Image quality of mammography in Croatian nationwide screening program: comparison between various types of facilities

Purpose

The study was aimed to provide objective evidence about the mammographic image quality in Croatia, to compare it between different types of MG facilities and to identify the most common deficiencies and possible reasons as well as the steps needed to improve image quality.

Materials and methods

A total of 420 mammographic examinations collected from 84 mammographic units participating in the Croatian nationwide breast cancer screening program were reviewed in terms of four image quality categories: identification of patient and examination, breast positioning and compression, exposure and contrast, and artifacts. Those were rated using image evaluating system based on American College of Radiology and European Commission proposals. The results were compared among different types of mammographic units, and common image quality deficiencies were identified.

Results

Total image quality scores of 12.8, 16.1, 13.0 and 13.7 were found for general hospitals, university hospitals, private clinics and public healthcare centres, respectively. Average score for all mammographic units was 13.5 (out of 25 points). University hospitals were significantly better than all other mammography units in overall image quality, which was mostly contributed by better breast positioning practices. Private clinics showed the worst results in identification, exposure, contrast and artifacts.

Conclusions

Serious deficiencies in identification and breast positioning, which might compromise breast cancer screening outcome, were detected in our material. They occur mainly due to subjective reasons and could be corrected through additional staff training and improvement of working discipline.     

A comparison between the electronic magnification (EM) and true magnification (TM) of breast phantom images using a CDMAM phantom

Purpose

To provide a comparison between the image quality of electronically magnified (EM) and geometric, or true, magnification (TM) mammographic images.

Materials and methods

One Computed Radiography (CR), one Digital Radiography (DR) and two screen–film (S–F) imaging systems were investigated. A Contrast-Detail Mammography (CDMAM) phantom was used as a test object. Three contact images and three sets of TM images with a magnification factor of 1.8 were taken on all systems. Software was used to zoom the contact images by a factor of 1.8 to produce EM images. Two observers evaluated all of the images. An Image Quality Figure and contrast detail curve were used to analyze the observer data and Mann–Whitney U-tests were performed to determine the statistical significance of the results.

Results

No significant differences were found between soft copy and hard copy for any imaging modality. No significant difference in contrast detail detectability (CDD) was seen between EM images from the two digital systems and TM images on S–F systems. The results for the DR EM images and S–F TM images also showed no differences. The CDD of DR TM images was significantly better than both EM and S–F TM images.

Conclusion

Digitally zoomed images offer the same level of CDD as S–F TM images, and so may be viably used in their place. DR systems offer greater CDD than conventional S–F images, when comparing the TM images. This implies that doses can be greatly reduced for TM views using DR systems, while maintaining acceptable image quality.     

Imaging findings in phyllodes tumors of the breast

Purpose

To study the radiological appearance and pathological features of breast phyllodes tumors (PTs), and to enhance the recognition of the tumor.

Materials and methods

Clinical and imaging findings were retrospectively reviewed in 24 women with PTs confirmed by surgical pathology. All of the 24 patients had preoperative MRI and sonography, and 10 had preoperative mammography.

Results

The histologic findings were benign, borderline and malignant PTs in 16.7% (4/24), 45.8% (11/24) and 37.5% (9/24) of cases, respectively. The tumor size (p = 0.001), irregular shape on sonographic imaging (p = 0.039), internal non-enhanced septations (p = 0.009), silt-like changes in enhanced images (p = 0.006) and signal changes from T2-weighted to enhanced images on MRI (p = 0.001) correlated significantly with the histologic grade; the BI-RADS category of the MRI could reflect the PT's histologic grade with a correlation coefficient of 0.440 (p = 0.031). If the category BI-RADS ≥4a was considered to be a suspicious malignant lesion, the diagnostic accuracy of mammography, US and MRI would be 70% (7/10), 62.5% (15/24) and 95.8% (23/24), respectively.

Conclusion

The tumor size and several US and MRI findings can be used to help preoperatively determine the histologic grade of breast PTs. When a patient presents with a progressively enlarging, painless breast mass, MRI should be recommended first.     

乳腺专用磁共振成像、乳腺X线摄影及超声检查对乳腺癌诊断价值的对照研究

目的回顾性比较研究乳腺专用磁共振成像(dedicated breast magnetic resonance imaging,DBMRI)、超声(ultrasound,US)及乳腺X线摄影(mammography,MG)3种检查方法对乳腺癌的诊断价值。方法搜集我院行手术治疗并于术前同时行DBMRI、MG及US 3种检查的患者共612例,剔除36例于检查时已行新辅助化疗的患者,共576例患者纳入本研究,所有入组患者均以病理学结果作为金标准。数据分析与统计采用SPSS 13.0统计软件。以P<0.05为差异有统计学意义。结果 DBMR对乳腺癌病灶检出的敏感性为97.1%,高于MG(77.6%)(χ2=53.904,P=0.000)及US(91.0%)(χ2=10.370,P=0.001);MG对乳腺癌病灶检出的特异性为88.8%,高于DB-MR(82.8%)(χ2=3.925,P=0.048)及US(82.5%)(χ2=4.383,P=0.036)。对于导管内癌,DBMRI检出的敏感性为97.9%,高于US(77.8%)(χ2=29.445,P=0.000)及MG(71.1%)(χ2=9.680,P=0.002)。在致密型乳腺中,DBMRI诊断灵敏度高为96.0%,高于MG(66.7%)(χ2=35.806,P=0.000);US诊断敏感性为92.1%,高于MG(66.7%)(χ2=24.812,P=0.000)。在非致密型乳腺中,DBMR诊断敏感性为97.9%,高于MG(85%)(χ2=19.684,P=0.000)及US(90.4%)(χ2=19.684,P=0.002)。DBMRI、MG、US对伴钙化的乳腺癌检出的敏感性分别为98.3%、94.0%和94.8%。结论 DBMRI对乳腺癌的检出敏感性高,但特异性较低;对于导管内癌的诊断,DBMRI具有显著优势;在致密型乳腺乳腺癌的检出中,DBMRI与US均具有高敏感性,优于MG。     

Population-Based Effects of Mammography Screening in Bavaria on the Distribution of TNM-T Categories with Respect to Different Histological Subgroups

Background

Organized mammography screening was implemented in Bavaria in 2003, with a target population of about 1.5 million women (aged 50–69 years). We evaluated the population-based effects of mammography screening on the distribution of tumor-node-metastasis (TNM)-T categories with regard to different histological subgroups of breast cancer.

Patients and Methods

Women diagnosed with breast cancer between 2002 and 2008 were included. The annual age-specific incidence rates separated by T category were calculated for different histological subgroups and plotted against time. Time trends were analyzed not only in the screening population but also based on women aged 15–49 and ≥70 years, respectively. Furthermore, correlation coefficients were calculated in order to evaluate the possible association between participation rate and incidence of certain TNM-T categories.

Results

With ductal carcinomas, the incidence of early-stage tumors shows a strong increase in the screening population and a significant correlation with the participation rate, whereas with lobular carcinomas there is a stagnation of incidence in women aged 50–69 years irrespective of TNM-T category.

Conclusions

Short-term effects of mammography screening can already be demonstrated. However, depending on breast cancer type, not all women appear to benefit from screening. The expected long-term reduction of breast cancer mortality remains to be seen.     

钼靶立体定位系统引导下乳房微创手术的定位失准原因分析及预防

目的分析Lorad俯卧式钼靶立体定位系统引导下麦默通乳房病灶微创切除术中定位失准的原因并进行改进,探讨提高钼靶定位穿刺准确率的方法。方法分析2009年1月—2010年5月我院40例钼靶定位乳房肿物微创切除术病例,找出穿刺置刀发生偏差的原因,并采取了相应的改进措施。在完成随后50例微创手术后,比较改进前后微创刀放置的准确率。结果微创刀一次放置的准确率由改进前的80%(32/40)上升到改进后的100%(50/50),差异有统计学意义(P<0.01)。结论采取必要措施可以提高钼靶定位穿刺准确率。     

MRI在临床触诊阳性的乳腺X线非对称性致密影病变诊断中的价值

目的:探讨MRI在临床触诊阳性的乳腺X线非对称性致密影病变中良、恶性疾病的诊断价值。方法;收集2009年3月～2012年3月临床触诊阳性的乳腺X线非对称性致密影病变80例,病变不伴肿块、钙化及结构扭曲,于术后分别与病理对照,观察病灶形态、分布、动态增强、时间-曲线及周围影像改变等显示情况,并统计诊断准确率。所有患者在手术前2周内均进行乳腺X线及MRI检查。结果:肿块型强化22例,非肿块型强化58例;病灶强化均匀14例,强化不均匀66例;其内伴多发脓肿,壁呈均匀或非均匀环形强化34例;患侧乳内异常血管增粗并较对侧丰富28例,皮肤局部或广泛性增厚32例,皮下水肿27例,腋下淋巴结实性增大15例;时间-曲线Ⅰ型36例,Ⅱ型22例,Ⅲ型22例。乳腺良性病变48例,其中乳腺增生症8例,硬化性腺病2例;乳腺炎症37例(慢性炎症23例,肉芽肿性乳腺炎8例,浆细胞性乳腺炎2例,囊肿伴感染4例),纤维腺瘤1例;乳腺癌32例,其中乳腺导管癌23例,乳腺小叶癌5例,乳腺血管肉瘤2例,乳腺导管癌合并乳腺小叶癌2例。结论:对临床触诊阳性的乳腺X线非对称性致密影病变中,乳腺MRI在发现病变及良、恶性疾病定性诊断具有重要价值,特别是乳腺癌的早期诊断。     

高频彩色多普勒超声联合X线钼靶诊断早期乳腺癌的临床价值

目的研究高频彩色多普勒超声联合X线钼靶在诊断早期乳腺癌中的临床应用价值。方法将在我院进行治疗的150例早期乳腺癌患者作为观察对象,以病理检查结果为标准,对高频多普勒彩超与X线钼靶及其联合诊断的准确率进行综合分析。结果 150例经病理检验确诊的早期乳腺癌患者中,多普勒彩超的诊断符合人数为119例,占79.3%,误诊人数为17例,占34.0%,漏诊人数为14例,占9.3%;X线钼靶的诊断符合人数为113例,占75.3%,误诊人数为21例,占14.0%,漏诊人数为16例,占10.6%,联合诊断符合人数为147例,占98.0%,误诊人数为2例,占1.3%,漏诊人数为1例,占0.6%。患者肿块、微小钙化、异常血管特征或血流信以及腋窝淋巴结肿大等病理检出特征差异有统计学意义（P〈0.05）。结论高频多普勒彩超与X线钼靶在诊断早期乳腺癌上各具长处,联合两种方法综合判断,有助于提升早期乳腺癌的诊断准确率。