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2.
Value Health ; 23(9): 1246-1255, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940243

RESUMO

OBJECTIVES: Low uptake of cancer screening services is a global concern. Our aim was to understand factors that influence the screening decision, including screening and treatment subsidies and a gain-frame message designed to present screening as a win-win. METHODS: We analyzed preferences for mammography and Pap smear among women in Singapore by means of discrete choice experiments while randomly exposing half of respondents to a gain-framed public health message promoting the benefits of screening. RESULTS: Results showed that the message did not influence stated uptake, and given the levels shown, respondents were influenced more by treatment attributes, including effectiveness and out-of-pocket cost should they test positive, than by screening attributes, including the offer of a monetary incentive for screening. Respondents also underestimated the survival chances of screen-detected breast and cervical cancers. CONCLUSIONS: Combined, these findings suggest that correcting misconceptions about screen-detected cancer prognosis or providing greater financial protection for those who test positive could be more effective and more cost-effective than subsidizing screening directly in increasing screening uptakes.


Assuntos
Detecção Precoce de Câncer/psicologia , Mamografia/psicologia , Programas de Rastreamento/psicologia , Teste de Papanicolaou/psicologia , Adulto , Neoplasias da Mama/diagnóstico , Comportamento de Escolha , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Mamografia/economia , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Teste de Papanicolaou/economia , Singapura , Inquéritos e Questionários , Neoplasias do Colo do Útero/diagnóstico
3.
Medicine (Baltimore) ; 99(37): e22097, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925753

RESUMO

This study aimed to improve the diagnostic accuracy of breast diseases by combining breast imaging-reporting and data system (BI-RADS) with the enhancement intensity and pattern of contrast-enhanced spectral mammography (CESM) (this combination of BI-RADS and CESM was designated as BaC).BI-RADS was used to evaluate low-energy CESM images. Spearman nonparametric correlation analysis was performed to analyze the correlation between the enhancement intensity of CESM subtraction images and the pathological results. Odds ratio (OR) values were calculated to determine whether the enhancement pattern of CESM subtraction images is a risk factor for benign and malignant lesions. The diagnostic efficacies of BI-RADS, CESM, and BaC scores for benign and malignant breast diseases were analyzed using the receiver operating characteristic (ROC) curve.Lesions with a high enhancement intensity were more likely to be malignant than those with low enhancement intensity. Lesions with heterogeneous enhancement tended to be malignant, whereas those with homogeneous enhancement tended to be benign. No significant correlation was observed between ring enhancement and the benignity or malignancy of lesions. The area under the ROC curve of BaC was higher than that of BI-RADS or CESM, and the difference was statistically significant.The diagnostic efficacy of BI-RADS combined with CESM enhancement was superior to that of either method alone.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Mamografia , Intensificação de Imagem Radiográfica , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Adulto Jovem
4.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(9): 974-980, 2020 Sep 06.
Artigo em Chinês | MEDLINE | ID: mdl-32907288

RESUMO

Objective: To analyze the current status of breast cancer screening among females in Urban Beijing Cancer Screening Program, 2014-2019. Methods: Based on an on-going cancer screening program launched by the National Urban Cancer Screening Program, women residences aged 40 to 69 were recruited from 80 streets in six districts of Beijing (Dongcheng, Xicheng, Chaoyang, Haidian, Fengtai and Shijingshan District) using cluster sampling method. General demographic information and potential risk factors, results of clinical examination and follow-up outcomes of the target population (diagnosed breast cancer or not) were collected using epidemiological questionnaire, risk evaluation, clinical examination using ultrasound and (or) joint screening with mammography and follow-up, respectively. Proportion of high-risk cases evaluated by the questionnaire, recall rate, proportion of cases with BI-RADS grade 3 and BI-RADS grade 4/5, proportion of the cases with stage 0 or I, incidence rate and cumulative incidence rate were calculated. Cox proportional hazard regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (95%CI) among females who experienced different screening scenario. Results: A total of 53 916 women with the age of (57.2±7.3) completed high-risk assessment were included into analysis. The proportion of overweigh and obesity were 40.90% (22 053 cases) and 15.34% (8 270 cases), respectively. A total of 17 535 cases (32.52%) were evaluated as positive case detected by the questionnaire. The clinical recall rate was 47.64% (8 353 cases) among the high-risk females. The positive rate detected by ultrasound or mammography alone was 1.84% and 4.00%, while the suspicious positive detection rates were 14.50% and 17.83%, respectively. The positive rate and suspicious positive rate detected by joint screening using ultrasound and mammography were 5.44% and 27.74% respectively. In total, 252 cases were diagnosed with breast cancer after an average of 2.68 years follow-up. The incidence rate and cumulative incidence rate of breast cancer were 174.34/100 000 person years and 470/100 000, respectively. The early detection rate was 68.6% among the residences who received clinical examination. Compared with the negative residence evaluated by the questionnaire, the positive cases has a 55% higher risk of diagnosed with breast cancer (HR=1.55, 95%CI:1.20-2.00); Cases that recognized by baseline ultrasound and mammography joint screening as BI-RADS 4/5 and BI-RADS 3 have higher risk of diagnosed with breast cancer than that of with the results of BI-RADS 1-2, with the HR of 12.60 (95%CI:6.49-24.47) and 1.89 (0.93-3.83), respectively. Conclusion: Females with high risk of breast cancer in Beijing have a better recall rate of receiving the clinical screening examination. Joint using ultrasonography and mammography in breast cancer screening can improve the positive detection rate among high risk females.


Assuntos
Neoplasias da Mama/epidemiologia , Detecção Precoce de Câncer , Adulto , Idoso , Pequim , Mama , Feminino , Humanos , Mamografia , Programas de Rastreamento , Pessoa de Meia-Idade , Medição de Risco
5.
Medicine (Baltimore) ; 99(39): e22405, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991467

RESUMO

This study aims to compare Quantra, as an automated volumetric breast density (Vbd) tool, with visual assessment according to ACR BI-RADS density categories and to determine its potential usage in clinical practice.Five hundred randomly selected screening and diagnostic mammograms were included in this retrospective study. Three radiologists independently assigned qualitative ACR BI-RADS density categories to the mammograms. Quantra automatically calculates the volumetric density data into the system. The readers were blinded to the Quantra and other readers assessment. Inter-reader agreement and agreement between Quantra and each reader were tested. Region under the curve (ROC) analysis was performed to obtain the cut-off value to separate dense from a non-dense breast. Results with P value <.05 was taken as significant.There were 40.4% Chinese, 27% Malays, 19% Indian and 3.6% represent other ethnicities. The mean age of the patients was 57. 15%, 45.6%, 30.4%, and 9% of patients fall under BI-RADS A, B, C and D density category respectively. Fair agreement with Kappa (κ) value: 0.49, 0.38, and 0.30 were seen for Reader 1, 2 and 3 versus Quantra. Moderate agreement with κ value: 0.63, 0.64, 0.51 was seen when the data were dichotomized (density A and B to "non-dense", C and D to "dense"). The cut-off Vbd value was 13.5% to stratify dense from non-dense breasts with a sensitivity of 86.2% and specificity of 83.1% (AUC 91.4%; confidence interval: 88.8, 94.1).Quantra showed moderate agreement with radiologists visual assessment. Hence, this study adds to the available evidence to support the potential use of Quantra as an adjunct tool for breast density assessment in routine clinical practice in the Asian population. We found 13.5% is the best cut-off value to stratify dense to non-dense breasts in our study population. Its application will provide an objective, consistent and reproducible results as well as aiding clinical decision-making on the need for supplementary breast ultrasound in our screening population.


Assuntos
Densidade da Mama , Mama/diagnóstico por imagem , Mamografia/métodos , Software , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
In Vivo ; 34(5): 3047-3053, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32871851

RESUMO

BACKGROUND/AIM: Coronavirus disease is spreading worldwide. Due to fast transmission and high fatality rate drastic emergency restrictions were issued. During the lockdown, only urgent medical services are guaranteed. All non-urgent services, as breast cancer (BC) screening, are temporarily suspended. The potential of breast cancer screening programs in increasing the survival rate and decreasing the mortality rate has been widely confirmed. Suspension could lead to worse outcomes for breast cancer patients. Our study aimed to analyse the data and provide estimates regarding the temporary BC screening suspension. PATIENTS AND METHODS: Data regarding breast cancer and respective screening programs were achieved through literature research and analysis. RESULTS: Considering three different scenarios with respect to the lockdown's impact on breast cancer screening, we estimate that approximately 10,000 patients could have a missed diagnosis during these 3 months. Considering a 6-month period, as suggested by the Imperial college model, the number of patients who will not receive a diagnosis will rise to 16,000. CONCLUSION: Breast cancer screening should be resumed as soon as possible in order to avoid further breast cancer missed diagnosis and reduce the impact of delayed diagnosis.


Assuntos
Neoplasias da Mama/diagnóstico , Infecções por Coronavirus/epidemiologia , Detecção Precoce de Câncer , Programas de Rastreamento/tendências , Pneumonia Viral/epidemiologia , Idoso , Betacoronavirus/patogenicidade , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Feminino , Humanos , Mamografia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia
7.
Adv Exp Med Biol ; 1252: 17-25, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816258

RESUMO

All breast disorders found during pregnancy and lactation should be carefully evaluated. Most of them are benign, but it is essential to exclude pregnancy-associated breast cancer (PABC), which is too often diagnosed late. The first-line imaging technique is ultrasound (US), which must be completed by mammography if there is any clinical or US suspicious sign . In lactating patients with PABC , breast magnetic resonance imaging (MRI) can be useful for local assessment.Management depends on the precise analysis and BI-RADS classification of the lesion. During pregnancy and lactation, there is an overlap in imaging: many benign lesions can grow, infarct, become heterogeneous and thus suspicious, and on the other hand, PABC does not always present with typical malignant features. That is why biopsy must be performed if after the clinical and radiological evaluation the doubt persists, i.e. for all BI-RADS 4 and 5 lesions, and for some BI-RADS 3 lesions.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Mama/diagnóstico por imagem , Lactação , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Mamografia , Gravidez
8.
Ann R Coll Surg Engl ; 102(8): 577-580, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32777930

RESUMO

INTRODUCTION: An increasing quantity of data is required to guide precision medicine and advance future healthcare practices, but current analytical methods often become overwhelmed. Artificial intelligence (AI) provides a promising solution. Plastic surgery is an innovative surgical specialty expected to implement AI into current and future practices. It is important for all plastic surgeons to understand how AI may affect current and future practice, and to recognise its potential limitations. METHODS: Peer-reviewed published literature and online content were comprehensively reviewed. We report current applications of AI in plastic surgery and possible future applications based on published literature and continuing scientific studies, and detail its potential limitations and ethical considerations. FINDINGS: Current machine learning models using convolutional neural networks can evaluate breast mammography and differentiate benign and malignant tumours as accurately as specialist doctors, and motion sensor surgical instruments can collate real-time data to advise intraoperative technical adjustments. Centralised big data portals are expected to collate large datasets to accelerate understanding of disease pathogeneses and best practices. Information obtained using computer vision could guide intraoperative surgical decisions in unprecedented detail and semi-autonomous surgical systems guided by AI algorithms may enable improved surgical outcomes in low- and middle-income countries. Surgeons must collaborate with computer scientists to ensure that AI algorithms inform clinically relevant health objectives and are interpretable. Ethical concerns such as systematic biases causing non-representative conclusions for under-represented patient groups, patient confidentiality and the limitations of AI based on the quality of data input suggests that AI will accompany the plastic surgeon, rather than replace them.


Assuntos
Inteligência Artificial , Interpretação de Imagem Assistida por Computador , Procedimentos Cirúrgicos Reconstrutivos , Big Data , Mama/diagnóstico por imagem , Mama/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamografia
9.
Medicine (Baltimore) ; 99(30): e21095, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791685

RESUMO

RATIONALE: Anaplastic large T-cell lymphoma (BI-ALCL) is a rare primitive lymphoma described in women with breast implant prostheses, which has been arousing interest in recent years due to its potentially high social impact. The difficult diagnosis associated with the high and increasing number of prosthetic implants worldwide has led to hypothesize an underestimation of the real impact of the disease among prosthesis-bearing women. The aim of this work is to search for specific radiological signs of disease linked to the chronic inflammatory pathogenetic mechanism. PATIENT CONCERNS: This work describes a case of BI-ALCL in an American woman with no personal or family history of cancer, who underwent breast augmentation for esthetic purposes at our Institute. After about 10 years of relative well-being, the patient returned to our Institute with clear evidence of breast asymmetry due to the increase in volume of the right breast which had progressively become larger over a period of 6 months. There was no evidence of palpable axillary lymph nodes or other noteworthy signs. DIAGNOSIS: The ultrasound and magnetic resonance (MR) tests indicated the presence of seroma with amorphous material in the exudate which was confirmed by indirect signs, visible in right breast mammography. Due to suspected cold seroma, an ultrasound-guided needle aspiration was performed for the cytological analysis of the effusion which highlighted the presence of a number of large-sized atypical cells with an irregular nucleus with CD30 immunoreactivity, leucocyte common antigen (CD45) compatible with the BI-ALCL diagnosis. INTERVENTIONS: In our case, a capsulectomy was performed because the disease was limited inside the capsule and periprosthetic seroma. The final histological examination confirmed the stage. LESSONS: The patient is being monitored and shows no signs of recurrence of disease >24 months after surgery. CONCLUSION: A diagnosis of BI-ALCL can be reached using new radiological indicators, such as fibrin, which is clearly visible by MR in the form of nonvascularized debris of amorphous material hypointense in all sequences, free flowing or adhered to the external surface of the prosthesis.


Assuntos
Implantes de Mama/efeitos adversos , Linfoma Anaplásico de Células Grandes/diagnóstico por imagem , Biópsia por Agulha , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Linfoma Anaplásico de Células Grandes/etiologia , Linfoma Anaplásico de Células Grandes/patologia , Imagem por Ressonância Magnética , Mamografia , Pessoa de Meia-Idade , Seroma/diagnóstico por imagem , Ultrassonografia Mamária
10.
Medicine (Baltimore) ; 99(34): e21764, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846803

RESUMO

RATIONALE: Triple or more primary malignancies are rare, with only 23 previous cases including breast cancer reported in the English language studies between January 1990 and December 2019. PATIENT CONCERNS: The patient was a 67-year-old woman with a mass in her right breast. She had a previous history of uterine and colon cancer. Both ultrasonography and mammography revealed a Breast Imaging Reporting and Data System (BI-RADS) category 3 breast lesion, in which proliferative nodules are more likely. Given her previous history of 2 malignancies, her doctors strongly recommended a biopsy. DIAGNOSIS AND INTERVENTIONS: The biopsy pathology suggested intraductal breast cancer. Mastectomy and sentinel lymph node biopsy were performed. The postoperative pathological diagnosis was invasive ductal carcinoma, grade II, stage I. The sample was positive for estrogen receptor and progesterone receptor and negative for cerbB-2. No radiotherapy or chemotherapy was administered except for endocrine therapy. A follow-up at 19 months showed no breast recurrence or distant metastases. OUTCOMES: No recurrence or distant metastasis occurred within the 19-month, 11-year, and 20-year follow-ups for breast, colon, and uterine cancers, respectively. LESSONS: To our knowledge, this is the first review of triple or more primary malignancies including breast cancer. These malignancies occur predominantly in older female patients. The most prevalent tumors of triple or more primary malignancies including breast cancer occur in the colon, uterus, and lung. A favorable prognosis is associated with early-stage malignancies.


Assuntos
Neoplasias da Mama/complicações , Neoplasias do Colo/complicações , Neoplasias Uterinas/complicações , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Feminino , Humanos , Mamografia , Mastectomia , Biópsia de Linfonodo Sentinela
11.
Lancet Oncol ; 21(9): 1165-1172, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32800099

RESUMO

BACKGROUND: The appropriate age range for breast cancer screening remains a matter of debate. We aimed to estimate the effect of mammographic screening at ages 40-48 years on breast cancer mortality. METHODS: We did a randomised, controlled trial involving 23 breast screening units across Great Britain. We randomly assigned women aged 39-41 years, using individual randomisation, stratified by general practice, in a 1:2 ratio, to yearly mammographic screening from the year of inclusion in the trial up to and including the calendar year that they reached age 48 years (intervention group), or to standard care of no screening until the invitation to their first National Health Service Breast Screening Programme (NHSBSP) screen at approximately age 50 years (control group). Women in the intervention group were recruited by postal invitation. Women in the control group were unaware of the study. The primary endpoint was mortality from breast cancers (with breast cancer coded as the underlying cause of death) diagnosed during the intervention period, before the participant's first NHSBSP screen. To study the timing of the mortality effect, we analysed the results in different follow-up periods. Women were included in the primary comparison regardless of compliance with randomisation status (intention-to-treat analysis). This Article reports on long-term follow-up analysis. The trial is registered with the ISRCTN registry, ISRCTN24647151. FINDINGS: 160 921 women were recruited between Oct 14, 1990, and Sept 24, 1997. 53 883 women (33·5%) were randomly assigned to the intervention group and 106 953 (66·5%) to the control group. Between randomisation and Feb 28, 2017, women were followed up for a median of 22·8 years (IQR 21·8-24·0). We observed a significant reduction in breast cancer mortality at 10 years of follow-up, with 83 breast cancer deaths in the intervention group versus 219 in the control group (relative rate [RR] 0·75 [95% CI 0·58-0·97]; p=0·029). No significant reduction was observed thereafter, with 126 deaths versus 255 deaths occurring after more than 10 years of follow-up (RR 0·98 [0·79-1·22]; p=0·86). INTERPRETATION: Yearly mammography before age 50 years, commencing at age 40 or 41 years, was associated with a relative reduction in breast cancer mortality, which was attenuated after 10 years, although the absolute reduction remained constant. Reducing the lower age limit for screening from 50 to 40 years could potentially reduce breast cancer mortality. FUNDING: National Institute for Health Research Health Technology Assessment programme.


Assuntos
Fatores Etários , Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/normas , Mamografia/normas , Adulto , Idoso , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Feminino , Humanos , Mamoplastia , Pessoa de Meia-Idade , Sistema de Registros , Reino Unido
13.
Zhonghua Yi Xue Za Zhi ; 100(30): 2367-2371, 2020 Aug 11.
Artigo em Chinês | MEDLINE | ID: mdl-32791813

RESUMO

Objective: To analyze the screening results of breast cancer in rural women in Fujian Province from 2015 to 2018, and to explore the screening mode of breast cancer. Methods: Breast cancer screening was provided for 35-64 years old rural women in Fujian province. Color Doppler ultrasound was used as the primary screening method. Suspected patients were referred to mammography. Color Doppler ultrasound and breast X -ray 4-5 grade were diagnosed by pathology. Results: The incidence of breast cancer from 2015 to 2018 was 56.96/10 million, 94.41/10 million, 71.61/10 million, and 73.05/10 million, respectively. And the peak age of breast cancer was (46-55) years. From 2015 to 2018, the proportion of cancer in situ showed an overall upward trend. The sensitivity of color Doppler ultrasound was 79.06%, and the sensitivity of mammography for those diagnosed abnormally by ultrasound was 91.88%. Conclusion: Breast cancer screening for women of the right age is an important measure to raise the rate of early diagnosis and early treatment and reduce the mortality of breast cancer. Screening mode based on breast ultrasound is the most suitable technology. We need to further expand the coverage of screening, improve the screening system and process, and ensure the health of women.


Assuntos
Neoplasias da Mama , Detecção Precoce de Câncer , Adulto , Feminino , Humanos , Mamografia , Programas de Rastreamento , Pessoa de Meia-Idade , Ultrassonografia Mamária
14.
Ther Umsch ; 77(2): 81-84, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32633223

RESUMO

New Trends in Breast Imaging Abstract. The examination of the breast, especially as a screening examination for breast cancer, has so far been carried out primarily by means of mammography and occasionally supplementary ultrasound. These check-ups have become established because early diagnosis of breast cancer increases the chances of recovery. Breast cancer is the most common cancer in women (approximately every 8th woman is affected). While the MRI examination, which offers a high level of sensitivity and specificity, has so far established itself as a further clarification, new examination methods have emerged in the recent past, which on the one hand make the examination more pleasant for women (e. g. no compression of the mammary gland tissue, as is the case with mammography) and which could potentially be diagnostically equivalent. In particular, this article mentions automatic breast ultrasound (ABUS) and computer tomography of the breast (breast CT). In the future, programs with artificial intelligence could also help confirm the diagnoses or increase accuracy so that no relevant lesion is overlooked.


Assuntos
Inteligência Artificial , Neoplasias da Mama , Feminino , Humanos , Imagem por Ressonância Magnética , Mamografia , Sensibilidade e Especificidade , Ultrassonografia Mamária
15.
Br J Radiol ; 93(1114): 20200495, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32667855

RESUMO

As tomosynthesis is rapidly adopted by breast imaging practices, tomosynthesis-guided procedures are increasingly being performed. Tomosynthesis-guided needle localizations are feasible and efficient and allow for localization of tomosynthesis-only findings or one-view findings, which may be difficult to localize under standard digital mammography. In this review, we describe our step-by-step approach for performing tomosynthesis-guided localizations of the breast and axilla using a standard tomosynthesis unit.


Assuntos
Axila/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Biópsia Guiada por Imagem/métodos , Axila/patologia , Neoplasias da Mama/patologia , Feminino , Humanos , Mamografia , Intensificação de Imagem Radiográfica
16.
Br J Radiol ; 93(1114): 20200363, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32730088

RESUMO

OBJECTIVES: This study aims to explore the reading performances of radiologists in detecting cancers on mammograms using Tabar Breast Imaging Reporting and Data System (BIRADS) classification and identify factors related to breast imaging reporting scores. METHODS: 117 readings of five different mammogram test sets with each set containing 20 cancer and 40 normal cases were performed by Australian radiologists. Each radiologist evaluated the mammograms using the BIRADS lexicon with category 1 - negative, category 2 - benign findings, category 3 - equivocal findings (Recall), category 4 - suspicious findings (Recall), and category 5 - highly suggestive of malignant findings (Recall). Performance metrics (true positive, false positive, true negative, and false negative) were calculated for each radiologist and the distribution of reporting categories was analyzed in reader-based and case-based groups. The association of reader characteristics and case features among categories was examined using Mann-Whitney U and Kruskal-Wallis tests. RESULTS: 38% of cancer-containing mammograms were reported with category 3 which decreased to 32.3% with category 4 and 16.2% with category 5 while 16.6 and 10.3% of cancer cases were marked with categories 1 and 2. Female readers had less false-negative rates when using categories 1 and 2 for cancer cases than male readers (p < 0.01). A similar pattern as gender category was also found in Breast Screen readers and readers completed breast reading fellowships compared with non-Breast Screen and non-fellowship readers (p < 0.05). Radiologists with low number of cases read per week were more likely to record the cancer cases with category 4 while the ones with high number of cases were with category 3 (p < 0.01). Discrete mass and asymmetric density were the two types of abnormalities reported mostly as equivocal findings with category 3 (47-50%; p = 0.005) while spiculated mass or stellate lesions were mostly selected as highly suggestive of malignancy with category 5 (26%, p = 0.001). CONCLUSIONS: Most radiologists used category 3 when reporting cancer mammograms. Gender, working for BreastScreen, fellowship completion, and number of cases read per week were factors associated with scoring selection. Radiologists reported higher Tabar BIRADS category for specific types of abnormalities on mammograms than others. ADVANCES IN KNOWLEDGE: The study identified factors associated with the decision of radiologists in assigning a BIRADS Tabar score for mammograms with abnormality. These findings will be useful for individual training programs to improve the confidence of radiologists in recognizing abnormal lesions on screening mammograms.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Competência Clínica , Radiologistas , Austrália , Tomada de Decisões , Diagnóstico Diferencial , Feminino , Humanos , Mamografia , Variações Dependentes do Observador
17.
PLoS Comput Biol ; 16(7): e1008036, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32628726

RESUMO

The benefits of mammography screening have been controversial, with conflicting findings from various studies. We hypothesize that unmeasured heterogeneity in tumor aggressiveness underlies these conflicting results. Based on published data from the Canadian National Breast Screening Study (CNBSS), we develop and parameterize an individual-based mechanistic model for breast cancer incidence and mortality that tracks five stages of breast cancer progression and incorporates the effects of age on breast cancer incidence and all-cause mortality. The model accurately reproduces the reported outcomes of the CNBSS. By varying parameters, we predict that the benefits of mammography depend on the effectiveness of cancer treatment and tumor aggressiveness. In particular, patients with the most rapidly growing or potentially largest tumors have the highest benefit and least harm from the screening, with only a relatively small effect of age. However, the model predicts that confining mammography to populations with a high risk of acquiring breast cancer increases the screening benefit only slightly compared with the full population.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/mortalidade , Detecção Precoce de Câncer , Mamografia , Adulto , Idoso , Algoritmos , Biologia Computacional , Feminino , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Modelos Teóricos , Modelos de Riscos Proporcionais , Processos Estocásticos , Resultado do Tratamento
19.
Radiography (Lond) ; 26 Suppl 2: S49-S53, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32698948

RESUMO

INTRODUCTION: Radiologists' image reading skills vary, such variations in image interpretations can influence the effectiveness of the early treatment of disease and may have important clinical and economic implications. In screening mammography, clinical audits are used to assess radiologists' performance annually, however, the nature of these audits prevent robust data analysis due to the low prevalence of breast cancer and the long waiting periods for the audit results. Research-based evidence revealed a need for changes in the methods utilised to optimise the assessment of the efficacy of radiologists' interpretations. METHODS: A cloud-based platform was developed to assess and enhance radiologists' performance help reduce variability in medical image interpretations in a research environment; however, to address a number of limitations, the platform was commercialised to make it available worldwide. RESULTS: DetectED-X's team have been able to make their cloud-based platform available worldwide, tailored to the needs of radiologists and accredited for continuing medical/professional education; thus, changing the continuous professional development practice globally. CONCLUSION: DetectED-X's Rivelato, was developed to address a need for effective, available and affordable educational solutions for clinicians and health care workers wherever they are located. A true fusion of industry, academia, clinics and consumer to adapt to the growing needs of clinicians' around the world, the latest being COVID-19 global pandemic. DetectED-X repurposed its platform to educate physicians around the world on the appearances of COVID-19 on Lung Computed Tomography scans, introducing CovED to clinicians worldwide free of charge as a multi-national consortium of collaboration to help fight COVID-19, showing how research-based evidence can create effective and scalable change globally.


Assuntos
Competência Clínica , Educação Médica Continuada/métodos , Interpretação de Imagem Radiográfica Assistida por Computador , Radiologia/educação , Betacoronavirus , Neoplasias da Mama/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Mamografia , Pandemias , Pneumonia Viral/diagnóstico por imagem
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