Breast cancer imaging-clinical experience with two-dimensionalshear wave elastography:A retrospective study

BACKGROUND Breast cancer morbidity has been increasing worldwide,but treatments are improving.The therapeutic response depends on the stage at which the disease is diagnosed.Therefore,early diagnosis has never been more essential for successful treatment and a reduction in mortality rates.Radiology plays a pivotal role in cancer detection,and advances in ultrasound(US)palpation have shown promising results for breast cancer imaging.The addition of two-dimensional-shear wave elastography(2D-SWE)US in the routine breast imaging exam can increase early cancer detection and promote better surveillance.AIM To evaluate the clinical applications of 2D-SWE US in breast cancer detection and its combination with other imaging modalities.METHODS The 200 consecutive female patients aged 50-80 were examined to evaluate palpable breast lesions.All patients underwent mammography,bright mode(B-mode)US,and 2D-SWE followed by US-guided biopsy in two consecutive sessions.RESULTS Combining B-mode and shear wave US imaging with X-ray mammography revealed 100%of the suspicious lesions,resulting in greater sensitivity,specificity,and negative predictive value.The result improves compared to either B-mode or 2D-SWE alone(P=0.02).CONCLUSION Combining 2D-SWE with conventional US and X-ray techniques improves the chance of early cancer detection.Including 2D-SWE in regular breast imaging routines can reduce the need for biopsies and improve the chance of early cancer detection and survivability with the proper line of therapy.

Optical mammography:Diffuse optical imaging of breast cancer

Existing imaging modalities for breast cancer screening,diagnosis and therapy monitoring,namely X-ray mammography and magnetic resonance imaging,have been proven to have limitations.Diffuse optical imaging is a set of non-invasive imaging modalities that use near-infrared light,which can be an alternative,if not replacement,to those existing modalities.This review covers the background knowledge,recent clinical outcome,and future outlook of this newly emerging medical imaging modality.

Complement of ^(99m)Tc-octreotide scintimammography to mammography in evaluating breast cancers

In this paper,the 99mTc-octreotide scintimammography as a useful complementary technique of mammography was evaluated in diagnosing breast cancers.The 45 breast lesions were consecutively detected by mammography,and 99mTc-octreotide scintimammography,and both combination technique on the basis of self-examination,physical examination.Clinical diagnosis was confirmed by histopathologic analysis.Radioactivity uptake ratios for tumor vs normal breast tissues (T/NT) were calculated using regions of interest.In the breast cancer groups and the benign lesion groups,the average uptake ratios of the 99mTc-octreotide were 1.63±0.19 and 1.09±0.13,respectively,and t was 9.638 (P<0.001).Based on sensitivity,specificity,accuracy,positive predicting value,and negative predicting value,99mTc-octreotide scintimammography was 87%,79%,84%,90%,and 73%,the mammography was 65%,64%,64%,80%,and 45%,and both combination was 95%,100%,97%,100% and 92%,respectively.This showed that the 99mTc-octreotide scintimammography was more useful than mammography in the evaluating suspected breast cancers,and the combination technique can accurately discriminate lesions.

Women’s Performance of Breast Cancer Screening (Breast Self-Examination, Clinical Breast Exam and Mammography)

Background: Breast cancer is the most common malignancy among women in Saudi Arabia. Despite the availability of early detection methods to diagnose breast cancer, a huge number of women are still unaware about these methods. This study was conducted to identify the attitude of women in Medina toward breast cancer screening methods, including breast self-examination (BSE), clinical breast examination (CBE) and mammography. Methods and Materials: A cross-sectional survey has been conducted on 124 women aged from 39 and older, who attended Taibah Medical Center for cancer screening either by doctor’s recommendation, family or friends advice, or by herself. Face to face questionnaire was used to collect data. All data were analyzed by statistical analysis system software. Results: The results showed only 35.5%, 27.4% and 37.8% of participants reported that they practiced BSE, CBE and annual mammography, respectively. Only 27.3% of women practiced BSE once per month, and 8.8% visited doctor annually for CBE. Both educational level (p = 0.004) and family history (p = 0.01) were significantly related to BSE. 57.7% of the participants who had positive family history practiced BSE, and 56.0% of the participants who practiced BSE were highly educated. Lacking awareness about BSE is the most important barrier in not practicing BSE, while not having a breast lump was the reason for not undergoing either clinical breast examination (38.7%) or periodic mammography (54.9%). Conclusion: This study emphasized the need for massive health education program to increase awareness, and improve the attitude of women toward breast cancer screening methods.

Mammography during Breast Cancer Awareness Month Campaigns in Lomé(Togo): In Relation to 1074 Cases over a Period of 5 Years

Background: This study aimed to describe the results of mammography done during breast cancer awareness campaigns in Lomé. Methods: This was a retrospective multicenter study which focused on the analysis of mammographic examinations, with or without breast ultrasound, carried out in three (3) clinics in Lomé over a period of five (5) years during the breast cancer awareness month (Pink October) campaigns. We included in our study women of all ages who underwent a mammography during the study period. Additional ultrasound was performed as needed in some women to better characterize a lesion. The parameters studied were socio-demographic data, and aspects of breast lesions. We classified the lesions in order of severity according to the BI-RADS classification. Results: During the study we counted one thousand and seventy-four (1074) women who underwent mammography examinations, corresponding to an average of 214.8 women per year. The median age of the women was 46 years. The most represented age group was 40 - 49, constituting 30% of cases. Mammography was performed on all women and ultrasound was performed on 51.3% of women. Lesions suspicious for malignancy (BI-RADS IV) and lesions highly suggestive of malignancy (BI-RADS V) represented 3.5% and 1.9% of cases respectively, amounting to a prevalence of 5.4%. They occurred more frequently from the age of 30 years with a statistically significant difference (p = 0.02). These lesions could be identified on mammograms as masses with irregular shapes and spiculated margins representing 16.1% and 9.7% of masses respectively. On ultrasound, these were solid masses with irregular and ill-defined borders, representing 25.2% and 5.2% of solid masses respectively. Lesions suspicious for malignancy were most often found in the UOQ (upper outer quadrant) in 70% of cases. Conclusion: Mammography screening for breast cancer remains a necessity in our community, even if the rate of cancer detected remains low. It allows for early diagnosis of cancers, promoting better management.

Mammography and ^(99m)Tc-MIBI scintimammography inbreast cancer diagnosis

The aim of this work has been to evaluate whether a diagnostic protocol based on the joint use of mammography and 99mTc-MIBI scintimammography can help to distinguish the lesions and to reduce the number of biopsies required in patients with suspected breast cancer. A total of 58 women were evaluated by palpation, mammography, scintimammography. Twenty-four patients were scintimammographed with 99mTc-MIBI at 10min after injection. Thirty-four patients were taken doublephase scintimammography with 99mTc-MIBI 10min and 60-90min after injection. Based on mammography, the supicion degrees of malignancy were rated, and 30 results of malignancy were confirmed by histopathology. Based on mammography, 18 lesions were considered to be most probably benign (of which 3 were histopathologi-cally breast cancer), 19 as indeterminate (of which 9 were histopathologically breast cancer), and 21 as malignant (of which 18 were histopathologically breast cancer). The results of early and delayed phases 99mTc-MIBI scintimammography were the same. The sensitivity, specificity and accuracy of scintimammography were 74.29%, 86.96% and 79.31%, respectively. Scintimammography gave 16 correct diagnosis in 19 mammogram indeterminate (84.2%) and demonstrated 5 out of 8 cases axillary lymph nodes metastasis (62.5%). These studies show that 99mTc-MIBI scintimammography used as a complementary testing technique to mammography is useful in the examination of patients with suspected breast cancer. The adoption of a joint mammography-scintimammography diagnostic protocol conld considerably reduce the number of biopsies performed in patients with lesions of indeterminate mammographic suspicion of malignancy.

Comparison between Visualization of Microcalcifications by Digital Breast Tomosynthesis and Full-Field Digital Mammography

Objective: To date, few studies have compared the diagnostic performance and visibility of microcalcifications obtained using digital breast tomosynthesis (DBT) with those obtained from full-field digital mammography (FFDM). The visualization and characterization of microcalcifications with DBT remain controversial. The purpose of this study was to compare the visibility of microcalcifications and determine whether DBT exhibits a diagnostic advantage for visualizing microcalcifications over FFDM. Methods: We retrospectively reviewed 120 cases including DBT and FFDM imaging (60 histologically verified as breast cancers and 60 as benign microcalcifications or normal). DBT images with a wide scan-angle of 50° and FFDM images were obtained using a flat-panel system (MAMMOMAT Inspiration, Siemens). Images were independently reviewed by four board-certified radiologists and evaluated for the presence of microcalcifications, probability of malignancy (BI-RADS classification), and visibility. Results: In predicting the malignancy of detected microcalcifications, no significant difference was found between readers’ areas under the receiver operating characteristic curve for DBT and FFDM (p = 0.068). The visibility scores of detected microcalcifications were 3.74 ± 1.06 for DBT and 3.46 ± 0.93 for FFDM, respectively. The visibility of microcalcifications when using DBT was found to be significantly superior to that of FFDM (p < 0.05). Conclusion: Our results suggest that the image quality of DBT with a wide scan-angle is comparable or superior to that obtained with FFDM in terms of both visibility and assessment of microcalcifications.

Initial Experience with Contrast Enhanced Digital Mammography (SenoBright)—In a Comprehensive Clinical Breast Center

Objective: The purpose of initiating contrast enhanced digital mammography in our center was to evaluate the complimentary benefit of this technology with screening digital mammography and real time ultrasound in equivocal cases and high risk patients with dense breast. The intended goal was to reduce the incidence of further diagnostic and invasive procedures. Methods: Patients thought to be candidates who had good renal function confirmed by serum Blood Urea Nitrogen (BUN) and Creatinine were offered the procedure, and 225 patients had the procedure during the period of March 2013 through November 2014. The contrast enhanced digital mammograms (SenoBright) are performed on the Senograph Essential Unit. A total of 8 images are obtained: 4 conventional digital mammograms and 4 contrast enhanced digital mammograms. The patients with a positive SenoBright study had a tissue diagnosis of the lesion obtained by either a stereotactic needle biopsy, ultrasound guided core biopsy, or ultrasound directed open excisional biopsy. Results: The 225 patients who had the procedure included high risk patients with dense breast (41), patients with abnormal mammograms (92), and patients with equivocal clinical, mammographic and real time ultrasound findings (92). 31 studies were interpreted as positive and 194 as negative. 33 biopsies were performed, with 31 patients having a positive study and 2 patients with a negative study. 22 cancers were detected. Conclusion: We found that the addition of dynamic contrast enhanced digital subtraction mammography (SenoBright) was helpful in distinguishing malignant from non-malignant lesions. It was also effective in demonstrating multifocal lesions and identifying non-palpable occult carcinomas in the dense breast. It proved to be a valuable complimentary adjunctive diagnostic modality for a comprehensive clinical breast center.

Interpretation of breast cancer screening guideline for Chinese women

Breast cancer is the most common malignant tumor in Chinese women.Early screening is the best way to improve the rates of early diagnosis and survival of breast cancer patients.The peak onset age for breast cancer in Chinese women is considerably younger than those in European and American women.It is imperative to develop breast cancer screening guideline that is suitable for Chinese women.By summarizing the current evidence on breast cancer screening in Chinese women,and referring to the latest guidelines and consensus on breast cancer screening in Europe,the United States,and East Asia,the China Anti-Cancer Association and National Clinical Research Center for Cancer(Tianjin Medical University Cancer Institute and Hospital)have formulated population-based guideline for breast cancer screening in Chinese women.The guideline provides recommendations on breast cancer screening for Chinese women at average or high risk of breast cancer according to the following three aspects:age of screening,screening methods,and screening interval.This article provides more detailed information to support the recommendations in this guideline and to provide more direction for current breast cancer screening practices in China.

Preventing breast cancer in LMICs via screening and/or early detection: The real and the surreal

To review the present status of breast cancer(BC) screening/early detection in low- and middle-income countries(LMICs) and identify the way forward, an open focused search for articles was undertaken in Pub Med, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on Research Gate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer(BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. No-tably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer modalities such as ultrasonography which is more suited to LMIC populations and use of m Health for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC.

Efficacy of digital breast tomosynthesis combined with magnetic resonance imaging in the diagnosis of early breast cancer

BACKGROUND The incidence and mortality rate of breast cancer in China rank 120th and 163rd,worldwide,respectively.The incidence of breast cancer is on the rise;the risk increases with age but is slightly reduced after menopause.Early screening,diagnosis,and timely determination of the best treatment plan can ensure clinical efficacy and prognosis.AIM To evaluate the clinical value of magnetic resonance imaging(MRI) combined with digital breast tomosynthesis(DBT) in diagnosing early breast cancer and the effect of breast-conserving surgery by arc incision.METHODS This study was divided into two parts.Firstly,110 patients with early breast cancer confirmed by pathological examination and 110 with benign breast diseases diagnosed simultaneously in Changzhi People’s Hospital of Shanxi Province and Shanxi Dayi Hospital from May 2019 to September 2020 were included in the breast cancer group and the benign group,respectively.Both groups underwent DBT and MRI examination,and the pathological results were used as the gold standard to evaluate the effectiveness of the combined application of DBT and MRI in the diagnosis of early breast cancer.Secondly,according to the operation method,110 patients with breast cancer were divided into either a breast-conserving group(69 patients) or a modified radical mastectomy group(41 patients).The surgical effect,cosmetic effect,and quality of life of the two groups were compared.RESULTS Among the 110 cases of breast cancer,66 were of invasive ductal carcinoma(60.00%),and 22 were of ductal carcinoma in situ(20.00%).Among the 110 cases of benign breast tumors,55 were of breast fibromas(50.00%),and 27 were of breast adenosis(24.55%).The sensitivity,specificity,and area under the curve(AUC) of DBT in the differential diagnosis of benign and malignant breast tumors were 73.64%,84.55%,and 0.791,respectively.The sensitivity,specificity,and AUC of MRI in the differential diagnosis of benign and malignant breast tumors were 84.55%,85.45%,and 0.850,respectively.The sensitivity,specificity,and AUC of DBT combined with MRI in the differential diagnosis of benign and malignant breast tumors were 97.27%,93.64%,and 0.955,respectively.The blood loss,operation time and hospitalization time of the breast-conserving group were significantly lower than those of the modified radical treatment group,and the difference was statistically significant(P < 0.05).After 3 mo of observation,the breast cosmetic effect of the breast-conserving group was better than that of the modified radical group,and the difference was statistically significant(P < 0.05).Before surgery,the quality-of-life scores of the breast-conserving and modified radical mastectomy groups did not differ(P > 0.05).Three months after surgery,the quality-of-life scores in both groups were higher than those before surgery(P < 0.05),and the quality-of-life score of the breast-conserving group was higher than that of the modified radical group(P < 0.05).In the observation of tumor recurrence rate two years after the operation,four patients in the breast-conserving group and one in the modified radical treatment group had a postoperative recurrence.There was no significant difference in the recurrence rate between the two groups(χ2 = 0.668,P = 0.414 > 0.05).CONCLUSION MRI combined with DBT in diagnosing early breast cancer can significantly improve the diagnostic efficacy compared with the two alone.Breast-conserving surgery leads to better cosmetic breast effects and reduces the impact of surgery on postoperative quality of life.

Development and evaluation of the screening performance of a low-cost high-risk screening strategy for breast cancer

Objective:To develop and evaluate the screening performance of a low-cost high-risk screening strategy for breast cancer in low resource areas.Methods:Based on the Multi-modality Independent Screening Trial,6 questionnaire-based risk factors of breast cancer(age at menarche,age at menopause,age at first live birth,oral contraceptive,obesity,family history of breast cancer)were used to determine the women with high risk of breast cancer.The screening performance of clinical breast examination(CBE),breast ultrasonography(BUS),and mammography(MAM)were calculated and compared to determine the optimal screening method for these high risk women.Results:A total of 94 breast cancers were detected among 31,720 asymptomatic Chinese women aged 45–65 years.Due to significantly higher detection rates(DRs)and suitable coverage of the population,high risk women were defined as those with any of 6 risk factors.Among high risk women,the DR for BUS[3.09/1,000(33/10,694)]was similar to that for MAM[3.18/1,000(34/10,696)],while it was significantly higher than that for the CBE[1.73/1,000(19/10,959),P=0.002].Compared with MAM,BUS showed significantly higher specificity[98.64%(10,501/10,646)vs.98.06%(10,443/10,650),P=0.001],but no significant differences in sensitivity[68.75%(33/48)vs.73.91%(34/46)],positive prediction values[18.54%(33/178)vs.14.11%(34/241)],and negative prediction values[99.86%(10,501/10,516)vs.99.89%(10,443/10,455)].Further analyses showed no significant difference in the percentages of early stage breast cancer[53.57%(15/28)vs.50.00%(15/30)],lymph node involvement[22.73%(5/22)vs.28.00%(7/25)],and tumor size≥2 cm[37.04%(10/27)vs.29.03%(9/31)]between BUS and MAM.Subgroup analyses stratified by breast densities or age at enrollment showed similar results.Conclusions:The low-cost high-risk screening strategy based on 6 questionnaire-based risk factors was an easy-to-use method to identify women with high risk of breast cancer.Moreover,BUS and MAM had comparable screening performances among high risk women.

Role of mammogram and ultrasound imaging in predicting breast cancer subtypes in screening and symptomatic patients

BACKGROUND Breast cancer(BC)radiogenomics,or correlation analysis of imaging features and BC molecular subtypes,can complement genetic analysis with less resourceintensive diagnostic methods to provide an early and accurate triage of BC.This is pertinent because BC is the most prevalent cancer amongst adult women,resulting in rising demands on public health resources.AIM To find combinations of mammogram and ultrasound imaging features that predict BC molecular subtypes in a sample of screening and symptomatic patients.METHODS This retrospective study evaluated 328 consecutive patients in 2017-2018 with histologically confirmed BC,of which 237(72%)presented with symptoms and 91(28%)were detected via a screening program.All the patients underwent mammography and ultrasound imaging prior to biopsy.The images were retrospectively read by two breast-imaging radiologists with 5-10 years of experience with no knowledge of the histology results to ensure statistical independence.To test the hypothesis that imaging features are correlated with tumor subtypes,univariate binomial and multinomial logistic regression models were performed.Our study also used the multivariate logistic regression(with and without interaction terms)to identify combinations of mammogram and ultrasound(US)imaging characteristics predictive of molecular subtypes.RESULTS The presence of circumscribed margins,posterior enhancement,and large size is correlated with triple-negative BC(TNBC),while high-risk microcalcifications and microlobulated margins is predictive of HER2-enriched cancers.Ductal carcinoma in situ is characterized by small size on ultrasound,absence of posterior acoustic features,and architectural distortion on mammogram,while luminal subtypes tend to be small,with spiculated margins and posterior acoustic shadowing(Luminal A type).These results are broadly consistent with findings from prior studies.In addition,we also find that US size signals a higher odds ratio for TNBC if presented during screening.As TNBC tends to display sonographic features such as circumscribed margins and posterior enhancement,resulting in visual similarity with benign common lesions,at the screening stage,size may be a useful factor in deciding whether to recommend a biopsy.CONCLUSION Several imaging features were shown to be independent variables predicting molecular subtypes of BC.Knowledge of such correlations could help clinicians stratify BC patients,possibly enabling earlier treatment or aiding in therapeutic decisions in countries where receptor testing is not readily available.

The Experience of Mammography Based on the Memoirs of Examinees

The purpose of this study was to shed light on the pattern of the mammography experience from the examinee’s perspective based on episodic information extracted from notes written by the examinees. Using the notes is an effective approach to maintain privacy and avoid excessive stress. The study methods were qualitative inductive analyses of four sets of notes. Results showed that examinees “checked the words and actions of the medical staff” while relying on the “peace of mind instilled by the technician” before taking the mammogram. However, as breast compression became more intense, their feelings changed to a sense of “betrayal by someone on whom they were relying” since they felt that the technician was “ignoring the situation” or “considering but continuing breast compression”. They were also affected by the “shooting position which is impossible to avoid”. Breast compression during the mammography was a “pressure pain that exceeded their expectations” causing “dissatisfaction with the screening as a result of the pain” and “subconsciously created systemic tension”. Meanwhile, during the shooting, the examinees had performed “quiet countermeasures” such as “self-coping to distract themselves from the pain”. Examinees “earnestly desired a minimal shooting time” but, on the other hand, they also wanted “certainty of shooting rather than consideration of pain”. From these results, it is apparent that examinees were objectively observing the staff, even during shooting and the examinees were using self-coping measures to counter the pain. Providing support measures during mammography procedures is suggested based on the patterns of experiences.

Efficacy of Magnetic Resonance Imaging in BIRADS 3, 4 and 5 Patients Detected on Full Field Digital Mammography: Our Experience

Aim of the study: To perform Dynamic contrast enhanced MRI of breast in patients with positive findings (BIRADS 3, 4 and 5) detected on screening mammography;to correlate the findings of digital mammography and contrast enhanced MRI of breast with histopathological examinations. Settings and Design: A prospective observation study was conducted at a single centre, i.e. HCG Manavata Cancer Centre. Materials and Methods: Screening mammography was performed on patients with age > 40 years and on patients with age 35 - 40 years having positive family history. The positive mammography was reported and the lesions classified according to BIRADS criteria for mammography. Results: Mammographic examination of the breast lesions yielded an overall sensitivity of 97.67% and a specificity of 85.71%. In our study we combined both morphologic and dynamic parameters and its modification into BIRADS category for lesion classification. The sensitivity of MRI examinations was 97.67% while the specificity was 71.43%. Spiculated margins were encountered only in malignant lesions (p = 0.0006). Statistical correlation was obtained between the pathologically proven benign and malignant lesions regarding their enhancement pattern with p value of Conclusion: As per the results, dynamic contrast MRI had high sensitivity but limited specificity. We did not find any significant difference between FFDM and MRI in terms of diagnostic accuracy. The use of DWI showed high specificity at cut off point of ADC value—0.85 mm2/s. Thus, DWI can be used in addition of morphological and dynamic kinetic characteristics to increase specificity of MRI.

Intraductal papilloma of the breast in association with preoncogenic gene of breast cancer

We reported a case of an African American woman who went to the hospital with palpable right breast lump with bloody nipple discharge at University of Texas Medical Brand at Galvestion. The modalities of breast imagings included mammography and ultrasongraphy.The method used for viral identification was Linear Array HPV genotyping test Intraductal papilloma revealed as high density tubular or rounded lobular masses with partially circumscribed,obscured margins and clustered punctate microcalcifications on mammograms.Ultrasound showed as intraductal masses with dilated ducts.The core biopsy demonstrated duct filled with papillary lesion and post excision revealed intraductal papilloma.HPV DNA types 16,33,58 and 71 were detected after use of Linear Array HPV genotyping test.

Overdiagnosis of breast cancer in population screening:does it make breast screening worthless?

The risk of breast cancer(BC) overdiagnosis attributed to mammography screening is an unresolved issue, complicated by heterogeneity in the methodology of quantifying its magnitude, and both political and scientific elements surrounding interpretation of the evidence on this phenomenon. Evidence from randomized trials and also from observational studies shows that mammography screening reduces the risk of BC death; similarly, these studies provide sufficient evidence that overdiagnosis represents a serious harm from population breast screening. For both these outcomes of screening, BC mortality reduction and overdiagnosis, estimates of magnitude vary between studies however overdiagnosis estimates are associated with substantial uncertainty. The trade-off between the benefit and the collective harms of BC screening, including false-positives and overdiagnosis, is more finely balanced than initially recognized, however the snapshot of evidence presented on overdiagnosis does not mean that breast screening is worthless. Future efforts should be directed towards(a) ensuring that any changes in the implementation of BC screening optimize the balance between benefit and harms, including assessing how planned or actual changes modify the risk of overdiagnosis;(b) informing women of all the outcomes that may affect them when they participate in screening using well-crafted and balanced information; and(c) investing in research that will help define and reduce the ensuing overtreatment of screen-detected BC.

SEGMENTATION AND CORRELATION OF OPTICAL COHERENCE TOMOGRAPHY AND X-RAY IMAGES FOR BREAST CANCER DIAGNOSTICS

Pre-operative X ray mammography and int raoperative X-ray specimen radiography are routinely used to identify breast cancer pathology.Recent advances in optical coherence tomography(OCT)have enabled its 1use for the intraoperative assessment of surgical margins during breast cancer surgery.While each modality offers distinct contrast of normal and pathological features,there is an essential need to correlate image based features between the two modalities to take adv antage of the diagnostic capabilities of each technique.We compare OCT to X-ray images of resected human breast tissue and correlate different tissue features between modalities for future use in real-tine intraoperative OCT imaging.X ray imaging(specimen radiography)is currently used during surgical breast cancer procedures to verify tumor margins,but cannot image tissue in situ.OCT has the potential to solve this problem by providing intrao-perative imaging of the resected specimen as well as the in situ tumor cavity.OCT and micro-CT(X-ray)images are automatically segmented using different computational approaches,and quantitatively compared to determine the ability of these algorithms to automat ically differentiate regions of adipose tissue from tumor.Furthermore,two-dimensional(2D)and three-dimensional(3D)results are compared.These correlations,combined with real-time intraoperative OCT,have the potential to identify possible regions of tumor within breast tissue which correlate to tumor regions identified previously on X-ray imaging(mammography or specimen radiography).

Indications and the Outcome of the Mammography at Douala General Hospital (Cameroon)

Background: Recent reports indicate that the use of mammography in breast screening plays a major role in reducing breast cancer-related deaths. It helps to improve quality of care and patient information. However, in Cameroon, there are no organized general breast screening programs which give women the opportunity to regularly screen their breasts, except for the few who take their own initiative for breast screening. Purpose: This study aimed to list indications and results of mammography and/or breast ultrasounds at Douala General Hospital in order to determine the proportion of routine mammographic screening. Method: This descriptive cross-sectional study was carried out at Douala General Hospital using pre-established data sheets. The study recruited all patients who met the selection criteria and reported to the radiology and medical imaging department for breast screening using physical examinations, mammography and/or ultrasounds. Results: The study recruited 372 patients, 96.8% of whom were between 40 to 50 years old. The reasons given for the medical consultation were systematic screening (33.01%);pain (27.18%) and lumps (25.24%). Breast examination by inspection was normal in 87.1% of women, and by palpation in 66.7%. Mammography revealed nodular opacities (18.3%), spiculated images (4.3%) and micro calcifications (3.2%), while ultrasound identified fibroadenomas (16.48%) and cysts (6.18%). Suspicious lesions (ACR 4 and 5) were discovered in 7.6% of cases by mammography and 8.51% of cases by ultrasound. The results indicated that there was no significant association between the use of clinical examination and mammography (p = 0.754). The use of clinical examination alone for breast screening may not be sufficient. Conclusion: Our findings indicate that in Cemaroon, the routine screening mammography accounts for less than one-third (33.1%) of all indications. Benign lesions were most common, however 7.6% and 8.51% of suspicious malignant lesions were observed using mammography and ultrasound respectively.

Analysis of Machine Learning Techniques Applied to the Classification of Masses and Microcalcification Clusters in Breast Cancer Computer-Aided Detection

Breast cancer is one of the most common and deadliest types of cancer among women and early detection is of major importance to decrease mortality rates. Microcalcification clusters and masses are two major indicators of malignancy in the early stages of this disease, when mammography is typically used as the screening technology. Computer-Aided Diagnosis (CAD) systems can support the radiologists’ work, by performing a double-reading process, which provides a second opinion that the physician can take into account in the detection process. This paper presents a CAD model based on computer vision procedures for locating suspicious regions that are later analyzed by artificial neural networks, support vector machines and linear discriminant analysis, to classify them into benign or malignant, based on a set of features that are extracted from lesions to characterize their visual content. A genetic algorithm is used to find the subset of features that provide the greatest discriminant power. Our results show that the SVM presented the highest overall accuracy and specificity for classifying microcalcification clusters, while the NN outperformed the rest for mass-classification in the same parameters. Overall accuracy, sensitivity and specificity were measured.