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Marvi Valentini - One of the best experts on this subject based on the ideXlab platform.
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breast cancer screening with tomosynthesis 3d Mammography with acquired or synthetic 2d Mammography compared with 2d Mammography alone storm 2 a population based prospective study
Lancet Oncology, 2016Co-Authors: Daniela Bernardi, Petra Macaskill, Marco Pellegrini, Carmine Fanto, Marvi Valentini, Livio Ostillio, Paolina Tuttobene, Andrea Luparia, Nehmat HoussamiAbstract:Summary Background Breast tomosynthesis (pseudo-3D Mammography) improves breast cancer detection when added to 2D Mammography. In this study, we examined whether integrating 3D Mammography with either standard 2D Mammography acquisitions or with synthetic 2D images (reconstructed from 3D Mammography) would detect more cases of breast cancer than 2D Mammography alone, to potentially reduce the radiation burden from the combination of 2D plus 3D acquisitions. Methods The Screening with Tomosynthesis Or standard Mammography-2 (STORM-2) study was a prospective population-based screening study comparing integrated 3D Mammography (dual-acquisition 2D–3D Mammography or 2D synthetic–3D Mammography) with 2D Mammography alone. Asymptomatic women aged 49 years or older who attended population-based screening in Trento, Italy were recruited for the study. All participants underwent digital Mammography with 2D and 3D Mammography acquisitions, with the use of software that allowed synthetic 2D mammographic images to be reconstructed from 3D acquisitions. Mammography screen-reading was done in two parallel double-readings conducted sequentially for 2D acquisitions followed by integrated acquisitions. Recall based on a positive Mammography result was defined as recall at any screen read. Primary outcome measures were a comparison between integrated (2D–3D or 2D synthetic–3D) Mammography and 2D Mammography alone of the number of cases of screen-detected breast cancer, the cancer detection rate per 1000 screens, the incremental cancer detection rate, and the number and percentage of false-positive recalls. Findings Between May 31, 2013, and May 29, 2015, 10 255 women were invited to participate, of whom 9672 agreed to participate and were screened. In these 9672 participants (median age 58 years [IQR 53–63]), screening detected 90 cases of breast cancer, including 74 invasive breast cancers, in 85 women (five women had bilateral breast cancer). To account for these bilateral cancers in cancer detection rate estimates, the number of screens used for analysis was 9677. Both 2D–3D Mammography (cancer detection rate 8·5 per 1000 screens [82 cancers detected in 9677 screens]; 95% CI 6·7–10·5) and 2D synthetic–3D Mammography (8·8 per 1000 [85 in 9677]; 7·0–10·8) had significantly higher rates of breast cancer detection than 2D Mammography alone (6·3 per 1000 [61 in 9677], 4·8–8·1; p Interpretation Integration of 3D Mammography (2D–3D or 2D synthetic–3D) detected more cases of breast cancer than 2D Mammography alone, but increased the percentage of false-positive recalls in sequential screen-reading. These results should be considered in the context of the trade-off between benefits and harms inherent in population breast cancer screening, including that significantly increased breast cancer detection from integrating 3D Mammography into screening has the potential to augment screening benefit and also possibly contribute to overdiagnosis. Funding None.
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breast screening using 2d Mammography or integrating digital breast tomosynthesis 3d Mammography for single reading or double reading evidence to guide future screening strategies
European Journal of Cancer, 2014Co-Authors: Nehmat Houssami, Daniela Bernardi, Francesca Caumo, Petra Macaskill, Marco Pellegrini, Silvia Brunelli, Paola Tuttobene, Paola Bricolo, Carmine Fanto, Marvi ValentiniAbstract:Abstract Purpose We compared detection measures for breast screening strategies comprising single-reading or double-reading using standard 2D-Mammography or 2D/3D-Mammography, based on the ‘screening with tomosynthesis or standard Mammography’ (STORM) trial. Methods STORM prospectively examined screen-reading in two sequential phases, 2D-Mammography alone and integrated 2D/3D-Mammography, in asymptomatic women participating in Trento and Verona (Northern Italy) population-based screening services. Outcomes were ascertained from assessment and/or excision histology or follow-up. For each screen-reading strategy we calculated the number of detected and non-detected (including interval) cancers, cancer detection rates (CDRs), false positive recall (FPR) measures and incremental CDR relative to a comparator strategy. We estimated the false:true positive (FP:TP) ratio and sensitivity of each Mammography screening strategy. Paired binary data were compared using McNemar’s test. Results Amongst 7292 screening participants, there were 65 (including six interval) breast cancers; estimated first-year interval cancer rate was 0.82/1000 screens (95% confidence interval (CI): 0.30–1.79/1000). For single-reading, 35 cancers were detected at both 2D and 2D/3D-Mammography, 20 cancers were detected only with 2D/3D-Mammography compared with none at 2D-Mammography alone (p Conclusion The evidence we report warrants rethinking of breast screening strategies and should be used to inform future evaluations of 2D/3D-Mammography that assess whether or not the estimated incremental detection translates into improved screening outcomes such as a reduction in interval cancer rates.
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effect of integrating 3d Mammography digital breast tomosynthesis with 2d Mammography on radiologists true positive and false positive detection in a population breast screening trial
European Journal of Cancer, 2014Co-Authors: Daniela Bernardi, Francesca Caumo, Petra Macaskill, S Ciatto, Marco Pellegrini, Silvia Brunelli, Paola Tuttobene, Paola Bricolo, Carmine Fanto, Marvi ValentiniAbstract:Abstract Objective We investigated the effect of integrating three-dimensional (3D)-Mammography with 2D-Mammography on radiologists' detection measures in the ‘ s creening with t omosynthesis or standard m ammography' (STORM) trial. Methods STORM, a prospective population-based trial (Trento and Verona breast screening services) compared sequential screen-reading: 2D-Mammography alone and integrated 2D/3D-Mammography. Radiologist-specific detection measures were calculated for each screen-reading phase for eight radiologists: number of detected cancers, proportion of true-positive (TP) detection, and number and rate of false-positive (FP) recalls (FPR). We estimated the incremental cancer detection rate (CDR). Results There were 59 cancers and 395 false recalls amongst 7292 screening participants. At 2D-Mammography screening, radiologist-specific TP detection ranged between 38% and 83% (median 63%; mean 60% and sd 15.4%); at integrated 2D/3D-Mammography, TP detection ranged between 78% and 93% (median 87%; mean 87% and sd 5.2%). For all but one radiologist, 2D/3D-Mammography improved breast cancer detection (relative to 2D-Mammography) ranging between 0% and 54% (median 29%; mean 27% and sd 16.2%) increase in the proportion of detected cancers. Incremental CDR attributable to integrating 3D-Mammography in screening varied between 0/1000 and 5.3/1000 screens (median 1.8/1000; mean 2.3/1000 and sd 1.6/1000). Radiologist-specific FPR for 2D-Mammography ranged between 1.5% and 4.2% (median 3.1%; mean 2.9% and sd 0.87%), and FPR based on the integrated 2D/3D-Mammography read ranged between 1.0% and 3.3% (median 2.4%; mean 2.2% and sd 0.72%). Integrated 2D/3D-Mammography screening, relative to 2D-Mammography, had the effect of reducing FP and increasing TP detection for most radiologists. Conclusion There was broad variability in radiologist-specific TP detection at 2D-Mammography and hence in the additional TP detection and incremental CDR attributable to integrated 2D/3D-Mammography; more consistent (less variable) TP-detection estimates were observed for the integrated screen-read. Integrating 3D-Mammography with 2D-Mammography improves radiologists' screen-reading through improved cancer detection and/or reduced FPR, with most readers achieving both using integrated 2D/3D Mammography.
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integration of 3d digital Mammography with tomosynthesis for population breast cancer screening storm a prospective comparison study
Lancet Oncology, 2013Co-Authors: S Ciatto, Daniela Bernardi, Francesca Caumo, Marco Pellegrini, Silvia Brunelli, Paola Tuttobene, Paola Bricolo, Carmine Fanto, Nehmat Houssami, Marvi ValentiniAbstract:Summary Background Digital breast tomosynthesis with 3D images might overcome some of the limitations of conventional 2D Mammography for detection of breast cancer. We investigated the effect of integrated 2D and 3D Mammography in population breast-cancer screening. Methods Screening with Tomosynthesis OR standard Mammography (STORM) was a prospective comparative study. We recruited asymptomatic women aged 48 years or older who attended population-based breast-cancer screening through the Trento and Verona screening services (Italy) from August, 2011, to June, 2012. We did screen-reading in two sequential phases—2D only and integrated 2D and 3D Mammography—yielding paired data for each screen. Standard double-reading by breast radiologists determined whether to recall the participant based on positive Mammography at either screen read. Outcomes were measured from final assessment or excision histology. Primary outcome measures were the number of detected cancers, the number of detected cancers per 1000 screens, the number and proportion of false positive recalls, and incremental cancer detection attributable to integrated 2D and 3D Mammography. We compared paired binary data with McNemar's test. Findings 7292 women were screened (median age 58 years [IQR 54–63]). We detected 59 breast cancers (including 52 invasive cancers) in 57 women. Both 2D and integrated 2D and 3D screening detected 39 cancers. We detected 20 cancers with integrated 2D and 3D only versus none with 2D screening only (p Interpretation Integrated 2D and 3D Mammography improves breast-cancer detection and has the potential to reduce false positive recalls. Randomised controlled trials are needed to compare integrated 2D and 3D Mammography with 2D Mammography for breast cancer screening. Funding National Breast Cancer Foundation, Australia; National Health and Medical Research Council, Australia; Hologic, USA; Technologic, Italy.
Nehmat Houssami - One of the best experts on this subject based on the ideXlab platform.
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breast cancer screening with tomosynthesis 3d Mammography with acquired or synthetic 2d Mammography compared with 2d Mammography alone storm 2 a population based prospective study
Lancet Oncology, 2016Co-Authors: Daniela Bernardi, Petra Macaskill, Marco Pellegrini, Carmine Fanto, Marvi Valentini, Livio Ostillio, Paolina Tuttobene, Andrea Luparia, Nehmat HoussamiAbstract:Summary Background Breast tomosynthesis (pseudo-3D Mammography) improves breast cancer detection when added to 2D Mammography. In this study, we examined whether integrating 3D Mammography with either standard 2D Mammography acquisitions or with synthetic 2D images (reconstructed from 3D Mammography) would detect more cases of breast cancer than 2D Mammography alone, to potentially reduce the radiation burden from the combination of 2D plus 3D acquisitions. Methods The Screening with Tomosynthesis Or standard Mammography-2 (STORM-2) study was a prospective population-based screening study comparing integrated 3D Mammography (dual-acquisition 2D–3D Mammography or 2D synthetic–3D Mammography) with 2D Mammography alone. Asymptomatic women aged 49 years or older who attended population-based screening in Trento, Italy were recruited for the study. All participants underwent digital Mammography with 2D and 3D Mammography acquisitions, with the use of software that allowed synthetic 2D mammographic images to be reconstructed from 3D acquisitions. Mammography screen-reading was done in two parallel double-readings conducted sequentially for 2D acquisitions followed by integrated acquisitions. Recall based on a positive Mammography result was defined as recall at any screen read. Primary outcome measures were a comparison between integrated (2D–3D or 2D synthetic–3D) Mammography and 2D Mammography alone of the number of cases of screen-detected breast cancer, the cancer detection rate per 1000 screens, the incremental cancer detection rate, and the number and percentage of false-positive recalls. Findings Between May 31, 2013, and May 29, 2015, 10 255 women were invited to participate, of whom 9672 agreed to participate and were screened. In these 9672 participants (median age 58 years [IQR 53–63]), screening detected 90 cases of breast cancer, including 74 invasive breast cancers, in 85 women (five women had bilateral breast cancer). To account for these bilateral cancers in cancer detection rate estimates, the number of screens used for analysis was 9677. Both 2D–3D Mammography (cancer detection rate 8·5 per 1000 screens [82 cancers detected in 9677 screens]; 95% CI 6·7–10·5) and 2D synthetic–3D Mammography (8·8 per 1000 [85 in 9677]; 7·0–10·8) had significantly higher rates of breast cancer detection than 2D Mammography alone (6·3 per 1000 [61 in 9677], 4·8–8·1; p Interpretation Integration of 3D Mammography (2D–3D or 2D synthetic–3D) detected more cases of breast cancer than 2D Mammography alone, but increased the percentage of false-positive recalls in sequential screen-reading. These results should be considered in the context of the trade-off between benefits and harms inherent in population breast cancer screening, including that significantly increased breast cancer detection from integrating 3D Mammography into screening has the potential to augment screening benefit and also possibly contribute to overdiagnosis. Funding None.
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breast screening using 2d Mammography or integrating digital breast tomosynthesis 3d Mammography for single reading or double reading evidence to guide future screening strategies
European Journal of Cancer, 2014Co-Authors: Nehmat Houssami, Daniela Bernardi, Francesca Caumo, Petra Macaskill, Marco Pellegrini, Silvia Brunelli, Paola Tuttobene, Paola Bricolo, Carmine Fanto, Marvi ValentiniAbstract:Abstract Purpose We compared detection measures for breast screening strategies comprising single-reading or double-reading using standard 2D-Mammography or 2D/3D-Mammography, based on the ‘screening with tomosynthesis or standard Mammography’ (STORM) trial. Methods STORM prospectively examined screen-reading in two sequential phases, 2D-Mammography alone and integrated 2D/3D-Mammography, in asymptomatic women participating in Trento and Verona (Northern Italy) population-based screening services. Outcomes were ascertained from assessment and/or excision histology or follow-up. For each screen-reading strategy we calculated the number of detected and non-detected (including interval) cancers, cancer detection rates (CDRs), false positive recall (FPR) measures and incremental CDR relative to a comparator strategy. We estimated the false:true positive (FP:TP) ratio and sensitivity of each Mammography screening strategy. Paired binary data were compared using McNemar’s test. Results Amongst 7292 screening participants, there were 65 (including six interval) breast cancers; estimated first-year interval cancer rate was 0.82/1000 screens (95% confidence interval (CI): 0.30–1.79/1000). For single-reading, 35 cancers were detected at both 2D and 2D/3D-Mammography, 20 cancers were detected only with 2D/3D-Mammography compared with none at 2D-Mammography alone (p Conclusion The evidence we report warrants rethinking of breast screening strategies and should be used to inform future evaluations of 2D/3D-Mammography that assess whether or not the estimated incremental detection translates into improved screening outcomes such as a reduction in interval cancer rates.
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integration of 3d digital Mammography with tomosynthesis for population breast cancer screening storm a prospective comparison study
Lancet Oncology, 2013Co-Authors: S Ciatto, Daniela Bernardi, Francesca Caumo, Marco Pellegrini, Silvia Brunelli, Paola Tuttobene, Paola Bricolo, Carmine Fanto, Nehmat Houssami, Marvi ValentiniAbstract:Summary Background Digital breast tomosynthesis with 3D images might overcome some of the limitations of conventional 2D Mammography for detection of breast cancer. We investigated the effect of integrated 2D and 3D Mammography in population breast-cancer screening. Methods Screening with Tomosynthesis OR standard Mammography (STORM) was a prospective comparative study. We recruited asymptomatic women aged 48 years or older who attended population-based breast-cancer screening through the Trento and Verona screening services (Italy) from August, 2011, to June, 2012. We did screen-reading in two sequential phases—2D only and integrated 2D and 3D Mammography—yielding paired data for each screen. Standard double-reading by breast radiologists determined whether to recall the participant based on positive Mammography at either screen read. Outcomes were measured from final assessment or excision histology. Primary outcome measures were the number of detected cancers, the number of detected cancers per 1000 screens, the number and proportion of false positive recalls, and incremental cancer detection attributable to integrated 2D and 3D Mammography. We compared paired binary data with McNemar's test. Findings 7292 women were screened (median age 58 years [IQR 54–63]). We detected 59 breast cancers (including 52 invasive cancers) in 57 women. Both 2D and integrated 2D and 3D screening detected 39 cancers. We detected 20 cancers with integrated 2D and 3D only versus none with 2D screening only (p Interpretation Integrated 2D and 3D Mammography improves breast-cancer detection and has the potential to reduce false positive recalls. Randomised controlled trials are needed to compare integrated 2D and 3D Mammography with 2D Mammography for breast cancer screening. Funding National Breast Cancer Foundation, Australia; National Health and Medical Research Council, Australia; Hologic, USA; Technologic, Italy.
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a systematic review of the effectiveness of magnetic resonance imaging mri as an addition to Mammography and ultrasound in screening young women at high risk of breast cancer
European Journal of Cancer, 2007Co-Authors: Sarah J Lord, W Lei, P Craft, Jennifer N Cawson, I Morris, Silke Walleser, Alison Griffiths, Sharon K Parker, Nehmat HoussamiAbstract:Abstract Breast magnetic resonance imaging (MRI) has been proposed as an additional screening test for young women at high risk of breast cancer in whom Mammography alone has poor sensitivity. We conducted a systematic review to assess the effectiveness of adding MRI to Mammography with or without breast ultrasound and clinical breast examination (CBE) in screening this population. We found consistent evidence in 5 studies that adding MRI provides a highly sensitive screening strategy (sensitivity range: 93–100%) compared to Mammography alone (25–59%) or Mammography plus ultrasound +/− CBE (49–67%). Meta-analysis of the three studies that compared MRI plus Mammography versus Mammography alone showed the sensitivity of MRI plus Mammography as 94% (95%CI 86–98%) and the incremental sensitivity of MRI as 58% (95%CI 47–70%). Incremental sensitivity of MRI was lower when added to Mammography plus ultrasound (44%, 95%CI 27–61%) or to the combination of Mammography, ultrasound plus CBE (31–33%). Estimates of screening specificity with MRI were less consistent but suggested a 3–5-fold higher risk of patient recall for investigation of false positive results. No studies assessed as to whether adding MRI reduces patient mortality, interval or advanced breast cancer rates, and we did not find strong evidence that MRI leads to the detection of earlier stage disease. Conclusions about the effectiveness of MRI therefore depend on assumptions about the benefits of early detection from trials of mammographic screening in older average risk populations. The extent to which high risk younger women receive the same benefits from early detection and treatment of MRI-detected cancers has not yet been established.
Daniela Bernardi - One of the best experts on this subject based on the ideXlab platform.
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breast cancer screening with tomosynthesis 3d Mammography with acquired or synthetic 2d Mammography compared with 2d Mammography alone storm 2 a population based prospective study
Lancet Oncology, 2016Co-Authors: Daniela Bernardi, Petra Macaskill, Marco Pellegrini, Carmine Fanto, Marvi Valentini, Livio Ostillio, Paolina Tuttobene, Andrea Luparia, Nehmat HoussamiAbstract:Summary Background Breast tomosynthesis (pseudo-3D Mammography) improves breast cancer detection when added to 2D Mammography. In this study, we examined whether integrating 3D Mammography with either standard 2D Mammography acquisitions or with synthetic 2D images (reconstructed from 3D Mammography) would detect more cases of breast cancer than 2D Mammography alone, to potentially reduce the radiation burden from the combination of 2D plus 3D acquisitions. Methods The Screening with Tomosynthesis Or standard Mammography-2 (STORM-2) study was a prospective population-based screening study comparing integrated 3D Mammography (dual-acquisition 2D–3D Mammography or 2D synthetic–3D Mammography) with 2D Mammography alone. Asymptomatic women aged 49 years or older who attended population-based screening in Trento, Italy were recruited for the study. All participants underwent digital Mammography with 2D and 3D Mammography acquisitions, with the use of software that allowed synthetic 2D mammographic images to be reconstructed from 3D acquisitions. Mammography screen-reading was done in two parallel double-readings conducted sequentially for 2D acquisitions followed by integrated acquisitions. Recall based on a positive Mammography result was defined as recall at any screen read. Primary outcome measures were a comparison between integrated (2D–3D or 2D synthetic–3D) Mammography and 2D Mammography alone of the number of cases of screen-detected breast cancer, the cancer detection rate per 1000 screens, the incremental cancer detection rate, and the number and percentage of false-positive recalls. Findings Between May 31, 2013, and May 29, 2015, 10 255 women were invited to participate, of whom 9672 agreed to participate and were screened. In these 9672 participants (median age 58 years [IQR 53–63]), screening detected 90 cases of breast cancer, including 74 invasive breast cancers, in 85 women (five women had bilateral breast cancer). To account for these bilateral cancers in cancer detection rate estimates, the number of screens used for analysis was 9677. Both 2D–3D Mammography (cancer detection rate 8·5 per 1000 screens [82 cancers detected in 9677 screens]; 95% CI 6·7–10·5) and 2D synthetic–3D Mammography (8·8 per 1000 [85 in 9677]; 7·0–10·8) had significantly higher rates of breast cancer detection than 2D Mammography alone (6·3 per 1000 [61 in 9677], 4·8–8·1; p Interpretation Integration of 3D Mammography (2D–3D or 2D synthetic–3D) detected more cases of breast cancer than 2D Mammography alone, but increased the percentage of false-positive recalls in sequential screen-reading. These results should be considered in the context of the trade-off between benefits and harms inherent in population breast cancer screening, including that significantly increased breast cancer detection from integrating 3D Mammography into screening has the potential to augment screening benefit and also possibly contribute to overdiagnosis. Funding None.
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breast screening using 2d Mammography or integrating digital breast tomosynthesis 3d Mammography for single reading or double reading evidence to guide future screening strategies
European Journal of Cancer, 2014Co-Authors: Nehmat Houssami, Daniela Bernardi, Francesca Caumo, Petra Macaskill, Marco Pellegrini, Silvia Brunelli, Paola Tuttobene, Paola Bricolo, Carmine Fanto, Marvi ValentiniAbstract:Abstract Purpose We compared detection measures for breast screening strategies comprising single-reading or double-reading using standard 2D-Mammography or 2D/3D-Mammography, based on the ‘screening with tomosynthesis or standard Mammography’ (STORM) trial. Methods STORM prospectively examined screen-reading in two sequential phases, 2D-Mammography alone and integrated 2D/3D-Mammography, in asymptomatic women participating in Trento and Verona (Northern Italy) population-based screening services. Outcomes were ascertained from assessment and/or excision histology or follow-up. For each screen-reading strategy we calculated the number of detected and non-detected (including interval) cancers, cancer detection rates (CDRs), false positive recall (FPR) measures and incremental CDR relative to a comparator strategy. We estimated the false:true positive (FP:TP) ratio and sensitivity of each Mammography screening strategy. Paired binary data were compared using McNemar’s test. Results Amongst 7292 screening participants, there were 65 (including six interval) breast cancers; estimated first-year interval cancer rate was 0.82/1000 screens (95% confidence interval (CI): 0.30–1.79/1000). For single-reading, 35 cancers were detected at both 2D and 2D/3D-Mammography, 20 cancers were detected only with 2D/3D-Mammography compared with none at 2D-Mammography alone (p Conclusion The evidence we report warrants rethinking of breast screening strategies and should be used to inform future evaluations of 2D/3D-Mammography that assess whether or not the estimated incremental detection translates into improved screening outcomes such as a reduction in interval cancer rates.
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effect of integrating 3d Mammography digital breast tomosynthesis with 2d Mammography on radiologists true positive and false positive detection in a population breast screening trial
European Journal of Cancer, 2014Co-Authors: Daniela Bernardi, Francesca Caumo, Petra Macaskill, S Ciatto, Marco Pellegrini, Silvia Brunelli, Paola Tuttobene, Paola Bricolo, Carmine Fanto, Marvi ValentiniAbstract:Abstract Objective We investigated the effect of integrating three-dimensional (3D)-Mammography with 2D-Mammography on radiologists' detection measures in the ‘ s creening with t omosynthesis or standard m ammography' (STORM) trial. Methods STORM, a prospective population-based trial (Trento and Verona breast screening services) compared sequential screen-reading: 2D-Mammography alone and integrated 2D/3D-Mammography. Radiologist-specific detection measures were calculated for each screen-reading phase for eight radiologists: number of detected cancers, proportion of true-positive (TP) detection, and number and rate of false-positive (FP) recalls (FPR). We estimated the incremental cancer detection rate (CDR). Results There were 59 cancers and 395 false recalls amongst 7292 screening participants. At 2D-Mammography screening, radiologist-specific TP detection ranged between 38% and 83% (median 63%; mean 60% and sd 15.4%); at integrated 2D/3D-Mammography, TP detection ranged between 78% and 93% (median 87%; mean 87% and sd 5.2%). For all but one radiologist, 2D/3D-Mammography improved breast cancer detection (relative to 2D-Mammography) ranging between 0% and 54% (median 29%; mean 27% and sd 16.2%) increase in the proportion of detected cancers. Incremental CDR attributable to integrating 3D-Mammography in screening varied between 0/1000 and 5.3/1000 screens (median 1.8/1000; mean 2.3/1000 and sd 1.6/1000). Radiologist-specific FPR for 2D-Mammography ranged between 1.5% and 4.2% (median 3.1%; mean 2.9% and sd 0.87%), and FPR based on the integrated 2D/3D-Mammography read ranged between 1.0% and 3.3% (median 2.4%; mean 2.2% and sd 0.72%). Integrated 2D/3D-Mammography screening, relative to 2D-Mammography, had the effect of reducing FP and increasing TP detection for most radiologists. Conclusion There was broad variability in radiologist-specific TP detection at 2D-Mammography and hence in the additional TP detection and incremental CDR attributable to integrated 2D/3D-Mammography; more consistent (less variable) TP-detection estimates were observed for the integrated screen-read. Integrating 3D-Mammography with 2D-Mammography improves radiologists' screen-reading through improved cancer detection and/or reduced FPR, with most readers achieving both using integrated 2D/3D Mammography.
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integration of 3d digital Mammography with tomosynthesis for population breast cancer screening storm a prospective comparison study
Lancet Oncology, 2013Co-Authors: S Ciatto, Daniela Bernardi, Francesca Caumo, Marco Pellegrini, Silvia Brunelli, Paola Tuttobene, Paola Bricolo, Carmine Fanto, Nehmat Houssami, Marvi ValentiniAbstract:Summary Background Digital breast tomosynthesis with 3D images might overcome some of the limitations of conventional 2D Mammography for detection of breast cancer. We investigated the effect of integrated 2D and 3D Mammography in population breast-cancer screening. Methods Screening with Tomosynthesis OR standard Mammography (STORM) was a prospective comparative study. We recruited asymptomatic women aged 48 years or older who attended population-based breast-cancer screening through the Trento and Verona screening services (Italy) from August, 2011, to June, 2012. We did screen-reading in two sequential phases—2D only and integrated 2D and 3D Mammography—yielding paired data for each screen. Standard double-reading by breast radiologists determined whether to recall the participant based on positive Mammography at either screen read. Outcomes were measured from final assessment or excision histology. Primary outcome measures were the number of detected cancers, the number of detected cancers per 1000 screens, the number and proportion of false positive recalls, and incremental cancer detection attributable to integrated 2D and 3D Mammography. We compared paired binary data with McNemar's test. Findings 7292 women were screened (median age 58 years [IQR 54–63]). We detected 59 breast cancers (including 52 invasive cancers) in 57 women. Both 2D and integrated 2D and 3D screening detected 39 cancers. We detected 20 cancers with integrated 2D and 3D only versus none with 2D screening only (p Interpretation Integrated 2D and 3D Mammography improves breast-cancer detection and has the potential to reduce false positive recalls. Randomised controlled trials are needed to compare integrated 2D and 3D Mammography with 2D Mammography for breast cancer screening. Funding National Breast Cancer Foundation, Australia; National Health and Medical Research Council, Australia; Hologic, USA; Technologic, Italy.
Emily F Conant - One of the best experts on this subject based on the ideXlab platform.
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effect of mammographic screening modality on breast density assessment digital Mammography versus digital breast tomosynthesis
Radiology, 2019Co-Authors: Aimilia Gastounioti, Marie Synnestvedt, Anne Marie Mccarthy, Lauren Pantalone, Despina Kontos, Emily F ConantAbstract:Background Breast Imaging Reporting and Data System (BI-RADS) breast density categories assigned by interpreting radiologists often influence decisions surrounding supplemental breast cancer screening and risk assessment. The landscape of mammographic screening continuously evolves, and different mammographic screening modalities may result in different perception of density, reflected in different assignment of BI-RADS density categories. Purpose To investigate the effect of screening Mammography modality on BI-RADS breast density assessments. Materials and Methods Data were retrospectively analyzed from 24 736 individual women (42.3% [10 455 of 24 736] white women, 57.7% [14 281 of 24 736] black women; mean age, 56.3 years; age range, 40.0-74.9 years) who underwent from one to seven mammographic screening examinations from September 2010 through February 2017 (60 766 examinations). Three screening modalities were used: digital Mammography alone (8935 examinations); digital Mammography with digital breast tomosynthesis (DBT; 30 779 examinations); and synthetic Mammography with DBT (21 052 examinations). Random-effects logistic regression analysis was performed to estimate the likelihood of assignment to high versus low BI-RADS density category according to each modality, adjusted for ethnicity, age, body mass index (BMI), and radiologist. The interactions of modality with ethnicity and BMI on density categorization were also tested with the model. Results Women screened with DBT versus digital Mammography alone had lower likelihood regarding categorization of high density breasts (digital Mammography and DBT vs digital Mammography: odds ratio, 0.69 [95% confidence interval: 0.61, 0.80], P < .001; synthetic Mammography and DBT vs digital Mammography: odds ratio, 0.43 [95% confidence interval: 0.37, 0.50], P < .001). Lower likelihood of high density was also observed at synthetic Mammography and DBT compared with digital Mammography and DBT (odds ratio, 0.62; 95% confidence interval: 0.56, 0.69; P < .001). There were interactions of modality with ethnicity (P = .007) and BMI (P = .003) on breast density assessment, with greater differences in density categorization according to modality observed for black women than for white women and groups with higher BMI. Conclusion Breast density categorization may vary by screening mammographic modality, and this effect appears to vary by ethnicity and body mass index. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Philpotts in this issue.
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implementation of synthesized two dimensional Mammography in a population based digital breast tomosynthesis screening program
Radiology, 2016Co-Authors: Samantha P Zuckerman, Susan P Weinstein, Emily F Conant, Brad M Keller, Andrew D A Maidment, Bruno Barufaldi, Marie Synnestvedt, Elizabeth S McdonaldAbstract:Purpose To evaluate the early implementation of synthesized two-dimensional (s2D) Mammography in a population screened entirely with s2D and digital breast tomosynthesis (DBT) (referred to as s2D/DBT) and compare recall rates and cancer detection rates to historic outcomes of digital Mammography combined with DBT (referred to as digital Mammography/DBT) screening. Materials and Methods This was an institutional review board-approved and HIPAA-compliant retrospective interpretation of prospectively acquired data with waiver of informed consent. Compared were recall rates, biopsy rates, cancer detection rates, and radiation dose for 15 571 women screened with digital Mammography/DBT from October 1, 2011, to February 28, 2013, and 5366 women screened with s2D/DBT from January 7, 2015, to June 30, 2015. Two-sample z tests of equal proportions were used to determine statistical significance. Results Recall rate for s2D/DBT versus digital Mammography/DBT was 7.1% versus 8.8%, respectively (P < .001). Biopsy rate for s2D/DBT versus digital Mammography/DBT decreased (1.3% vs 2.0%, respectively; P = .001). There was no significant difference in cancer detection rate for s2D/DBT versus digital Mammography/DBT (5.03 of 1000 vs 5.45 of 1000, respectively; P = .72). The average glandular dose was 39% lower in s2D/DBT versus digital Mammography/DBT (4.88 mGy vs 7.97 mGy, respectively; P < .001). Conclusion Screening with s2D/DBT in a large urban practice resulted in similar outcomes compared with digital Mammography/DBT imaging. Screening with s2D/DBT allowed for the benefits of DBT with a decrease in radiation dose compared with digital Mammography/DBT. © RSNA, 2016 An earlier incorrect version of this article appeared online. This article was corrected on August 11, 2016.
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multimodality screening of high risk women a prospective cohort study
Journal of Clinical Oncology, 2009Co-Authors: Susan P Weinstein, Russell A Localio, Emily F Conant, Mark A Rosen, Kathleen Thomas, Mitchell D SchnallAbstract:Purpose Mammography has been established as the primary imaging screening method for breast cancer; however, the sensitivity of Mammography is limited, especially in women with dense breast tissue. Given the limitations of Mammography, interest has developed in alternative screening techniques. This interest has led to numerous studies reporting mammographically occult breast cancers detected on magnetic resonance imaging (MRI) or ultrasound. In addition, digital Mammography was shown to be more sensitive than film Mammography in selected populations. Our goal was to prospectively compare cancer detection of digital Mammography (DM), whole-breast ultrasound (WBUS), and contrast-enhanced MRI in a high-risk screening population previously screened negative by film screen mammogram (FSM). Methods During a 2-year period, 609 asymptomatic high-risk women with nonactionable FSM examinations presented for a prospective multimodality screening consisting of DM, WBUS, and MRI. The FSM examinations were reinterpret...
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diagnostic performance of digital versus film Mammography for breast cancer screening
The New England Journal of Medicine, 2005Co-Authors: Etta D. Pisano, Emily F Conant, Constantine Gatsonis, Edward Hendrick, Martin J Yaffe, Janet K Baum, Suddhasatta Acharyya, Laurie L Fajardo, Lawrence W Bassett, Roberta A JongAbstract:background Film Mammography has limited sensitivity for the detection of breast cancer in women with radiographically dense breasts. We assessed whether the use of digital Mammography would avoid some of these limitations. methods A total of 49,528 asymptomatic women presenting for screening Mammography at 33 sites in the United States and Canada underwent both digital and film Mammography. All relevant information was available for 42,760 of these women (86.3 percent). Mammograms were interpreted independently by two radiologists. Breast-cancer status was ascertained on the basis of a breast biopsy done within 15 months after study entry or a follow-up mammogram obtained at least 10 months after study entry. Receiver-operating-characteristic (ROC) analysis was used to evaluate the results. results In the entire population, the diagnostic accuracy of digital and film Mammography was similar (difference between methods in the area under the ROC curve, 0.03; 95 percent confidence interval, i0.02 to 0.08; P=0.18). However, the accuracy of digital Mammography was significantly higher than that of film Mammography among women under the age of 50 years (difference in the area under the curve, 0.15; 95 percent confidence interval, 0.05 to 0.25; P=0.002), women with heterogeneously dense or extremely dense breasts on Mammography (difference, 0.11; 95 percent confidence interval, 0.04 to 0.18; P=0.003), and premenopausal or perimenopausal women (difference, 0.15; 95 percent confidence interval, 0.05 to 0.24; P=0.002). conclusions The overall diagnostic accuracy of digital and film Mammography as a means of screening for breast cancer is similar, but digital Mammography is more accurate in women under the age of 50 years, women with radiographically dense breasts, and premenopausal or perimenopausal women. (clinicaltrials.gov number, NCT00008346.)
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breast cancer screening with tomosynthesis 3d Mammography with acquired or synthetic 2d Mammography compared with 2d Mammography alone storm 2 a population based prospective study
Lancet Oncology, 2016Co-Authors: Daniela Bernardi, Petra Macaskill, Marco Pellegrini, Carmine Fanto, Marvi Valentini, Livio Ostillio, Paolina Tuttobene, Andrea Luparia, Nehmat HoussamiAbstract:Summary Background Breast tomosynthesis (pseudo-3D Mammography) improves breast cancer detection when added to 2D Mammography. In this study, we examined whether integrating 3D Mammography with either standard 2D Mammography acquisitions or with synthetic 2D images (reconstructed from 3D Mammography) would detect more cases of breast cancer than 2D Mammography alone, to potentially reduce the radiation burden from the combination of 2D plus 3D acquisitions. Methods The Screening with Tomosynthesis Or standard Mammography-2 (STORM-2) study was a prospective population-based screening study comparing integrated 3D Mammography (dual-acquisition 2D–3D Mammography or 2D synthetic–3D Mammography) with 2D Mammography alone. Asymptomatic women aged 49 years or older who attended population-based screening in Trento, Italy were recruited for the study. All participants underwent digital Mammography with 2D and 3D Mammography acquisitions, with the use of software that allowed synthetic 2D mammographic images to be reconstructed from 3D acquisitions. Mammography screen-reading was done in two parallel double-readings conducted sequentially for 2D acquisitions followed by integrated acquisitions. Recall based on a positive Mammography result was defined as recall at any screen read. Primary outcome measures were a comparison between integrated (2D–3D or 2D synthetic–3D) Mammography and 2D Mammography alone of the number of cases of screen-detected breast cancer, the cancer detection rate per 1000 screens, the incremental cancer detection rate, and the number and percentage of false-positive recalls. Findings Between May 31, 2013, and May 29, 2015, 10 255 women were invited to participate, of whom 9672 agreed to participate and were screened. In these 9672 participants (median age 58 years [IQR 53–63]), screening detected 90 cases of breast cancer, including 74 invasive breast cancers, in 85 women (five women had bilateral breast cancer). To account for these bilateral cancers in cancer detection rate estimates, the number of screens used for analysis was 9677. Both 2D–3D Mammography (cancer detection rate 8·5 per 1000 screens [82 cancers detected in 9677 screens]; 95% CI 6·7–10·5) and 2D synthetic–3D Mammography (8·8 per 1000 [85 in 9677]; 7·0–10·8) had significantly higher rates of breast cancer detection than 2D Mammography alone (6·3 per 1000 [61 in 9677], 4·8–8·1; p Interpretation Integration of 3D Mammography (2D–3D or 2D synthetic–3D) detected more cases of breast cancer than 2D Mammography alone, but increased the percentage of false-positive recalls in sequential screen-reading. These results should be considered in the context of the trade-off between benefits and harms inherent in population breast cancer screening, including that significantly increased breast cancer detection from integrating 3D Mammography into screening has the potential to augment screening benefit and also possibly contribute to overdiagnosis. Funding None.
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breast screening using 2d Mammography or integrating digital breast tomosynthesis 3d Mammography for single reading or double reading evidence to guide future screening strategies
European Journal of Cancer, 2014Co-Authors: Nehmat Houssami, Daniela Bernardi, Francesca Caumo, Petra Macaskill, Marco Pellegrini, Silvia Brunelli, Paola Tuttobene, Paola Bricolo, Carmine Fanto, Marvi ValentiniAbstract:Abstract Purpose We compared detection measures for breast screening strategies comprising single-reading or double-reading using standard 2D-Mammography or 2D/3D-Mammography, based on the ‘screening with tomosynthesis or standard Mammography’ (STORM) trial. Methods STORM prospectively examined screen-reading in two sequential phases, 2D-Mammography alone and integrated 2D/3D-Mammography, in asymptomatic women participating in Trento and Verona (Northern Italy) population-based screening services. Outcomes were ascertained from assessment and/or excision histology or follow-up. For each screen-reading strategy we calculated the number of detected and non-detected (including interval) cancers, cancer detection rates (CDRs), false positive recall (FPR) measures and incremental CDR relative to a comparator strategy. We estimated the false:true positive (FP:TP) ratio and sensitivity of each Mammography screening strategy. Paired binary data were compared using McNemar’s test. Results Amongst 7292 screening participants, there were 65 (including six interval) breast cancers; estimated first-year interval cancer rate was 0.82/1000 screens (95% confidence interval (CI): 0.30–1.79/1000). For single-reading, 35 cancers were detected at both 2D and 2D/3D-Mammography, 20 cancers were detected only with 2D/3D-Mammography compared with none at 2D-Mammography alone (p Conclusion The evidence we report warrants rethinking of breast screening strategies and should be used to inform future evaluations of 2D/3D-Mammography that assess whether or not the estimated incremental detection translates into improved screening outcomes such as a reduction in interval cancer rates.
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effect of integrating 3d Mammography digital breast tomosynthesis with 2d Mammography on radiologists true positive and false positive detection in a population breast screening trial
European Journal of Cancer, 2014Co-Authors: Daniela Bernardi, Francesca Caumo, Petra Macaskill, S Ciatto, Marco Pellegrini, Silvia Brunelli, Paola Tuttobene, Paola Bricolo, Carmine Fanto, Marvi ValentiniAbstract:Abstract Objective We investigated the effect of integrating three-dimensional (3D)-Mammography with 2D-Mammography on radiologists' detection measures in the ‘ s creening with t omosynthesis or standard m ammography' (STORM) trial. Methods STORM, a prospective population-based trial (Trento and Verona breast screening services) compared sequential screen-reading: 2D-Mammography alone and integrated 2D/3D-Mammography. Radiologist-specific detection measures were calculated for each screen-reading phase for eight radiologists: number of detected cancers, proportion of true-positive (TP) detection, and number and rate of false-positive (FP) recalls (FPR). We estimated the incremental cancer detection rate (CDR). Results There were 59 cancers and 395 false recalls amongst 7292 screening participants. At 2D-Mammography screening, radiologist-specific TP detection ranged between 38% and 83% (median 63%; mean 60% and sd 15.4%); at integrated 2D/3D-Mammography, TP detection ranged between 78% and 93% (median 87%; mean 87% and sd 5.2%). For all but one radiologist, 2D/3D-Mammography improved breast cancer detection (relative to 2D-Mammography) ranging between 0% and 54% (median 29%; mean 27% and sd 16.2%) increase in the proportion of detected cancers. Incremental CDR attributable to integrating 3D-Mammography in screening varied between 0/1000 and 5.3/1000 screens (median 1.8/1000; mean 2.3/1000 and sd 1.6/1000). Radiologist-specific FPR for 2D-Mammography ranged between 1.5% and 4.2% (median 3.1%; mean 2.9% and sd 0.87%), and FPR based on the integrated 2D/3D-Mammography read ranged between 1.0% and 3.3% (median 2.4%; mean 2.2% and sd 0.72%). Integrated 2D/3D-Mammography screening, relative to 2D-Mammography, had the effect of reducing FP and increasing TP detection for most radiologists. Conclusion There was broad variability in radiologist-specific TP detection at 2D-Mammography and hence in the additional TP detection and incremental CDR attributable to integrated 2D/3D-Mammography; more consistent (less variable) TP-detection estimates were observed for the integrated screen-read. Integrating 3D-Mammography with 2D-Mammography improves radiologists' screen-reading through improved cancer detection and/or reduced FPR, with most readers achieving both using integrated 2D/3D Mammography.
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integration of 3d digital Mammography with tomosynthesis for population breast cancer screening storm a prospective comparison study
Lancet Oncology, 2013Co-Authors: S Ciatto, Daniela Bernardi, Francesca Caumo, Marco Pellegrini, Silvia Brunelli, Paola Tuttobene, Paola Bricolo, Carmine Fanto, Nehmat Houssami, Marvi ValentiniAbstract:Summary Background Digital breast tomosynthesis with 3D images might overcome some of the limitations of conventional 2D Mammography for detection of breast cancer. We investigated the effect of integrated 2D and 3D Mammography in population breast-cancer screening. Methods Screening with Tomosynthesis OR standard Mammography (STORM) was a prospective comparative study. We recruited asymptomatic women aged 48 years or older who attended population-based breast-cancer screening through the Trento and Verona screening services (Italy) from August, 2011, to June, 2012. We did screen-reading in two sequential phases—2D only and integrated 2D and 3D Mammography—yielding paired data for each screen. Standard double-reading by breast radiologists determined whether to recall the participant based on positive Mammography at either screen read. Outcomes were measured from final assessment or excision histology. Primary outcome measures were the number of detected cancers, the number of detected cancers per 1000 screens, the number and proportion of false positive recalls, and incremental cancer detection attributable to integrated 2D and 3D Mammography. We compared paired binary data with McNemar's test. Findings 7292 women were screened (median age 58 years [IQR 54–63]). We detected 59 breast cancers (including 52 invasive cancers) in 57 women. Both 2D and integrated 2D and 3D screening detected 39 cancers. We detected 20 cancers with integrated 2D and 3D only versus none with 2D screening only (p Interpretation Integrated 2D and 3D Mammography improves breast-cancer detection and has the potential to reduce false positive recalls. Randomised controlled trials are needed to compare integrated 2D and 3D Mammography with 2D Mammography for breast cancer screening. Funding National Breast Cancer Foundation, Australia; National Health and Medical Research Council, Australia; Hologic, USA; Technologic, Italy.
