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The optimal mammography screening strategy for women aged 45-49 years is a matter of debate. We present the RIBBS study protocol, a quasi-experimental, prospective, population-based study comparing a risk- and breast density-stratified screening model (interventional cohort) with annual digital mammography (DM) screening (observational control cohort) in a real-world setting. The interventional cohort consists of 10,269 women aged 45 years enrolled between 2020 and 2021 from two provinces of the Veneto Region (northen Italy). At baseline, participants underwent two-view digital breast tomosynthesis (DBT) and completed the Tyrer-Cuzick risk prediction model. Volumetric breast density (VBD) was calculated from DBT and the lifetime risk (LTR) was estimated by including VBD among the risk factors. Based on VBD and LTR, women were classified into five subgroups with specific screening protocols for subsequent screening rounds: (1) LTR ≤ 17% and nondense breast: biennial DBT; (2) LTR ≤ 17% and dense breast: biennial DBT and ultrasound; (3) LTR 17-30% or LTR > 30% without family history of BC, and nondense breast: annual DBT; (4) LTR 17-30% or > 30% without family history of BC, and dense breast: annual DBT and ultrasound; and (5) LTR > 30% and family history of BC: annual DBT and breast MRI. The interventional cohort is still ongoing. An observational, nonequivalent control cohort of 43,000 women aged 45 years participating in an annual DM screening programme was recruited in three provinces of the neighbouring Emilia-Romagna Region. Cumulative incidence rates of advanced BC at three, five, and ten years between the two cohorts will be compared, adjusting for the incidence difference at baseline.Trial registration This study is registered on Clinicaltrials.gov (NCT05675085).
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Densidade da Mama , Neoplasias da Mama , Detecção Precoce de Câncer , Mamografia , Humanos , Feminino , Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Detecção Precoce de Câncer/métodos , Itália , Medição de Risco , Programas de Rastreamento/métodos , Fatores de RiscoRESUMO
PURPOSE: This study quantifies the impact on budget and cost per health benefit of implementing digital breast tomosynthesis (DBT) in place of digital mammography (DM) for breast cancer screening among asymptomatic women in Italy. METHODS: A budget impact analysis and a cost consequence analysis were conducted using parameters from the MAITA project and literature. The study considered four scenarios for DBT implementation, i.e., DBT for all women, DBT for women aged 45-49 years, DBT based on breast density (BI-RADS C + D or D only), and compared these to the current DM screening. Healthcare provider's perspective was adopted, including screening, diagnosis, and cancer treatment costs. RESULTS: Introducing DBT for all women would increase overall screening costs by 20%. Targeting DBT to women aged 45-49 years or with dense breasts would result in smaller cost increases (3.2% for age-based and 1.4-10.7% for density-based scenarios). The cost per avoided interval cancer was significantly higher when DBT was applied to all women compared to targeted approaches. The cost per gained early-detected cancer slightly increases in targeted approaches, while the assumptions on the clinical significance and overdiagnosis of cancers detected by DBT and not by DM have a strong impact. CONCLUSIONS: Implementing DBT as a primary breast cancer test in screening programs in Italy would lead to a substantial increase in costs. Tailoring DBT use to women aged 45-49 or with dense breasts could enhance the feasibility and sustainability of the intervention. Further research is needed to clarify the impact of DBT on overdiagnosis and the long-term outcomes.
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PURPOSE: We present a comprehensive investigation into the organizational, social, and ethical impact of implementing digital breast tomosynthesis (DBT) as a primary test for breast cancer screening in Italy. The analyses aimed to assess the feasibility of DBT specifically for all women aged 45-74, women aged 45-49 only, or those with dense breasts only. METHODS: Questions were framed according to the European Network of Health Technology Assessment (EuNetHTA) Screening Core Model to produce evidence for the resources, equity, acceptability, and feasibility domains of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) decision framework. The study integrated evidence from the literature, the MAITA DBT trials, and Italian pilot programs. Structured interviews, surveys, and systematic reviews were conducted to gather data on organizational impact, acceptability among women, reading and acquisition times, and the technical requirements of DBT in screening. RESULTS: Implementing DBT could significantly affect the screening program, primarily due to increased reading times and the need for additional human resources (radiologists and radiographers). Participation rates in DBT screening were similar, if not better, to those observed with standard digital mammography, indicating good acceptability among women. The study also highlighted the necessity for specific training for radiographers. The interviewed key persons unanimously considered feasible tailored screening strategies based on breast density or age, but they require effective communication with the target population. CONCLUSIONS: An increase in radiologists' and radiographers' workload limits the feasibility of DBT screening. Tailored screening strategies may maximize the benefits of DBT while mitigating potential challenges.
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Neoplasias da Mama , Detecção Precoce de Câncer , Mamografia , Humanos , Feminino , Neoplasias da Mama/diagnóstico por imagem , Itália , Mamografia/métodos , Pessoa de Meia-Idade , Idoso , Detecção Precoce de Câncer/métodos , Estudos de ViabilidadeRESUMO
Assessment of treatment response in patients (pts) with leptomeningeal metastases (LM) represents a significant challenge and standardized criteria are needed. In 2017, the RANO LM Working Group proposed a standardized scorecard to evaluate MRI findings (further simplified in 2019). Here, we aim to validate the prognostic impact of response to treatment assessed using this tool in a multicentric cohort of breast cancer (BC) pts. Pts with BC-related LM diagnosed at two institutions between 2005 and 2018 were identified. Baseline and follow-up MRI scans were centrally reviewed and response assessment was evaluated using 2019 revised RANO LM criteria. A total of 142 pts with BC-related LM and available baseline brain MRI imaging were identified; 60 of them had at least one follow-up MRI. In this subgroup, median overall survival (OS) was 15.2 months (95%CI 9.5-21.0). At first re-evaluation, radiological response by RANO criteria was: complete response (CR) in 2 pts (3%), partial response (PR) in 12 (20%), stable disease (SD) in 33 (55%) and progression of disease (PD) in 13 (22%). Median OS was 31.1 months (HR 0.10, 95%CI 0.01-0.78) in pts with CR, 16.1 months (HR 0.41, 95%CI 0.17-0.97) in pts with PR, 17.9 months (HR 0.45, 95%CI 0.22-0.91) in pts with SD and 9.5 months in pts with PD (P = .029). A second blinded evaluation showed a moderate interobserver agreement (K = 0.562). Radiological response according to 2019 RANO criteria is significantly associated with OS in pts with BC-related LM, thus supporting the use of this evaluation tool both in trials and clinical practice.
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Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/diagnóstico por imagem , Prognóstico , Imageamento por Ressonância Magnética/métodos , Mama , Estudos RetrospectivosRESUMO
INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) has disrupted health services worldwide. The evidence on the impact of the pandemic on cancer care provision, however, is conflicting. We aimed to audit the management of patients diagnosed with early breast cancer (EBC) during the pandemic in a large, tertiary-level cancer center in Italy. METHODS: We conducted a cross-sectional study to track the route to first treatment for patients diagnosed with EBC during 2019, 2020, and 2021. We abstracted data for all consecutive patients referred to the Veneto Institute of Oncology (Padua, Italy). We defined as point of contact (POC) the date of the first consultation with a breast cancer specialist of the breast unit. First treatment was defined as either upfront surgery or neoadjuvant chemotherapy (NACT). RESULTS: We reviewed medical records for 878 patients for whom an MDT report during 2019-2021 (April through June) was available. Of these, 431 (49%) were eligible. The proportion of screen-detected tumors was larger in 2019 and 2021 than in 2020 (59%). Conversely, the proportion of screen-detected tumors was offset by the proportion of palpable tumors in 2020 (Pâ =â .004). Distribution of tumor and nodal stage was unchanged over time, but in situ tumors were slightly fewer in 2020 than in 2019 or 2021. The adjusted odds ratio for treatment delay (45 days or more) was 0.87 for 2020 versus 2019 (95% CI, 0.5-1.53) and 0.9 for 2021 versus 2019 (95% CI, 0.52-1.55). CONCLUSIONS: There was no evidence for major changes in the management of patients with EBC during 2019-2021 and no treatment delays were observed. Our findings suggest that more women presented with palpable nodules at diagnosis, but the stage distribution did not change over time. Validation on a larger cohort of patients is warranted to robustly assess the impact of the COVID-19 pandemic on treatment practices for patients with EBC.
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Neoplasias da Mama , COVID-19 , Humanos , Feminino , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , COVID-19/epidemiologia , Estudos Transversais , Pandemias , Itália/epidemiologiaRESUMO
OBJECTIVE: To improve breast radiographers' individual performance by using automated software to assess the correctness of breast positioning and compression in tomosynthesis screening. MATERIALS AND METHODS: In this retrospective longitudinal analysis of prospective cohorts, six breast radiographers with varying experience in the field were asked to use automated software to improve their performance in breast compression and positioning. The software tool automatically analyzes craniocaudal (CC) and mediolateral oblique (MLO) views for their positioning quality by scoring them according to PGMI classifications (perfect, good, moderate, inadequate) and checking whether the compression pressure is within the target range. The positioning and compression data from the studies acquired before the start of the project were used as individual baselines, while the data obtained after the training were used to test whether conscious use of the software could help the radiographers improve their performance. The percentage of views rated perfect or good and the percentage of views in target compression were used as overall metrics to assess changes in performance. RESULTS: Following the use of the software, all radiographers significantly increased the percentage of images rated as perfect or good in both CCs and MLOs. Individual improvements ranged from 7 to 14% for CC and 10 to 16% for MLO views. Moreover, most radiographers exhibited improved compression performance in CCs, with improvements up to 16%. CONCLUSION: Active use of a software tool to automatically assess the correctness of breast compression and positioning in breast cancer screening can improve the performance of radiographers. CLINICAL RELEVANCE STATEMENT: This study suggests that the use of a software tool for automatically evaluating correctness of breast compression and positioning in breast cancer screening can improve the performance of radiographers on these metrics, which may ultimately lead to improved screening outcomes. KEY POINTS: ⢠Proper breast positioning and compression are critical in breast cancer screening to ensure accurate diagnosis. ⢠Active use of the software increased the quality of craniocaudal and mediolateral oblique views acquired by all radiographers. ⢠Improved performance of radiographers is expected to improve screening outcomes.
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BACKGROUND: Despite recommendations, mammography screening is often insufficiently integrated into specialist breast centres. A national, cross-sectional, voluntary, online survey on this issue was carried out among the Italian breast centres associated with Senonetwork, the Italian network of breast cancer services. METHODS: A 73-item questionnaire was created, pre-tested and piloted. Centres integrating and not integrating a screening programme were compared using the unified theory of acceptance and use of technology (UTAUT) model. Centres' clustering was performed using the Gower's distance metric. Groups and clusters were compared with the equality-of-means test. RESULTS: The response rate was 82/128 (65%). Overall, 84% (69/82) breast centres reported a collaboration with a screening programme in performing and/or reading mammograms and in the diagnostic work-up of women with abnormal screening results. The same proportion was observed among those centres responding to all questions (62/74). Performance expectancies (or the perceived usefulness of integration in terms of clinical quality, patient convenience, ease of job, and professional growth), satisfaction and motivation were higher in those centres collaborating with the screening programme. Effort expectancy indicators (or the degree to which the respondents believe that the integration is easy to implement) and those concerning the existence of facilitating conditions were lower both in centres collaborating and not collaborating with the screening programme. Among the former, six clusters of centres, distributed from 'no integration' to 'high', were identified. In cluster analysis, the highest level of integration was associated with higher agreement that integration eases the job, offers better opportunities for professional growth, and makes the working environment more satisfactory. The least integrated cluster assigned the lowest score to the statement that local health authority made available the resources needed. CONCLUSIONS: While confirming the positive effects of integrating screening programmes into breast centres, this survey has brought to light specific difficulties that must be faced. The results provide insights into the importance of integration focusing on the perspectives of professional career and motivation. The deficiency of facilitating conditions to integration is modifiable. Screening professionals' societies may have a role as initiators of the integration. Other supporting actions may be included in health laws at the national and regional level.
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Neoplasias da Mama , Mamografia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/prevenção & controle , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Humanos , ItáliaRESUMO
INTRODUCTION: In 2016, the Italian Group for Mammography Screening and the Italian College of Breast Radiologists by the Italian Society of Medical and Interventional Radiology recommended that screening programmes and specialist breast centres actively invite women with a history of breast cancer to follow-up imaging. OBJECTIVE: A survey of breast centres associated with Senonetwork, the Italian network of breast cancer services, has offered the opportunity to assess the implementation of this recommendation. METHODS: A national, cross-sectional, voluntary, online survey was developed, pre-tested, and administered during the months July-October 2020. Five of the 73 questionnaire items concerned breast cancer follow-up. RESULTS: The response rate was 82/128 (65%). Of the 82 respondent centres, 69 (84%) were involved in a screening programme. Fifty-six (68%) reported the presence of a programme of active invitation to breast cancer follow-up targeted at patients living in their catchment area, with a significant north-to-south gradient. Four centres (5%) reported that the screening programme was responsible for actively initiating follow-up during the 10-year period since diagnosis. Only after 10 years did the proportion increase moderately. CONCLUSION: Screening programmes have still a marginal role in active breast cancer follow-up.
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Neoplasias da Mama , Detecção Precoce de Câncer , Assistência ao Convalescente , Neoplasias da Mama/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Mamografia , Programas de Rastreamento , RadiologistasRESUMO
BACKGROUND: Radiology is an essential tool in the management of a patient. The aim of this manuscript was to build structured report (SR) Mammography based in Breast Cancer. METHODS: A working team of 16 experts (group A) was composed to create a SR for Mammography Breast Cancer. A further working group of 4 experts (group B), blinded to the activities of the group A, was composed to assess the quality and clinical usefulness of the SR final draft. Modified Delphi process was used to assess level of agreement for all report sections. Cronbach's alpha (Cα) correlation coefficient was used to assess internal consistency and to measure quality analysis according to the average inter-item correlation. RESULTS: The final SR version was built by including n = 2 items in Personal Data, n = 4 items in Setting, n = 2 items in Comparison with previous breast examination, n = 19 items in Anamnesis and clinical context; n = 10 items in Technique; n = 1 item in Radiation dose; n = 5 items Parenchymal pattern; n = 28 items in Description of the finding; n = 12 items in Diagnostic categories and Report and n = 1 item in Conclusions. The overall mean score of the experts and the sum of score for structured report were 4.9 and 807 in the second round. The Cronbach's alpha (Cα) correlation coefficient was 0.82 in the second round. About the quality evaluation, the overall mean score of the experts was 3.3. The Cronbach's alpha (Cα) correlation coefficient was 0.90. CONCLUSIONS: Structured reporting improves the quality, clarity and reproducibility of reports across departments, cities, countries and internationally and will assist patient management and improve breast health care and facilitate research.
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Neoplasias da Mama , Neoplasias da Mama/diagnóstico por imagem , Técnica Delphi , Feminino , Humanos , Mamografia , Reprodutibilidade dos Testes , Raios XRESUMO
Background Few results are available about subsequent outcomes after screening with digital breast tomosynthesis (DBT). Purpose To compare the diagnostic accuracy of a screening round with DBT plus synthetic mammography (SM) (hereafter, DBT+SM) and the repeat screening round with DBT with SM (hereafter, DBT+SM) or full-field digital mammography (FFDM) with FFDM screening. Materials and Methods This prospective study (Verona Pilot Study, clinical trial identification: 2015/1238) included women screened with DBT+SM between April 2015 and March 2017 and rescreened with DBT+SM or FFDM between April 2017 and March 2019. Screening performance (recall rate, cancer detection rate [CDR], and positive predictive value of recall [PPV1]) was compared with that obtained from 28 680 women screened with FFDM between 2013 and 2014 (control group). Cancer stages were compared between modalities and screening rounds. A χ2 test was used to evaluate differences. P < .05 was indicative of a statistically significant difference. Results Of 34 638 women enrolled, 32 870 (median age, 58 years; age range, 52-71 years) underwent repeat screening-16 198 with DBT+SM and 16 672 with FFDM. The CDR was higher for repeat screening with DBT+SM than for the control group with FFDM (8.1 per 1000 women screened vs 4.5 per 1000 women screened, respectively; P < .01) and was not significantly lower for repeat screening with FFDM (3.5 per 1000 women screened vs 4.5 per 1000 women screened, respectively; P = .11). Compared with the control group, there was no difference in the recall rate at repeat screening with both DBT+SM (3.71% vs 3.40%, respectively; P = .10) and FFDM (3.71% vs 3.69%, P = .92), whereas PPV1 was higher only when repeat screening was performed with DBT+SM (23.8% vs 12.0%, P < .01). At repeat screening, the proportion of cancers stage II or higher was 14.5% (19 of 131 cancers) with DBT+SM and 8.5% (five of 59 cancers) with FFDM, both of which were lower than the proportion in the control group with FFDM (30 of 110 cancers, 27.3%) (P ≤ .01). Conclusion At repeat screening, digital breast tomosynthesis plus synthetic mammography depicted more cancers than full-field digital mammography (FFDM) and found a lower number of stage II cancers compared with FFDM. © RSNA, 2020 See also the editorial by Bae in this issue.
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Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Idoso , Mama/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
The Italian College of Breast Radiologists by the Italian Society of Medical Radiology (SIRM) provides recommendations for breast care provision and procedural prioritization during COVID-19 pandemic, being aware that medical decisions must be currently taken balancing patient's individual and community safety: (1) patients having a scheduled or to-be-scheduled appointment for in-depth diagnostic breast imaging or needle biopsy should confirm the appointment or obtain a new one; (2) patients who have suspicious symptoms of breast cancer (in particular: new onset palpable nodule; skin or nipple retraction; orange peel skin; unilateral secretion from the nipple) should request non-deferrable tests at radiology services; (3) asymptomatic women performing annual mammographic follow-up after breast cancer treatment should preferably schedule the appointment within 1 year and 3 months from the previous check, compatibly with the local organizational conditions; (4) asymptomatic women who have not responded to the invitation for screening mammography after the onset of the pandemic or have been informed of the suspension of the screening activity should schedule the check preferably within 3 months from the date of the not performed check, compatibly with local organizational conditions. The Italian College of Breast Radiologists by SIRM recommends precautions to protect both patients and healthcare workers (radiologists, radiographers, nurses, and reception staff) from infection or disease spread on the occasion of breast imaging procedures, particularly mammography, breast ultrasound, breast magnetic resonance imaging, and breast intervention procedures.
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Agendamento de Consultas , Betacoronavirus , Neoplasias da Mama/diagnóstico por imagem , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Radiologia , Sociedades Médicas , Assistência ao Convalescente/organização & administração , Doenças Assintomáticas , Neoplasias da Mama/psicologia , Neoplasias da Mama/terapia , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Detecção Precoce de Câncer/normas , Feminino , Humanos , Itália , Doenças Profissionais/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , SARS-CoV-2 , Avaliação de Sintomas/métodos , Avaliação de Sintomas/normasRESUMO
BACKGROUND: The Verona population-based breast cancer (BC) screening program provides biennial mammography to women aged 50-69 years. Based on emerging evidence of enhanced detection, the program transitioned to digital breast tomosynthesis (DBT) screening. METHODS: This is a prospective pilot evaluation of DBT with synthesised 2D mammography screening implemented during April 2015-March 2017; the rate and characteristics of cancers detected at DBT screening were compared with those detected at the preceding digital mammography (DM) screening round (April 2013-March 2015) in the same screening program. Distribution of imaging and tumour characteristics were compared. RESULTS: Amongst 34,071 women screened in the Verona DBT pilot, 315 BCs were detected; 153 BCs were detected amongst 29,360 women in the DM screening round. Estimated CDRs were 9.2/1000 (95% CI 8.3-10.3) DBT screens versus 5.2/1000 (95% CI 4.4-6.1) DM screens, P < 0.001. Statistically significant differences were found in the distribution of whether recall by one/both screen readers (more BCs recalled by both readers at DBT than DM); whether detected on one/two views (higher proportion detected on only one view at DBT than DM); type of radiological lesions; tumour stage, pT and histological categories (lower proportion of DCIS/pTis, higher proportions of pT1a and pT1b, and higher proportion of invasive cancers of special types, at DBT than DM); and tumour grade (higher proportion of grade I at DBT than DM). There were no differences in distributions of nodal and hormone receptor (ER/PR) status. CONCLUSIONS: Our findings provide early insights into the extent that transitioning to DBT screening may modify the characteristics of screen-detected breast cancer to inform discussion regarding pros and cons of DBT screening; although our data provide some reassurance that DBT does not increase the proportion of screen-detected DCIS, they highlight mixed findings on comparative tumour characteristics, suggesting a potential for enhancing screening benefit and possibly also over-diagnosis from DBT screening.
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Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Detecção Precoce de Câncer , Mamografia , Idoso , Neoplasias da Mama/mortalidade , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Mamografia/métodos , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Vigilância da População , PrognósticoRESUMO
Purpose To examine the outcomes of a breast cancer screening program based on digital breast tomosynthesis (DBT) plus synthesized two-dimensional (2D) mammography compared with those after full-field digital mammography (FFDM). Materials and Methods This prospective study included 16 666 asymptomatic women aged 50-69 years who were recruited in April 2015 through March 2016 for DBT plus synthetic 2D screening in the Verona screening program. A comparison cohort of women screened with FFDM (n = 14 423) in the previous year was included. Screening detection measures for the two groups were compared by calculating the proportions associated with each outcome, and the relative rates (RRs) were estimated with multivariate logistic regression. Results Cancer detection rate (CDR) for DBT plus synthetic 2D imaging was 9.30 per 1000 screening examinations versus 5.41 per 1000 screening examinations with FFDM (RR, 1.72; 95% confidence interval [CI]: 1.30, 2.29). CDR was significantly higher in patients screened with DBT plus synthetic 2D imaging than in those screened with FFDM among women classified as having low breast density (RR, 1.53; 95% CI: 1.13, 2.10) or high breast density (RR, 2.86; 95% CI: 1.42, 6.25). The positive predictive value (PPV) for recall was almost doubled with DBT plus synthetic 2D imaging: 23.3% versus 12.9% of recalled patients who were screened with FFDM (RR, 1.81; 95% CI: 1.34, 2.47). The recall rate was similar between groups (RR, 0.95; 95% CI: 0.84, 1.06), whereas the recall rate with invasive assessment was higher for DBT plus synthetic 2D imaging than for FFDM (RR, 1.93; 95% CI: 1.31, 2.03). The mean number of screening studies interpreted per hour was significantly lower for screening examinations performed with DBT plus synthetic 2D imaging (38.5 screens per hour) than with FFDM (60 screens per hour) (P < .001). Conclusion DBT plus synthetic 2D imaging increases CDRs with recall rates comparable to those of FFDM. DBT plus synthetic 2D imaging increased image reading time and the time needed for invasive assessments. © RSNA, 2017.
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Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Programas de Rastreamento/métodos , Idoso , Mama/diagnóstico por imagem , Feminino , Humanos , Itália , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
OBJECTIVES: To test 3T proton magnetic resonance spectroscopy (1H-MRS) for breast mass lesions. METHODS: Patients with BI-RADS 4-5 lesions at mammography/ultrasound were prospectively enrolled. After contrast-enhanced breast MRI, single-voxel MRS (point-resolved volume selection, PRESS); pencil-beam shimming; volume of interest 1 cm3; TR/TE = 3000/135 ms) was performed. Spectra were considered reliable if the full width at half maximum (FWHM) of the water peak was ≤45 Hz. A signal-to-noise ratio of the total choline (tCho) peak at 3.21 ppm ≥2 was used as cutoff for malignancy. All lesions underwent needle sampling. Final pathology was available for all malignant lesions; for benign lesions the reference standard was final pathology or at least 1-year negative follow-up. RESULTS: Reliable spectra were obtained in 115/127 lesions (91%), with a mean FWHM of 32.4 Hz (range 8-45 Hz). A tCho peak SNR ≥2 was detected in 66 malignant lesions (62 invasive cancers; 4 ductal carcinoma in situ) and in 3 benign lesions. Excluding lesions located ≤1 cm from the skin (n = 3) or pectoral muscle (n = 11), sensitivity was 65/73 [89%, 95% confidence interval (CI): 80-95%], and specificity 25/28 (89%) (95% CI: 72-98%). Considering only invasive cancers, sensitivity reached 61/68 (90%, 95% CI: 81-96%). MRS additional time was 8 min. CONCLUSIONS: When lesions close to the skin or pectoral muscle are excluded, 3T 1H-MRS of mass lesions ≥1 cm showed a high diagnostic performance, however, insufficient to avoid needle biopsy.
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Neoplasias da Mama/diagnóstico , Espectroscopia de Prótons por Ressonância Magnética , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Água Corporal , Mama/química , Mama/patologia , Neoplasias da Mama/química , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/química , Carcinoma Intraductal não Infiltrante/diagnóstico , Carcinoma Intraductal não Infiltrante/patologia , Colina , Intervalos de Confiança , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Músculos Peitorais/diagnóstico por imagem , Estudos Prospectivos , Sensibilidade e Especificidade , Razão Sinal-Ruído , Ultrassonografia MamáriaRESUMO
This position paper, issued by ICBR/SIRM and GISMa, summarizes the evidence on DBT and provides recommendations for its use. In the screening setting, DBT in adjunct to digital mammography (DM) increased detection rate by 0.5-2.7 and decreased false positives by 0.8-3.6% compared to DM alone in observational and double-testing experimental studies. The reduction in recall rate could be less prominent in those screening programs which already have low recall rates with DM. The increase in radiation exposure associated with DM/DBT protocols has been solved by the introduction of synthetic mammograms (sDM) reconstructed from DBT datasets. Thus, whenever possible, sDM/DBT should be preferred to DM/DBT. However, before introducing DBT as a routine screening tool for average-risk women, we should wait for the results of randomized controlled trials and for a statistically significant and clinically relevant reduction in the interval cancer rate, hopefully associated with a reduction in the advanced cancer rate. Otherwise, a potential for overdiagnosis and overtreatment cannot be excluded. Studies exploring this issue are ongoing. Screening of women at intermediate risk should follow the same recommendations, with particular protocols for women with previous BC history. In high-risk women, if mammography is performed as an adjunct to MRI or in the case of MRI contraindications, sDM/DBT protocols are suggested. Evidence exists in favor of DBT usage in women with clinical symptoms/signs and asymptomatic women with screen-detected findings recalled for work-up. The possibility to perform needle biopsy or localization under DBT guidance should be offered when DBT-only findings need characterization or surgery.
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Neoplasias da Mama/diagnóstico por imagem , Mamografia , Detecção Precoce de Câncer , Medicina Baseada em Evidências , Feminino , Humanos , ItáliaRESUMO
Women who underwent chest radiation therapy (CRT) during pediatric/young-adult age (typically, lymphoma survivors) have an increased breast cancer risk, in particular for high doses. The cumulative incidence from 40 to 45 years of age is 13-20 %, similar to that of BRCA mutation carriers for whom contrast-enhanced magnetic resonance imaging (MRI) is recommended. However, in women who underwent CRT, MRI sensitivity is lower (63-80 %) and that of mammography higher (67-70 %) than those observed in women with hereditary predisposition, due to a higher incidence of ductal carcinoma in situ with microcalcifications and low neoangiogenesis. A sensitivity close to 95 % can be obtained only using mammography as an adjunct to MRI. Considering the available evidence, women who underwent CRT before 30 receiving a cumulative dose ≥10 Gy should be invited after 25 (or, at least, 8 years after CRT) to attend the following program: 1. interview about individual risk profile and potential of breast imaging; 2. annual MRI using the same protocol recommended for women with hereditary predisposition; 3. annual bilateral two-view full-field digital mammography or digital breast tomosynthesis (DBT) with synthetic 2D reconstructions. Mammography and MRI can be performed at once or alternately every 6 months. In the case of MRI or contrast material contraindications, ultrasound will be performed instead of MRI. Reporting using BI-RADS is recommended. At the age for entering population screening, the individual risk profile will be discussed with the woman about opting for only mammography/DBT screening or for continuing the intensive protocol.
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Neoplasias da Mama/diagnóstico por imagem , Linfoma/radioterapia , Imageamento por Ressonância Magnética , Mamografia , Neoplasias Induzidas por Radiação/diagnóstico por imagem , Vigilância da População , Adulto , Consenso , Meios de Contraste , Feminino , Humanos , Itália , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Women who were previously treated for breast cancer (BC) are an important particular subgroup of women at intermediate BC risk. Their breast follow-up should be planned taking in consideration a 1.0-1.5 % annual rate of loco-regional recurrences and new ipsilateral or contralateral BCs during 15-20 years, and be based on a regional/district invitation system. This activity should be carried out by a Department of Radiology integrating screening and diagnostics in the context of a Breast Unit. We recommend the adoption of protocols dedicated to women previously treated for BC, with a clear definition of responsibilities, methods for invitation, site(s) of visits, methods for clinical and radiological evaluation, follow-up duration, role and function of family doctors and specialists. These women will be invited to get a mammogram in dedicated sessions starting from the year after the end of treatment. The planned follow-up duration will be at least 10 years and will be defined on the basis of patient's age and preferences, taking into consideration organizational matters. Special agreements can be defined in the case of women who have their follow-up planned at other qualified centers. Dedicated screening sessions should include: evaluation of familial/personal history (if previously not done) for identifying high-risk conditions which could indicate a different screening strategy; immediate evaluation of mammograms by one or, when possible, two breast radiologists with possible addition of supplemental mammographic views, digital breast tomosynthesis, clinical breast examination, breast ultrasound; and prompt planning of possible further workup. Results of these screening sessions should be set apart from those of general female population screening and presented in dedicated reports. The following research issues are suggested: further risk stratification and effectiveness of follow-up protocols differentiated also for BC pathologic subtype and molecular classification, and evaluation of different models of survivorship care, also in terms of cost-effectiveness.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Continuidade da Assistência ao Paciente , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Neoplasias da Mama/terapia , Consenso , Feminino , Humanos , Itália , Mamografia , Programas de Rastreamento , Medição de Risco , Sociedades MédicasRESUMO
BACKGROUND: Digital breast tomosynthesis with 3D images might overcome some of the limitations of conventional 2D mammography for detection of breast cancer. We investigated the effect of integrated 2D and 3D mammography in population breast-cancer screening. METHODS: Screening with Tomosynthesis OR standard Mammography (STORM) was a prospective comparative study. We recruited asymptomatic women aged 48 years or older who attended population-based breast-cancer screening through the Trento and Verona screening services (Italy) from August, 2011, to June, 2012. We did screen-reading in two sequential phases-2D only and integrated 2D and 3D mammography-yielding paired data for each screen. Standard double-reading by breast radiologists determined whether to recall the participant based on positive mammography at either screen read. Outcomes were measured from final assessment or excision histology. Primary outcome measures were the number of detected cancers, the number of detected cancers per 1000 screens, the number and proportion of false positive recalls, and incremental cancer detection attributable to integrated 2D and 3D mammography. We compared paired binary data with McNemar's test. FINDINGS: 7292 women were screened (median age 58 years [IQR 54-63]). We detected 59 breast cancers (including 52 invasive cancers) in 57 women. Both 2D and integrated 2D and 3D screening detected 39 cancers. We detected 20 cancers with integrated 2D and 3D only versus none with 2D screening only (p<0.0001). Cancer detection rates were 5.3 cancers per 1000 screens (95% CI 3.8-7.3) for 2D only, and 8.1 cancers per 1000 screens (6.2-10.4) for integrated 2D and 3D screening. The incremental cancer detection rate attributable to integrated 2D and 3D mammography was 2.7 cancers per 1000 screens (1.7-4.2). 395 screens (5.5%; 95% CI 5.0-6.0) resulted in false positive recalls: 181 at both screen reads, and 141 with 2D only versus 73 with integrated 2D and 3D screening (p<0.0001). We estimated that conditional recall (positive integrated 2D and 3D mammography as a condition to recall) could have reduced false positive recalls by 17.2% (95% CI 13.6-21.3) without missing any of the cancers detected in the study population. INTERPRETATION: Integrated 2D and 3D mammography improves breast-cancer detection and has the potential to reduce false positive recalls. Randomised controlled trials are needed to compare integrated 2D and 3D mammography with 2D mammography for breast cancer screening. FUNDING: National Breast Cancer Foundation, Australia; National Health and Medical Research Council, Australia; Hologic, USA; Technologic, Italy.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Lobular/diagnóstico por imagem , Detecção Precoce de Câncer/normas , Mamografia/métodos , Tomografia Computadorizada por Raios X , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/epidemiologia , Carcinoma Ductal de Mama/patologia , Carcinoma Intraductal não Infiltrante/epidemiologia , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Lobular/epidemiologia , Carcinoma Lobular/patologia , Feminino , Seguimentos , Humanos , Itália/epidemiologia , Pessoa de Meia-Idade , Invasividade Neoplásica , Prognóstico , Estudos Prospectivos , Interpretação de Imagem Radiográfica Assistida por ComputadorRESUMO
BACKGROUND: Automatic exposure control (AEC) plays a crucial role in mammography by determining the exposure conditions needed to achieve specific image quality based on the absorption characteristics of compressed breasts. This study aimed to characterize the behavior of AEC for digital mammography (DM), digital breast tomosynthesis (DBT), and low-energy (LE) and high-energy (HE) acquisitions used in contrast-enhanced mammography (CEM) for three mammography systems from two manufacturers. METHODS: Using phantoms simulating various breast thicknesses, 363 studies were acquired using all available AEC modes 165 DM, 132 DBT, and 66 LE-CEM and HE-CEM. AEC behaviors were compared across systems and modalities to assess the impact of different technical components and manufacturers' strategies on the resulting mean glandular doses (MGDs) and image quality metrics such as contrast-to-noise ratio (CNR). RESULTS: For all systems and modalities, AEC increased MGD for increasing phantom thicknesses and decreased CNR. The median MGD values (interquartile ranges) were 1.135 mGy (0.772-1.668) for DM, 1.257 mGy (0.971-1.863) for DBT, 1.280 mGy (0.937-1.878) for LE-CEM, and 0.630 mGy (0.397-0.713) for HE-CEM. Medians CNRs were 14.2 (7.8-20.2) for DM, 4.91 (2.58-7.20) for a single projection in DBT, 11.9 (8.0-18.2) for LE-CEM, and 5.2 (3.6-9.2) for HE-CEM. AECs showed high repeatability, with variations lower than 5% for all modes in DM, DBT, and CEM. CONCLUSIONS: The study revealed substantial differences in AEC behavior between systems, modalities, and AEC modes, influenced by technical components and manufacturers' strategies, with potential implications in radiation dose and image quality in clinical settings. RELEVANCE STATEMENT: The study emphasized the central role of automatic exposure control in DM, DBT, and CEM acquisitions and the great variability in dose and image quality among manufacturers and between modalities. Caution is needed when generalizing conclusions about differences across mammography modalities. KEY POINTS: ⢠AEC plays a crucial role in DM, DBT, and CEM. ⢠AEC determines the "optimal" exposure conditions needed to achieve specific image quality. ⢠The study revealed substantial differences in AEC behavior, influenced by differences in technical components and strategies.
Assuntos
Mamografia , Intensificação de Imagem Radiográfica , Doses de Radiação , Intensificação de Imagem Radiográfica/métodos , Mamografia/métodos , Imagens de FantasmasRESUMO
Radiomics, analysing quantitative features from medical imaging, has rapidly become an emerging field in translational oncology. Radiomics has been investigated in several neoplastic malignancies as it might allow for a non-invasive tumour characterization and for the identification of predictive and prognostic biomarkers. Over the last few years, evidence has been accumulating regarding potential clinical applications of machine learning in many crucial moments of cancer patients' history. However, the incorporation of radiomics in clinical decision-making process is still limited by low data reproducibility and study variability. Moreover, the need for prospective validations and standardizations is emerging. In this narrative review, we summarize current evidence regarding radiomic applications in high-incidence cancers (breast and lung) for screening, diagnosis, staging, treatment choice, response, and clinical outcome evaluation. We also discuss pro and cons of the radiomic approach, suggesting possible solutions to critical issues which might invalidate radiomics studies and propose future perspectives.