Can digital breast tomosynthesis perform better than standard digital mammography work-up in breast cancer assessment clinic?

PURPOSE: To compare the efficacy of use of digital breast tomosynthesis (DBT) with standard digital mammography (DM) workup views in the breast cancer assessment clinic. MATERIALS AND METHODS: The Tomosynthesis Assessment Clinic trial (TACT), conducted between 16 October 2014 and 19 April 2016, is an ethics-approved, monocenter, multireader, multicase split-plot reading study. After written informed consent was obtained, 144 females (age > 40 years) who were recalled to the assessment clinic were recruited into TACT. These cases (48 cancers) were randomly allocated for blinded review of (1) DM workup and (2) DBT, both in conjunction with previous DM from the screening examination. Fifteen radiologists of varying experience levels in the Australia BreastScreen Program were included in this study, wherein each radiologist read 48 cases (16 cancers) in 3 non-overlapping blocks. Diagnostic accuracy was measured by means of sensitivity, specificity, and positive (PPV) and negative predictive values (NPV). The receiver-operating characteristic area under the curve (AUC) was calculated to determine radiologists' performances. RESULTS: Use of DBT (AUC = 0.927) led to improved performance of the radiologists (z = 2.62, p = 0.008) compared with mammography workup (AUC = 0.872). Similarly, the sensitivity, specificity, PPV, and NPV of DBT (0.93, 0.75, 0.64, 0.96) were higher than those of the workup (0.90, 0.56, 0.49, 0.92). Most radiologists (80%) performed better with DBT than standard workup. Cancerous lesions on DBT appeared more severe (U = 33,172, p = 0.02) and conspicuous (U = 24,207, p = 0.02). There was a significant reduction in the need for additional views (χ2 = 17.63, p < 0.001) and recommendations for ultrasound (χ2 = 8.56, p = 0.003) with DBT. CONCLUSIONS: DBT has the potential to increase diagnostic accuracy and simplify the assessment process in the breast cancer assessment clinic. KEY POINTS: • Use of DBT in the assessment clinic results in increased diagnostic accuracy. • Use of DBT in the assessment clinic improves performance of radiologists and also increases the confidence in their decisions. • DBT may reduce the need for additional views, ultrasound imaging, and biopsy.

The contribution of work-up or additional views to the accuracy of diagnostic mammography.

This study examines the influence of work-up on the accuracy of diagnostic mammography in symptomatic women. Subjects were sampled from all women consecutively attending a symptomatic breast clinic and aged 25-55 years (240 women shown to have breast cancer and 240 age-matched women shown not to have cancer). Mammography films were prospectively reported by two radiologists independently of each other and in a blinded manner using two phases of film reading: initially only baseline films were read, then mammography was re-read with work-up films. The accuracy of reporting mammography with and without work-up was compared using sensitivity and specificity, likelihood ratios, and receiver operating characteristic (ROC) curves. Reporting the mammogram with work-up (compared to without any work-up films) improved sensitivity (75.3% vs 69.0%, P=0.059) for one radiologist, with a non-significant gain in specificity (84.5% vs 79.4%, P=0.38). For the other radiologist, it resulted in a non-significant decrease in sensitivity (79.5% vs 83.7%, P=0.14) with a significant increase in specificity (85.6% vs 61.9%, P=0.00001). ROC curves for both radiologists showed that reporting mammography with work-up resulted in significant improvement (4.5% for R1, 6.8% for R2) in overall test accuracy. Our findings support the use of work-up mammography in the diagnostic setting.

Patients not seen in three years: will invitations for health checks be of benefit?

An attempt has been made to evaluate the evidence for the likely benefit or otherwise, of the obligatory three-yearly checks as defined within the terms of service for doctors in general practice introduced to British general practitioners in April 1990. The content, interval, age groups, ethics, organizational cost, yield and outcome of the three-yearly checks are examined. No particular evidence is apparent which should deflect general practice from its present opportunistic approach to screening, and the already established national screening programmes.

Rapid coastal survey of anthropogenic radionuclides, metals, and organic compounds in surficial marine sediments.

A towed survey system, the GIMS/CS3, has been developed to enable the rapid measurement and mapping of a variety of physical and geochemical parameters in the surficial sediments of aquatic environments while the survey vessel is underway. With its capability for measuring radiometric, elemental and organic compound constituents of sediments, as well as bathymetry and water quality parameters, the GIMS/CS3 provides a cost-effective means of performing reconnaissance determinations of contaminant distributions and environmental monitoring tasks over broad geographic regions.

Morton's metatarsalgia: sonographic findings and correlated histopathology.

The results of 79 high resolution ultrasound examinations of the forefoot that were performed for suspected Morton's metatarsalgia were retrospectively assessed. Scans were only obtained if the pain was poorly localized or if there were atypical features that made the clinical diagnosis uncertain. Ultrasound detected 92 hypoechoic intermetatarsal web space masses in 63 patients. Surgery was performed on 23 web spaces in 22 patients where the response to nonsurgical management had been poor. The surgical specimens were retrieved and reviewed by a pathologist in 21 cases. The histopathology in 20 of 21 operated cases was that of Morton's neuroma; however, prominent mucoid degeneration was also found to involve the adjacent loose fibroadipose tissues in 19 of 20 neuroma specimens. Ultrasound was sensitive in the detection of web space abnormality (sensitivity, 0.95), but could not clearly separate Morton's neuroma from associated mass-like mucoid degeneration in the adjacent loose connective tissues. The implications of these observations for both diagnosis and treatment are discussed.

Comparison of environmental radiation dosimetry and gamma-ray spectroscopy.

During the period 1975-1980, direct radiation dose rates were measured at 16 fixed locations in the vicinity of the Joseph M. Farley Nuclear Plant, Houston County, AL, by exposure of TLDs which were read quarterly. The average quarterly dose rates using LiF chips varied widely over the 6-yr period and were divided into 2 distinct population groups of 4 and 2 yr each, corresponding to the vendor labs supplying and reading the TLDs. The simultaneous exposure of CaSO4:Dy TLDs for 2 yr gave a third set of values which fell between the 2 LiF groups. During the period December 1976-November 1980, simultaneous pressurized ion chamber (PIC) and in situ Ge(Li) gamma-ray spectroscopy measurements were made at the same locations at approx. 6-month intervals. The PIC exposure rate values were relatively constant for each location except for 1 measurement at the end of a long dry period broken by showers of rain. The average PIC dose rate values were in good agreement with the average 2-yr LiF TLD values. Also, good agreement resulted from converting the in situ radioactivity values to dose rates using conversion values previously published. Using the in situ Ge(Li) gross gamma count rates, and a new equation developed by the authors for calculating exposure rate, resulted in excellent agreement with both individual and average PIC values. The natural radioactivity and fallout 137Cs in the soil showed little variation for a specific site, but varied widely between some sites. With the event of rain at the end of a long dry period, there was a large increase in 214Bi and 214Pb activity detected. Short half-life manmade radionuclides were seen for a few months following several atmospheric nuclear tests by the People's Republic of China.

Ureteral entrapment injury in blunt pelvic trauma: a case report.

An unusual ureteral injury occurred during blunt pelvic trauma in a 6-year-old boy. Crush injury opened the sacroiliac joint, and the ureter was trapped and obstructed during realignment of the joint. Combined retrograde and anterograde pyelography accurately localized the injury and surgical repair restored renal function, despite total ureteral obstruction lasting more than 3 months. The mechanism, diagnosis and treatment of this injury are discussed. Vascular and ureteral injuries must be ruled out carefully when treating blunt renal injuries conservatively.

Magnetic resonance imaging in clinically-definite multiple sclerosis.

Forty-two patients with clinically-definite multiple sclerosis were examined by magnetic resonance imaging using a 1.5-T instrument. Magnetic resonance imaging detected an abnormality in 90% of patients. In four patients, no lesions were demonstrated. The number, size and site of the lesions by magnetic resonance imaging were compared with the patients' clinical status and other variables. The Kurtzke disability status scale score increased in patients with corpus callosum atrophy, and brainstem and basal ganglia lesions, and correlated with the total number of lesions. No correlation was shown between the findings of magnetic resonance imaging and disease duration, age, sex or pattern-reversal visual-evoked potentials. This article highlights the variety of magnetic resonance images that is obtained in patients with clinically-definite multiple sclerosis.