The chest radiologist's role in invasive breast cancer detection (original) (raw)
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Focal Breast Lesions in Clinical CT Examinations of the Chest: A Retrospective Analysis
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren
Purpose Based on radiological reports, the percentage of breast cancers visualized as incidental findings in routine CT examinations is estimated at ≤ 2 %. In view of the rising number of CT examinations and the high prevalence of breast cancer, it was the goal of the present study to verify the frequency and image morphology of false-negative senological CT findings. Materials and Methods All first contrast-enhanced CT examinations of the chest in adult female patients carried out in 2012 were retrospectively included. A senior radiologist systematically assessed the presence of breast lesions on all CT images using the BI-RADS system. All BI-RADS ≥ 3 notations were evaluated by a second senior radiologist. A consensus was obtained in case of differing BI-RADS assessments. Reference diagnoses were elaborated based on all available clinical, radiological and pathological data. The findings of the CT reports were classified according to the BI-RADS system and were compared with the r...
INCIDENTAL BREAST PATHOLOGY DETECTED IN CHEST COMPUTER TOMOGRAPHY (CT)
Objective To emphasize the importance of requested chest CT scan for cardiothoracic conditions for radiologist to evaluate the breast area this may impact patient’s management. Material and method A total number of 130 female patients whom underwent chest CT for cardiothoracic reasons, were retrospectively reviewed their images to evaluate and characterize breast lesions in a period between June 2016 –December 2017 at King Hussein Medical Center. The age of the patient’s ranges from (20-70 years) with the mean age 45 years. All scans were performed with Siemens definition dual source 64 slice CT scan, chest CT scan protocol with intravenous (IV) contrast media. The results will be analyzed by simple statistical method.
Value of tomography in detecting breast masses and discriminating malign and benign lesions
Turkish Journal of Surgery, 2019
Objective: The main purpose of the present study was to determine the effectivity of computerized tomography (CT) in detecting breast masses and discriminating masses as malignant or benign. Material and Methods: After having received the institutional local ethics committee approval, an experienced radiologist who did not participate in the study created a patient pool by searching our health center's Pathology department database between 2010 and 2018. The group created consisted of dense and non-dense breast types equally and included approximately similar percentages of benign and malignant breast mass sizes. Finally, 70 subjects were included: 30 females with definite malign, 20 with definite benign breast masses, and 20 without any breast pathology based on mammography and ultrasonography results, who were considered as the control group. Three experienced Radiologists (R1, R2, R3) who were not aware of the final diagnosis evaluated all images independently. Radiologist performance was assessed by calculating the area under the receiver operating characteristic curve (AUC) and interobserver reliability values were estimated by intraclass correlation coefficient (ICC) analysis. Results: The diagnostic accuracy suitability of CT according to BI-RADS scores for R1, R2 and R3 were found as p< 0.001, p< 0.001 and p< 0.001, respectively. There were significant interobserver reliability rates between all investigators (p= 0.0001). Conclusion: CT may be used as a valuable diagnostic tool in discriminating breast masses with further training in widely varying appearances of normal breast tissues leading to false positive findings.
Breast Cancer Screening and Diagnosis
2015
Breast Screening Considerations (BSCR-A) Risk Factors Used in the Modified Gail Model (BSCR-B) Assessment Category Definitions (BSCR-C) Clinical Trials: Categories of Evidence and Consensus: NCCN All recommendations are Category 2A unless otherwise specified. Under Screening Follow-up, 4th bullet changed the word Consider to "Recommend." Under Increased Risk, 2nd branch, added "or LCIS." Deleted 3rd branch of algorithm. Changed Dominant mass to "Palpable Mass" (Also for thru). Under Ultrasound Findings, deleted first and second branch and under Follow-up Evaluation. Deleted Tissue diagnosis under Ultrasound findings. Fluid cyst, mass resolves and bloody fluid: added (if possible) after Place tissue marker. Under Follow-up Evaluation flipped "Tissue biopsy" and "Observe every 3-6 mo." Added BI-RADS® Category 3. Under Diagnostic Mammogram Follow-up deleted "Needle localization excisional biopsy + specimen radiograph" and corresponding branches. Added a new table; ACS recommendations on using MRI in screening and footnote which specifically describes the type of breast imaging required. • Added "per Gail Model" under Increased risk, 2nd bullet. Changed 4th bullet to read, "Pedigree suggestive of genetic predisposition." Changed footnote "d" to read, "Per models other than Gail." Under Follow-up Evaluation, added "BI-RADS category 3 and 4" to Short term follow-up and Aspiration respectively. Changed "surgical excision" to "Image-guided biopsy" and added new footnote, "Surgical excision if image-guided/core needle biopsy not possible." • • • NCCN Guidelines Index Breast Screening Table of Contents Discussion, References Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
Radiological Screening of Breast Cancer: Evolution
U. Veronesi et al. (eds.) Breast Cancer, 2017
Mammography screening is one of the revolutionary advances in the fight against breast cancer, alongside breastconserving surgery. Few medical interventions have been so extensively evidence-based and yet subjected to persistent critiques. The clear scientific evidence of the efficacy of screening in reducing breast cancer mortality is discussed. Benefits provided by screening are substantial, well above any negative effect. In the age of modern treatment, early detection still contributes to breast cancer mortality reduction. A full appreciation is advocated for organized screening programs and the added value they provide in terms of high quality, equitable health service, and as the optimal environment where best capitalize on the new advances in treatment. Future evolution might include (a) tailored, risk-based protocols, in the first place extending the age range of offered screening; (b) new imaging tools; and (c) optimization of existing programs, through better monitoring, training, and research-always abiding by the big caveats: evidence of efficacy, incremental cost-effectiveness, and sustainability. Both screening and treatment have merits in achieving mortality reduction. It would be clever to recognize their mutual enhancing power and devote resources to a very appropriate topic for research: how early detection might or should change the treatment of breast cancer.
Clinical Radiology, 2003
AIM: To review all previous mammograms of breast cancer cases diagnosed during a randomized trial comparing 3 yearly to annual mammographic screening with a view to identifying and quantifying cases that might potentially have been diagnosed earlier. METHODS: Mammograms of 602 breast cancer cases (399 screen-detected and 203 interval cases) were reviewed in chronological order and suspicious radiological features noted for each mammogram, up to and including the diagnostic mammogram. RESULTS: Of the 602 cases, 79 (13%) had features at diagnosis that were visible on previous mammograms, suggesting a sensitivity of interpretation of 87%. A similar proportion of screen-detected (14%) and interval cancers (11%) had signs at diagnosis that were visible on previous mammograms. The potential for improvement was particularly noted for asymmetric density (sensitivity 77%, average time visible before diagnosis 14 months) and parenchymal deformity/stellate lesion (sensitivity 81%, average time visible before diagnosis 12 months). CONCLUSION: The highest sensitivity was observed for comedo-type microcalci®cations (sensitivity 97%, average time visible before diagnosis 5 months). By improvements in sensitivity to asymmetric density and parenchymal deformity/stellate lesion, 4% of tumours could have their time of diagnosis advanced substantially. Warren R. M. L. et al. (2003) Clinical Radiology 58, 128±132.
The need to be all inclusive: Chest CT scans should include imaged breast parenchyma
Clinical imaging
The benefits of early diagnosis and treatment of breast cancer are well established. Thoracic CT which is performed with increased frequency for lung cancer screening can diagnose breast cancer earlier then might be possible clinically. The imaged and radiation exposed breasts must be included in their entirety on images which are reviewed by the radiologist. Because of concerns about how altering the field of view might affect image quality, we advocate for inclusion of the entire breast on the soft tissue series, which can be viewed on mediastinal window settings and expose the patient to no additional radiation.
The value of yearly chest X-ray in patients with stage I breast cancer
European Journal of Cancer and Clinical Oncology, 1989
In 263 patients with stage I breast cancer, i.e. tumour less than 5 cm in diameter, no invasion of skin and deep fascia, and no involvement of axillary bmph nodes, S-rays of the chest were performed at 6, 12 months andyearly thereafter to the 6th year or until recurrence, another cancer was detected, the patient refused further follow-up or died. Among 1599 examinations, in onb 0.25% vourpatients) were unsuspected malignant changes observed. Due to this low cost/benefit ratio a fixed routine schedule of repeated chest *Y-rays in stage I cancer patients, otherwise apparentb ,free of disease, is notjustified.