The breast
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Soft tissue radiographs are taken by placing the breast in direct contact with ultrasensitive film and exposing it to low-voltage, high-amperage x-rays (Figure53.2). The dose of radiation is approximately 0.1 cGy and, therefore, mammography is a very safe investigation. The sensitivity of this investigation increases with age as the breast becomes less dense. In total, 5% of breast cancers are missed by population-based mammographic screening programmes; even in retrospect, such carcinomas are not apparent. Thus, a normal mammogram does not exclude the presence of carcinoma. Digital mammography is being introduced, which allows manipulation of the images and computer-aided diagnosis. Tomo-mammography is also being assessed as a more sensitive diagnostic modality.
Breast cancer
Ruijiang Li, Lei Xing, Sandy Napel, Daniel L. Rubin in Radiomics and Radiogenomics, 2019
Full-field digital mammography (FFDM) is used in both screening programs and diagnostic workups to detect early cancers and better diagnose/determine patient management, respectively (6). FFDM is a 2D single-projection radiographic image that allows for image formation due to the differential X-ray attenuation of the components within the breast—e.g., parenchyma stroma tissue, tumors, microcalcifications. In mammography, the breast is compressed, and attenuated X-rays are subsequently passed through a grid to reduce scatter radiation and then recorded by a digital detector system. Digital mammography systems have a large dynamic range, as compared to prior screen/film mammography, which had a nonlinear response with a limited exposure range (7). Since FFDM is a single projection image, a disadvantage is the presence of overlapping tissue from the 3D breast volume to the 2D planar image.
Breast cancer
Peter Hoskin, Peter Ostler in Clinical Oncology, 2020
Mammography is a sensitive means of detecting carcinomas, often before the lump is palpable by the patient or clinician, thereby facilitating the detection of early breast cancers with a particularly good prognosis. In the United Kingdom, the National Breast Screening Programme screens all women aged 50–70 years with 3-yearly mammograms. This age range is being extended to 47–73 over the next few years. Women older than this can be screened on request. Such a programme should result in a mortality reduction of 20%–30%. There is at present no consensus as to what age premenopausal women should be included in a screening programme, as they tend to have dense breasts, which can obscure the radiological signs of early breast cancers; studies to date have indicated a much smaller impact on survival than in the >50 year age group. However, young women with a family history of breast cancer should be offered regular clinical assessments and mammographic screening at an earlier age. Digital mammography seems to lead to fewer false-positive results than traditional film-based mammography and is superior for young women with dense breasts. Ultrasonography is a poor substitute for mammography. In younger women with dense breasts, particularly those with BRCA gene mutations, magnetic resonance mammography is the optimum screening modality.
The role of screening mammography in the era of modern breast cancer treatment
Published in Climacteric, 2018
When the Working Group considered the CNBSS, the main criticism was that it used outdated technology. Interestingly, a radiologist who was a visiting scientist at IARC at the time of the Working Group meeting insisted that the images from the HIP trial era were good, so that this trial was included in the evaluation. Film-screen mammography was not used in the HIP trial, but it was in the CNBSS, and in all other trials in the same era. We are the only trialists to have used a reference radiologist and a reference physicist and have submitted our films to independent evaluation31–33 but there are no data to assess the films from the other trials. When indirect evidence is used, the CNBSS performs well34. Although nowadays digital mammography is the norm, there is no evidence that screening using digital mammography reduces breast cancer mortality, a conclusion accepted by the Working Group, and it seems very likely that its use increases over-diagnosis35.
Economic evaluation of supplemental breast cancer screening modalities to mammography or digital breast tomosynthesis in women with heterogeneously and extremely dense breasts and average or intermediate breast cancer risk in US healthcare
Published in Journal of Medical Economics, 2023
Michael Blankenburg, Irene Sánchez-Collado, Busayo Oladimeji Soyemi, Örjan Åkerborg, Amrit Caleyachetty, James Harris, Elizabeth Morris, Gillian Newstead, Franziska Lobig
Some studies have suggested that CEM may be less costly54 and more accessible than MRI55,56, with potentially faster examination and reading times. Capacity modeling in the present study suggests that, when existing facilities are considered, wide-scale CEM may be more challenging to implement in practice than is typically anticipated as more scanners at higher additional costs than MRI would be needed. Not all existing mammography units can be adapted or upgraded to deliver contrast-enhanced imaging – only certain mammography suites can be upgraded, and this varies across models. Therefore, the cost of a purpose-built contrast-enhanced, mammography-capable facility may not be that much different from the cost of acquiring a new MRI facility.
Systematic review of agreement between tomosynthesis and pathologic tumor size for newly diagnosed breast cancer and comparison with other imaging tests
Published in Expert Review of Medical Devices, 2018
M. Luke Marinovich, Petra Macaskill, Daniela Bernardi, Nehmat Houssami
Measurement of tumor size is inherently subject to error. For example, the longest tumor dimension visible on imaging may not correspond to the dimension measured at pathology, resulting in underestimation of pathologic size. Conversely, imaging may overestimate size due to dense tissue being difficult to distinguish from tumor. Quasi-3D images from tomosynthesis have potential advantages over 2D mammography in reducing such measurement errors. Current guidelines for the diagnosis and evaluation of breast cancer note the potential of tomosynthesis to improve accuracy for staging, particularly for women with dense breasts [6], but do not yet recommend its routine use outside the screening setting [7]. Although several reviews have evaluated this test in the screening setting, the evidence for tomosynthesis in assessing breast cancer extent has not been systematically reviewed, and despite the theoretical advantages of this technology over conventional mammography, its accuracy in measuring tumor size in newly diagnosed patients is uncertain. Therefore, we undertook a systematic review to investigate the accuracy of tomosynthesis compared with mammography to measure tumor size, with histopathologic measurement as the reference standard.
Related Knowledge Centers
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