Breast Cancer Screening Recommendations Inclusive of All Women at Average Risk: Update from the ACR and Society of Breast Imaging

Breast cancer remains the most common nonskin cancer, the second leading cause of cancer deaths, and the leading cause of premature death in US women. Mammography screening has been proven effective in reducing breast cancer deaths in women age 40 years and older. A mortality reduction of 40% is possible with regular screening. Treatment advances cannot overcome the disadvantage of being diagnosed with an advanced-stage tumor. The ACR and Society of Breast Imaging recommend annual mammography screening beginning at age 40, which provides the greatest mortality reduction, diagnosis at earlier stage, better surgical options, and more effective chemotherapy. Annual screening results in more screening-detected tumors, tumors of smaller sizes, and fewer interval cancers than longer screening intervals. Screened women in their 40s are more likely to have early-stage disease, negative lymph nodes, and smaller tumors than unscreened women. Delaying screening until age 45 or 50 will result in an unnecessary loss of life to breast cancer and adversely affects minority women in particular. Screening should continue past age 74 years, without an upper age limit unless severe comorbidities limit life expectancy. Benefits of screening should be considered along with the possibilities of recall for additional imaging and benign biopsy and the less tangible risks of anxiety and overdiagnosis. Although recall and biopsy recommendations are higher with more frequent screening, so are life-years gained and breast cancer deaths averted. Women who wish to maximize benefit will choose annual screening starting at age 40 years and will not stop screening prematurely.     

Comparison of Contrast-Enhanced Mammography With Conventional Digital Mammography in Breast Cancer Screening: A Pilot Study

PurposeTo perform a pilot evaluation of contrast-enhanced mammography (CEM) for screening to determine whether it can improve accuracy and reader confidence in diagnosis.Methods and MaterialsThis institutional review board–approved reader study was comprised of 64 de-identified CEM cases acquired from December 1, 2014, to June 7, 2016, including 48 negative, 5 biopsy-proven benign, and 11 biopsy-proven malignancies. Negative cases were followed for at least 2 years without evidence of cancer. Ten breast imagers of varying experience first rated the low-energy (LE) mammogram and then the CEM examination using BI-RADS categories and a 5-point Likert scale for confidence in diagnosis.ResultsThere were 635 out a total possible 640 complete reader interpretations included in this analysis. The remaining five incomplete interpretations were excluded. Median sensitivity and specificity improved with the addition of CEM (sensitivity: 0.86 [95% confidence interval {CI}: 0.74-0.95] versus 1 [95% CI: 0.83-1.00], specificity: 0.85 [95% CI: 0.64-0.94] versus 0.88 [95% CI: 0.80-0.92]). Individual receiver operating characteristic curves showed significant improvement with CEM (mean area under the curve increase = 0.056 [95% CI: 0.015-0.097], P = .002). The addition of CEM significantly improved average confidence in 5 of 10 readers when compared with LE (P < .0001) and improved pooled confidence across all tissue density categories, except the almost entirely fatty category. There was a trend toward improved confidence with increasing tissue density with CEM. Degree of background parenchymal enhancement did not affect readers’ level of improvement in confidence when interpreting CEM.SummaryCEM improved reader performance and confidence compared with viewing only LE, suggesting a role for CEM in breast cancer screening for which larger trials are warranted.     

乳腺内微钙化X线征象再认识

目的探讨微钙化对乳腺癌诊断的价值。方法收集钼靶X线片表现有微钙化的乳腺病变共120例,均经病理证实,其中乳腺癌97例(浸润性导管癌71例,浸润性小叶癌23例,黏液癌2例,髓样癌1例)及良性病变23例(乳腺增生13例,慢性炎症4例,脂肪坏死3例,增生伴脂肪坏死3例),所有病例均行钼靶X线摄影,并对照分析其钼靶X线表现。结果(1)120例乳腺病变微钙化按密度分为高、中、低3类,分别占37.50%(45/120)、28.33%(34/120)和34.16%(41/120),其中高密度钙化多见于良性病变,占82.00%(19/23),中、低密度微钙化恶性多见,占73.19%(71/97)。(2)恶性微钙化直径多<0.5mm,表现为泥沙样、沙砾状68例,粗大钙化18例,“Y”、“V”、“树枝”形或粗棒铸型钙化8例,蠕虫样钙化3例。良性微钙化的直径一般>0.5mm,形态规则,边缘清楚。(3)大片密集或成簇的微钙化恶性多见,占84.53%(82/97),散在稀疏或粗大微钙化良性多见,占69.56%(16/23)。结论微钙化在乳腺癌诊断中,特别是早期癌诊断中具有重要价值,应重视与良性微钙化的鉴别诊断。     

乳腺癌钼靶X线征象分析(附114例报告)

目的探讨乳腺癌钼靶X线表现、X线分型和病理关系,以提高乳腺癌诊断水平。方法收集经手术病理证实、有完整影像资料的乳腺癌114例,回顾分析其钼靶X线征象及与病理关系。结果乳腺癌分5型:肿块型34例,肿块伴钙化型27例,钙化型28例,结构异常型21例,隐匿型4例。浸润性导管癌最多,占61.4%,其次是单纯癌,占20.1%。结论肿块型、肿块伴钙化型和钙化型乳腺癌钼靶X线表现具有特征性,乳腺钼靶X线摄影能明确诊断。结构异常型乳腺癌X线表现不典型,认识其X线征象,可明显提高乳腺癌的影像诊断率。     

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report

BackgroundThe risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic.MethodsAn expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario.ResultsTwelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non–small-cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non–small-cell lung cancer.ConclusionsThere was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.     

Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Imaging Case Volumes

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has had significant economic impact on radiology with markedly decreased imaging case volumes. The purpose of this study was to quantify the imaging volumes during the COVID-19 pandemic across patient service locations and imaging modality types.MethodsImaging case volumes in a large health care system were retrospectively studied, analyzing weekly imaging volumes by patient service locations (emergency department, inpatient, outpatient) and modality types (x-ray, mammography, CT, MRI, ultrasound, interventional radiology, nuclear medicine) in years 2020 and 2019. The data set was split to compare pre-COVID-19 (weeks 1-9) and post-COVID-19 (weeks 10-16) periods. Independent-samples t tests compared the mean weekly volumes in 2020 and 2019.ResultsTotal imaging volume in 2020 (weeks 1-16) declined by 12.29% (from 522,645 to 458,438) compared with 2019. Post-COVID-19 (weeks 10-16) revealed a greater decrease (28.10%) in imaging volumes across all patient service locations (range 13.60%-56.59%) and modality types (range 14.22%-58.42%). Total mean weekly volume in 2020 post-COVID-19 (24,383 [95% confidence interval 19,478-29,288]) was statistically reduced (P = .003) compared with 33,913 [95% confidence interval 33,429-34,396] in 2019 across all patient service locations and modality types. The greatest decline in 2020 was seen at week 16 specifically for outpatient imaging (88%) affecting all modality types: mammography (94%), nuclear medicine (85%), MRI (74%), ultrasound (64%), interventional (56%), CT (46%), and x-ray (22%).DiscussionBecause the duration of the COVID-19 pandemic remains uncertain, these results may assist in guiding short- and long-term practice decisions based on the magnitude of imaging volume decline across different patient service locations and specific imaging modality types.     

Imaging Utilization During the COVID-19 Pandemic Highlights Socioeconomic Health Disparities

ObjectiveThe devastating impact from the coronavirus disease 2019 (COVID-19) pandemic highlights long-standing socioeconomic health disparities in the United States. The purpose of this study was to evaluate socioeconomic factors related to imaging utilization during the pandemic.MethodsRetrospective review of consecutive imaging examinations was performed from January 1, 2019, to May 31, 2020, across all service locations (inpatient, emergency, outpatient). Patient level data were provided for socioeconomic factors (age, sex, race, insurance status, residential zip code). Residential zip code was used to assign median income level. The weekly total imaging volumes in 2020 and 2019 were plotted from January 1 to May 31 stratified by socioeconomic factors to demonstrate the trends during the pre-COVID-19 (January 1 to February 28) and post-COVID-19 (March 1 to May 31) periods. Independent-samples t tests were used to statistically compare the 2020 and 2019 socioeconomic groups.ResultsCompared with 2019, the 2020 total imaging volume in the post-COVID-19 period revealed statistically significant increased imaging utilization in patients who are aged 60 to 79 years (P = .0025), are male (P < .0001), are non-White (Black, Asian, other, unknown; P < .05), are covered by Medicaid or uninsured (P < .05), and have income below $80,000 (P < .05). However, there was a significant decrease in imaging utilization among patients who are younger (<18 years old; P < .0001), are female (P < .0001), are White (P = .0003), are commercially insured (P < .0001), and have income ≥$80,000 (P < .05).DiscussionDuring the pandemic, there was a significant change in imaging utilization varying by socioeconomic factors, consistent with the known health disparities observed in the prevalence of COVID-19. These findings could have significant implications in directing utilization of resources during the pandemic and subsequent recovery.     

Utilization and Cancer Yield of Probably Benign Assessment Category in the National Mammography Database: 2009 to 2018

PurposeData on utilization rate and cancer yield of BI-RADS® category 3 in routine clinical practice in diagnostic mammography are sparse. The aim of this study was to determine utilization rate and cancer yield of BI-RADS 3 in diagnostic mammography in the ACR National Mammography Database (NMD).MethodsRetrospective analysis of NMD mammograms from January 1, 2009, to June 30, 2018, was performed. BI-RADS 3 utilization rate in diagnostic setting was calculated and stratified by patient, facility, and examination-level variables. Patient-level cancer yield was calculated among women with BI-RADS 3 assessment and adequate follow-up (imaging follow-up ≥24 months or biopsy). Logistic regression was performed to assess the odds of utilization of BI-RADS 3, with respect to facility, examination, and patient variables, and the odds of malignancy among patients with probably benign findings. Chi-square and t tests were used to determine significance (P < .05).ResultsData from 19,443,866 mammograms from 500 NMD facilities across 31 states were analyzed, of which 3,039,952 were diagnostic mammograms. Utilization rate of BI-RADS 3 was 15.5% (470,155 of 3,039,952) in the diagnostic setting. There was a statistically significant difference in BI-RADS 3 utilization rate across all collected variables (P < .001). Patient-level cancer yield at 2-year follow-up was 0.91% (2,009 of 220,672; 95% confidence interval [CI], 0.87%-0.95%) in the diagnostic setting. Patient and examination variables associated with significantly higher likelihood of malignancy included calcifications (odds ratio, 4.27; 95% CI, 2.43-7.51), patient age > 70 years (odds ratio, 3.77; 95% CI, 2.49-5.7), and presence of prior comparisons (odds ratio, 1.23; 95% CI, 1.07-1.42).ConclusionsIn the NMD, BI-RADS 3 assessment was common in diagnostic mammography (15.5%), with an overall cancer yield of 0.91%, less than the benchmark of 2%. Utilization trends in diagnostic mammography warrant further research for optimization of use.     

Collateral Damage: The Impact of the COVID-19 Pandemic on Acute Abdominal Emergency Presentations

IntroductionIn March 2020, the World Health Organization declared a pandemic caused by a novel coronavirus. Public information created awareness as well as concern in the general population. There has been a reported decrease in the number of patients attending emergency departments (ED) during the pandemic. This is the first study to determine differences in the types of presenting illnesses, severity, and rate of resultant surgical intervention during the pandemic.Methods and MaterialsWe carried out a retrospective, observational cohort study comparing two groups of patients attending the ED at our tertiary-care academic hospital. A historical comparison cohort was obtained by reviewing the number of patients referred by the ED for abdominal CT between March 15 and April 15, 2020, compared with March 15 and April 15, 2019. CT reports were reviewed; primary pathologies, complications, and subsequent surgical intervention were documented and compared between the two groups.ResultsIn all, 733 patients were included in the 2019 cohort, and 422 patients were included in the 2020 cohort. In 2019, 32.7% had positive CT findings, increasing to 50.5% in 2020. The number of complications increased from 7.9% to 19.7%. The rate requiring surgical intervention increased from 26.3% to 47.6% in 2020.ConclusionTo date, there is little published data regarding the presentation and severity of illnesses during the coronavirus disease 2019 pandemic. This information has important public health implications, highlighting the need to educate patients to continue to present to hospital services during such crises, including if a purported second wave of COVID-19 arises.     

数字钼靶X线诊断乳腺癌分析

目的 探讨数字钼靶X线摄影在诊断乳腺癌中的价值.方法 回顾性分析36例经病理证实的乳腺癌的数字钼靶X线片.结果 X线显示肿块22例(61.1%),肿块伴钙化7例(19.4%),不对称性密度增高伴结构紊乱4例(11.1%),Pagets病1例(2.7%),仅有钙化者3例(8.33%),异常血管影3例(8.33%),皮肤增厚4例(8.73%).结论数字钼靶X线摄影对乳腺癌早期诊断及鉴别诊断有重要意义.     

Identifying Factors Important to Patients for Resuming Elective Imaging During the COVID-19 Pandemic

PurposeTo identify factors important to patients for their return to elective imaging during the coronavirus disease 2019 (COVID-19) pandemic.MethodsIn all, 249 patients had elective MRIs postponed from March 23, 2020, to April 24, 2020, because of the COVID-19 pandemic. Of these patients, 99 completed a 22-question survey about living arrangement and health care follow-up, effect of imaging postponement, safety of imaging, and factors important for elective imaging. Mann-Whitney U, Fisher’s exact, χ² tests, and logistic regression analyses were performed. Statistical significance was set to P ≤ .05 with Bonferroni correction applied.ResultsOverall, 68% of patients felt imaging postponement had no impact or a small impact on health, 68% felt it was fairly or extremely safe to obtain imaging, and 53% thought there was no difference in safety between hospital-based and outpatient locations. Patients who already had imaging performed or rescheduled were more likely to feel it was safe to get an MRI (odds ratio [OR] 3.267, P = .028) and that the hospital setting was safe (OR 3.976, P = .004). Staff friendliness was the most important factor related to an imaging center visit (95% fairly or extremely important). Use of masks by staff was the top infection prevention measure (94% fairly or extremely important). Likelihood of rescheduling imaging decreased if a short waiting time was important (OR = 0.107, P = .030).ConclusionAs patients begin to feel that it is safe to obtain imaging examinations during the COVID-19 pandemic, many factors important to their imaging experience can be considered by radiology practices when developing new strategies to conduct elective imaging.     

Mammography Clinical Image Quality and the False Positive Rate in a Canadian Breast Cancer Screening Program

Purpose

The study sought to determine if mammography quality is associated with the false positive (FP) rate in the Quebec breast cancer screening program in 2004 and 2005.

CR钼靶征象对乳腺癌的诊断价值

目的探讨乳腺癌CR钼靶X线征象的特点,以提高乳腺癌的诊断水平。方法回顾性分析经手术病理证实的37例乳腺癌的CR钼靶X线表现。结果37例乳腺癌表现为肿块29例;无肿块8例;钙化性改变15例;异常血管影7例;乳头回缩6例;皮肤增厚3例;塔尖征3例,漏斗征1例;乳腺局部结构紊乱和小灶性密度增高影3例。结论肿块和钙化是乳腺癌的主要X线征象,CR钼靶X线摄影可以充分显示乳腺癌的表现特征,是诊断乳腺癌的首选方法之一。     

乳腺钼靶摄影及X线立体定位穿刺对早期乳腺癌的诊断价值

目的评价应用乳腺钼靶摄影结合X线立体定位穿刺活检对早期乳腺癌的诊断价值。方法经定位穿刺活检、手术及病理证实的早期乳腺癌53例,对其X线表现进行回顾性分析。结果53例早期乳腺癌X线影像中,结节肿块影23例,单纯性簇样钙化17例,结节伴钙化8例,非对称性局限性密度增高影伴结构紊乱12例,星芒征15例,血管影增多增粗18例,导管破坏、中断3例。结论乳腺钼靶摄影结合X线立体定位穿刺是目前诊断早期乳腺癌的首选而有效的方法。