Kristina Lång

Breast cancer detection in digital breast tomosynthesis and digital mammography-a side-by-side review of discrepant cases.

OBJECTIVE To analyse discrepant breast cancer detection in digital breast tomosynthesis (DBT) and digital mammography (DM). METHODS From a previous detection study comparing DBT and DM, 26 discrepant cases were extracted, 19 detected by DBT only and 7 by DM only. An expert panel of three radiologists reviewed these cases and documented the level of discrepancy, lesion visibility, radiographic pattern and lesion conspicuity and assessed the reason for non-detection. Differences between groups were tested using the Wilcoxon rank sum test, the Kruskal-Wallis test and visual grading characteristics. RESULTS The proportion of lesion periphery in fatty tissue was statistically significantly larger, and there were significantly more spiculated masses in DBT compared with DM in the DBT only group (p = 0.018; p = 0.015). The main reasons for missing a lesion were poor lesion visibility when using DM and interpretative error when using DBT. CONCLUSION Lesion visualization is superior with DBT, particularly of spiculated tumours. A major reason for non-detection in DBT seems to be interpretative error, which may be due to lack of experience. ADVANCES IN KNOWLEDGE Our findings suggest that DBT is better than DM in visualizing breast cancer and that non-detection when using DBT is related to interpretative error regarding clearly visible lesions.

Digital breast tomosynthesis (3D-mammography) screening: A pictorial review of screen-detected cancers and false recalls attributed to tomosynthesis in prospective screening trials

This pictorial review highlights cancers detected only at tomosynthesis screening and screens falsely recalled in the course of breast tomosynthesis screening, illustrating both true-positive (TP) and false-positive (FP) detection attributed to tomosynthesis. Images and descriptive data were used to characterise cases of screen-detection with tomosynthesis, sourced from prospective screening trials that performed standard (2D) digital mammography (DM) and tomosynthesis (3D-mammography) in the same screening participants. Exemplar cases from four trials highlight common themes of relevance to screening practice including: the type of lesions frequently made more conspicuous or perceptible by tomosynthesis (spiculated masses, and architectural distortions); the histologic findings (both TP and FP) of tomosynthesis-only detection; and the need to extend breast work-up protocols (additional imaging including ultrasound and MRI, and tomosynthesis-guided biopsy) if tomosynthesis is adopted for primary screening.

Optimizing viewing procedures of breast tomosynthesis image volumes using eye tracking combined with a free response human observer study

The purpose of this study was to evaluate four different viewing procedures as part of improving viewing conditions of breast tomosynthesis (BT) image volumes. The procedures consisted of free scroll volume browsing, and a combination of initial cine loops at three different frame rates (9, 14 and 25 fps) terminated upon request followed by free scroll volume browsing. Fifty-five normal BT image volumes in MLO view were collected. In these, simulated lesions (20 masses and 20 clusters of microcalcifications) were randomly inserted, creating four unique image sets for each procedure. Four readers interpreted the cases in a random order. Their task was to locate a lesion, mark and assign a five level confidence scale. The diagnostic accuracy was analyzed using Jackknife Free Receiver Operating Characteristics (JAFROC). Time efficiency and visual search behavior were also investigated using eye tracking. The results indicate that there was no statistically significant difference in JAFROC FOM between the different viewing procedures, however the medium cine loop speed seemed to be the preferred viewing procedure in terms of total analyze time and dwell time.

Dorsal agenesis of the pancreas - a rare cause of abdominal pain and insulin-dependent diabetes

Dorsal agenesis of the pancreas is a rare congenital disorder. We report a case of a 65-year-old man with mild abdominal pain and insulin-dependent diabetes mellitus. Computed tomography (CT) of the abdomen showed a short pancreas with no pancreatic tissue ventral to the splenic vein. Magnetic resonance cholangiopancreatography (MRCP) visualized the absence of a dorsal duct system and confirmed the suspicion of complete agenesis of the dorsal pancreas. Endoscopic ultrasound (EUS) was also performed to rule out pancreatic malignancy.

Breast Imaging.: 13th International Workshop, IWDM 2016 Malmö, Sweden, June 19-22, 2016, Proceedings

This book constitutes the refereed proceedings of the 13th International Workshop on Breast Imaging, IWDM 2016, held in Malmo, Sweden, in June 2016. The 35 revised full papers and 50 revised poster papers presented together with 6 invited talks were carefully reviewed and selected from 89 submissions. The papers are organized in topical sections on screening; CAD; mammography, tomosynthesis, and breast CT; novel technology; density assessment and tissue analysis; dose and classification; image processing, CAD, breast density, and new technology; contrast-enhanced imaging; phase contrast breast imaging; simulations and virtual clinical trials

Factors affecting recall rate and false positive fraction in breast cancer screening with breast tomosynthesis – A statistical approach

In this study, we investigate which factors affect the false positive fraction (FPF) for digital breast tomosynthesis (DBT) compared to digital mammography (DM) in a screening population by using classification and regression trees (C&RT) and binary marginal generalized linear models. The data was obtained from the Malmö Breast Tomosynthesis Screening Trial, which aimed to compare the performance of DBT to DM in breast cancer screening. By using data from the first half of the study population (7500 women), a tree with the recall probability for different groups was calculated. The effect of age and breast density on the FPF was estimated using a binary marginal generalized linear model. Our results show that breast density and breast cancer were the main factors influencing recall. The FPF is mainly affected by breast density and increases with breast density for DBT and DM. In conclusion, the results obtained with C&RT are easy to interpret and similar to those obtained using binary marginal generalized linear models. The FPF is approximately 40% higher for DBT compared to DM for all breast density categories.

Differences in radiologists' experiences and performance in breast tomosynthesis

The purpose was to study the ability of radiologists to detect breast cancers using 1-view breast tomosynthesis (BT) compared to 2-view digital mammography (DM) correlated with their experience in mammography. The patient population was enriched with difficult cases (89 abnormal and 96 normal/benign breasts). Eight breast radiologists with various experience levels in mammography interpreted the BT and DM image sets individually in a FROC study. Their performance was measured by the JAFROC figure-of-merit ( (non-parametric area under the AFROC curve) and analyzed as a function of experience level. The improvement was significant for the highly experienced radiologists, mean (BT−DM = 0.092; 95% CI: [0.023, 0.161] and for the experienced radiologists, mean (BT−DM = 0.094; 95% CI: [0.034, 0.149] while it was not for the less experienced radiologists, mean (BT−DM = 0.021: 95% CI: [-0.161, 0.202]. The results indicate that experience is necessary to achieve optimal performance in BT.

ESTIMATES OF BREAST CANCER GROWTH RATE FROM MAMMOGRAMS AND ITS RELATION TO TUMOUR CHARACTERISTICS.

This study aimed to investigate the growth rate of 31 consecutive invasive breast cancers based on volume measures on at least two serial mammograms and its relation to histopathological findings. The average tumour volume-doubling time in all invasive breast cancer subtypes was 282 d (range 46-749 d). Grade III breast cancers had a significantly shorter average tumour volume-doubling time of 105 d (range 46-157 d) compared with Grade I and II tumours (average of 296 d, range 147-531 d and average of 353 d, range 139-749 d, respectively) (p = 0.002). Multiple linear regression identified that tumour volume-doubling time was positively associated with patient age, histological grade and progesterone receptor expression and inversely associated with axillary lymph node involvement, human epidermal growth factor receptor 2 and Ki-67 expression (p < 0.001). In conclusion, tumour volume-doubling time as estimated on serial mammography may provide important prognostic information relevant for clinical decision-making.

One-view digital breast tomosynthesis as a stand-alone modality for breast cancer detection : do we need more?

PurposeTo compare the performance of one-view digital breast tomosynthesis (1v-DBT) to that of three other protocols combining DBT and mammography (DM) for breast cancer detection.Materials and methodsSix radiologists, three experienced with 1v-DBT in screening, retrospectively reviewed 181 cases (76 malignant, 50 benign, 55 normal) in two sessions. First, they scored sequentially: 1v-DBT (medio-lateral oblique, MLO), 1v-DBT (MLO) + 1v-DM (cranio-caudal, CC) and two-view DM + DBT (2v-DM+2v-DBT). The second session involved only 2v-DM. Lesions were scored using BI-RADS® and level of suspiciousness (1–10). Sensitivity, specificity, receiver operating characteristic (ROC) and jack-knife alternative free-response ROC (JAFROC) were computed.ResultsOn average, 1v-DBT was non-inferior to any of the other protocols in terms of JAFROC figure-of-merit, area under ROC curve, sensitivity or specificity (p>0.391). While readers inexperienced with 1v-DBT screening improved their sensitivity when adding more images (69–79 %, p=0.019), experienced readers showed similar sensitivity (76 %) and specificity (70 %) between 1v-DBT and 2v-DM+2v-DBT (p=0.482). Subanalysis by lesion type and breast density showed no difference among modalities.ConclusionDetection performance with 1v-DBT is not statistically inferior to 2v-DM or to 2v-DM+2v-DBT; its use as a stand-alone modality might be sufficient for readers experienced with this protocol.Key points• One-view breast tomosynthesis is not inferior to two-view digital mammography.• One-view DBT is not inferior to 2-view DM plus 2-view DBT.• Training may lead to 1v-DBT being sufficient for screening.

14C BOMB-PULSE DATING AND STABLE ISOTOPE ANALYSIS FOR GROWTH RATE AND DIETARY INFORMATION IN BREAST CANCER?

The purpose of this study was to perform an initial investigation of the possibility to determine breast cancer growth rate with 14C bomb-pulse dating. Tissues from 11 breast cancers, diagnosed in 1983, were retrieved from a regional biobank. The estimated average age of the majority of the samples overlapped the year of collection (1983) within 3σ. Thus, this first study of tumour tissue has not yet demonstrated that 14C bomb-pulse dating can obtain information on the growth of breast cancer. However, with further refinement, involving extraction of cell types and components, there is a possibility that fundamental knowledge of tumour biology might still be gained by the bomb-pulse technique. Additionally, δ 13C and δ 15N analyses were performed to obtain dietary and metabolic information, and to serve as a base for improvement of the age determination.