patients' screening mammograms at two geographically remote academic institutions (institutions A and B). Thirteen radiologists who specialized in breast imaging participated in this pilot study. For each case, the individual radiologist performed a prospective Breast Imaging Reporting and Data System (BI-RADS) assessment after viewing of the screening mammogram. Subsequently, the radiologist was shown CAD results and rendered a second BI-RADS assessment by using knowledge of both mammographic appearance and CAD results. Outcome analysis of results of examination in patients recalled for a repeat examination, of biopsy, and of 1-year follow-up examination was recorded. Correct detection with CAD included a computer-generated mark indicating a possible malignancy on craniocaudal or mediolateral oblique views or both. RESULTS: Eleven (0.46%) of 2,389 patients had mammographically detected nonpalpable breast cancers. Ten (91%) of 11 (95% CI: 74%, 100%) cancers were correctly identified with CAD. Radiologist sensitivity without CAD was 91% (10 of 11; 95% CI: 74%, 100%). In 1,077 patients, follow-up findings were documented at 1 year. Five (0.46%) patients developed cancers, which were found on subsequent screening mammograms. The area where the cancers developed in two (40%) of these five patients was marked (true-positive finding) by the computer in the preceding year. Because of CAD results, a 9.7% increase in recall rate from 14.4% (344 of 2,389) to 15.8% (378 of 2,389) occurred. Radiologists' recall rate of study patients prior to use of CAD was 31% higher than the average rate for nonstudy cases (10.3%) during the same time period at institution A. CONCLUSION: Performance of the CAD program had a very high sensitivity of 91% (95% CI: 74%, 100%).     

Does computer-aided detection assist in the early detection of breast cancer?

PURPOSE: To evaluate whether breast cancers detected at screening are visible in previous mammograms, and to assess the performance of a computer-aided detection (CAD) system in detecting lesions in preoperative and previous mammograms. MATERIAL AND METHODS: Initial screening detected 67 women with 69 surgically verified breast cancers (Group A). An experienced screening radiologist retrospectively analyzed previous mammograms for visible lesions (Group B), noting in particular their size and morphology. Preoperative and previous mammograms were analyzed with CAD; a relatively inexperienced resident also analyzed previous mammograms. The performances of CAD and resident were then compared. RESULTS: Of the 69 lesions identified, 36 were visible in previous mammograms. Of these 36 "missed" lesions, 14 were under 10 mm in diameter and 29 were mass lesions. The sensitivity of CAD was 81% in Group A and 64% in Group B. Small mass lesions were harder for CAD to detect. The specificity of CAD was 3% in Group A and 9% in Group B. Together, CAD and the resident found more "missed" lesions than separately. CONCLUSION: Of the 69 breast cancers, 36 were visible in previous mammograms. CAD's sensitivity in detecting cancer lesions ranged from 64% to 81%, while specificity ranged from 9% to as low as 3%. CAD may be helpful if the radiologist is less subspecialized in mammography.     

"Memory effect" in observer performance studies of mammograms

RATIONALE AND OBJECTIVE: To evaluate breast radiologists' recognition of mammograms showing cancers that they correctly detected or "missed" during clinical interpretations. MATERIALS AND METHODS: Two similar experiments were conducted. In the first, 33 bilateral screening mammograms were reviewed by four breast imagers. These included five cancers that each radiologist had detected, two cancers that each radiologist had "missed," and five mammograms recalled by other radiologists that were not cancer. Radiologists were asked if they had interpreted the mammogram in clinic and if the mammogram was suspicious for cancer. In the second experiment, four different breast imagers reviewed 48 mammograms that included five cancers that each radiologist had detected, two cancers that each radiologist had "missed," and five mammograms that were recalled by each radiologist but were not cancer. Using chi-square analysis, the performance of the radiologists on screening mammograms they had read in clinic was compared with their performance on mammograms read in clinic by other radiologists. RESULTS: Seven of eight radiologists did not remember interpreting any of the mammograms in clinic. One radiologist correctly remembered interpreting one mammogram in clinic, but interpreted it incorrectly. Average performance showed no significant difference (P = .60) between mammograms they had interpreted in clinic and those interpreted by others. CONCLUSION: Radiologists do not remember most mammograms showing cancer that they have interpreted, either correctly or incorrectly, after they are mixed with mammograms showing cancer that were interpreted by other radiologists. Screening mammograms can be used in observer performance studies in which the interpreting radiologist participates as an observer.     

Breast cancer: importance of spiculation in computer-aided detection

PURPOSE: To determine the prevalence of spiculation in a large series of screening-detected breast cancers appearing as masses on mammograms and to assess the sensitivity of a computer-aided detection (CAD) algorithm that uses spiculation measures in the detection of such lesions. MATERIALS AND METHODS: Six hundred seventy-seven consecutive cases of breast cancers detected as masses on mammograms were independently reviewed by three radiologists who determined if the lesions were spiculated. All cancers were then analyzed by the CAD system. RESULTS: All three radiologists interpreted 375 (55%) of the 677 masses as being spiculated on at least one view. The CAD algorithm correctly marked 322 (86%) of the 375 clearly spiculated masses, with a mean of 0.24 additional mass mark per image. With a looser definition of spiculation, 585 (86%) of the 677 masses were called spiculated by at least one radiologist on one view. The algorithm correctly marked 464 (79%) of the 585 lesions that were spiculated or possibly spiculated. CONCLUSION: Spiculation was clearly present in a majority (55%) of consecutive screening-detected breast cancer masses found on mammograms in a large clinical trial. Incorporation of spiculation measures is, therefore, an important strategy in the detection of breast cancer with CAD. A present-generation CAD algorithm correctly identified a large proportion (86%) of spiculated breast cancers.     

Breast carcinoma in women previously treated for Hodgkin's disease: clinical and mammographic findings

The aim of this study was to describe the radiological characteristics of breast cancers occurring after treatment of Hodgkin's disease (HD). This study identified 23 women (age range 28–70 years, mean age 40 years) with 29 breast cancers (22 infiltrating carcinomas, 5 in situ, 1 sarcoma, 1 indeterminate) who had previously undergone mantle irradiation (35–40 Gy) for HD. Clinical and mammographic data were reviewed by two radiologists. Dosimetry was available for 16 patients. Time from treatment of HD to the occurrence of breast cancer ranged from 15 months to 35 years (mean 18 years); 79 % were younger than 45 years and 76 % of cancers occurred between 10 and 25 years of follow-up. The physical examination was positive in 76 % and 6 patients had bilateral tumors (synchronous, n = 2; metachronous, n = 4). Eighty-three percent of mammograms (n = 24) were abnormal (microcalcifications, n = 72 %; opacity, n = 54 %; two inflammatory breast cancers). Seven cancers were only detected by mammography, but mammograms were normal in 4 patients. Breast cancer was located beyond or was overlapping radiation fields in 75 % of cases. Starting 10 years after mantle irradiation of women with HD, the follow-up should include annual clinical breast examination and mammography. Received: 27 July 1998; Revision received: 15 January 1999; Accepted: 16 March 1999     

Small (< 2.0-cm) breast cancers: mammographic and US findings at US-guided cryoablation--initial experience

PURPOSE: To determine the mammographic and ultrasonographic (US) findings at cryoablation of small solitary invasive breast cancers and compare them with presence of residual malignancy after treatment. MATERIALS AND METHODS: Institutional review board approval and informed patient consent were obtained. Nine patients with small solitary invasive breast cancers diagnosed at core biopsy were treated with US-guided cryoablation and a 2.7-mm cryoprobe. Mean cancer size was 12 mm (range, 8-18 mm); four were palpable. Tabletop argon gas-based cryoablation system with a double-freeze-thaw protocol was used to treat cancers in outpatient setting. Tumor sites were excised at lumpectomy 2-3 weeks after cryoablation. Findings at mammography and US before, during, and after cryoablation were assessed to categorize densities and masses on mammograms and masses on US images with Breast Imaging Reporting and Data System (BI-RADS); maximum cancer size was measured. Imaging findings and clinical breast examination data were compared with histologic findings from lumpectomy specimens to determine presence of intraductal or invasive cancer. RESULTS: With US guidance, ice balls (maximal mean size, 4.4 cm) were formed around cancers. Before excision, eight patients underwent mammography; all had new focal densities (maximum size, 2.5-5.0 cm) at cancer sites. Six patients underwent preexcisional US; 100% of them had new hyperechogenicity in tissue surrounding cancer site. Seven (78%) of nine patients had no residual cancer; specimens contained fat necrosis. One patient had a small focus of invasive cancer; one had extensive multifocal ductal carcinoma in situ. Patients with BI-RADS category 1 or 2 densities on mammograms or nonpalpable tumors had no residual malignancy. No residual invasive cancer occurred in tumors 17 mm or smaller or in cancers without spiculated margins at US. CONCLUSION: After cryoablation, there was increased echogenicity at US and increased density at mammography; these findings were observed in areas that approximated location and size of the ice ball. Tumor size, mammographic density, and US characteristics may be indicators of likelihood of complete cryoablation.     

Dental age assessment (DAA): reference data for British children at the 10-year-old threshold

The purpose of this work was to develop a reference dataset for dental age assessment at the 10-year-old threshold. Dental panoramic radiographs of children aged between 9 and 11 years were reused to determine the age of attainment of tooth development stages relevant to the 10-year threshold. These data were used to test the accuracy of the dental age assessment (DAA) on a separate study sample of known chronological age. The study sample comprised 100 radiographs (50 female, 50 male) of known chronological age that did not form part of the reference dataset. For each subject in the study sample, the mathematical procedure used in meta-analysis was applied to all teeth that were still developing. The weighted average of all the developing teeth in a given child was assigned as the dental age for that individual. This was compared to the gold standard of chronological age. Three thousand six hundred sixty-two radiographs comprised the reference sample. The mean difference between the chronological age and dental age estimated for the sample of female subjects was 0.12 years (1.44 months) and for the males was 0.33 years (3.96 months). A method comparison technique was used to evaluate the difference between the chronological age and estimated dental age for each study subject. This showed a good agreement for both females and males. DAA using meta-analysis provides a simple method of estimating the age of subjects of unknown birth date at the 10-year threshold. This is, presently, the most accurate method of age assessment for individuals of unknown date of birth.     

Breast cancers in women 35 years of age and younger: mammographic findings

During an 8-year period, 74 breast cancers were diagnosed in 66 patients 35 years of age and younger who underwent preoperative mammography. Mammograms and clinical data in these women were reviewed retrospectively to evaluate the mammographic findings and the efficacy of mammography. In 58 cases the cancer was detected by means of both clinical examination and mammography; in eight cases, mammography alone enabled readers to find the lesion; in seven cases, the lesion was found by means of clinical examination, but mammograms were negative; and in one case a cancer was found by means of incidental biopsy of the contralateral breast. Although 34 patients (52%) had dense breasts, mammography demonstrated the lesion in 66 cases (89%); the most common mammographic finding was microcalcifications, with or without associated masses (n = 28 [38%]). The authors do not suggest that screening of women younger than 35 years be performed routinely, but they believe that mammography can be valuable in screening young women at high risk for breast cancer or in confirming and suggesting prompt biopsy of a suspicious lesion.     

A true screening environment for review of interval breast cancers: pilot study to reduce bias

PURPOSE: To retrospectively assess the feasibility of an uninformed review process to evaluate interval breast cancers and to compare the number of false-negative cancers detected at uninformed review with the number detected at standard informed review. MATERIALS AND METHODS: Institutional review board approval was obtained for this retrospective study, and informed consent was waived. Mammograms showing interval cancer were included in the daily work of radiologists in a high-volume screening center. Each of three experienced radiologists read studies in the normal screening environment, without knowledge that identifiers had been changed to conceal the fact that studies were not current (ie, uninformed review). Results were compared with the standard review procedure, in which mammograms showing interval cancers were mixed with normal mammograms and read in a panel of 17-20 interval cancers per 80 normal studies by radiologists who were aware that they were participating in a review process (ie, informed review). RESULTS: Of 21 interval cancers, six (29%) were interpreted as positive more often by the informed radiologists than by the uninformed radiologists. For 14 (67%) cancers, there was no difference in detection rate between the two groups, and one cancer (5%) was seen by one of the uninformed radiologists but by none of the informed radiologists. The screening environment review process was found to be feasible at the low volumes tested. CONCLUSION: The number of false-negative cancers was higher in the informed review than in the uninformed review. This result suggests that bias exists with the informed review process.     

Computerized analysis of digitized mammograms of BRCA1 and BRCA2 gene mutation carriers

PURPOSE: To evaluate, by using computer image analysis, the mammographic density patterns of women with germ-line mutations in BRCA1 and BRCA2 genes in comparison with those of women at low risk of developing breast cancer. MATERIALS AND METHODS: Mammograms from 30 carriers of BRCA1 and BRCA2 mutations and from 142 low-risk women were collected retrospectively and digitized. In addition, 60 of the 142 low-risk women were randomly selected and age matched at 5-year intervals with the 30 mutation carriers. Mammographic features were extracted from the central regions of the breast images to characterize the mammographic density and heterogeneity of dense portions of the breast. These features were then merged into a single value related to the risk of breast cancer by using linear discriminant analysis. The applicability of these computer-extracted features and the output from linear discriminant analysis to differentiate between the carriers of BRCA1 and BRCA2 mutations and the low-risk women in the entire database and in an age-matched group were evaluated by using receiver operating characteristic analysis. RESULTS: Quantitative analysis of mammograms demonstrated that carriers of BRCA1 and BRCA2 mutations tended to have dense breast tissue, and their mammographic patterns tended to be low in contrast, with a coarse texture. Linear discriminant analysis resulted in values of the areas under the receiver operating characteristic curve of 0.91 and 0.92 in distinguishing between the BRCA1 and BRCA2 mutation carriers and the low-risk women in the entire database and the age-matched group, respectively. CONCLUSION: The computerized analysis of mammograms suggests that mammographic patterns in carriers of BRCA1 and BRCA2 mutations differ from those of women at low risk for breast cancer. Our computer-extracted features may be useful as radiographic markers for identifying women at high risk for breast cancer.     

Problems in radiographic detection and diagnosis of lung cancer

All chest radiographs of 107 proven lung cancer patients who received consecutive biennial chest radiography were reviewed to elucidate problems detecting their cancers, and diagnosing them when initially radiographically detected. Subjects, members of a fixed population sample, originally numbered 20,000 persons, 17,000 of whom consistently received consecutive biennial chest radiography during examinations for late effects of atomic-bomb radiation. Among the 107 subjects, 64 had radiographic manifestations of cancer; 47 were initially correctly diagnosed; 17 were not. Eleven of the 17 were initially equivocal, diagnosable only after subsequent radiography and retrospective review of serial radiographs. Diagnostic problems consisted of 1) six detection errors with cancer images superimposed on musculoskeletal and cardiovascular structures, reducible by stereoscopic p.a. instead of single p.a. radiography; immediate tentative interpretations; and by comparing earlier with current radiographs. 2) Eight decision errors, wherein cancers mimicked other diseases, were reducible by greater index of suspicion and scrutiny during interpretations.     

Screening mammograms: interpretation with computer-aided detection--prospective evaluation

PURPOSE: To prospectively determine the effect of a commercially available computer-aided detection (CAD) system on interpretations of screening mammograms. MATERIALS AND METHODS: Institutional review board approval was granted; informed consent and HIPAA compliance were waived. A total of 21 349 screening mammograms obtained in 18 096 women were interpreted first without and then with review of CAD images to determine the effect of CAD analysis on the screening breast cancer detection rate, recall rate, and positive predictive value (PPV) for biopsy. The percentage of total cancers detected by the radiologists independent of CAD and the percentage correctly marked by the CAD system were determined. RESULTS: On the basis of pre-CAD interpretations, 2101 patients were recalled for diagnostic evaluation, 256 biopsies were performed, and 105 breast cancers were diagnosed. The breast cancer detection rate per 1000 screening mammograms was 4.92 (105 of 21 349 mammograms), the recall rate was 9.84% (2101 of 21 349 mammograms), and the PPV for biopsy was 41.0% (105 of 256 biopsies). After CAD image review, 199 additional patients were recalled, 21 additional biopsies were performed, and eight additional cancers were detected. The effect was a 7.62% (eight of 105) increase in the number of breast cancers detected, an increase in the recall rate to 10.77% (2300 of 21 349 mammograms), and a slight decrease in the PPV to 40.8% (113 of 277 biopsies). Radiologists detected 92.9% (105 of 113 cancers) of the total cancers, and CAD correctly marked 76.1% (86 of 113 cancers). CONCLUSION: The use of CAD improved the detection of breast cancer, with an acceptable increase in the recall rate and a minimal increase in the number of biopsies with benign results.