Take a break: should breaks be enforced during digital breast tomosynthesis reading sessions?

OBJECTIVES: Digital breast tomosynthesis (DBT) can improve diagnostic accuracy compared to 2D mammography, but DBT reporting is time-consuming and potentially more fatiguing. Changes in diagnostic accuracy and subjective and objective fatigue were evaluated over a DBT reporting session, and the impact of taking a reporting break was assessed. MATERIALS AND METHODS: Forty-five National Health Service (NHS) mammography readers from 6 hospitals read a cancer-enriched set of 40 DBT cases whilst eye tracked in this prospective cohort study, from December 2020 to April 2022. Eye-blink metrics were assessed as objective fatigue measures. Twenty-one readers had a reporting break, 24 did not. Subjective fatigue questionnaires were completed before and after the session. Diagnostic accuracy and subjective and objective fatigue measures were compared between the cohorts using parametric and non-parametric significance testing. RESULTS: Readers had on average 10 years post-training breast screening experience and took just under 2 h (105.8 min) to report all cases. Readers without a break reported greater levels of subjective fatigue (44% vs. 33%, p = 0.04), which related to greater objective fatigue: an increased average blink duration (296 ms vs. 286 ms, p < 0.001) and a reduced eye-opening velocity (76 mm/s vs. 82 mm/s, p < 0.001). Objective fatigue increased as the trial progressed for the no break cohort only (ps < 0.001). No difference was identified in diagnostic accuracy between the groups (accuracy: 87% vs. 87%, p = 0.92). CONCLUSIONS: Implementing a break during a 2-h DBT reporting session resulted in lower levels of subjective and objective fatigue. Breaks did not impact diagnostic accuracy, which may be related to the extensive experience of the readers. CLINICAL RELEVANCE STATEMENT: DBT is being incorporated into many mammography screening programmes. Recognising that reporting breaks are required when reading large volumes of DBT studies ensures this can be factored in when setting up reading sessions. TRIAL REGISTRATION: Clinical trials registration number: NCT03733106 KEY POINTS: • Use of digital breast tomosynthesis (DBT) in breast screening programmes can cause significant reader fatigue. • The effectiveness of incorporating reading breaks into DBT reporting sessions, to reduce mammography reader fatigue, was investigated using eye tracking. • Integrating breaks into DBT reporting sessions reduced reader fatigue; however, diagnostic accuracy was unaffected.

Lessons learned from independent external validation of an AI tool to detect breast cancer using a representative UK data set.

OBJECTIVE: To pilot a process for the independent external validation of an artificial intelligence (AI) tool to detect breast cancer using data from the NHS breast screening programme (NHSBSP). METHODS: A representative data set of mammography images from 26,000 women attending 2 NHS screening centres, and an enriched data set of 2054 positive cases were used from the OPTIMAM image database. The use case of the AI tool was the replacement of the first or second human reader. The performance of the AI tool was compared to that of human readers in the NHSBSP. RESULTS: Recommendations for future external validations of AI tools to detect breast cancer are provided. The tool recalled different breast cancers to the human readers. This study showed the importance of testing AI tools on all types of cases (including non-standard) and the clarity of any warning messages. The acceptable difference in sensitivity and specificity between the AI tool and human readers should be determined. Any information vital for the clinical application should be a required output for the AI tool. It is recommended that the interaction of radiologists with the AI tool, and the effect of the AI tool on arbitration be investigated prior to clinical use. CONCLUSION: This pilot demonstrated several lessons for future independent external validation of AI tools for breast cancer detection. ADVANCES IN KNOWLEDGE: Knowledge has been gained towards best practice procedures for performing independent external validations of AI tools for the detection of breast cancer using data from the NHS Breast Screening Programme.

OPTIMAM Mammography Image Database: A Large-Scale Resource of Mammography Images and Clinical Data.

Supplemental material is available for this article.

The National Patient Notification Exercise: How well did local breast screening services cope with the additional workload?

OBJECTIVE: To describe how three English breast screening services responded to the 2018 Patient Notification Exercise, a national intervention whereby women who had potentially missed their final screening invitation were offered new appointments. To compare key performance indicators for women thus invited with key performance indicators for women invited routinely in the same period. METHODS: Uptake, assessment and cancer detection for 9439 women aged over 70 in the Patient Notification Exercise were compared with key performance indicators for 14,824 women, of similar age, who were routinely invited in the same period, using chi squared (χ2) tests. Invitation cancellation and attendance levels were also compared. RESULTS: Uptake was significantly lower among Patient Notification Exercise women sent a new, timed appointment than for women who were routinely invited (67.3% and 70.8%, respectively, p = 0.001). Assessment rates were higher for Patient Notification Exercise women (5.2% vs. 4.4%, p = 0.192) as were cancer detection rates (1.87% vs. 1.28%, p = 0.080). Services achieved national round-length standards for routine invitations during and after the Patient Notification Exercise but screen-to-assessment standards were breached (80%) in the smallest service. More Patient Notification Exercise women than routinely invited women rebooked appointments (43.6% and 33.2%, respectively); they were also slightly more likely to miss their appointments (24.5% vs. 21.2%). CONCLUSIONS: Screening invitation performance can be maintained whilst responding to an additional demand of ∼5%. Larger services that cover a compact geographical area may find it easier to respond. Women affected by the incident are not more likely to attend but may require relatively more assessment capacity in incidents where invitations have been delayed.

Pagets disease of uncertain origin: case report.

BACKGROUND: Pagets disease of the nipple presents as an eczematous lesion, occurs in 1 - 4% of all female breast carcinoma cases and is invariably associated with underlying malignancy either overt or occult. The majority of these cases are invasive disease although 40-45% are associated with DCIS. CASE PRESENTATION: A 39 year old lady presented to our unit with a palpable lump in the right breast. Radiological and histological investigation proved this to be an extensive area of Ductal Carcinoma in Situ (DCIS) for which she underwent a simple mastectomy and immediate latissimus dorsi flap reconstruction. Histology revealed high grade DCIS with 2 small foci of invasive carcinoma. At 1 year the patient represented with a nodule adjacent to the reconstruction scar which was proved on biopsy to be consistent with Paget's disease. This was proved on formal excision. CONCLUSION: In the absence of underlying breast or apocrine tissue this case details a case of Paget's disease of uncertain origin.