Michael N. Linver

Benefits versus risks from mammography: A critical reasessment

The use of mammography has increased rapidly over the last decade. The justification for mammographic examinations is the potential benefit they provide in detecting breast cancer at an early stage and reducing mortality. However, this benefit must be balanced against the associated potential risk of radiation carcinogenesis, economic costs, and a number of other factors. Most publications to date have used radiation risk factors and data from studies that were published over a decade ago, which now have been superseded by the results of more recent epidemiological studies.

The New Mexico Mammography Project: Screening mammography performance in Albuquerque, New Mexico, 1991 to 1993

This project was designed to collect and link population‐based mammography and breast carcinoma data to assess the performance of community mammography screening.

Clinically Missed Cancer: How Effectively Can Radiologists Use Computer-Aided Detection?

OBJECTIVE The purpose of this study was to determine the effectiveness with which radiologists can use computer-aided detection (CADe) to detect cancer missed at screening. MATERIALS AND METHODS An observer study was performed to measure the ability of radiologists to detect breast cancer on mammograms with and without CADe. The images in the study were from 300 analog mammographic examinations. In 234 cases the mammograms were read clinically as normal and free of cancer for at least 2 subsequent years. In the other 66 cases, cancers were missed clinically. In 256 cases, current and previous mammograms were available. Eight radiologists read the dataset and recorded a BI-RADS assessment, the location of the lesion, and their level of confidence that the patient should be recalled for diagnostic workup for each suspicious lesion. Jackknife alternative free-response receiver operating characteristic analysis was used. RESULTS The jackknife alternative free-response receiver operating characteristic figure of merit was 0.641 without aid and 0.659 with aid (p = 0.06; 95% CI, -0.001 to 0.036). The sensitivity increased 9.9% (95% CI, 3.4-19%) and the callback rate 12.1% (95% CI, 7.3-20%) with CADe. Both increases were statistically significant (p < 0.001). Radiologists on average ignored 71% of correct computer prompts. CONCLUSION Use of CADe can increase radiologist sensitivity 10% with a comparable increase in recall rate. There is potential for CADe to have a bigger clinical impact because radiologists failed to recognize a correct computer prompt in 71% of missed cancer cases [corrected].

Can radiologists recognize that a computer has identified cancers that they have overlooked

For computer-aided detection (CADe) to be effective, the computer must be able to identify cancers that a radiologist misses clinically and the radiologist must be able to recognize that a cancer was missed when he or she reviews the computer output. There are several papers indicating CADe can detected clinically missed cancers. The purpose of this study is to examine whether radiologists can use the CADe output effectively to detect more cancers. Three-hundred mammographic cases, which included current and previous exams, were collected: 66 cases containing a missed cancer that was recognized in retrospect and 234 were normal cases. These were analyzed by a commercial CADe system. An observer study with eight MQSA-qualified radiologists was conducted using a sequential reading method. That is, the radiologist viewed the mammograms and scored the case. Then they reviewed the CADe output and rescored the case. The computer had a sensitivity of 55% with an average of 0.59 false detections per image. For all cancers (n=69), the radiologists had a sensitivity of 58% with no aid and 64% with aid (p=0.002). In cases where the computer detected the cancer in all views that the cancer was visible (n=17), the radiologists had a sensitivity of 74% unaided and increased to 85% aided (p=0.02). In cases where the computer missed the cancer in one view (n=21), the radiologists had a sensitivity of 65% unaided and 72% aided (p<0.001). The radiologists, on average, ignored 20% of all correct computer prompts.

Mammographic Screening: Sensitivity of General Radiologists

High quality mammography can detect early, curable breast cancer and decrease mortality. Much research effort is being expended to improve mammography (digital mammography, computer-aided diagnosis [CAD]), and develop alternative modalities (ultrasound, MRI, radionuclide imaging). However, the human observer is at this point potentially the weakest link in the diagnostic imaging chain, and the range of performance in routine practice is unknown. We have conducted a large observer study using a standardized test base to further investigate this issue.

Bilateral Multiple Mammary Myofibroblastomas in an Adult Male

In 2007, a 74-year-old male resident of New Mexico presented with bilateral breast masses. Notable history included cutaneous melanoma (status-post wide resection, in 1987) and prostatic adenocarcinoma (status-post radical prostatectomy, in 1992); without evidence of recurrence or metastases from either malignancy. Mammography showed 3 well-circumscribed, round, and homogeneous masses in the right (R) breast (largest 1.4 cm), and 2 similar masses in the left (L, largest 1.7 cm) (Figure 1A and B). These tumors were present in different quadrants, at variable distances from the respective nipples. Ultrasound examination revealed all 5 masses to be solid (Figure 1C and D). Needle core biopsies of the bilateral masses showed histologically similar spindle cell neoplasms. The lesional spindle cells displayed pale cytoplasm and elongated nuclei with micronucleoli, and were arranged in fascicles amid wispy straps of collagen. Neither nuclear atypia nor mitotic activity was evident (Figure 2). The spindle cells were immunoreactive for CD34, desmin, estrogen receptor, and Bcl-2 (Figure 3). Based on these findings, the diagnosis of bilateral multiple mammary myofibroblastomas (MM) was rendered. Clinical observation, and not surgical excision, was opted for. The subsequent 8 years were uneventful. In 2015, the patient was diagnosed to have mantle cell lymphoma. Computed tomography, performed as part of 735895 IJSXXX10.1177/1066896917735895International Journal of Surgical PathologyViswanathan et al research-article2017