A Pilot Study to Assess the Performance of Phase-Sensitive Breast Tomosynthesis.

Background A new modality, phase-sensitive breast tomosynthesis (PBT), may have similar diagnostic performance to conventional breast tomosynthesis but with a reduced radiation dose. Purpose To perform a pilot study of the performance of a novel PBT system compared with conventional digital breast tomosynthesis (DBT) in patients undergoing additional diagnostic imaging workup for breast lesions. Materials and Methods In a prospective study from June 2020 to March 2021, participants with suspicious breast lesions detected at screening DBT or MRI were recruited for additional PBT imaging before additional diagnostic workup or biopsy. In this pilot study, nine radiologists independently evaluated image quality and assessed the likelihood of lesion malignancy by retrospectively evaluating DBT and PBT images in two separate reading sessions. Image quality was rated subjectively using a Likert scale from 1 to 5. Areas under the receiver operating characteristic curve (AUCs) were used to compare the lesion classification (malignant vs benign) performance of the radiologists. Results Images in 50 patients (mean age, 56 years ± 12 [SD]; 49 women) with 52 evaluable lesions (28 malignant) were assessed. For image appearance and general feature visibility, DBT images had a higher total mean image quality score (3.8) than PBT images (2.9), with P < .002 for each comparison. For classification of lesions as benign or malignant, the AUCs were 0.74 for both PBT and DBT. PBT images were acquired at a 24% mean radiation dose reduction (mean, 1.78 mGy vs 2.34 mGy for DBT; P < .001). Conclusion The phase-sensitive breast tomosynthesis system had a 24% lower mean radiation dose compared with digital breast tomosynthesis, although with lower image quality. Diagnostic performance of the system remains to be determined in larger studies. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Gao and Moy in this issue.

Evaluation and comparison of a CdTe based photon counting detector with an energy integrating detector for X-ray phase sensitive imaging of breast cancer.

PURPOSE: To compare imaging performance of a cadmium telluride (CdTe) based photon counting detector (PCD) with a CMOS based energy integrating detector (EID) for potential phase sensitive imaging of breast cancer. METHODS: A high energy inline phase sensitive imaging prototype consisting of a microfocus X-ray source with geometric magnification of 2 was employed. The pixel pitch of the PCD was 55µm, while 50µm for EID. The spatial resolution was quantitatively and qualitatively assessed through modulation transfer function (MTF) and bar pattern images. The edge enhancement visibility was assessed by measuring edge enhancement index (EEI) using the acrylic edge acquired images. A contrast detail (CD) phantom was utilized to compare detectability of simulated tumors, while an American College of Radiology (ACR) accredited phantom for mammography was used to compare detection of simulated calcification clusters. A custom-built phantom was employed to compare detection of fibrous structures. The PCD images were acquired at equal, and 30% less mean glandular dose (MGD) levels as of EID images. Observer studies along with contrast to noise ratio (CNR) and signal to noise ratio (SNR) analyses were performed for comparison of two detection systems. RESULTS: MTF curves and bar pattern images revealed an improvement of about 40% in the cutoff resolution with the PCD. The excellent spatial resolution offered by PCD system complemented superior detection of the diffraction fringes at boundaries of the acrylic edge and resulted in an EEI value of 3.64 as compared to 1.44 produced with EID image. At equal MGD levels (standard dose), observer studies along with CNR and SNR analyses revealed a substantial improvement of PCD acquired images in detection of simulated tumors, calcification clusters, and fibrous structures. At 30% less MGD, PCD images preserved image quality to yield equivalent (slightly better) detection as compared to the standard dose EID images. CONCLUSION: CdTe-based PCDs are technically feasible to image breast abnormalities (low/high contrast structures) at low radiation dose levels using the high energy inline phase sensitive imaging technique.

Dual-energy phase retrieval algorithm for inline phase sensitive x-ray imaging system.

Phase retrieval is vital for quantitative x-ray phase contrast imaging. This work presents an iterative method to simultaneously retrieve the x-ray absorption and phase images from a single x-ray exposure. The proposed approach uses the photon-counting detectors' energy-resolving capability in providing multiple spectrally resolved phase contrast images from a single x-ray exposure. The retrieval method is derived, presented, and experimentally tested with a multi-material phantom in an inline phase contrast imaging setup. By separating the contributions of photoelectric absorption and Compton scattering to the attenuation, the authors divide the phase contrast image into two portions, the attenuation map arises from photoelectric absorption and a pseudo phase contrast image generated by electron density. This way one can apply the Phase Attenuation Dualiby (PAD) algorithm and Fresnel propagation for the iteration. The retrieval results from the experimental images show that this iterative method is fast, accurate, robust against noise, and thus yields noticeable enhancement in contrast to noise ratios.

Characteristics of Invasive Breast Cancer Detected by Digital Breast Tomosynthesis on Screening and Diagnostic Mammograms.

OBJECTIVE: To determine whether there is added benefit for 3D mammography in the context of screening and diagnostic imaging, particularly relating to known prognostic characteristics, including histopathology, receptor status, and axillary lymph node involvement. METHODS: An institutional review board-approved retrospective review was performed of our mammography and pathology databases from October 2012 to May 2015 to identify biopsy-proven invasive breast carcinoma detected on screening and diagnostic mammograms by 2D plus 3D (2D + 3D) imaging. Percentages of cancer detection by 2D and 3D were compared. Correlation with histopathology and lymph node status was analyzed. RESULTS: Of 53 cancers diagnosed on 12 543 screening mammograms, 36 (67.9%) were better visualized on 3D (not visualized, equivocal, or only seen in retrospect on 2D). Of the 62 cancers diagnosed on 4090 diagnostic mammograms, 24 (38.7%) cancers were better detected on 3D. A statistically significant greater number of cancers were better detected on 3D in the screening compared to the diagnostic mammograms (67.9% vs 38.7%, P < .05). A significantly higher frequency of less aggressive tumors (grade I and grade II, positive estrogen/progesterone receptor, Her2 negative) was detected by 3D, with higher significance in the screening population. Additionally, there was a higher frequency of positive axillary lymph nodes in cancers detected by 3D in the screening group. CONCLUSION: Three-dimension increases invasive breast cancer detection, particularly pathologically less aggressive tumors, in both screening and diagnostic mammograms with more benefit for the screening population. Three-dimensional mammography detected more breast cancer associated with metastatic axillary lymph nodes in the screening population.

Can Digital Breast Tomosynthesis Replace Full-Field Digital Mammography? A Multireader, Multicase Study of Wide-Angle Tomosynthesis.

OBJECTIVE. The purpose of this study was to test the hypothesis whether two-view wide-angle digital breast tomosynthesis (DBT) can replace full-field digital mammography (FFDM) for breast cancer detection. SUBJECTS AND METHODS. In a multireader multicase study, bilateral two-view FFDM and bilateral two-view wide-angle DBT images were independently viewed for breast cancer detection in two reading sessions separated by more than 1 month. From a pool of 764 patients undergoing screening and diagnostic mammography, 330 patient-cases were selected. The endpoints were the mean ROC AUC for the reader per breast (breast level), ROC AUC per patient (subject level), noncancer recall rates, sensitivity, and specificity. RESULTS. Twenty-nine of 31 readers performed better with DBT than FFDM regardless of breast density. There was a statistically significant improvement in readers' mean diagnostic accuracy with DBT. The subject-level AUC increased from 0.765 (standard error [SE], 0.027) for FFDM to 0.835 (SE, 0.027) for DBT (p = 0.002). Breast-level AUC increased from 0.818 (SE, 0.019) for FFDM to 0.861 (SE, 0.019) for DBT (p = 0.011). The noncancer recall rate per patient was reduced by 19% with DBT (p < 0.001). Masses and architectural distortions were detected more with DBT (p < 0.001); calcifications trended lower (p = 0.136). Accuracy for detection of invasive cancers was significantly greater with DBT (p < 0.001). CONCLUSION. Reader performance in breast cancer detection is significantly higher with wide-angle two-view DBT independent of FFDM, verifying the robustness of DBT as a sole view. However, results of perception studies in the vision sciences support the inclusion of an overview image.

Imaging Features of Nonmalignant and Malignant Architectural Distortion Detected by Tomosynthesis.

OBJECTIVE: The objective of our study was to determine the ability of tomosynthesis (3D) to detect nonmalignant and malignant architectural distortion (AD) on 3D screening mammograms compared with digital mammography (2D) only and to correlate the 3D imaging features of nonmalignant and malignant AD with pathology findings. MATERIALS AND METHODS: For this single-institution retrospective study, screening mammography reports from October 1, 2012, to December 1, 2016, that included AD as a finding were reviewed. Associated additional imaging studies and pathology results were also reviewed. RESULTS: Three-dimensional mammography showed statistically significant increased detection of both nonmalignant and malignant AD compared with 2D only (0.10% [24/24,902 examinations] vs 0.01% [1/9470 examinations], p < 0.05; and 0.21% [52/24,902 examinations] vs 0.07% [7/9470 examinations], p < 0.05, respectively). Higher percentages of nonmalignant AD (16%) were occult on ultrasound compared with malignant AD (3%). The pathologic diagnoses of nonmalignant AD included radial scar (42%), sclerosing adenosis (16%), stromal or dense fibrosis (16%), and other miscellaneous benign causes (25%). Morphologically, nonmalignant AD was more likely to show symmetric or spoke-wheel spiculation appearance (58% vs 2%, p < 0.05) and central lucency (25% vs 0%, p < 0.05) than malignant AD, whereas malignant AD was more likely to show asymmetric spiculation (98% vs 42%, p < 0.05) and central mass 60% vs 0%, p < 0.05) than nonmalignant AD. CONCLUSION: Malignant AD and nonmalignant AD are more readily detected by 3D mammography than 2D mammography. Three-dimensional imaging features of AD can help to distinguish nonmalignant types in which symmetric or spoke-wheel spiculation with central lucency are more often seen and are more often occult on ultrasound.

Detection and Clinical Significance of Sternal Lesions on Breast MRI.

The purpose of this study is to characterize sternal lesions detected on breast magnetic resonance imaging (MRI), compare MRI detection of sternal lesions with other imaging modalities (bone scan, positron emission tomography/computed tomography (PET/CT) and chest CT), and ascertain how often patient management is altered by discovery of sternal lesions. Retrospective review of 1143 breast MRIs between 2007 and 2012 identified 17 patients with sternal lesions including 15 patients with newly diagnosed breast cancer and two patients with remote history of breast cancer. Tumor size, histopathology, receptor status, nodal and distant metastasis, and images of breast MRI, and other modalities were reviewed. Sternal lesions in 9 of the 17 patients were determined to be malignant (metastasis) either by biopsy or presence of widespread metastases. Sternal lesions in 8 of the 17 were benign, confirmed by biopsy or presumed benign as not detected by other modalities. The malignant group had statistically significant larger breast cancer size (malignant: 6.4 cm; benign: 2.3 cm), a higher percentage of diffuse sternal lesions (malignant: 56%; benign: 0%), and more frequently showed rapid initial enhancing (malignant: 100%; benign: 63%) and delayed washout curves (malignant: 67%; benign: 13%). Although not statistically significant, the malignant group had a higher frequency of invasive lobular carcinoma (malignant: 44%; benign: 13%) and more lymph node involvement (malignant: 78%; benign: 50%). Breast MRI detected more sternal lesions than did bone scan, PET/CT and chest CT. Four of the 17 (24%) patients were upgraded to stage 4 due to unsuspected metastatic sternal lesions on breast MRI. In conclusion, breast MRI is more sensitive than other modalities in detecting sternal lesions. Sternal metastases occur more frequently in aggressive breast cancer and exhibit malignant-type dynamics on breast MRI. Detection of unsuspected sternal metastasis alters staging and improves patient management with more appropriate treatment.

Detection of posteriorly located breast tumors using gold nanoparticles: a breast-mimicking phantom study.

BACKGROUND: Accurately depicting breast tumors located posteriorly, close to the chest wall musculature, with conventional mammography is a technical challenge. OBJECTIVE: This study demonstrates the proof of concept of an x-ray fluorescence mapping (XFM) technique to address this issue. METHODS: A tissue-equivalent gel phantom is designed to mimic structures in the central part of a compressed breast. The posterior aspect of the breast and adjacent pectoralis major muscle are represented by another 10-mm-thickness breast tissue simulation phantom (BR12) that is attached to the back of the gel phantom as a region of interest (ROI). Two gold nanoparticle (GNP) solutions are embedded into the ROI to simulate varying GNP uptake within breast lesions. The ROI is imaged through performing the XFM technique with an x-ray pencil-beam and a single spectrometer. RESULTS: A 2D mapping of the middle plane in the ROI demonstrates feasibility and matches well the known spatial distribution and different GNP concentrations. 3D reconstruction of the ROI is easily rendered by repeating the 2D mapping process. CONCLUSION: XFM system geometry and its insensitivity to attenuation coefficients of breast tissue components are unique characteristics that may complement conventional mammography and improve the detection of breast cancers located posteriorly, adjacent to or overlying the chest wall musculature.

State-of-the-art for contrast-enhanced mammography.

Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with promise for breast cancer screening, diagnosis, and procedural guidance. However, best uses of CEM in comparison with other breast imaging modalities such as tomosynthesis, ultrasound, and MRI remain inconclusive in many clinical settings. This review article summarizes recent peer-reviewed literature, emphasizing retrospective reviews, prospective clinical trials, and meta-analyses published from 2020 to 2023. The intent of this article is to supplement prior comprehensive reviews and summarize the current state-of-the-art of CEM.

Assessing the stand-alone sensitivity of computer-aided detection with cancer cases from the Digital Mammographic Imaging Screening Trial.

OBJECTIVE: The purpose of this study was to assess the sensitivities and false-detection rates of two computer-aided detection (CADe) systems when applied to digital or film-screen mammograms in detecting the known breast cancer cases from the Digital Mammographic Imaging Screening Trial (DMIST) breast cancer screening population. MATERIALS AND METHODS: Available film-screen and digital mammograms of 161 breast cancer cases from DMIST were analyzed by two CADe systems, iCAD Second-Look and R2 ImageChecker. Three experienced breast-imaging radiologists reviewed the CADe marks generated for each available cancer case, recording the number and locations of CADe marks and whether each CADe mark location corresponded with the known location of the cancer. RESULTS: For the 161 cancer cases included in this study, the sensitivities of the DMIST reader without CAD were 0.43 (69/161, 95% CI 0.35-0.51) for digital and 0.41 (66/161, 0.33-0.49) for film-screen mammography. The sensitivities of iCAD were 0.74 (119/161, 0.66-0.81) for digital and 0.69 (111/161, 0.61-0.76) for film-screen mammography, both significantly higher than the DMIST study sensitivities (p < 0.0001 for both). The average number of false CADe marks per case of iCAD was 2.57 (SD, 1.92) for digital and 3.06(1.72) for film-screen mammography. The sensitivity of R2 was 0.74 (119/161, 0.66-0.81) for digital, and 0.60 (97/161, 0.52-0.68) for film-screen mammography, both significantly higher than the DMIST study sensitivities (p < 0.0001 for both). The average number of false CADe marks per case of R2 was 2.07 (1.57) for digital and 1.52 (1.45) for film-screen mammography. CONCLUSION: Our results suggest the use of CADe in interpretation of digital and film-screen mammograms could lead to improvements in cancer detection.

Autologous Fat Grafting to the Breast: An Educational Review.

Autologous fat grafting (AFG) is a technique that is increasingly utilized in breast cosmetic and reconstructive surgery. In this procedure, fat is aspirated by liposuction from one area of the body and injected into the breast. The procedure and process of AFG has evolved over the last few decades, leading to more widespread use, though there is no standard method. Autologous fat grafting is generally considered a safe procedure but may result in higher utilization of diagnostic imaging due to development of palpable lumps related to fat necrosis. Imaging findings depend on surgical technique but typically include bilateral, symmetric, retromammary oil cysts and scattered dystrophic and/or coarse calcifications when AFG is used for primary breast augmentation. More focal findings occur when AFG is used to improve specific areas of cosmetic deformity, scarring, or pain following breast cancer surgery. As with any cause of fat necrosis, imaging features tend to appear more benign over time, with development of rim calcifications associated with oil cysts and a shift in echogenicity of oil cyst contents on ultrasound towards anechoic in some cases. This article reviews the AFG procedure, uses, complications, and imaging findings.

AUR-RRA Review: Logistics of Academic-Industry Partnerships in Artificial Intelligence.

The Radiology Research Alliance (RRA) of the Association of University Radiologists (AUR) convenes Task Forces to address current topics in radiology. In this article, the AUR-RRA Task Force on Academic-Industry Partnerships for Artificial Intelligence, considered issues of importance to academic radiology departments contemplating industry partnerships in artificial intelligence (AI) development, testing and evaluation. Our goal was to create a framework encompassing the domains of clinical, technical, regulatory, legal and financial considerations that impact the arrangement and success of such partnerships.

A phase sensitive x-ray breast tomosynthesis system: Preliminary patient images with cancer lesions.

Phase-sensitive x-ray imaging continues to attract research for its ability to visualize weakly absorbing details like those often encountered in biology and medicine. We have developed and assembled the first inline-based high-energy phase sensitive breast tomosynthesis (PBT) system, which is currently undergoing patient imaging testing at a clinical site. The PBT system consists of a microfocus polychromatic x-ray source and a direct conversion-based flat panel detector coated with a 1 mm thick amorphous selenium layer allowing a high detective quantum efficiency at high energies. The PBT system scans a compressed breast over 15° with 9 angular projection views. The high-energy scan parameters are carefully selected to ensure similar or lower mean glandular dose levels to the clinical standard of care systems. Phase retrieval and data binning are applied to the phase contrast angular projection views and a filtered back-projection algorithm is used to reconstruct the final images. This article reports the distributions of radiation dose versus thickness of the compressed breasts at 59 and 89 kV and sample PBT images acquired from 3 patients. Preliminary PBT images demonstrate the feasibility of this new imaging modality to acquire breast images at lower radiation dose as compared to the clinical digital breast tomosynthesis system with enhanced lesion characteristics (i.e. lesion spiculation and margins).

Development and preclinical evaluation of a patient-specific high energy x-ray phase sensitive breast tomosynthesis system.

BACKGROUND: This article reports the first x-ray phase sensitive breast tomosynthesis (PBT) system that is aimed for direct translation to clinical practice for the diagnosis of breast cancer. PURPOSE: To report the preclinical evaluation and comparison of the newly built PBT system with a conventional digital breast tomosynthesis (DBT) system. METHODS AND MATERIALS: The PBT system is developed based on a comprehensive inline phase contrast theoretical model. The system consists of a polyenergetic microfocus x-ray source and a flat panel detector mounted on an arm that is attached to a rotating gantry. It acquires nine projections over a 15° angular span in a stop-and-shoot manner. A dedicated phase retrieval algorithm is integrated with a filtered back-projection method that reconstructs tomographic slices. The American College of Radiology (ACR) accreditation phantom, a contrast detail (CD) phantom and mastectomy tissue samples were imaged at the same glandular dose levels by both the PBT and a standard of care DBT system for image quality characterizations and comparisons. RESULTS: The PBT imaging scores with the ACR phantom are in good to excellent range and meet the quality assurance criteria set by the Mammography Quality Standard Act. The CD phantom image comparison and associated statistical analyses from two-alternative forced-choice reader studies confirm the improvement offered by the PBT system in terms of contrast resolution, spatial resolution, and conspicuity. The artifact spread function (ASF) analyses revealed a sizable lateral spread of metal artifacts in PBT slices as compared to DBT slices. Signal-to-noise ratio values for various inserts of the ACR and CD phantoms further validated the superiority of the PBT system. Mastectomy sample images acquired by the PBT system showed a superior depiction of microcalcifications vs the DBT system. CONCLUSION: The PBT imaging technology can be clinically employed for improving the accuracy of breast cancer screening and diagnosis.

Cancer cases from ACRIN digital mammographic imaging screening trial: radiologist analysis with use of a logistic regression model.

PURPOSE: To determine which factors contributed to the Digital Mammographic Imaging Screening Trial (DMIST) cancer detection results. MATERIALS AND METHODS: This project was HIPAA compliant and institutional review board approved. Seven radiologist readers reviewed the film hard-copy (screen-film) and digital mammograms in DMIST cancer cases and assessed the factors that contributed to lesion visibility on both types of images. Two multinomial logistic regression models were used to analyze the combined and condensed visibility ratings assigned by the readers to the paired digital and screen-film images. RESULTS: Readers most frequently attributed differences in DMIST cancer visibility to variations in image contrast--not differences in positioning or compression--between digital and screen-film mammography. The odds of a cancer being more visible on a digital mammogram--rather than being equally visible on digital and screen-film mammograms--were significantly greater for women with dense breasts than for women with nondense breasts, even with the data adjusted for patient age, lesion type, and mammography system (odds ratio, 2.28; P < .0001). The odds of a cancer being more visible at digital mammography--rather than being equally visible at digital and screen-film mammography--were significantly greater for lesions imaged with the General Electric digital mammography system than for lesions imaged with the Fischer (P = .0070) and Fuji (P = .0070) devices. CONCLUSION: The significantly better diagnostic accuracy of digital mammography, as compared with screen-film mammography, in women with dense breasts demonstrated in the DMIST was most likely attributable to differences in image contrast, which were most likely due to the inherent system performance improvements that are available with digital mammography. The authors conclude that the DMIST results were attributable primarily to differences in the display and acquisition characteristics of the mammography devices rather than to reader variability.

Phase-contrast diffuse optical tomography for in vivo breast imaging: a two-step method.

We present a two-step reconstruction method that can qualitatively and quantitatively improve the reconstruction of tissue refractive index (RI) distribution by phase-contrast diffuse optical tomography (PCDOT). In this two-step method, we first recover the distribution of tissue absorption and scattering coefficients by conventional diffuse optical tomography to obtain the geometrical information of lesions, allowing the incorporation of geometrical information as a priori in the PCDOT reconstruction using a locally refined mesh. The method is validated by a series of phantom experiments and evaluated using in vivo data from 42 human subjects. The results demonstrate clear contrast of RI between the lesion and the surroundings, making the image interpretation straightforward. The sensitivity and specificity from these 42 cases are both 81% when RI is used as an imaging parameter for distinguishing between malignant and benign lesions.

Diagnostic performance of digital versus film mammography for breast-cancer screening.

BACKGROUND: Film mammography has limited sensitivity for the detection of breast cancer in women with radiographically dense breasts. We assessed whether the use of digital mammography would avoid some of these limitations. METHODS: A total of 49,528 asymptomatic women presenting for screening mammography at 33 sites in the United States and Canada underwent both digital and film mammography. All relevant information was available for 42,760 of these women (86.3 percent). Mammograms were interpreted independently by two radiologists. Breast-cancer status was ascertained on the basis of a breast biopsy done within 15 months after study entry or a follow-up mammogram obtained at least 10 months after study entry. Receiver-operating-characteristic (ROC) analysis was used to evaluate the results. RESULTS: In the entire population, the diagnostic accuracy of digital and film mammography was similar (difference between methods in the area under the ROC curve, 0.03; 95 percent confidence interval, -0.02 to 0.08; P=0.18). However, the accuracy of digital mammography was significantly higher than that of film mammography among women under the age of 50 years (difference in the area under the curve, 0.15; 95 percent confidence interval, 0.05 to 0.25; P=0.002), women with heterogeneously dense or extremely dense breasts on mammography (difference, 0.11; 95 percent confidence interval, 0.04 to 0.18; P=0.003), and premenopausal or perimenopausal women (difference, 0.15; 95 percent confidence interval, 0.05 to 0.24; P=0.002). CONCLUSIONS: The overall diagnostic accuracy of digital and film mammography as a means of screening for breast cancer is similar, but digital mammography is more accurate in women under the age of 50 years, women with radiographically dense breasts, and premenopausal or perimenopausal women. (ClinicalTrials.gov number, NCT00008346.)

Diagnostic accuracy of digital versus film mammography: exploratory analysis of selected population subgroups in DMIST.

PURPOSE: To retrospectively compare the accuracy of digital versus film mammography in population subgroups of the Digital Mammographic Imaging Screening Trial (DMIST) defined by combinations of age, menopausal status, and breast density, by using either biopsy results or follow-up information as the reference standard. MATERIALS AND METHODS: DMIST included women who underwent both digital and film screening mammography. Institutional review board approval at all participating sites and informed consent from all participating women in compliance with HIPAA was obtained for DMIST and this retrospective analysis. Areas under the receiver operating characteristic curve (AUCs) for each modality were compared within each subgroup evaluated (age < 50 vs 50-64 vs >or= 65 years, dense vs nondense breasts at mammography, and pre- or perimenopausal vs postmenopausal status for the two younger age cohorts [10 new subgroups in toto]) while controlling for multiple comparisons (P < .002 indicated a significant difference). All DMIST cancers were evaluated with respect to mammographic detection method (digital vs film vs both vs neither), mammographic lesion type (mass, calcifications, or other), digital machine type, mammographic and pathologic size and diagnosis, existence of prior mammographic study at time of interpretation, months since prior mammographic study, and compressed breast thickness. RESULTS: Thirty-three centers enrolled 49 528 women. Breast cancer status was determined for 42,760 women, the group included in this study. Pre- or perimenopausal women younger than 50 years who had dense breasts at film mammography comprised the only subgroup for which digital mammography was significantly better than film (AUCs, 0.79 vs 0.54; P = .0015). Breast Imaging Reporting and Data System-based sensitivity in this subgroup was 0.59 for digital and 0.27 for film mammography. AUCs were not significantly different in any of the other subgroups. For women aged 65 years or older with fatty breasts, the AUC showed a nonsignificant tendency toward film being better than digital mammography (AUCs, 0.88 vs 0.70; P = .0025). CONCLUSION: Digital mammography performed significantly better than film for pre- and perimenopausal women younger than 50 years with dense breasts, but film tended nonsignificantly to perform better for women aged 65 years or older with fatty breasts.

Automated breast cancer classification using near-infrared optical tomographic images.

An automated procedure for detecting breast cancer using near-infrared (NIR) tomographic images is presented. This classification procedure automatically extracts attributes from three imaging parameters obtained by an NIR imaging system. These parameters include tissue absorption and reduced scattering coefficients, as well as a tissue refractive index obtained by a phase-contrast-based reconstruction approach. A support vector machine (SVM) classifier is utilized to distinguish the malignant from the benign lesions using the automatically extracted attributes. The classification results of in vivo tomographic images from 35 breast masses using absorption, scattering, and refractive index attributes demonstrate high sensitivity, specificity, and overall accuracy of 81.8%, 91.7%, and 88.6% respectively, while the classification sensitivity, specificity, and overall accuracy are 63.6%, 83.3%, and 77.1%, respectively, when only the absorption and scattering attributes are used. Furthermore, the automated classification procedure provides significantly improved specificity and overall accuracy for breast cancer detection compared to those by an experienced technician through visual examination.