The performance of 3D ABUS versus HHUS in the visualisation and BI-RADS characterisation of breast lesions in a large cohort of 1,886 women

Objectives

This study aimed to evaluate automated breast ultrasound (ABUS) compared to hand-held traditional ultrasound (HHUS) in the visualisation and BIRADS characterisation of breast lesions.

Materials and methods

From January 2016 to January 2017, 1,886 women with breast density category C or D (aged 48.6±10.8 years) were recruited. All participants underwent ABUS and HHUS examination; a subcohort of 1,665 women also underwent a mammography.

Results

The overall agreement between HHUS and ABUS was 99.8 %; kappa=0.994, p<0.0001. Two cases were graded as BI-RADS 1 in HHUS, but were graded as BIRADS 4 in ABUS; biopsy revealed a radial scar. Three carcinomas were graded as BI-RADS 2 in mammography but BI-RADS 4 in ABUS; two additional carcinomas were graded as BI-RADS 2 in mammography but BI-RADS 5 in ABUS. Two carcinomas, appearing as a well-circumscribed mass or developing asymmetry in mammography, were graded as BI-RADS 4 in mammography but BI-RADS 5 in ABUS.

Conclusions

ABUS could be successfully used in the visualisation and characterisation of breast lesions. ABUS seemed to outperform HHUS in the detection of architectural distortion on the coronal plane and can supplement mammography in the detection of non-calcified carcinomas in women with dense breasts.

Key Points

? The new generation of ABUS yields comparable results to HHUS. ? ABUS seems superior to HHUS in detecting architectural distortions. ? In dense breasts, supplemental ABUS to mammography detects additional cancers.

     

自动乳腺容积成像与手持超声对触诊阴性乳腺的诊断价值比较

目的 比较自动乳腺容积成像(ABUS)与手持超声(HHUS)对触诊阴性乳腺患者诊断价值的差异.资料与方法 纳入228例触诊阴性、术后经病理确诊乳腺患者的428枚手术切除乳腺病灶,比较ABUS与HHUS对病变检出率和诊断准确率的差异.结果 ABUS对触诊阴性乳腺患者病灶的检出率(97.2％)显著高于HHUS(87.6％)...     

Improved breast cancer detection in asymptomatic women using 3D-automated breast ultrasound in mammographically dense breasts

Automated breast ultrasound (ABUS)was performed in 3418 asymptomatic women with mammographically dense breasts. The addition of ABUS to mammography in women with greater than 50% breast density resulted in the detection of 12.3 per 1,000 breast cancers, compared to 4.6 per 1,000 by mammography alone. The mean tumor size was 14.3 mm and overall attributable risk of breast cancer was 19.92 (95% confidence level, 16.75 - 23.61) in our screened population. These preliminary results may justify the cost-benefit of implementing the judicious us of ABUS in conjunction with mammography in the dense breast screening population.     

Double reading of automated breast ultrasound with digital mammography or digital breast tomosynthesis for breast cancer screening

PurposeTo evaluate the impact of double reading automated breast ultrasound (ABUS) when added to full field digital mammography (FFDM) or digital breast tomosynthesis (DBT) for breast cancer screening.MethodsFrom April 2014 to June 2015, 124 women with dense breasts and intermediate to high breast cancer risk were recruited for screening with FFDM, DBT, and ABUS. Readers used FFDM and DBT in clinical practice and received ABUS training prior to study initiation. FFDM or DBT were first interpreted alone by two independent readers and then with ABUS. All recalled women underwent diagnostic workup with at least one year of follow-up. Recall rates were compared using the sign test; differences in outcomes were evaluated using Fisher's exact test.ResultsOf 121 women with complete follow-up, all had family (35.5%) or personal (20.7%) history of breast cancer, or both (43.8%). Twenty-four women (19.8%) were recalled by at least one modality. Recalls increased from 5.0% to 13.2% (p = 0.002) when ABUS was added to FFDM and from 3.3% to 10.7% (p = 0.004) when ABUS was added to DBT. Findings recalled by both readers were more likely to result in a recommendation for short term follow-up imaging or tissue biopsy compared to findings recalled by only one reader (100% vs. 42.1%, p = 0.041). The cancer detection rate was 8.3 per 1000 screens (1/121); mode of detection: FFDM and DBT.ConclusionsAdding ABUS significantly increased the recall rate of both FFDM and DBT screening. Double reading of ABUS during early phase adoption may reduce false positive recalls.     

Perspektiven der digitalen Mammographieplattform

In Europe one out of every nine women suffers from breast cancer during her lifetime. Since the introduction of mammography screening programs more breast cancers are being diagnosed when they are still small and early stage cancers with a favourable prognosis. The introduction of digital mammography systems has led to a continuous reduction of breast cancer mortality especially in specific patient subgroups. Furthermore, the digital mammography platform enables the development of new, innovative breast imaging methods to increase sensitivity and decrease breast cancer mortality. This digital mammography platform includes digital breast tomosynthesis, digital contrast medium mammography and digital contrast medium breast tomosynthesis as well as fused data sets from digital mammography with ultrasound or MRI. The following article summarizes these new applications, describes the strengths of the digital platform and illustrates the potential advantages of an improved breast cancer diagnosis by digital mammography.     

Interobserver reliability of automated breast volume scanner (ABVS) interpretation and agreement of ABVS findings with hand held breast ultrasound (HHUS), mammography and pathology results

Objectives

Handheld breast ultrasound (HHUS) lacks standardization and reproducibility. The automated breast volume scanner (ABVS) could overcome this limitation. To analyze the interobserver reliability of ABVS and the agreement with HHUS, mammography and pathology is the aim of this study.

Methods

All 42 study participants (=84 breasts) received an ABVS examination in addition to the conventional breast diagnostic work-up. 25 breasts (30%) showed at least one lesion. The scans were interpreted by six breast diagnostic specialists blinded to results of breast imaging and medical history. 32 lesions received histological work-up: 20 cancers were detected. We used kappa statistics to interpret agreement between examiners and diagnostic instruments.

Results

On the basis of the Breast Imaging Reporting and Data System (BI-RADS) classification of the 84 breasts an agreement (defined as ≥4 of 6 examiners) was achieved in 63 cases (75%) (mk = 0.35) and even improved when dichotomizing the interpretation in benign (BI-RADS 1, 2) and suspicious (BI-RADS 4, 5) to 98% (mk = 0.52). Agreement of ABVS examination to HHUS, mammography and pathology was fair to substantial depending on the specific analysis.

Conclusions

The development of an ABVS seems to be a promising diagnostic method with a good interobserver reliability, as well as a comparable good test criteria as HHUS.     

Automated breast ultrasound: Supplemental screening for average-risk women with dense breasts

ObjectiveWe review ultrasound (US) options for supplemental breast cancer screening of average risk women with dense breasts.ConclusionPerformance data of physician-performed handheld US (HHUS), technologist-performed HHUS, and automated breast ultrasound (AUS) indicate that all are appropriate for adjunctive screening. Volumetric 3D acquisitions, reduced operator dependence, protocol standardization, reliable comparison with previous studies, independence of performance and interpretation, and whole breast depiction on coronal view may favor selection of AUS. Important considerations are workflow adjustments for physicians and staff.     

Aries乳腺超声诊断装置在乳腺病变筛查中的价值初探

目的 探讨Aries乳腺超声诊断装置在乳腺病变筛查中的应用价值.方法 采用常规手持式超声(handheld ultrasound,HHUS)和Aries乳腺超声诊断装置对119例志愿者进行乳腺筛查,记录乳腺结节的位置、数量、大小、回声、边界、形态等,比较两种方法检查乳腺病灶的大小、回声、边界、形态的一致性.结果 在HH...     

致密型乳腺影像筛查技术及研究进展

乳腺密度反映乳腺X 线摄影上乳腺的组成成分,乳腺密度评估是乳腺X 线筛查的常规临床需求。致密型乳腺是乳腺癌的潜在危险因素之一,也是乳腺X 线筛查乳腺癌敏感性及特异性偏倚存在的主要因素之一。就数字乳腺X 线摄影、超声、乳腺断层融合摄影及MRI 对致密型乳腺的诊断效能及研究进展予以综述。     

5307名女性乳腺首次筛查影像结果分析

目的 探讨X线、超声和体检3种筛查组合方法对早期乳腺癌检出的意义,分析筛查癌的特点.方法 对5307名女性乳腺进行初次筛查,受检者年龄20～76岁(中位年龄49岁).分析X线加超声和体检、X线加体检、X线检查3种筛查组合的回叫率、活检率和癌检出率,并对筛查癌进行影像分析.各组间比较使用行×列的X2检验或者Fisher's精确检验.结果 X线加超声和体检、X线加体检、X线检查3种筛查组合比较如下:回叫率分别为4.90%(49/1001)、6.90%(166/2407)、4.48%(85/1899);活检率为1.60%(16/1001)、1.04%(25/2407)、0.163%(12/1899);癌检出率为0.50%(5/1001)、0.17%(4/2407)、0(0/1899).X线加超声和体格检查的癌检出率最高,共发现10例乳腺癌,其中9例为筛检癌.3组间的回叫率、活检率和癌检出率比较差异均有统计学意义(X2值分别为12.99、6.264、8.764,P值均<0.05).筛检癌中8例为早期乳腺癌(导管原位癌4例,Ⅰ期浸润性乳腺癌4例).X线检出的7例病灶中仅2例被超声发现,其他5例超声和体检均未检出.表现为簇状分布的多形性钙化2例,交界性钙化呈线样分布2例,不对称致密、不对称致密伴钙化、多簇状钙化伴多发结节各1例.X线漏诊的2例经回顾性阅片都予以正确诊断,均表现为非对称致密影.结论 X线加超声和体格检查3者组合是乳腺癌筛查的最佳组合,X线检查检出的病灶较其他方法更为早期.     

Patient Awareness of Breast Density and Interest in Supplemental Screening Tests: Comparison of an Academic Facility and a County Hospital

PurposeThe aim of this study was to measure women’s knowledge of breast density and their attitudes toward supplemental screening tests in the setting of the California Breast Density Notification Law at an academic facility and a county hospital, serving women with higher and lower socioeconomic status, respectively.MethodsInstitutional review board exemptions were obtained. A survey was administered during screening mammography at two facilities, assessing women’s awareness of and interest in knowing their breast density and interest in and willingness to pay for supplemental whole breast ultrasound and contrast-enhanced spectral mammography (CEMG). The results were compared by using Fisher exact tests between groups.ResultsA total of 105 of 130 and 132 of 153 women responded to the survey at the academic and county facilities, respectively. Among respondents at the academic and county facilities, 23% and 5% were aware of their breast density, and 94% and 79% wanted to know their density. A majority were interested in supplemental ultrasonography and CEMG at both sites; however, fewer women had a willingness to pay for the supplemental tests at the county hospital compared with those at the academic facility (22% and 70%, respectively, for ultrasound, P < .0001; 20% and 65%, respectively, for CEMG, P < .0001).ConclusionsBoth groups of women were interested in knowing their breast density and in supplemental screening tests. However, women at the county hospital were less willing to incur out-of-pocket expenses, suggesting a potential for a disparity in health care access for women of lower socioeconomic status after the enactment of breast density notification legislation.     

Tomosynthesis as a screening tool for breast cancer: A systematic review

BackgroundMammography is an important screening tool for reducing breast cancer mortality. Digital breast tomosynthesis (DBT) can potentially be integrated with mammography to aid in cancer detection.MethodUsing the PRISMA guidelines, a systematic review of current literature was conducted to identify issues relating to the use of tomosynthesis as a screening tool together with mammography.FindingsUsing tomosynthesis with digital mammography (DM) increases breast cancer detection, reduces recall rates and increases the positive predictive value of those cases recalled. Invasive cancer detection is significantly improved in tomosynthesis compared to mammography, and has improved success for women with heterogeneous or extremely dense breasts.ConclusionTomosynthesis reduces some limitations of mammography at the time of screening that until recently were most often addressed by ultrasound at later work-up. Tomosynthesis can potentially be adopted alongside mammography as a screening tool.     

Breast tomosynthesis in clinical practice: initial results

The purpose of this study was to assess the potential value of tomosynthesis in women with an abnormal screening mammogram or with clinical symptoms. Mammography and tomosynthesis investigations of 513 woman with an abnormal screening mammogram or with clinical symptoms were prospectively classified according to the ACR BI-RADS criteria. Sensitivity and specificity of both techniques for the detection of cancer were calculated. In 112 newly detected cancers, tomosynthesis and mammography were each false-negative in 8 cases (7%). In the false-negative mammography cases, the tumor was detected with ultrasound (n?=?4), MRI (n?=?2), by recall after breast tomosynthesis interpretation (n?=?1), and after prophylactic mastectomy (n?=?1). Combining the results of mammography and tomosynthesis detected 109 cancers. Therefore in three patients, both mammography and tomosynthesis missed the carcinoma. The sensitivity of both techniques for the detection of breast cancer was 92.9%, and the specificity of mammography and tomosynthesis was 86.1 and 84.4%, respectively. Tomosynthesis can be used as an additional technique to mammography in patients referred with an abnormal screening mammogram or with clinical symptoms. Additional lesions detected by tomosynthesis, however, are also likely to be detected by other techniques used in the clinical work-up of these patients.     

Differentiation of benign and malignant breast lesions: A comparison between automatically generated breast volume scans and handheld ultrasound examinations

Objective

To assess the diagnostic value of automated breast volume scanning (ABVS) or conventional handheld ultrasonography (HHUS) for the differentiation of benign and malignant breast lesions.

Materials and methods

The study prospectively evaluated 239 lesions in 213 women who were scheduled for open biopsy. The patients underwent ABVS and conventional HHUS. The sensitivity, specificity, accuracy, false positive rate, false negative rate, and positive and negative predictive values for HHUS and ABVS images were calculated using histopathological examination as the gold standard. Additionally, diagnostic accuracy was further evaluated according to the size of the masses.

Results

Among the 239 breast lesions studied, pathology revealed 85 (35.6%) malignant lesions and 154 (64.4%) benign lesions. ABVS was similar to HHUS in terms of sensitivity (95.3% vs. 90.6%), specificity (80.5% vs. 82.5%), accuracy (85.8% vs. 85.3%), positive predictive value (73.0% vs. 74.0%), and negative predictive value (93.3% vs. 94.1%). The area under the receiver operating characteristic (ROC) curve, which is used to estimate the accuracy of the methods, demonstrated only minor differences between HHUS and ABVS (0.928 and 0.948, respectively).

Conclusions

The diagnostic accuracy of HHUS and ABVS in differentiating benign from malignant breast lesions is almost identical. However, ABVS can offer new diagnostic information. ABVS may help to distinguish between real lesions and inhomogeneous areas, find small lesions, and demonstrate the presence of intraductal lesions. This technique is feasible for clinical applications and is a promising new technique in breast imaging.     

Mammasonographie und Magnetresonanz-Mammographie als ergänzende Methoden im Mammographiescreening

Ultrasonography and magnetic resonance (MR) tomography are helpful tools to evaluate unclear lesions found at screening mammography. Ultrasound is particularly useful to prove the presence of a cyst or to further examine unclear, asymmetrical densities. With MR mammography, carcinomas can be found even when x-ray mammography or ultrasonography are limited due to diffuse, benign, proliferative changes. Ultrasound guidance has greatly facilitated core needle biopsy for suspicious lesions. Additionally, approved devices for MR-guided biopsy are commercially available. As a primary screening tool, ultrasound or MR mammography may be used only in women who are positive for BRCA-1 or BRCA-2 mutations or who are otherwise at high risk for breast cancer.     

Emerging technologies in breast cancer detection

While screening mammography is recognized as the most effective method for early detection of breast cancer, this modality has limitations that are the driving force behind efforts to refine existing mammography technologies and develop new ones offering improved detection of breast cancer. Full-field digital mammography (FFDM) systems use digital detectors to convert x-ray photons to digital signals for display on high-resolution monitors. These systems offer capabilities not provided by conventional film-screen mammography. Contrast-enhanced mammography utilizes the basic biological principle that aggressive cancers are associated with increased vascularity. Iodinated contrast agents--the same used in computed tomography (CT) examinations--are administered through an injection in a vein usually in the arm. They distribute throughout the blood system, and x-ray imaging shows increased contrast in areas where they concentrate. Tomosynthesis acquisition involves acquiring multiple images of a stationary compressed breast at different angles during a short scan. The individual images are then reconstructed into a 3D series of thin high-resolution slices. The slices can be displayed individually or in a dynamic ciné mode. The individual slices reduce tissue overlap and structure noise relative to standard 2D projection mammography, with a total dose comparable to that required for standard screening mammography. Initial efforts are underway to develop prototype systems to achieve high-resolution, whole-breast 3D ultrasound images that are co-registered with digital mammograms. This technology has the potential to improve specificity in breast imaging studies, particularly in dense breasts. Computer-aided detection (CAD) programs are intended to help radiologists identify suspicious lesions that may otherwise be overlooked. CAD software works similarly to a spellchecker and has the potential to increase the detection of cancer Magnetic resonanace imaging (MRI) is a generally accepted diagnostic procedure for a number of breast related indications. Its greatest strength is that it is very sensitive to tumors. If a suspected area does not exhibit contrast agent uptake, the probability that it is malignant is very small. Conversely, its specificity is poorer. If the area does show enhancement, it may or may not be a tumor. Further imaging or biopsy may be needed to resolve the question. Ultrasound holds promise as a method for detection of cancers in women with dense breast tissue, which is often problematic with conventional film-screen mammography. Ultrasound has also assumed an important role in breast imaging, as an adjunct to diagnostic mammography for biopsy guidance, palpable mass evaluation, and serial evaluation of benign masses.     

X线摄影和超声检查对早期乳腺癌诊断的价值

目的:探讨单独与联合应用X线乳腺摄影(MMG)及彩色多谱勒超声(US)检查对于早期乳腺癌的诊断价值.方法:收集27例经病理证实的早期乳腺癌(病灶直径≤20mm)病例,回顾性分析经单独采用MMG或US检查以及两者联合应用对于诊断结果的准确程度.结果:X线乳腺摄影及彩色多谱勒超声单项检查对早期乳腺癌的检出率无明显差异(均为85.2%),而联合应用X线乳腺摄影及超声检查对早期乳腺癌的检出率(92.6%)明显优于单项检查的检出率(85.2%),两者检出率的差别无统计学意义(P>0.05).结论:X线乳腺摄影和彩色多谱勒超声联合检查综合诊断可明显降低早期乳腺癌的漏诊率.     

Mamografía con realce de contraste mediante técnica de energía dual

The degree of vascularization in breast lesions is related to their malignancy. For this reason, functional diagnostic imaging techniques have become important in recent years. Dual-energy contrast-enhanced mammography is a new, apparently promising technique in breast cancer that provides information about the degree of vascularization of the lesion in addition to the morphological information provided by conventional mammography. This article describes the state of the art for dual-energy contrast-enhanced mammography. Based on 15 months’ clinical experience, we illustrate this review with clinical cases that allow us to discuss the advantages and limitations of this technique.     

Digital mammography: what do we and what don’t we know?

High-quality full-field digital mammography has been available now for several years and is increasingly used for both diagnostic and screening mammography. A number of different detector technologies exist, which all have their specific advantages and disadvantages. Diagnostic accuracy of digital mammography has been shown to be at least equivalent to film-screen mammography in a general screening population. Digital mammography is superior to screen-film mammography in younger women with dense breasts due to its ability to selectively optimize contrast in areas of dense parenchyma. This advantage is especially important in women with a genetic predisposition for breast cancer, where intensified early detection programs may have to start from 25 to 30 years of age. Tailored image processing and computer-aided diagnosis hold the potential to further improve the early detection of breast cancer. However, at present no consensus exists among radiologists on which processing is optimal for digital mammograms. Image processing may also vary significantly among vendors with so far limited interoperability. This review aims to summarize the available information regarding the impact of digital mammography on workflow and breast cancer diagnosis.     

Supplementary Screening Sonography in Mammographically Dense Breast: Pros and Cons

Sonography is an attractive supplement to mammography in breast cancer screening because it is relatively inexpensive, requires no contrast-medium injection, is well tolerated by patients, and is widely available for equipment as compared with MRI. Sonography has been especially valuable for women with mammographically dense breast because it has consistently been able to detect a substantial number of cancers at an early stage. Despite these findings, breast sonography has known limitations as a screening tool; operator-dependence, the shortage of skilled operators, the inability to detect microcalcifications, and substantially higher false-positive rates than mammography. Further study of screening sonography is still ongoing and is expected to help establish the role of screening sonography.