L rotenberg, g lenczner premalignant breast lesion imaging jfim hanoi 2015 compLuc ROTENBERG
This document discusses breast premalignant lesions, their imaging appearance, diagnosis, and management. It provides information on lesions such as DCIS, ADH, ALH, and LCIS. Imaging modalities like mammography, ultrasound, and MRI can detect these lesions as masses, calcifications or other abnormalities. Biopsy is often used for diagnosis but may underestimate the lesion. Surgical excision is generally recommended when premalignant lesions are found on biopsy to rule out associated malignancy, though careful radiologic-pathologic correlation in some cases can guide observation over excision. Underestimation rates vary by biopsy method and number of specimens obtained.
The document discusses the evolution of colposcopy terminology and standards. It notes that terminology and techniques vary widely in different settings, making it difficult to compare outcomes and practices. The development of standardized terminology and rigorous training programs, like those in the UK, can help improve colposcopic accuracy and consistency between providers. The document also reviews studies on how factors like lesion size and excision dimensions may impact outcomes. It introduces new terminology for describing findings like the transformation zone type and ridge sign.
2 prof james bently differentiating high and low gradeTariq Mohammed
1) Differentiating between high grade (CIN 2/3) and low grade (CIN 1) cervical lesions is important for treatment decisions.
2) Colposcopic features that suggest high grade lesions include coarse mosaicism, irregular blood vessels, thick opaque white epithelium, well-demarcated ridges, and papillary configurations with sharp borders.
3) Low grade lesions typically have features like a transient whitening with acetic acid, fine punctation, ill-defined margins, and peripheral or small sizes.
ShearWave™ Elastography in Breast Cancer Patient Management: Clinical Researc...Joel Gay
With 100 peer-reviewed publications, SuperSonic Imagine’s proprietary ShearWave™ Elastography (SWE™) is the most clinically studied shear-wave based elastography for breast lesion characterization.
In this all new webinar, we will walk you through a literature review that will help you to familiarize yourself with clinical research results related to the use of ShearWave™ Elastography (SWE™) within breast ultrasound imaging.
This document summarizes advances in the management of breast cancer over the last 30 years. It discusses trends towards increased use of breast-conserving surgery rather than total mastectomy, as randomized trials have shown equivalent survival outcomes. Sentinel lymph node biopsy has largely replaced axillary lymph node dissection for nodal staging due to lower morbidity. While bilateral mastectomy rates have increased, studies find local recurrence rates remain low with breast-conserving surgery and radiation. Overall, management of breast cancer has shifted to less invasive surgical options due to long-term data demonstrating equivalent survival.
This document summarizes the surgical management of the axilla, focusing on sentinel lymph node biopsy techniques. It discusses:
1. The axilla contains 3 levels of lymph nodes that are assessed during axillary surgery. Sentinel lymph node biopsy targets levels I-II.
2. Techniques for identifying sentinel nodes include radioactive tracing using radiocolloids and blue dye mapping. Combined hot and blue methods increase detection rates.
3. Complications of axillary surgery include seroma, lymphedema, infection, and limited arm mobility. Sentinel node biopsy reduces these risks compared to axillary dissection.
4. Ongoing research aims to further minimize the morbidity of axillary staging while
3.Edward A. Sickles_Surveillance Imaging for Probably Benign Findings: Benefi...Wanfang Radiology
This document summarizes evidence on mammographic surveillance of probably benign breast lesions. Key points include:
- Studies have found positive predictive values of 0.1-11.2% for probably benign lesions identified on mammography and followed with serial imaging.
- Cancers detected through surveillance tend to be nonpalpable, early-stage lesions with favorable prognosis despite interval growth.
- Serial imaging can help identify cancers earlier through detection of interval change in probably benign lesions over time.
This document discusses treatment approaches for early stage cervical cancer. It notes that for invasive cervical cancers measuring less than 2 cm, removal of the parametrium may be omitted. For some very small tumors, pelvic lymphadenectomy can also be omitted as the risk of lymph node metastasis is limited. It also discusses outcomes from vaginal trachelectomy and laparoscopic pelvic lymphadenectomy for early stage cancers. The document considers conservative treatment approaches for stage IA2-IB1 cancers less than 3 cm in size, including a proposed study design stratifying patients based on tumor diameter.
L rotenberg, g lenczner premalignant breast lesion imaging jfim hanoi 2015 compLuc ROTENBERG
This document discusses breast premalignant lesions, their imaging appearance, diagnosis, and management. It provides information on lesions such as DCIS, ADH, ALH, and LCIS. Imaging modalities like mammography, ultrasound, and MRI can detect these lesions as masses, calcifications or other abnormalities. Biopsy is often used for diagnosis but may underestimate the lesion. Surgical excision is generally recommended when premalignant lesions are found on biopsy to rule out associated malignancy, though careful radiologic-pathologic correlation in some cases can guide observation over excision. Underestimation rates vary by biopsy method and number of specimens obtained.
The document discusses the evolution of colposcopy terminology and standards. It notes that terminology and techniques vary widely in different settings, making it difficult to compare outcomes and practices. The development of standardized terminology and rigorous training programs, like those in the UK, can help improve colposcopic accuracy and consistency between providers. The document also reviews studies on how factors like lesion size and excision dimensions may impact outcomes. It introduces new terminology for describing findings like the transformation zone type and ridge sign.
2 prof james bently differentiating high and low gradeTariq Mohammed
1) Differentiating between high grade (CIN 2/3) and low grade (CIN 1) cervical lesions is important for treatment decisions.
2) Colposcopic features that suggest high grade lesions include coarse mosaicism, irregular blood vessels, thick opaque white epithelium, well-demarcated ridges, and papillary configurations with sharp borders.
3) Low grade lesions typically have features like a transient whitening with acetic acid, fine punctation, ill-defined margins, and peripheral or small sizes.
ShearWave™ Elastography in Breast Cancer Patient Management: Clinical Researc...Joel Gay
With 100 peer-reviewed publications, SuperSonic Imagine’s proprietary ShearWave™ Elastography (SWE™) is the most clinically studied shear-wave based elastography for breast lesion characterization.
In this all new webinar, we will walk you through a literature review that will help you to familiarize yourself with clinical research results related to the use of ShearWave™ Elastography (SWE™) within breast ultrasound imaging.
This document summarizes advances in the management of breast cancer over the last 30 years. It discusses trends towards increased use of breast-conserving surgery rather than total mastectomy, as randomized trials have shown equivalent survival outcomes. Sentinel lymph node biopsy has largely replaced axillary lymph node dissection for nodal staging due to lower morbidity. While bilateral mastectomy rates have increased, studies find local recurrence rates remain low with breast-conserving surgery and radiation. Overall, management of breast cancer has shifted to less invasive surgical options due to long-term data demonstrating equivalent survival.
This document summarizes the surgical management of the axilla, focusing on sentinel lymph node biopsy techniques. It discusses:
1. The axilla contains 3 levels of lymph nodes that are assessed during axillary surgery. Sentinel lymph node biopsy targets levels I-II.
2. Techniques for identifying sentinel nodes include radioactive tracing using radiocolloids and blue dye mapping. Combined hot and blue methods increase detection rates.
3. Complications of axillary surgery include seroma, lymphedema, infection, and limited arm mobility. Sentinel node biopsy reduces these risks compared to axillary dissection.
4. Ongoing research aims to further minimize the morbidity of axillary staging while
3.Edward A. Sickles_Surveillance Imaging for Probably Benign Findings: Benefi...Wanfang Radiology
This document summarizes evidence on mammographic surveillance of probably benign breast lesions. Key points include:
- Studies have found positive predictive values of 0.1-11.2% for probably benign lesions identified on mammography and followed with serial imaging.
- Cancers detected through surveillance tend to be nonpalpable, early-stage lesions with favorable prognosis despite interval growth.
- Serial imaging can help identify cancers earlier through detection of interval change in probably benign lesions over time.
This document discusses treatment approaches for early stage cervical cancer. It notes that for invasive cervical cancers measuring less than 2 cm, removal of the parametrium may be omitted. For some very small tumors, pelvic lymphadenectomy can also be omitted as the risk of lymph node metastasis is limited. It also discusses outcomes from vaginal trachelectomy and laparoscopic pelvic lymphadenectomy for early stage cancers. The document considers conservative treatment approaches for stage IA2-IB1 cancers less than 3 cm in size, including a proposed study design stratifying patients based on tumor diameter.
A review of breast cancer in Saudi Arabia with an update on all aspects of breast cancer management including Diagnosis, Family History, Surgery (& Reconstructive Surgery), Sentinel Node Biopsy and Adjuvant Chemo, Radio and Hormone Therapy.
Jean Yves Seror : Interventional Senology Diagnostic and therapeutic : State...breastcancerupdatecongress
This document summarizes interventional senology techniques including biopsy methods and their indications, limitations, and complications. It discusses fine needle aspiration biopsy, core needle biopsy, vacuum-assisted biopsy, and percutaneous excisional biopsy. Fine needle aspiration biopsy is well tolerated but has limitations including insufficient samples and inability to assess microcalcifications. Core needle biopsy provides a histological diagnosis but has a risk of underdiagnosis for small or deep lesions. Vacuum-assisted biopsy allows removal of lesions under 8mm with low complication rates but has limitations for complex fibroadenomas or papillary lesions. Percutaneous excision can diagnose and remove lesions but is not feasible for large or deep masses. New techniques aim to remove lesions
Dr nisreen anfnan cervical cancer in saudi arabia last versionTariq Mohammed
The document discusses cervical cancer in Saudi Arabia. It finds that incidence of cervical cancer is low in Saudi Arabia, ranking 11th among cancers in females, with 152 new cases and 55 deaths per year. HPV is detected in 31.6-5.6% of women in Saudi Arabia. Nearly all cervical cancer cases (92.9-100%) are associated with HPV infection, most commonly HPV 16 and 18. The document calls for a nationwide cervical cancer screening program in Saudi Arabia, as the actual reasons for low incidence are unknown without screening. It proposes a screening program using HPV testing to screen women ages 30-65 every 5 years until age 65.
This document discusses the terminology used for preinvasive cervical lesions. It begins with definitions of dysplasia and provides a historical review of terminology, including carcinoma in situ (CIS) and cervical intraepithelial neoplasia (CIN). It then describes the 2001 Bethesda System for cervical cytology reporting and the Lower Anogenital Squamous Terminology (LAST) project. The LAST project aimed to create a unified histopathological nomenclature for HPV-associated preinvasive lesions across anatomical sites, recommending a two-tiered system of low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL).
Endometrial cancer starts when cells in the inner lining of the uterus grow abnormally and can spread. Some key risk factors include excess estrogen exposure without progesterone opposition, obesity, late menopause, and family history. Common symptoms are abnormal vaginal bleeding or discharge. Diagnosis involves endometrial biopsy and other imaging tests. Treatment options include surgery to remove the uterus and surrounding tissue, radiation therapy, chemotherapy, hormone therapy, and targeted therapies. The cancer is staged based on how much it has spread in the body.
This document discusses breast cancer, including its definition, risk factors, types, staging, diagnosis, and treatment. Breast cancer begins in the breast tissue and may start in the ducts or lobes. It is characterized by uncontrolled cell growth. Some key points:
- Invasive ductal carcinoma is the most common type, accounting for around 80% of cases.
- Staging uses the TNM system to classify tumors by size (T), lymph node involvement (N), and metastasis (M).
- Diagnosis involves clinical examination, imaging like mammography, and biopsy.
- Treatment depends on stage but commonly involves surgery, radiation, chemotherapy, hormone therapy, or a combination.
1 prof james bently cervical cancer screening 2014Tariq Mohammed
This document discusses options for cervical cancer screening including visual inspection with acetic acid (VIA), cervical cytology, HPV testing, and combinations of tests. It reviews the strengths and limitations of different screening methods and highlights priorities for efficient, low-cost screening in low-resource settings. Optimal screening may involve initial HPV testing at age 35 with reflex cytology for positives and cytology follow-up of negatives before longer interval rescreening.
This document summarizes the classification, pathology, diagnosis, and treatment of ductal carcinoma in situ (DCIS). It discusses the classification of DCIS into different types based on pathology. It describes investigations like mammography, ultrasound, and MRI that are used in the diagnosis of DCIS. It provides details about diagnostic procedures like biopsy. It summarizes several major clinical trials that have evaluated the effectiveness of lumpectomy with and without radiotherapy and adjuvant tamoxifen or anastrozole therapy in treating DCIS.
The document discusses screening for ovarian cancer. It provides guidelines from BGCS and NICE regarding screening recommendations for average and high-risk women. It summarizes a large study that found annual screening with CA-125 and transvaginal ultrasound (multimodal screening) increased early-stage cancer detection but did not reduce mortality. Therefore, general population screening is not recommended. For high-risk women, screening may be considered after discussing risks and benefits. Recent advances like liquid biopsies and analyzing the MUC16 gene show promise but require more research before implementing.
- Kettering General Hospital Breast Unit went digital between 2010-2012 and implemented tomosynthesis and contrast-enhanced spectral mammography (CESM) to improve cancer detection for women with dense breasts.
- A review of 50 patients who received tomosynthesis found it aided diagnosis in 36 patients (69%), providing extra information in 22 patients and more detailed information in 7 patients.
- A prospective study of 117 CESM exams found it to be as sensitive as MRI in detecting cancer and impacted management for 30% of cancer patients. CESM provided accurate sizing for invasive cancers but was less accurate for lobular cancers and cancers with ductal carcinoma in situ.
Regional lymph node management in breast cancerShreya Singh
Regional lymph nodes, including the axillary, supraclavicular, and internal mammary nodes, are important sites of potential breast cancer spread. Axillary ultrasound and sentinel lymph node biopsy help assess lymph node status. Several landmark trials have evaluated the benefits of radiotherapy to regional lymph nodes. The EBCTCG meta-analysis found regional radiotherapy reduced recurrence and breast cancer mortality in patients with 1-3 or 4+ positive lymph nodes. Current guidelines recommend regional radiotherapy for patients with extensive lymph node involvement or other high-risk features.
Has cancer science got you stumped and overwhelmed? Leading gynecologic oncologist, Dr. Don Dizon, takes us to cancer college in this webinar. He explains the science behind ovarian cancer, how it develops, how it's diagnosed, and how ovarian cancer treatments work.
The document summarizes information about male breast cancer. Some key points:
1) Male breast cancer is considered a rare or "orphan" disease that affects about 1 in 1000 men annually in the US, with estimated new cases of 2,140 and deaths of 450 in 2011.
2) The causes of male breast cancer include gene mutations like BRCA2 and PTEN, as well as factors like estrogen exposure.
3) Male breast cancer has some similarities to female breast cancer, especially the luminal/hormone receptor positive subtype, but the incidence peaks about 10 years later in men at age 75 compared to age 61 in women.
4) Treatment options are generally the same as for
DCIS Topic-Driven Round Table: Decision-Making and Treatment Choicesbkling
Facilitator Deb Hackenberry is joined by Cecilia Hammond, Senior Medical Science Liaison at Genomic Health, to discuss better decision-making and your treatment choices with DCIS.
Breast MRI is effective for screening high risk women. Studies show:
- MRI alone detects 96% of cancers in BRCA1 mutation carriers with only 4% interval cancers.
- Combining MRI and mammography in BRCA1/2 carriers aged 50 and older improves cancer detection compared to mammography alone.
- For BRCA1 carriers under age 50, MRI alone may be preferable to avoid unnecessary radiation from mammography given their increased radiation sensitivity.
- Prospective screening studies show improved cancer outcomes using MRI, with over 90% 5-year survival rates compared to historical controls.
- Based on these results, MRI is recommended for screening high risk populations beginning at age 25 and could potentially replace mammography
Uterine Cancer Recurrence: All You Need To Knowbkling
t's not uncommon for uterine cancer survivors to worry about recurrence.
Whether you've had a recurrence or want to become more informed, join Dr. Susan C. Modesitt, Director of Gynecologic Oncology at UVA Cancer Center, to learn more information about uterine cancer recurrence as well as available treatment options.
1) Interval cancers occur between mammography screenings and can be missed due to limitations in mammography detection or characterization. The rate of missed interval cancers is reported between 7.5 to 22 per 10,000 mammograms.
2) Factors that can contribute to missed cancers include breast density, small lesion size, subtle appearance, and improper characterization. Retrospective reviews often find lesions that were visible but not properly characterized on prior mammograms.
3) Newer digital mammography techniques like digital breast tomosynthesis have been shown to improve detection and characterization compared to full field digital mammography alone, especially for women under 50 and those with dense breasts. Larger studies are still needed to fully evaluate performance.
This document discusses breast imaging recommendations and tools. It recommends annual mammography screening starting at age 40 for average risk women, while high risk women may benefit from additional screening with MRI. Digital mammography is the gold standard but has limitations depending on breast density. New tools like tomosynthesis and ultrasound can help address these limitations and provide additional information. The document reviews various breast imaging tools and their uses, as well as risk factors, screening guidelines, and case examples.
The document discusses variation in how radiologists assess breast density on mammograms. In a study of 250 mammograms read by 8 radiologists, there was significant variability, with full agreement on density in only 28% of cases. Radiologists disagreed on the distinction between scattered fibroglandular tissue and heterogeneously dense tissue in about 32% of cases. Standardizing breast density assessment is important for accurately determining cancer risk and recommending appropriate screening.
A review of breast cancer in Saudi Arabia with an update on all aspects of breast cancer management including Diagnosis, Family History, Surgery (& Reconstructive Surgery), Sentinel Node Biopsy and Adjuvant Chemo, Radio and Hormone Therapy.
Jean Yves Seror : Interventional Senology Diagnostic and therapeutic : State...breastcancerupdatecongress
This document summarizes interventional senology techniques including biopsy methods and their indications, limitations, and complications. It discusses fine needle aspiration biopsy, core needle biopsy, vacuum-assisted biopsy, and percutaneous excisional biopsy. Fine needle aspiration biopsy is well tolerated but has limitations including insufficient samples and inability to assess microcalcifications. Core needle biopsy provides a histological diagnosis but has a risk of underdiagnosis for small or deep lesions. Vacuum-assisted biopsy allows removal of lesions under 8mm with low complication rates but has limitations for complex fibroadenomas or papillary lesions. Percutaneous excision can diagnose and remove lesions but is not feasible for large or deep masses. New techniques aim to remove lesions
Dr nisreen anfnan cervical cancer in saudi arabia last versionTariq Mohammed
The document discusses cervical cancer in Saudi Arabia. It finds that incidence of cervical cancer is low in Saudi Arabia, ranking 11th among cancers in females, with 152 new cases and 55 deaths per year. HPV is detected in 31.6-5.6% of women in Saudi Arabia. Nearly all cervical cancer cases (92.9-100%) are associated with HPV infection, most commonly HPV 16 and 18. The document calls for a nationwide cervical cancer screening program in Saudi Arabia, as the actual reasons for low incidence are unknown without screening. It proposes a screening program using HPV testing to screen women ages 30-65 every 5 years until age 65.
This document discusses the terminology used for preinvasive cervical lesions. It begins with definitions of dysplasia and provides a historical review of terminology, including carcinoma in situ (CIS) and cervical intraepithelial neoplasia (CIN). It then describes the 2001 Bethesda System for cervical cytology reporting and the Lower Anogenital Squamous Terminology (LAST) project. The LAST project aimed to create a unified histopathological nomenclature for HPV-associated preinvasive lesions across anatomical sites, recommending a two-tiered system of low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL).
Endometrial cancer starts when cells in the inner lining of the uterus grow abnormally and can spread. Some key risk factors include excess estrogen exposure without progesterone opposition, obesity, late menopause, and family history. Common symptoms are abnormal vaginal bleeding or discharge. Diagnosis involves endometrial biopsy and other imaging tests. Treatment options include surgery to remove the uterus and surrounding tissue, radiation therapy, chemotherapy, hormone therapy, and targeted therapies. The cancer is staged based on how much it has spread in the body.
This document discusses breast cancer, including its definition, risk factors, types, staging, diagnosis, and treatment. Breast cancer begins in the breast tissue and may start in the ducts or lobes. It is characterized by uncontrolled cell growth. Some key points:
- Invasive ductal carcinoma is the most common type, accounting for around 80% of cases.
- Staging uses the TNM system to classify tumors by size (T), lymph node involvement (N), and metastasis (M).
- Diagnosis involves clinical examination, imaging like mammography, and biopsy.
- Treatment depends on stage but commonly involves surgery, radiation, chemotherapy, hormone therapy, or a combination.
1 prof james bently cervical cancer screening 2014Tariq Mohammed
This document discusses options for cervical cancer screening including visual inspection with acetic acid (VIA), cervical cytology, HPV testing, and combinations of tests. It reviews the strengths and limitations of different screening methods and highlights priorities for efficient, low-cost screening in low-resource settings. Optimal screening may involve initial HPV testing at age 35 with reflex cytology for positives and cytology follow-up of negatives before longer interval rescreening.
This document summarizes the classification, pathology, diagnosis, and treatment of ductal carcinoma in situ (DCIS). It discusses the classification of DCIS into different types based on pathology. It describes investigations like mammography, ultrasound, and MRI that are used in the diagnosis of DCIS. It provides details about diagnostic procedures like biopsy. It summarizes several major clinical trials that have evaluated the effectiveness of lumpectomy with and without radiotherapy and adjuvant tamoxifen or anastrozole therapy in treating DCIS.
The document discusses screening for ovarian cancer. It provides guidelines from BGCS and NICE regarding screening recommendations for average and high-risk women. It summarizes a large study that found annual screening with CA-125 and transvaginal ultrasound (multimodal screening) increased early-stage cancer detection but did not reduce mortality. Therefore, general population screening is not recommended. For high-risk women, screening may be considered after discussing risks and benefits. Recent advances like liquid biopsies and analyzing the MUC16 gene show promise but require more research before implementing.
- Kettering General Hospital Breast Unit went digital between 2010-2012 and implemented tomosynthesis and contrast-enhanced spectral mammography (CESM) to improve cancer detection for women with dense breasts.
- A review of 50 patients who received tomosynthesis found it aided diagnosis in 36 patients (69%), providing extra information in 22 patients and more detailed information in 7 patients.
- A prospective study of 117 CESM exams found it to be as sensitive as MRI in detecting cancer and impacted management for 30% of cancer patients. CESM provided accurate sizing for invasive cancers but was less accurate for lobular cancers and cancers with ductal carcinoma in situ.
Regional lymph node management in breast cancerShreya Singh
Regional lymph nodes, including the axillary, supraclavicular, and internal mammary nodes, are important sites of potential breast cancer spread. Axillary ultrasound and sentinel lymph node biopsy help assess lymph node status. Several landmark trials have evaluated the benefits of radiotherapy to regional lymph nodes. The EBCTCG meta-analysis found regional radiotherapy reduced recurrence and breast cancer mortality in patients with 1-3 or 4+ positive lymph nodes. Current guidelines recommend regional radiotherapy for patients with extensive lymph node involvement or other high-risk features.
Has cancer science got you stumped and overwhelmed? Leading gynecologic oncologist, Dr. Don Dizon, takes us to cancer college in this webinar. He explains the science behind ovarian cancer, how it develops, how it's diagnosed, and how ovarian cancer treatments work.
The document summarizes information about male breast cancer. Some key points:
1) Male breast cancer is considered a rare or "orphan" disease that affects about 1 in 1000 men annually in the US, with estimated new cases of 2,140 and deaths of 450 in 2011.
2) The causes of male breast cancer include gene mutations like BRCA2 and PTEN, as well as factors like estrogen exposure.
3) Male breast cancer has some similarities to female breast cancer, especially the luminal/hormone receptor positive subtype, but the incidence peaks about 10 years later in men at age 75 compared to age 61 in women.
4) Treatment options are generally the same as for
DCIS Topic-Driven Round Table: Decision-Making and Treatment Choicesbkling
Facilitator Deb Hackenberry is joined by Cecilia Hammond, Senior Medical Science Liaison at Genomic Health, to discuss better decision-making and your treatment choices with DCIS.
Breast MRI is effective for screening high risk women. Studies show:
- MRI alone detects 96% of cancers in BRCA1 mutation carriers with only 4% interval cancers.
- Combining MRI and mammography in BRCA1/2 carriers aged 50 and older improves cancer detection compared to mammography alone.
- For BRCA1 carriers under age 50, MRI alone may be preferable to avoid unnecessary radiation from mammography given their increased radiation sensitivity.
- Prospective screening studies show improved cancer outcomes using MRI, with over 90% 5-year survival rates compared to historical controls.
- Based on these results, MRI is recommended for screening high risk populations beginning at age 25 and could potentially replace mammography
Uterine Cancer Recurrence: All You Need To Knowbkling
t's not uncommon for uterine cancer survivors to worry about recurrence.
Whether you've had a recurrence or want to become more informed, join Dr. Susan C. Modesitt, Director of Gynecologic Oncology at UVA Cancer Center, to learn more information about uterine cancer recurrence as well as available treatment options.
1) Interval cancers occur between mammography screenings and can be missed due to limitations in mammography detection or characterization. The rate of missed interval cancers is reported between 7.5 to 22 per 10,000 mammograms.
2) Factors that can contribute to missed cancers include breast density, small lesion size, subtle appearance, and improper characterization. Retrospective reviews often find lesions that were visible but not properly characterized on prior mammograms.
3) Newer digital mammography techniques like digital breast tomosynthesis have been shown to improve detection and characterization compared to full field digital mammography alone, especially for women under 50 and those with dense breasts. Larger studies are still needed to fully evaluate performance.
This document discusses breast imaging recommendations and tools. It recommends annual mammography screening starting at age 40 for average risk women, while high risk women may benefit from additional screening with MRI. Digital mammography is the gold standard but has limitations depending on breast density. New tools like tomosynthesis and ultrasound can help address these limitations and provide additional information. The document reviews various breast imaging tools and their uses, as well as risk factors, screening guidelines, and case examples.
The document discusses variation in how radiologists assess breast density on mammograms. In a study of 250 mammograms read by 8 radiologists, there was significant variability, with full agreement on density in only 28% of cases. Radiologists disagreed on the distinction between scattered fibroglandular tissue and heterogeneously dense tissue in about 32% of cases. Standardizing breast density assessment is important for accurately determining cancer risk and recommending appropriate screening.
The document discusses variation in how radiologists assess breast density on mammograms. In a study of 250 mammograms read by 8 radiologists, there was significant variability, with full agreement on density in only 28% of cases. Radiologists disagreed on the distinction between scattered fibroglandular tissue and heterogeneously dense tissue in about 32% of cases. Standardizing breast density assessment is important because density affects cancer risk estimates and screening recommendations, but current methods lack consistency.
This document provides information on breast cancer screening and prevention. It discusses screening principles and guidelines for mammography, MRI, ultrasound and other screening techniques. It outlines high-risk factors for breast cancer and recommends annual screening starting at age 30-40 for high-risk individuals, including those with BRCA gene mutations or family history. Screening mammography every 1-2 years is recommended for average risk women starting at age 40. Chemoprevention with tamoxifen or raloxifene can lower breast cancer risk in high risk postmenopausal women. Genetic testing guidelines are also provided.
This study found significant variation in breast density assessments among radiologists when reviewing mammograms. For approximately 28% of exams, all 8 radiologists agreed on the breast density. However, for 10% of exams, only half or less of radiologists agreed. Standardizing breast density reporting is important for accurately assessing cancer risk and determining appropriate screening recommendations, but current methods lack consistency. Improved radiologist education and computerized density analysis may help address this issue.
The document provides information about breast cancer including:
1. Breast cancer is the most common cancer and second leading cause of cancer death for women in the USA.
2. Survival rates for breast cancer have been increasing due to factors like adjuvant chemotherapy and hormone therapy as well as screening.
3. Risk factors for breast cancer include age, family history, genetic factors, lifestyle factors like alcohol consumption and obesity.
I. Screening mammography has become the primary screening tool for breast cancer. It has been shown to decrease mortality rates by detecting cancers early through routine screening.
II. Mammography screening guidelines vary based on risk level. Average risk women are typically recommended annual screening starting at age 40. High risk women may be recommended earlier or more frequent screening, including breast MRI.
III. Risk is determined through factors like family history, genetic testing, density of breast tissue, and use of models like Gail and Tyrer-Cuzick. Women at higher lifetime risk (>20%) may be counseled on additional screening or risk reduction options.
Breast cancer is the most common cancer in women, accounting for 26% of cancers. Genetic factors play a role, with around 10% of cases having inherited mutations like BRCA1/BRCA2. Risk is increased by factors like family history, benign breast disease, older age at first birth, hormone therapy, obesity, alcohol. Screening includes annual mammograms from age 40 and clinical exams. High risk women may benefit from more intense screening or preventative surgery/drugs due to genetic mutations or family history. Molecular markers help classify subtypes with different prognoses.
This document discusses benign breast disease, risk factors for breast cancer, hereditary breast cancer syndromes, screening and surveillance for breast cancer, evaluation of breast symptoms such as lumps, nipple discharge, and abnormal mammogram findings. It provides guidelines for managing increased risk and evaluating various breast abnormalities to determine if biopsy or other follow up is needed.
Breast cancer screening-2021 chan hio tongjim kuok
This document discusses breast cancer screening and provides guidance on screening strategies based on risk level. It covers:
1) Screening modalities like mammography, ultrasound, MRI and their limitations. Mammography is the primary screening tool for average risk women aged 50-74.
2) Risk assessment factors like family history, genetic mutations, breast density, reproductive history which determine screening frequency and additional tests. Women at high risk start screening earlier and more frequently.
3) Two case studies where mammography limitations are demonstrated. Early detection through clinical exams and additional tests led to cancer diagnosis in both cases. Regular screening tailored to risk level can improve early detection.
This document discusses breast disorders and breast cancer. It provides information on:
- The main symptoms of breast disorders including breast masses, skin changes, pain, and nipple discharge.
- Risk factors for breast cancer such as family history, age, reproductive history.
- The importance of self-breast exams, clinical breast exams, and mammography for early detection.
- Common breast masses including fibroadenomas, cysts, and fibrocystic changes.
- Evaluating breast masses through history, physical exam, diagnostic imaging such as mammography and ultrasound, and biopsy when needed.
- Presentation and workup of breast cancer with emphasis on early detection through screening.
For more information, visit https://www.timberlandmedical.com
Timberland Medical Centre is a private hospital that has been in operation since 1994. We are strategically located at the 3rd Mile roundabout on Jalan Rock, Kuching, Sarawak, East Malaysia. Our hospital is 10 minutes from the Kuching International Airport and 15 minutes from the Central Bus Terminal. We continually seek to improve and upgrade our services and facilities, as we strive to provide the best medical care for our patients and customers.
Breast cancer screening guidelines recommend biennial mammography for women aged 50-74 in well-resourced settings, as it can reduce breast cancer mortality by around 16% compared to no screening. For limited-resource settings, the guidelines conditionally recommend clinical breast examination as a low-cost alternative. Screening intervals of less than 24 months show no added benefit over longer intervals. Shared decision making around risks of false positives and overdiagnosis is important. Early diagnosis through awareness and symptom screening is prioritized where most women present at late stages due to weak health systems.
Caren Stalburg, MD, MA presented to the 2016 annual Snow meeting of the Michigan Section of the American Congress of Obstetricians and Gynecologists (ACOG) about her program to train Michigan providers about the new Breast Density Notification Law (http://www.midensebreasts.org/).
Dr. Stalburg is Division Chief and Clinical Assistant Professor in the Division of Professional Education in the Department of Learning Health Sciences and Assistant Professor of Obstetrics and Gynecology in the University of Michigan Medical School.
It contains details about breast carcinoma-pathology,investigations and diagnosis,NACT,surgery and adjuvant therapy. Hope you will find it helpful.....
- Mammography is the standard screening tool for breast cancer and should start at age 40 for asymptomatic women. Ultrasound may be used for screening high risk patients or to further evaluate abnormalities found on mammogram.
- Common breast cancer symptoms include palpable masses, nipple discharge, and breast pain. Evaluation depends on patient age and symptoms, but may involve mammogram, ultrasound, MRI, or biopsy.
- Risk factors include increasing age, family history, personal history of breast cancer or high-risk conditions. Early detection through screening and treatment of breast cancer have improved survival rates.
This document discusses breast premalignant lesions, their imaging appearance, and diagnosis. It notes that while imaging cannot definitively diagnose premalignant lesions, it can provide diagnostic hypotheses and guidance for biopsy. Premalignant lesions like DCIS, ADH, ALH and LCIS can appear as masses, masses with calcifications, microcalcifications, or non-mass lesions. Biopsy is needed for histological diagnosis but underestimation of premalignant lesions is possible, especially with core needle biopsy. Careful radiologic-pathologic correlation is important to determine if surgical excision is needed.
This document discusses various imaging modalities used for breast cancer screening and diagnosis, including mammography, ultrasound, MRI, CT, and PET scans. It provides details on mammography techniques for screening and diagnostic purposes. Key findings from studies on screening mammography for different age groups are summarized. Guidelines on screening from organizations like ACS, NCCN, and NCI are also outlined. The use of ultrasound and MRI as supplemental tools for diagnosis is discussed.
About this webinar:
Breast radiologist Dr. Paula Gordon will discuss the optimal strategy for achieving early detection of breast cancer. She will also describe the flawed process used in making Canadian breast screening guidelines, impacting millions of women. Patient advocate Jennie Dale from Dense Breasts Canada will look at the inequities in breast cancer screening and surveillance practices in Canada. She will also explore ways to advocate for better screening and surveillance.
About the presenters:
Dr. Paula Gordon is a Clinical Professor in the Department of Radiology at the University of British Columbia, and has been practicing for over 35 years. She is Founding Medical Director of the Sadie Diamond Breast Program at BC Women’s Hospital, and a founding member of the Canadian Society of Breast Imaging. She’s given hundreds of lectures at meetings around the globe. She received a Queen Elizabeth Diamond Jubilee Medal, and was invested in the Order of British Columbia. She was named one of Canada’s 100 Most Powerful Women by the Women’s Executive Network.
Jennie Dale is the Co-founder and Executive Director of Dense Breasts Canada (DBC). She was diagnosed with breast cancer in October 2014. Inspired by the successful advocacy and education efforts of similar American organizations, Jennie co-founded DBC with Michelle Di Tomaso in 2016. They teamed up with breast cancer survivors, dedicated individuals, and health care professionals nationwide to raise awareness of the risks of dense breasts and advocate for patient notification of breast density and access to supplemental screening. She is fighting for necessary revisions to the current Canadian Task Force breast cancer screening guidelines, which put women's lives at risk. In 2021, Jennie was named a top 5 finalist in Charity Village's awards in the category of Most Outstanding Impact by a Volunteer.
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Luc Rotenberg, Tomosynthese et densité mammaire 2015
1. !
Luc Rotenberg
ISHH – RPO Clinique Hartmann – Ambroise Paré
Neuilly Sur Seine - France
#drrotenberg
dr.rotenberg@radiologieparisouest.com
Tomosynthesis DBT
and Breast density
La valeur de la Tomosynthèse dépend elle de
la densité mammaire ?
Tomosynthèse Mammaire – Montpellier 10 & 11 septembre 2015
2. !
Evaluation de la densité mammaire:
Est-ce utile ?
Seins Denses
Facteur de Risque
Limites de l’imagerie RX
3. !
Historique
S 1976, Dr. Wolff
published major
paper on breast
patterns and risk
“Groups can be isolated with as much as a 37 times greater
incidence of the disease”
4. !
Breast Density
S The literature links breast density with the risk of breast
cancer:
S 1976: Wolfe1 discussed a 37× increased risk of
developing breast cancer
S 2004: Harvey2 summarized recent estimates at more
than 4× increased risk
1 AJR 126:1130-1139, 1976
2 Radiology 2004; 230:29–41
5. !
Classification
Incidence studies
RR [95% IC]
Prévalence studies
RR [95% IC]
Wolfe
N1 1 1
P1 1.8 [1.4-2.2] 1.3 [1-1.5]
P2 3.1 [2.5-3.7] 2 [1.3-3]
DY 4 [2.5-6.3] 2.4 [2-3]
% of Density
<5% 1 1
[5-24%] 1.8 [1.5-2.2] 1.4 [1.1-1.8]
[25-49%] 2.1 [1.7-2.6] 2.2 [1.8-2.8]
[50-74%] 2.9 [2.5-3.4] 2.9 [2.3-3.8]
> 75% 4.6 [3.6-5.9] 3.7 [2.7-5]
BI-RADS
1 1 1
2 2.2 [1.6-3] 1.6 [0.9-2.8]
3 3 [2.2-4.1] 2.3 [1.3-4.3]
4 4 [2.8-5.7] 4.5 [1.9-10.6]
McCormack VA & al : Breast density and parenchymal patterns as markers of breast cancer risk: a meta-analysis.
Cancer Epidemiol Biomarkers Prev 2006, 15:1159-1169.
Combined relative risks for breast cancer associated with different classifications of
mammographic density, study designs, and study populations from meta-analysis
6. !
Breast density & diseases
S Greater risk of benign breast disease
S RR 12.2 for usual hyperplasia
S RR 9.7 for ADH or DCIS
S RR 4.3 for Cancer
S Higher grade
S ER negative
S Larger size = rapid growth in dense tissue ?
S Masking ?
S Growth factors ?
7. !
Breast Cancer Risk Factors
Risk Factor Min Max x
LCIS on biopsy 1.00 8.70 8.70
No. 1st degree relatives with breast cancer 1.00 6.80 6.80
Mammographic density 0.41 1.76 4.29
No. of biopsies 1.00 2.88 2.88
Tamoxifen 0.45 1.00 2.22
Biopsy with atypical hyperplasia 0.93 1.82 1.96
Oral contraceptives / Menop Horm Therapy 1.00 1.49 1.49
Alcohol use / Obesity 0.99 1.41 1.42
Early menarche / late menopause 1.00 1.21 1.21
From http://www.halls.md/breast/gailmods.htm
8. !
Composants de la densité mammaire ?
S Canaux galactophoriques
S Lobules
S Stroma (facteurs de croissance)
S Collagène
S Fibroblaste
S Matrice intercellulaire
S Vaisseaux sanguins
S tissus de soutien (FAK-ERK link)* ….
Profil juvenile
Post-ménopausique
Asiatique…..
*Provenzano PP, Inman DR, Eliceiri KW, Keely Oncogene 2009; 28: 4326-43.
9. !
Aspect mammographique
S Clarté (noir) = graisse
S Opacité (blanc) = tissus
denses
S tissus fibro-glandulaire
S éléments fonctionnels
S parenchyme
S Éléments de soutien
S stroma
10. Qualitative Quantitative
Wolfe BI-RADS Visual estimation
Description
Visual classification of the
mammographic image into four
categories based on extent and
distribution of the parenchyma,
including ducts, nodular,
homogeneous densities, and fat.
Standardized reporting of visual
assessment of mammographic
findings by the American College
of Radiology BI-RADS. Both breasts
are used for the BI-RADS
Radiologist or expert
reader subjectively
assigns a percentage
density corresponding
to the proportion of
breast that is dense.
Categorization
N1 – Completely fatty breast
P1 – Mainly fatty breast with
prominent ducts, up to 25%
density
P2 – Prominent ducts, more than
25% density
DY – No visible ducts, diffuse and
extensive nodular density
Category 1 : Almost entirely fatty
(<25% dense)
Category 2 : Scattered
fibroglandular densities (25%–50%
dense)
Category 3 : Heterogeneously
dense (51%–75% dense)
Category 4 : Extremely dense
(>75% dense)
Visually estimated
directly into categories
<10%
10%–<25%
25%–<50%
50%–<75%
>75%)
Classifications mammographiqes de la DM
11. Un choix : BI-RADS®
Standardized reporting of visual assessment of mammographic findings by the American
College of Radiology BI-RADS. Both breasts are used for the BI-RADS
u Categorie 1 : Almost entirely fatty (<25% dense)
u Categorie 2 : Scattered fibroglandular densities (25%–50%
dense)
u Categorie 3 : Heterogeneously dense (51%–75% dense)
u Categorie 4 : Extremely dense (>75% dense)
Classifications mammographiqes de la DM
From the ACR BI-RADS Atlas
13. !
prevalence of increased density in the
general population
S percentage density :
S 26% to 32% had 50% or more
S parenchymal pattern
S 21% to 55% had the P2 or DY
S BI-RADS density
S 31% to 43% had a BI-RADS of 3 or 4
Dense breast ≥ 33%
14. !
What is Breast Density?
S But how does one classify
the density of this breast?
S By % density?
S By pattern?
15. !
Present Practice
S Radiologists assess breast density:
1. Visually
2. From two dimensional images
3. By estimating the amount of “whiteness”
16. !
mammographic density percentage visually estimated by two untrained
radiologists versus reference-standard density percentage
Harvey, J. A. et al. Radiology 2004;230:29-41
17. !
Then Why Use Density?
S Very simple … because until now there was no
alternative
S Then we must :
S standardize methods for measuring density
S with digital volumic breast density assessment
18. !
Volumic breast density assessment
S automatically differentiates dense tissue from fat in
the breast
S measures of total breast fibroglandular tissue volume
S calculates volumetric breast density
S Example : Quantra (Hologic)
19. !
Volumetric vs Area Density
S Fraction of fibro-glandular tissue
(pink) within a fatty breast:
By volume:
By area:
L
L 2L
4L
2L
2L
4L
2L
L
%25%100
24
2
=×
×
×
LL
LL
%5.12%100
224
2
=×
××
××
LLL
LLL
20. !
Risk and Density
S Any density measure is
subject to change if
the total volume of the
breast changes
S But if the amount of
fibroglandular tissue
remains constant, does
the risk change?
L
L 2L
4L
2L
2L
L
L 2L 4L
4L
2L
21. !
The Result
S A table of measures of volume and density in the breast:
23. !
N Engl J Med 2005; 353:1773-1783
conclusions
Digital mammography is
more accurate in women :
• under the age of 50 years,
• radiographically dense
breasts
• premenopausal or
perimenopausal
• Clinical trial made in 2004 – 2006 in
North America
• 50.000 women enrolled made both
exams (FFDM/SFM)
24. !
As a matter of fact we know:
• Breast screening target is EARLY DIAGNOSIS OF
BREAST CANCER
• In most of the cases Screening reaches the goal
• almost 10 – 15% of the found late cancers is
originated in regularly screened women
• FFDM is “blind” under some particular circumstances :
• dense breasts
• dense tissues overlapping lesions
FFDM: SUPERIOR TECHNIQUE, BUT NOT PERFECT
RESULTS
• For women ≤ 50 years old and/or dense breast
• Sensitivity goes from 51% (SFM) to 70 - 78% (FFDM)
• Visualized almost 28% more breast cancers
• More than 1 over 4 cancers were not recognized:
false negatives
25. !
Pooled BI-RADS–based ROC curves for diagnostic assessment
of conventional diagnostic views and tomosynthesis views
Zuley M L et al.
Radiology
2013;266:89-95,
Pittsburgh
Digital Breast Tomosynthesis - DBT
Detection
26. !
DBT
ROC curves for average probability of malignancy as assessed by using conventional
supplemental diagnostic views and tomosynthesis views.
Zuley M L et al. Radiology 2013;266:89-95
VPP
27. !
Pooled ROC curves for reader studies 1 and 2 using probability of
malignancy scores; curves represent average ROC performance
for 12 readers in study 1 and 15 in study 2.
Rafferty E A et al.
Radiology 2013;266:104-113
28. !
Assessing Radiologist Performance Using Combined Digital
Mammography and Breast Tomosynthesis Compared with Digital
Mammography Alone: Results of a Multicenter, Multireader Trial
Diagnostic Sensitivity, Specificity, and Positive and Negative Predictive Values
Rafferty E A et al. Radiology 2013;266:104-113, Boston
43. !
Breast Cancer Screening Using Tomosynthesis
in Combination With Digital Mammography
Sarah M. Friedewald, MD1; Elizabeth A. Rafferty, MD2; Stephen L. Rose, MD3,4; Melissa A. Durand, MD5; Donna
M. Plecha, MD6; Julianne S. Greenberg, MD7; Mary K. Hayes, MD8; Debra S. Copit, MD9; Kara L. Carlson, MD10;
Thomas M. Cink, MD11; Lora D. Barke, DO12; Linda N. Greer, MD13; Dave P. Miller, MS14; Emily F. Conant, MD15
JAMA. 2014 Jun 25;311(24):2499-507
S 454 850 examinations
S 281 187 digital mammography
S 173 663 digital mammography + tomosynthesis
S recall rate :
S 107 ‰ with digital mammography
S 91 ‰ with digital mammography + tomosynthesis;
S Difference = – 15% (P < .001)
S Biopsies
S 18.1‰ with digital mammography
S 19.3‰ with digital mammography + tomosynthesis
S difference + 6%
Recall Rate – 15%
Biopsy Rate + 6%
44. !
Breast Cancer Screening Using Tomosynthesis
in Combination With Digital Mammography
Sarah M. Friedewald, MD1; Elizabeth A. Rafferty, MD2; Stephen L. Rose, MD3,4; Melissa A. Durand, MD5; Donna
M. Plecha, MD6; Julianne S. Greenberg, MD7; Mary K. Hayes, MD8; Debra S. Copit, MD9; Kara L. Carlson, MD10;
Thomas M. Cink, MD11; Lora D. Barke, DO12; Linda N. Greer, MD13; Dave P. Miller, MS14; Emily F. Conant, MD15
JAMA. 2014 Jun 25;311(24):2499-507
S Cancer detection,
S 4.2 ‰ with digital mammography
S 5.4 ‰ with digital mammography + tomosynthesis
S Difference 1.2 ‰
S Invasive cancer detection
S 2.9 ‰ with digital mammography
S 4.1 ‰ with digital mammography + tomosynthesis
S difference +1.2 ‰
S in situ cancer detection
S 1.4 ‰ screens with both methods.
S Adding tomosynthesis increase in the PPV
S for recall from 4.3% to 6.4% = + 2.1%
S for biopsy from 24.2% to 29.2% = + 5.0%
CDR Rate + 28,5%
5 , 4 ‰ v s 4 , 2 ‰
CDR InvK + 41,3%
4 , 1 ‰ v s 2 , 9 ‰
P P V 1 + 4 8 , 8 %
6 , 4 % v s 4 , 3 %
PPV3 for biopsy + 20,6%
2 9 , 2 % v s 2 4 , 2 %
45. !
Breast Cancer Screening Using Tomosynthesis
in Combination With Digital Mammography
Sarah M. Friedewald, MD1; Elizabeth A. Rafferty, MD2; Stephen L. Rose, MD3,4; Melissa A. Durand, MD5; Donna
M. Plecha, MD6; Julianne S. Greenberg, MD7; Mary K. Hayes, MD8; Debra S. Copit, MD9; Kara L. Carlson, MD10;
Thomas M. Cink, MD11; Lora D. Barke, DO12; Linda N. Greer, MD13; Dave P. Miller, MS14; Emily F. Conant, MD15
JAMA. 2014 Jun 25;311(24):2499-507. doi: 10.1001/jama.2014.6095.
Conclusions and Relevance
S Addition of tomosynthesis to digital mammography was
associated with
S a decrease in recall rate
S an increase in cancer detection rate
S Further studies are needed to assess the relationship to
clinical outcomes.
46. !
AJR Am J Roentgenol. 2014 Sep;203(3):687-93.
Clinical performance metrics of 3D digital breast tomosynthesis compared with
2D digital mammography for breast cancer screening in community practice.
Greenberg JS1, Javitt MC, Katzen J, Michael S, Holland AE.
S Outcomes from screening mammography
between Aug 2011, and Nov 2012
S using 3D DBT
S n = 23,149 patients
S versus 2D DM
S n = 54,684 patients
47. !
AJR Am J Roentgenol. 2014 Sep;203(3):687-93
Clinical performance metrics of 3D digital breast tomosynthesis compared with
2D digital mammography for breast cancer screening in community practice.
Greenberg JS1, Javitt MC, Katzen J, Michael S, Holland AE.
RESULTS
S For patients screened with 3D DBT, the relative change in recall rate was
16.1% lower than for patients screened with 2D DM (p > 0.0001)
S The overall cancer detection rate (CDR), expressed as number of
cancers per 1000 patients screened, was 28.6% greater (p = 0.035) for 3D
DBT (6.3/1000) compared with 2D DM (4.9/1000).
S The CDR for invasive cancers with 3D DBT (4.6/1000) was 43.8% higher (p
= 0.0056) than with 2D DM (3.2/1000).
S The positive predictive value for recalls from screening (PPV1) was 53.3%
greater (p = 0.0003) for 3D DBT (4.6%) compared with 2D DM (3.0%).
S No significant difference in the positive predictive value for biopsy
(PPV3) was found for 3D DBT versus 2D DM (22.8% and 23.8%,
respectively) (p = 0.696).
Recall Rate - 16%
CDR Rate + 28,6%
6 , 3 ‰ v s 4 , 9 ‰
CDR InvK + 43,8%
4 , 6 ‰ v s 3 , 2 ‰
P P V 1 + 5 3 , 3 %
4 , 6 % v s 3 %
PPV3 for biopsy =
2 2 . 8 % v s 2 3 . 8 %
48. !
AJR Am J Roentgenol. 2014 Sep;203(3):687-93.
Clinical performance metrics of 3D digital breast tomosynthesis compared with
2D digital mammography for breast cancer screening in community practice.
Greenberg JS1, Javitt MC, Katzen J, Michael S, Holland AE.
CONCLUSION
S In community-based radiology practice, mammography
screening with 3D DBT yielded compared with 2D DM
S lower recall rates
S increased CDR for cancer overall
S increased CDR for invasive cancer
S increased PPV1 in the group screened using 3D DBT.
53. !
S To compare diagnostic performance of
S (2D) mammography
S 2D mammography plus digital breast tomosynthesis (DBT)
S synthetic 2D mammography plus DBT
S 8869 women
S age range, 29–85 years ; mean, 56 years
S from July 2011 to March 2013
Fiona J. Gilbert, FRCR
Lorraine Tucker, DCR
Maureen G. C. Gillan,
PhD Paula Willsher, DCR
Julie Cooke, FRCR
Karen A. Duncan, FRCR
Michael J. Michell, FRCR
Hilary M. Dobson, FRCR
Yit Yoong Lim, FRCR
Tamara Suaris, FRCR
Susan M. Astley, PhD
Oliver Morrish, MSc
Kenneth C. Young, PhD
Stephen W. Duffy, MSc
Radiology Ahead of Print - 2016
54. !
Figure 2a: Graphs show the ROCreceiver operating characteristics curve analysis curves for (a) all cases in the three arms of the study
Fiona J. Gilbert; Lorraine Tucker; Maureen G. C. Gillan; Paula Willsher; & al; Radiology Ahead of Print
§ 87% for 2D mammography,
§ 89% for 2D mammography + DBT,
§ 88% for synthetic 2D mammography +
DBT
SensitivitySpecificity
55. !
Figure 2b: Graphs show the ROC receiver operating characteristics curve analysis curves for cases with visually assessed breast density of 50%
or more in all three arms of the study
Fiona J. Gilbert; Lorraine Tucker; Maureen G. C. Gillan; Paula Willsher; & al; Radiology Ahead of Print
§ 86% for 2D mammography,
§ 93% for 2D mammography + DBT
SensitivitySpecificity
Density ≥ 50%
56. !
In women with dense breasts
§ DBT increased
§ the sensitivity
§ 86% for 2D mammography alone
§ 93% for 2DM plus DBT
§ the specificity
§ 58% for 2D mammography alone
§ 69% for 2DM plus DBT
§ when the dominant radiologic feature was a mass, sensitivity :
§ 89% for 2D mammography
§ 92% for 2D mammography plus DBT
Fiona J. Gilbert, FRCR
Lorraine Tucker, DCR
Maureen G. C. Gillan,
PhD Paula Willsher, DCR
Julie Cooke, FRCR
Karen A. Duncan, FRCR
Michael J. Michell, FRCR
Hilary M. Dobson, FRCR
Yit Yoong Lim, FRCR
Tamara Suaris, FRCR
Susan M. Astley, PhD
Oliver Morrish, MSc
Kenneth C. Young, PhD
Stephen W. Duffy, MSc
Radiology Ahead of Print - 2016
57. !
• reducing the number of false-positive results
• particular benefit in younger women with dense breasts
• Synthetic 2D mammography similar to that of 2D
mammography when used in conjunction with DBT
Fiona J. Gilbert, FRCR
Lorraine Tucker, DCR
Maureen G. C. Gillan,
PhD Paula Willsher, DCR
Julie Cooke, FRCR
Karen A. Duncan, FRCR
Michael J. Michell, FRCR
Hilary M. Dobson, FRCR
Yit Yoong Lim, FRCR
Tamara Suaris, FRCR
Susan M. Astley, PhD
Oliver Morrish, MSc
Kenneth C. Young, PhD
Stephen W. Duffy, MSc
Radiology Ahead of Print - 2016
58. !
S Birads before DBT ?
S 58 y
S Right Breast cancer 2003
S UOQ
S Left VABB OQ 2010 : benign
S Previous Mammo 2013 : Birads 2v
60. !
Christoph I. Lee, MD, MSHS
Mucahit Cevik, MS, Oguzhan
Alagoz, PhD, Brian L. Sprague,
PhD, Anna N. A. Tosteson,
ScD, Diana L. Miglioretti, PhD,
Karla Kerlikowske, MD,
Natasha K. Stout, PhD, Jeffrey
G. Jarvik, MD, MPH Scott D.
Ramsey, MD, PhD Constance
D. Lehman, MD, PhD
Radiology: Volume 274: Number 3—March 2015
To evaluate the effectiveness of combined biennial digital
mammography (DM) and tomosynthesis(DBT) screening,
compared with biennial digital mammography screening
alone, among women with dense breasts.
61. !
Advances in Knowledge
• Combined biennial DMand DBT, compared with DM alone
• U.S. women aged 50–74 years with dense breast
• would avert :
• 1 additional breast cancer death per 2000 women screened
• 405 false-positive screening examination findings per 1000 women
screened.
Comparative effectiveness of combined Digital
Mammography and Tomosynthesis screening for
Women with Dense Breasts
Christoph I. Lee, MD & all
Radiology: Volume 274: Number 3—March 2015
62. !
Implications for Patient Care
In women aged 50–74 years with dense breasts
Combined biennial DM and DBT screening compared with DM alone is :
• likely to decrease the number of false-positive findings
• increase the number of cancers detected
• likely to improve outcomes at reasonable additional cost :
• cost-effective if priced around $226 for combined DM+DBT vs $139 for DM alone
• if reported interpretive performance metrics of improved specificity with DBT in routine
Comparative effectiveness of combined Digital
Mammography and Tomosynthesis screening for
Women with Dense Breasts
Christoph I. Lee, MD & all
Radiology: Volume 274: Number 3—March 2015
63. !
Conclusion
Take Home Messages
S Best detection
S Best caracterisation
S Best localisation
S Decrease recall rate ++
S Increase :
S cancer detection
S Invasive +++
S PPV 1
S Dense Breast +++
S Risk factor x 4
S Best detection
S for mass
S Best specificity
S Focal density
assymetry
S Decrease recall
rate +++
S Best location
• National Screening Program ?
• Pricing ?
64. !
La valeur de la Tomosynthèse
dépend elle de la densité
mammaire ?
Les seins denses bénéficient le plus
de l’apport de la tomosynthèse
Conclusion
Take Home Messages