| 1. |
- Duffy, Stephen W., et al.
(author)
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Mammography screening reduces rates of advanced and fatal breast cancers : Results in 549,091 women
- 2020
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In: Cancer. - : John Wiley & Sons. - 0008-543X .- 1097-0142. ; 126:13, s. 2971-2979
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Journal article (peer-reviewed)abstract
- Background: It is of paramount importance to evaluate the impact of participation in organized mammography service screening independently from changes in breast cancer treatment. This can be done by measuring the incidence of fatal breast cancer, which is based on the date of diagnosis and not on the date of death.Methods: Among 549,091 women, covering approximately 30% of the Swedish screening‐eligible population, the authors calculated the incidence rates of 2473 breast cancers that were fatal within 10 years after diagnosis and the incidence rates of 9737 advanced breast cancers. Data regarding each breast cancer diagnosis and the cause and date of death of each breast cancer case were gathered from national Swedish registries. Tumor characteristics were collected from regional cancer centers. Aggregated data concerning invitation and participation were provided by Sectra Medical Systems AB. Incidence rates were analyzed using Poisson regression.Results: Women who participated in mammography screening had a statistically significant 41% reduction in their risk of dying of breast cancer within 10 years (relative risk, 0.59; 95% CI, 0.51‐0.68 [P < .001]) and a 25% reduction in the rate of advanced breast cancers (relative risk, 0.75; 95% CI, 0.66‐0.84 [P < .001]).Conclusions: Substantial reductions in the incidence rate of breast cancers that were fatal within 10 years after diagnosis and in the advanced breast cancer rate were found in this contemporaneous comparison of women participating versus those not participating in screening. These benefits appeared to be independent of recent changes in treatment regimens.
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| 2. |
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| 3. |
- Leifland, Karin
(author)
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Comparison of stereotactic fine needle aspiration biopsy and core needle biopsy in breast lesions
- 2004
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Doctoral thesis (other academic/artistic)abstract
- Purpose: The purpose of this study was to evaluate the diagnostic value of two biopsy methods by comparing stereotactic fine needle aspiration biopsy (S-FNAB) with stereotactic core needle biopsy (S-CNB). The biopsies were performed by the same radiologist, in the same breast lesion on the same occasion, in order to establish which method that best can be recommended in different kind of mammographically detected lesions. All lesions that were surgically extirpated after the stereotactic biopsies and had final post-operativ pathological anatomical diagnoses (PAD) were included in this study. Introduction: In Sweden fine needle aspiration biopsy (FNAB) has been successfully used in breast lesions since the 1960th due to both excellent biopsy technique and cytologists. Cytology is not standard procedure in many countries, due to lack of experienced cytologic diagnosticians and incorrect biopsy technique. Thus surgical biopsies have been performed instead of needle biopsies in many places. During the 1970th core needle biopsy (CNB) was developed and the method has later been refined. When we started our study 1993, CNB was not used in breast lesions in Sweden. Biopsy technique: Spinal needles with diameter 0.7 and 0.9 mm were used for S-FNAB and an average of three needle biopsies per lesion were taken. For S-CNB a needle with diameter 2.1 mm and 23 mm throw was used. Three needle biopsies per lesion were taken. Paper I: Between May 1993 and June 1998 pre-operative S-FNAB and S-CNB were performed on a single occasion in 22 breast lesions where post-operative PAD showed invasive lobular cancer (ILC). S-FNAB diagnosed cancer in nine (41 %) and probable cancer in five of the 22 lesions. In three cases S-FNAB showed atypia and in five normal cells without any atypia. S-CNB diagnosed ILC in 20 (91 %) of the 22 patients, a mixture of ILC and invasive ductal cancer (IDC) in one lesion and ductal cancer in situ (DCIS) in the final lesion. In conclusion S-CNB was superior to S-FNAB in lesions where post-operative PAD diagnosed ILC. Paper II: In 72 breast lesions that pre-operatively underwent simultaneous S-FNAB and S-CNB between May 1993 and June 1999 post-operative PAD diagnosed ductal cancer in situ (DCIS). S-FNAB in these 72 lesions diagnosed cancer in 34 cases (47 %) and probable cancer in six lesions, atypia in 12 cases and in 20 tumors the material was benign or unsatisfactory. S-CNB in the same lesions performed on the same occasion diagnosed DCIS in 56 cases (78 %). Another three biopsies showed probable cancer, seven showed atypia and in six lesions only benign material was found. In four of the 72 lesions (6 %) S-FNAB was superior to S-CNB and diagnosed cancer. S-CNB in these four lesions diagnosed two probable cancer, one atypia and one with benign material. In another four cases both methods showed only benign material and in four lesions both methods found atypia. In all of these 12 cases the radiologist had recommeded surgical extirpation due to the suspicious mammographic appearance. Paper III: From May 1993 to December 2000 522 patients underwent surgical extirpation of a breast lesion after simultaneous pre-operative S-FNAB and S-CNB. In 448 of these cases post-operative histopatology diagnosed malignancy and in 74 a benign lesion. S-FNAB pre-operatively diagnosed 254 of the 448 cancers (57 %) and in 48 cases diagnosed probable cancer. S-CNB diagnosed 388 of the cancer cases (87 %) and in 18 probable cancer. S-FNAB was false negative in 96 patients (21 %), while S-CNB was false negative in 22 cases (5 %). In 16 of the 74 benign breast lesions (21 %) PAD diagnosed radial scar, which is considered pre-malignant. Paper IV: Between September 1994 and December 2000 three S-CNBs were taken from every lesion irrespectively of its mammographical appearance. The lesions were divided into three groups depending on their mammographical appearance; microcalcifications only (group I), a mass and microcalcifications (group II) and a mass, a star or distorsion without microcalcifications (group III). Every biopsy was analysed separately. 523 of these breast lesions were extirpated surgically with a post-operative PAD. 454 lesions were malignant (87 %) and 69 were benign. Three S-CNBs diagnosed malignancy in 84 % of all cases in group I. In group II 97 % got a correct pre-operative malignant diagnosis with three S-CNBs, while the correct diagnosis was made in 93 % in group III. These results indicate that three S-CNBs are enough in group II and group III but not sufficient in lesions with microcalcifications only (group I). In spite of the differences concerning diagnostic accuracy the post-operative PAD ratio malignant to benign in the three groups were essentially the same i.e. approximately 85 % malignant lesions. The reason for this is that the interpretation of the mammograms also has to be taken into account when deciding if a surgical extirpation shall be done or not and not only the cytological and histopathological results of the biopsies. Final conclusions: When only the biopsy methods are compared, the pre-operative diagnostic results are generally better with S-CNB than with S-FNAB, especially in lesions diagnosed as ILC and DCIS. S-FNAB in combination with S-CNB can be valuable, since few lesions are pre-operatively diagnostic only with S-FNAB. In clinical routine, the combination of the mammography and the biopsy methods must be evaluated together. A combination of mammography and three S-CNBs gives the best diagnostic outcome in all types of breast lesions.
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| 4. |
- Norell, Björn, et al.
(author)
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Lesion characterization using spectral mammography
- 2012
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In: Medical Imaging 2012. - : SPIE - International Society for Optical Engineering.
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Conference paper (peer-reviewed)abstract
- We present a novel method for characterizing mammographic findings using spectral imaging without the use of contrast agent. Within a statistical framework, suspicious findings are analyzed to determine if they are likely to be benign cystic lesions or malignant tissue. To evaluate the method, we have designed a phantom where combinations of different tissue types are realized by decomposition into the material bases aluminum and polyethylene. The results indicate that the lesion size limit for reliable characterization is below 10 mm diameter, when quantum noise is the only considered source of uncertainty. Furthermore, preliminary results using clinical images are encouraging, but allow no conclusions with significance.
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| 5. |
- Tabar, Laszlo, et al.
(author)
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Early detection of breast cancer rectifies inequality of breast cancer outcomes
- 2020
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In: Journal of Medical Screening. - : Sage Publications. - 0969-1413 .- 1475-5793. ; 28:1, s. 34-38
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Journal article (peer-reviewed)abstract
- Objectives: To explain apparent differences among mammography screening services in Sweden using individual data on participation in screening and with breast cancer-specific survival as an outcome.Methods: We analysed breast cancer survival data from the Swedish Cancer Register on breast cancer cases from nine Swedish counties diagnosed in women eligible for screening. Data were available on 38,278 breast cancers diagnosed and 4312 breast cancer deaths. Survival to death from breast cancer was estimated using the Kaplan-Meier estimate, for all cases in each county, and separately for cases of women participating and not participating in their last invitation to screening. Formal statistical comparisons of survival were made using proportional hazards regression.Results: All counties showed a reduction in the hazard of breast cancer death with participation in screening, but the reductions for individual counties varied substantially, ranging from 51% (95% confidence interval 46-55%) to 81% (95% confidence interval 74-85%). Survival rates in nonparticipating women ranged from 53% (95% confidence interval 40-65%) to 74% (95% confidence interval 72-77%), while the corresponding survival in women participating in screening varied from 80% (95% confidence interval 77-84%) to 86% (95% confidence interval 83-88%), a considerably narrower range.Conclusions: Differences among counties in the effect of screening on breast cancer outcomes were mainly due to variation in survival in women not participating in screening. Screening conferred similarly high survival rates in all counties. This indicates that the performance of screening services was similar across counties and that detection and treatment of breast cancer in early-stage reduces inequalities in breast cancer outcome.
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| 6. |
- van Schie, Guido, et al.
(author)
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Mass detection in reconstructed digital breast tomosynthesis volumes with a computer-aided detection system trained on 2D mammograms
- 2013
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In: Medical physics (Lancaster). - : Wiley. - 0094-2405. ; 40:4, s. 041902-
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Journal article (peer-reviewed)abstract
- Purpose: To develop a computer-aided detection (CAD) system for masses in digital breast tomosynthesis (DBT) which can make use of an existing CAD system for detection of breast masses in full-field digital mammography (FFDM). This approach has the advantage that large digital screening databases that are becoming available can be used for training. DBT is currently not used for screening which makes it hard to obtain sufficient data for training. Methods: The proposed CAD system is applied to reconstructed DBT volumes and consists of two stages. In the first stage, an existing 2D CAD system is applied to slabs composed of multiple DBT slices, after processing the slabs to a representation similar to that of the FFDM training data. In the second stage, the authors group detections obtained in the slabs that detect the same object and determine the 3D location of the grouped findings using one of three different approaches, including one that uses a set of features extracted from the DBT slabs. Experiments were conducted to determine performance of the CAD system, the optimal slab thickness for this approach and the best method to establish the 3D location. Experiments were performed using a database of 192 patients (752 DBT volumes). In 49 patients, one or more malignancies were present which were described as a mass, architectural distortion, or asymmetry. Free response receiver operating characteristic analysis and bootstrapping were used for statistical evaluation. Results: Best performance was obtained when slab thickness was in the range of 1-2 cm. Using the feature based 3D localization procedure developed in the study, accurate 3D localization could be obtained in most cases. Case sensitivities of 80% and 90% were achieved at 0.35 and 0.99 false positives per volume, respectively. Conclusions: This study indicates that there may be a large benefit in using 2D mammograms for the development of CAD for DBT and that there is no need to exclusively limit development to DBT data.
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| 7. |
- Wallis, Matthew G., et al.
(author)
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Two-View and Single-View Tomosynthesis versus Full-Field Digital Mammography : High-Resolution X-Ray Imaging Observer Study
- 2012
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In: Radiology. - : Radiological Society of North America (RSNA). - 0033-8419 .- 1527-1315. ; 262:3, s. 788-796
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Journal article (peer-reviewed)abstract
- Purpose: To compare the diagnostic accuracy of two-dimensional (2D) full-field digital mammography with that of two-view (mediolateral and craniocaudal) and single-view (mediolateral oblique) tomosynthesis in an observer study involving two institutions. Materials and Methods: Ethical committee approval was obtained. All participating women gave informed consent. Two hundred twenty women (mean age, 56.3; range, 40-80 years) with breast density of 2-4 according to American College of Radiology criteria were recruited between November 2008 and September 2009 and underwent standard treatment plus tomosynthesis with a prototype photon-counting machine. After exclusion criteria were met, this resulted in a final test set of 130 women. Ten accredited readers classified the 130 cases (40 cancers, 24 benign lesions, and 66 normal images) using 2D mammography and two-view tomosynthesis. Another 10 readers reviewed the same cases using 2D mammography but single-view tomosynthesis. The multireader, multicase receiver operating characteristic (ROC) method was applied. The significance of the observed difference in accuracy between 2D mammography and tomosynthesis was calculated. Results: For diagnostic accuracy, 2D mammography performed significantly worse than two-view tomosynthesis (average area under ROC curve [AUC] = 0.772 for 2D, AUC = 0.851 for tomosynthesis, P = .021). Significant differences were found for both masses and microcalcification (P = .037 and .049). The difference in AUC between the two modalities of 20.110 was significant (P = .03) only for the five readers with the least experience (<10 years of reading); with AUC of 20.047 for the five readers with 10 years or more experience (P = .25). No significant difference (P = .79) in reader performance was seen when 2D mammography (average AUC = 0.774) was compared with single-view tomosynthesis (average AUC = 0.775). Conclusion: Two-view tomosynthesis outperforms 2D mammography but only for readers with the least experience. The benefits were seen for both masses and microcalcification. No differences in classification accuracy was seen between and 2D mammography and single-view tomosynthesis.
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| 9. |
- Zanca, Federica, et al.
(author)
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Diagnostic accuracy of digital mammography versus tomosynthesis : effect of radiologists' experience
- 2012
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In: Medical Imaging 2012. - International Society for Optics and Photonics : SPIE. - 9780819489678 ; , s. 83180-83180
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Conference paper (peer-reviewed)abstract
- Purpose: To investigate whether readers' experience affects performance in a study comparing 2D digital mammography (2D) with 2-view (CC and MLO) or 1-view (MLO) tomosynthesis. Materials and Methods: One-hundred-thirty 2D cases were collected from screening assessment and referral clinics; 64 of the cases had verified abnormalities and the remaining were confirmed normal. Two-view tomosynthesis images were obtained from the same patients. Ten accredited readers (5 with ≥ 10 years experience in mammography and 5 with < 10 years) classified the cases in terms of malignancy (rate 0-5), and recall (yes/no), for both modalities. A second experiment was performed with the same cases, with 10 other readers (again 5 experienced / 5 less experienced), but using 2D and 1-view tomosynthesis as the two modalities. The multi-reader-multi-case ROC method was applied and the significance of diagnostic accuracy difference of 2D vs tomosynthesis was calculated, as a function of experience and for each experiment. Recall rate (RR) on malignant and benign cases was also calculated, along with reading time. Results: No significant difference was reached between 2D and 2-view tomosynthesis for experienced readers (pvalue= 0.25); for less experienced readers the p-value was significant (0.03). No significant difference was found between 2D and 1-view tomosynthesis, independent of readers' experience. RR for benign cases decreased for tomosynthesis (for booth 1- and 2-view), independent of experience. Average reading time per case was 79 s (range 65- 91 s) and 134 s (range 119-158 s) for experienced readers; 56 s (range 46-67 s) and 115s (range 97-142 s) for nonexperienced, for 2D and 2-view tomosynthesis respectively. Reading time was 74 s (range 43-98 s) and 99 s (range 73- 117 s) for experienced readers; 74 s (range 62-85 s) and 94 s (range 82-137 s) for non-experienced, for 2D and 1-view tomosynthesis respectively. Conclusions: For experienced readers, there is no evidence of improved diagnostic accuracy when using 2-view or 1- view tomosynthesis, while less experienced readers perform better with 2-view tomosynthesis than 2D images. Tomosynthesis reduces the number of recall of benign cases, without hindering cancer detection.
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