Time Trends in Radiologists’ Interpretive Performance at Screening Mammography from the Community-based Breast Cancer Surveillance Consortium, 1996–2004
Laura E. Ichikawa, William E. Barlow, Melissa L. Anderson, Stephen H. Taplin, Berta M. Geller, R. James Brenner for the National Cancer Institute–sponsored Breast Cancer Surveillance Consortium
Radiology 2010;256 74-82
Link to Journal
We found an overall improvement in radiologists’ interpretive performance at subsequent screening mammography, 1996–2004, in a large national sample of women aged 40–79 years, with increases in both sensitivity and recall rate and a decrease in specificity
Recall rate and sensitivity for screening mammograms increased, whereas specificity decreased from 1996 to 2004 among women with a prior mammogram. This trend remained after accounting for risk factors. The net effect was an improvement in overall discrimination, a measure of the probability that a mammogram with cancer in the follow-up period has a higher Breast Imaging Reporting and Data System assessment category than does a mammogram without cancer in the follow-up period
Wednesday, 23 June 2010
Diffusion-weighted Imaging Improves the Diagnostic Accuracy of Conventional 3.0-T Breast MR Imaging
Diffusion-weighted Imaging Improves the Diagnostic Accuracy of Conventional 3.0-T Breast MR Imaging
Riham H. EI Khouli, Michael A. Jacobs, Sarah D. Mezban, Peng Huang, Ihab R. Kamel, Katarzyna J. Macura, and David A. Bluemke
Radiology 2010;256 64-73
Link to Journal
Adding quantitative diffusion-weighted imaging to the conventional MR imaging protocol resulted in significant diagnostic improvement.
DW imaging with glandular tissue–normalized ADC assessment improves the characterization of breast lesions beyond the characterization achieved with conventional 3D T1-weighted and dynamic contrast-enhanced MR imaging at 3.0 T
Riham H. EI Khouli, Michael A. Jacobs, Sarah D. Mezban, Peng Huang, Ihab R. Kamel, Katarzyna J. Macura, and David A. Bluemke
Radiology 2010;256 64-73
Link to Journal
Adding quantitative diffusion-weighted imaging to the conventional MR imaging protocol resulted in significant diagnostic improvement.
DW imaging with glandular tissue–normalized ADC assessment improves the characterization of breast lesions beyond the characterization achieved with conventional 3D T1-weighted and dynamic contrast-enhanced MR imaging at 3.0 T
BI-RADS Data Should Not Be Used to Estimate ROC Curves
BI-RADS Data Should Not Be Used to Estimate ROC Curves
Yulei Jiang and Charles E. Metz
Radiology 2010;256 29-31
Link to Journal
After applauding the recent trend of employing receiver operating characteristic (ROC) analysis to measure diagnostic performance in large clinical studies, we discuss why Breast Imaging Reporting and Data System data should not be used to estimate ROC curves in screening mammography
However, to truly realize the benefit of this assessment method, one must estimate ROC curves appropriately, addressing additional issues that arise as ROC analysis migrates from the laboratory to the clinic. Hypothetical perturbation of results from a recent study indicates that BI-RADS data do not provide a reliable basis for estimating ROC curves in screening mammography. Although we appreciate the potential benefit of—and therefore, the motivation for—estimating ROC curves from existing clinical cases in which BI-RADS assessments are recorded, we must recommend caution until an approach is found that overcomes the problems we have identified here. Any future methodologic innovations in prospective clinical study design that will allow diagnostic confidence to be reported on a true ordinal scale without introducing additional bias are welcome and should be exploited to help address these problems
Yulei Jiang and Charles E. Metz
Radiology 2010;256 29-31
Link to Journal
After applauding the recent trend of employing receiver operating characteristic (ROC) analysis to measure diagnostic performance in large clinical studies, we discuss why Breast Imaging Reporting and Data System data should not be used to estimate ROC curves in screening mammography
However, to truly realize the benefit of this assessment method, one must estimate ROC curves appropriately, addressing additional issues that arise as ROC analysis migrates from the laboratory to the clinic. Hypothetical perturbation of results from a recent study indicates that BI-RADS data do not provide a reliable basis for estimating ROC curves in screening mammography. Although we appreciate the potential benefit of—and therefore, the motivation for—estimating ROC curves from existing clinical cases in which BI-RADS assessments are recorded, we must recommend caution until an approach is found that overcomes the problems we have identified here. Any future methodologic innovations in prospective clinical study design that will allow diagnostic confidence to be reported on a true ordinal scale without introducing additional bias are welcome and should be exploited to help address these problems
The 2009 U.S. Preventive Services Task Force Guidelines Ignore Important Scientific Evidence and Should Be Revised or Withdrawn
The 2009 U.S. Preventive Services Task Force Guidelines Ignore Important Scientific Evidence and Should Be Revised or Withdrawn
Daniel B. Kopans
Radiology 2010;256 15-20
Link to Journal
The task force should know that their guidelines, and not revisionist statements, will be used to dissuade, if not prevent, women from undergoing mammographic screening
The USPSTF comprised individuals who had no direct expertise in mammographic screening. The members chosen to review mammographic screening are, by charter, “internists, pediatricians, family physicians, gynecologists/obstetricians, and nurses”.
Based on the oversights listed above, it seems to me that they did not understand the fundamentals of the randomized controlled trials of screening. They ignored direct data from screened populations in favor of computer models that were selected for them and decided to deprive women of access to screening because the task force decided that the anxiety caused by a recall from screening (most of which are easily resolved by extra mammographic views or US) was too much for women to tolerate
Daniel B. Kopans
Radiology 2010;256 15-20
Link to Journal
The task force should know that their guidelines, and not revisionist statements, will be used to dissuade, if not prevent, women from undergoing mammographic screening
The USPSTF comprised individuals who had no direct expertise in mammographic screening. The members chosen to review mammographic screening are, by charter, “internists, pediatricians, family physicians, gynecologists/obstetricians, and nurses”.
Based on the oversights listed above, it seems to me that they did not understand the fundamentals of the randomized controlled trials of screening. They ignored direct data from screened populations in favor of computer models that were selected for them and decided to deprive women of access to screening because the task force decided that the anxiety caused by a recall from screening (most of which are easily resolved by extra mammographic views or US) was too much for women to tolerate
Breast Cancer Screening: From Science to Recommendation
Breast Cancer Screening: From Science to Recommendation
Diana B. Petitti, Ned Calonge, Michael L. LeFevre, Bernadette Mazurek Melnyk, Timothy J. Wilt, J. Sanford Schwartz for the U.S. Preventive Services Task Force
Radiology 2010;256 8-14
Link to Journal
Further progress in reducing breast cancer morbidity and mortality will require a better understanding of methods for primary prevention, more effective therapy, and improved diagnostic tests that reduce false-positives and identify women with lesions likely to benefit from intervention
This is a response by the US Preventative Services Task Force to some of the criticisms leveled at their recent published guidelines (particularly the under 50's). Dan Kopans robust reply follows
Diana B. Petitti, Ned Calonge, Michael L. LeFevre, Bernadette Mazurek Melnyk, Timothy J. Wilt, J. Sanford Schwartz for the U.S. Preventive Services Task Force
Radiology 2010;256 8-14
Link to Journal
Further progress in reducing breast cancer morbidity and mortality will require a better understanding of methods for primary prevention, more effective therapy, and improved diagnostic tests that reduce false-positives and identify women with lesions likely to benefit from intervention
This is a response by the US Preventative Services Task Force to some of the criticisms leveled at their recent published guidelines (particularly the under 50's). Dan Kopans robust reply follows
Computer-aided US Diagnosis of Breast Lesions by Using Cell-based Contour Grouping
Computer-aided US Diagnosis of Breast Lesions by Using Cell-based Contour Grouping
Jie-Zhi Cheng, Yi-Hong Chou, Chiun-Sheng Huang, Yeun-Chung Chang, Chui-Mei Tiu, Kuei-Wu Chen, and Chung-Ming Chen
Radiology 2010; 255 746-754
Link to Journal
We present an efficient computer-aided diagnostic algorithm with an automatic segmentation approach where the lesion boundaries determined by using the cell-based contour grouping (CBCG) algorithms were shown to be close to the manually delineated boundaries, and the morphologic features determined from these CBCG-generated boundaries gave a high differentiation performance
Jie-Zhi Cheng, Yi-Hong Chou, Chiun-Sheng Huang, Yeun-Chung Chang, Chui-Mei Tiu, Kuei-Wu Chen, and Chung-Ming Chen
Radiology 2010; 255 746-754
Link to Journal
We present an efficient computer-aided diagnostic algorithm with an automatic segmentation approach where the lesion boundaries determined by using the cell-based contour grouping (CBCG) algorithms were shown to be close to the manually delineated boundaries, and the morphologic features determined from these CBCG-generated boundaries gave a high differentiation performance
Calcifications in Digital Mammographic Screening: Improvement of Early Detection of Invasive Breast Cancers?
Calcifications in Digital Mammographic Screening: Improvement of Early Detection of Invasive Breast Cancers?
Stefanie Weigel, Thomas Decker, Eberhard Korsching, Daniela Hungermann, Werner Böcker, and Walter Heindel
Radiology 2010; 255 738-745
Link to Journal
One-third of malignancies detected on the basis of calcifications only are invasive cancers. They tend to be smaller but not less aggressive than invasive cancers detected on the basis of other features.
Compared with published results of analog screening, digital screening offers the potential to increase the rate of invasive cancers detected on the basis of calcifications in population-based mammographic screening. Digital mammography has the potential to increase the rate of invasive cancers detected on the basis of isolated calcifications---cancers that tend to be smaller than those discovered because of other radiologic features
Stefanie Weigel, Thomas Decker, Eberhard Korsching, Daniela Hungermann, Werner Böcker, and Walter Heindel
Radiology 2010; 255 738-745
Link to Journal
One-third of malignancies detected on the basis of calcifications only are invasive cancers. They tend to be smaller but not less aggressive than invasive cancers detected on the basis of other features.
Compared with published results of analog screening, digital screening offers the potential to increase the rate of invasive cancers detected on the basis of calcifications in population-based mammographic screening. Digital mammography has the potential to increase the rate of invasive cancers detected on the basis of isolated calcifications---cancers that tend to be smaller than those discovered because of other radiologic features
Frequency of Malignancy Seen in Probably Benign Lesions at Contrast-enhanced Breast MR Imaging: Findings from ACRIN 6667
Frequency of Malignancy Seen in Probably Benign Lesions at Contrast-enhanced Breast MR Imaging: Findings from ACRIN 6667
Susan P. Weinstein, Lucy G. Hanna, Constantine Gatsonis, Mitchell D. Schnall, Mark A. Rosen, and Constance D. Lehman
Radiology 2010; 255 731-737
Link to Journal
In a multi-institutional study, the frequency of malignancy in MR-detected BI-RADS category 3 lesions was 0.9% (95% confidence interval: 0.02%, 5.14%)
Susan P. Weinstein, Lucy G. Hanna, Constantine Gatsonis, Mitchell D. Schnall, Mark A. Rosen, and Constance D. Lehman
Radiology 2010; 255 731-737
Link to Journal
In a multi-institutional study, the frequency of malignancy in MR-detected BI-RADS category 3 lesions was 0.9% (95% confidence interval: 0.02%, 5.14%)
Risk of Upgrade of Atypical Ductal Hyperplasia after Stereotactic Breast Biopsy: Effects of Number of Foci and Complete Removal of Calcifications
Risk of Upgrade of Atypical Ductal Hyperplasia after Stereotactic Breast Biopsy: Effects of Number of Foci and Complete Removal of Calcifications
Jennifer R. Kohr, Peter R. Eby, Kimberly H. Allison, Wendy B. DeMartini, Robert L. Gutierrez, Sue Peacock, and Constance D. Lehman
Radiology 2010; 255 723-730
Link to Journal
Ultimately, despite the theoretically improved accuracy of 9- and 11-gauge vacuum-assisted breast biopsy needles and the risk stratification performed on the basis of histopathologic and mammographic criteria, we were unable to identify a subpopulation of patients with atypical ductal hyperplasia who could safely avoid surgical excision
The upgrade rate is significantly higher when ADH involves at least three foci. Surgical excision is recommended even when ADH involves fewer than three foci and all mammographic calcifications have been removed, because the upgrade rate is 12%
Jennifer R. Kohr, Peter R. Eby, Kimberly H. Allison, Wendy B. DeMartini, Robert L. Gutierrez, Sue Peacock, and Constance D. Lehman
Radiology 2010; 255 723-730
Link to Journal
Ultimately, despite the theoretically improved accuracy of 9- and 11-gauge vacuum-assisted breast biopsy needles and the risk stratification performed on the basis of histopathologic and mammographic criteria, we were unable to identify a subpopulation of patients with atypical ductal hyperplasia who could safely avoid surgical excision
The upgrade rate is significantly higher when ADH involves at least three foci. Surgical excision is recommended even when ADH involves fewer than three foci and all mammographic calcifications have been removed, because the upgrade rate is 12%
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