Anne C. Kushwaha

Implementation of Breast Tomosynthesis in a Routine Screening Practice: An Observational Study

OBJECTIVE Digital mammography combined with tomosynthesis is gaining clinical acceptance, but data are limited that show its impact in the clinical environment. We assessed the changes in performance measures, if any, after the introduction of tomosynthesis systems into our clinical practice. MATERIALS AND METHODS In this observational study, we used verified practice- and outcome-related databases to compute and compare recall rates, biopsy rates, cancer detection rates, and positive predictive values for six radiologists who interpreted screening mammography studies without (n = 13,856) and with (n = 9499) the use of tomosynthesis. Two-sided analyses (significance declared at p < 0.05) accounting for reader variability, age of participants, and whether the examination in question was a baseline were performed. RESULTS For the group as a whole, the introduction and routine use of tomosynthesis resulted in significant observed changes in recall rates from 8.7% to 5.5% (p < 0.001), nonsignificant changes in biopsy rates from 15.2 to 13.5 per 1000 screenings (p = 0.59), and cancer detection rates from 4.0 to 5.4 per 1000 screenings (p = 0.18). The invasive cancer detection rate increased from 2.8 to 4.3 per 1000 screening examinations (p = 0.07). The positive predictive value for recalls increased from 4.7% to 10.1% (p < 0.001). CONCLUSION The introduction of breast tomosynthesis into our practice was associated with a significant reduction in recall rates and a simultaneous increase in breast cancer detection rates.

BI-RADS-MRI: A Primer

OBJECTIVE Variations in breast MRI techniques and descriptions of morphologic findings led to the development of a breast MRI lexicon. This lexicon, the American College of Radiologys BI-RADS-MRI, includes terminology for describing lesion architecture and enhancement characteristics. We show the use of these descriptors on breast MR images obtained at our institution. CONCLUSION BI-RADS-MRI is a common language with which to report MRI findings of studies from different institutions.

Comparison of Full-Field Digital Mammography and Screen-Film Mammography for Detection and Characterization of Simulated Small Masses

OBJECTIVE The two objectives of this study were to create an ex vivo phantom model that closely mimics human breast cancer for detection tasks and to compare the performance of full-field digital mammography with screen-film mammography in detecting and characterizing small breast masses in a phantom with a spectrum of complex tissue backgrounds. MATERIALS AND METHODS Sixteen phantom breast masses of varying sizes (0.3-1.2 cm), shapes (round and irregular), and densities (high and low) were created from shaved tumor specimens and imaged using both full-field digital and screen-film mammography techniques. We created 408 detection tasks that were captured on 68 films. On each radiograph, six detection tasks were partially obscured by areas of varying breast-pattern complexity, including low (predominantly fatty), mixed (scattered fibroglandular densities and heterogeneously dense), and high (extremely dense) density patterns. Each detection task was scored using a five-point confidence scale by three mammographers. Receiver operating characteristic (ROC) curve analysis was performed to analyze differences in detection of masses between the two imaging systems, and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were computed. RESULTS Full-field digital mammography showed higher area under the ROC curve than screen-film mammography for detecting masses in each breast background and performed significantly better than screen-film mammography in mixed (p = 0.010), dense (p = 0.029), and all breast backgrounds combined (p = 0.004). Full-field digital mammography was superior to screen-film mammography for characterizing round and irregular masses and low- and high-density masses. CONCLUSION Full-field digital mammography was significantly superior to screen-film technique for detecting and characterizing small masses in mixed and dense breast backgrounds in a phantom model.

Mammography, Magnetic Resonance Imaging of the Breast, and Radionuclide Imaging of the Breast

Breast imaging plays an important role in screening for breast cancer, classifying and sampling nonpalpable breast abnormalities, and defining the extent of breast tumors. Randomized clinical trials and meta-analyses have demonstrated decreased mortality rates in women who undergo mammographic screening compared with unscreened controls. In the past decade, there have been notable improvements in mammographic image quality and positioning. In breast conservation therapy, mammography is used to define the extent of malignancy before definitive segmentectomy and to monitor the breast after surgery and radiation therapy. Percutaneous biopsy techniques have been developed to facilitate safe, accurate tissue acquisition. The use of stereotactic and ultrasound-guided biopsies has resulted in a decrease in the number of surgical biopsies performed. Mammography can also be used to guide needle localizations, most of which, in our practice, are performed to help guide the excision of known cancers. Whereas technetium Tc 99m sestamibi imaging has been reasonably accurate in the evaluation of palpable lesions, sestamibi imaging is thought to be limited in the evaluation of nonpalpable lesions. Magnetic resonance imaging shows promise for detecting breast cancers and defining the extent of disease. Magnetic resonance imaging—guided needle localization and core needle biopsy techniques are being developed, and these techniques should allow for the increased utilization of magnetic resonance imaging in the staging of breast cancers. Digital imaging systems offer opportunities for post-processing and reconfiguring of the original data. Digital mammography should result in improved image quality, a lower call-back rate, and, perhaps, a decreased radiation dose.

Overutilization of Health Care Resources for Breast Pain

OBJECTIVE The objective of this study is to analyze the incidence of women with breast pain who present to an imaging center and assess the imaging findings, outcomes, and workup costs at breast imaging centers affiliated with one institution. MATERIALS AND METHODS Demographic characteristics of and imaging findings for female patients presenting with breast pain at three community breast imaging centers between January 1, 2014, and December 31, 2014, were reviewed. Patients who were pregnant, were lactating, had a history of breast cancer, or presented with palpable nipple or skin findings were excluded. RESULTS A total of 799 patients met the study criteria. Pain was diffuse in 30%, was focal in 30%, and was not localized in 40%. Of the 799 patients with breast pain, 790 (99%) presented for a diagnostic evaluation; 759 (95%) of these evaluated patients had negative findings. A benign sonographic correlate was detected in the area of pain in 5% of patients (39/799). One patient had a single cancer detected in the contralateral asymptomatic breast. When correlations between breast pain and the presence of cancer in the study patients were compared with the concurrent cancer detection rate in the screening population (5.5 cases per 1000 examinations performed), breast pain was not found to be a sign of breast cancer (p = 0.027). Patients younger than 40 years (316/799) underwent a total of 454 workup studies for breast pain; all findings were benign, and the cost of these studies was

Mammographic Findings after Breast Conservation Therapy

87,322. Patients 40 years or older (483/799) underwent 745 workup studies, for a cost of

Primary inflammatory carcinoma of the breast: Retrospective review of mammographic findings

152,732. CONCLUSION Breast pain represents an area of overutilization of health care resources. For female patients who present with pure breast pain, breast imaging centers should consider the following imaging protocols and education for referring physicians: an annual screening mammogram should be recommended for women 40 years or older, and reassurance without imaging should be offered to patients younger than 40 years.