Women's Imaging News

Based on a new study published in the September issue of the journal Radiology, size and perfusion changes of breast cancers prior to and following neoadjuvant chemotherapy (NAC) alongside computer-aided assessment of dynamic contrast agent-enhanced (DCE) MR images provide realistic imaging boundaries connected to survival. ‘The study was the first to use commercialized evaluation software in the NAC setting of breast cancer patients,’ stated Ann Yi, MD, of Seoul National University College of Medicine, Seoul, South Korea, and colleagues.  To confirm whether computer-assessed DCE MR boundaries are linked with recurrence-free and overall survival in breast cancer patients who received NAC, Yi and colleagues retrospectively reviewed data from 187 consecutive women who had undergone NAC between January 2007 and December 2009. Every patient had DCE MR imaging prior to and following NAC and surgery. A computer-aided assessment program measured tumor size, volume, and kinetic parameters, such as failure component. According to the authors, there were 50 instances after an average follow-up of 47.4 months, which included 12 deaths and 38 recurrences; 29 distant, six local, and three both distant and local. Multidimensional analysis showed that a smaller decline in tumor size and a smaller reduction in failure component following NAC were separate major variables for worse recurrence-free survival and overall survival. Yi and peers used a 91.3 percent failure component decline as a cutoff point for worse overall survival. Patients with tumors that had less than 91.3 percent decline in the failure component had a three-year overall survival rate of 84.8 percent as opposed to 95.7 percent for those with a greater decline in the failure component. “Thus, when a breast cancer patient showed a smaller reduction ... Read more

Young women and girls under the age of 20 who undergo radiotherapy can significantly raise the risk of them contracting breast cancer later in life. In a joint study where Berkeley Lab researchers played a crucial part, alluding to increased stem cell self-renewal and consequent mammary stem cell enhancement as the reason. Breasts enhanced with mammary stem cells due to the process of ionizing irradiation during puberty present a later-in-life tendency for developing ER negative tumors, which are cells that do not have the estrogen receptor; which are proteins enabled by the estrogen hormone that are vital to the normal development of the breast and other female sexual characteristics during puberty. "Our results are in agreement with epidemiology studies showing that radiation-induced human breast cancers are more likely to be ER negative than are spontaneous breast cancers.This is important because ER negative breast cancers are less differentiated, more aggressive, and often have a poor prognosis compared to the other breast cancer subtypes,” said biophysicist with Berkeley Lab's Life Sciences Division, Sylvain Costes. Costes and Jonathan Tang, who was also with Berkeley Lab's Life Sciences Division, were part of a collaboration headed by Mary Helen Barcellos-Hoff, formerly with Berkeley Lab and now at the New York University School of Medicine, that explored and analyzed the so-called "window of susceptibility," a condition known to stem from the use of radiation treatments in young women during puberty which can later lead to breast cancer during adulthood. A key component to the researcher’s success was two mammary lineage agent-based models (ABMs) they produced in which a system is modeled as a compilation of independent decision-making units called agents. One ABM simulated the effects of radiation on the mammary gland during either the developmental stages or during adulthood. The other simulated the growth dynamics of human mammary epithelial cells in culture after irradiation. "Our mammary gland ABM consisted of millions of agents, with each agent representing either a mammary stem cell, a progenitor cell or a differentiated cell in the breast. We ran thousands of simulations on Berkeley Lab's Lawrencium supercomputer during which each agent continually assessed its situation and made decisions on the basis of a set of rules that correspond to known or hypothesized biological properties of mammary cells. The advantage of this approach is that it allows us to view the global consequences to the system that emerge over time from our assumptions about the individual agents. To our knowledge, our mammary gland model is the first multi-scale model of the development of full glands starting from the onset of puberty all the way to adulthood,” said Tang. Additionally, epidemiological studies have demonstrated that girls below the age of 20 who receive radiotherapy treatment for disorders such as Hodgkin's lymphoma are just as prone to developing breast cancer in their 40s as women who were born with a BRCA gene mutation. From their study, Costes, Tang and their collaboration partners concluded that self-renewal of stem cells was the most likely responsible mechanism. "Stem cell self-renewal was the only mechanism in the mammary gland model that led to predictions that were consistent with data from both our in vivo mouse work and our in vitro experiments with MCF10A, a human mammary epithelial cell line. Additionally, our model predicts that this mechanism would only generate more stem cells during puberty while the gland is developing and considerable cell proliferation is taking place,” said Tang. As of now, Costes and Tang are seeking genetic or phenotypic biomarkers that would help identify young girls who are at the highest risk of developing breast cancer following radiation therapy. The results of their study with Barcellos-Hoff and her research group show that the links between ionizing radiation and breast cancer extend beyond DNA damage and mutations. Essentially, exposure of the breast to ionizing radiation generates an overall biochemical signal that tells the system something bad happened. If exposure takes place during puberty, this signal triggers a regenerative response leading to a larger pool of stem cells, thereby increasing the chance of developing aggressive ER negative breast cancers later in life,” Costes ... Read more

A study of 7,300 breast cancer patients revealed that more than two-thirds of breast cancer deaths occur in younger women with no indication of mammography or with time-period of two years or more between mammograms. Over a span of 18 years, it was reported that 71% of breast cancer deaths were associated with mammographically unscreened women. The average age at the time of diagnosis and consequent death was 49 years, compared to 72 women who died of other causes. Based on the studies findings, Blake Cady, MD, of Massachusetts General Hospital in Boston, and coauthors are vying for mammographic screening prior to age 50, as detailed on the online journal, Cancer. "Even with effective adjuvant therapies, the best method for women to avoid death from breast cancer is to participate in regular mammography screening. Regular screening increases the likelihood of detecting nonpalpable cancers, and annual screening further increases the likelihood relative to biennial screening,” the authors determined. "Furthermore, detecting and treating breast cancer in younger women to prevent death may further increase the disease-free life years saved. Our findings suggest decreasing the intensity of efforts to screen women older than 69 years while concomitantly emphasizing efforts to screening young women in particular,” they added. The history of breast cancer screenings via mammographies is one that has been riddled with controversy. Studies have indicated that early detection of the disease helps diminish the risk of mortality. Yet, the best and most suitable age to administer the procedure and the time intervals between screenings has gone unanswered. The debate surrounding mammographies reached new heights in 2009 when the United States Preventive Services Task Force (USPSTF) suggested that routine screening mammography commence at the age of 50 and that screening should be made elective for younger women. The USPSTF also recommended biennial screenings over annual ones, as a choice for women at an average risk. The USPSTF recommendations were met by fierce criticism from the American Cancer Society, American College of Radiology, and other organizations with a say in breast cancer diagnosis and management. For the most parts, naysayers agreed on the annual screening and launch of screening at a younger age. Randomized trials have downplayed the usefulness of screening mammography because of their focus on women who are offered mammography instead of women who are actually screened, the authors noted in their introduction. As a result, the suggestions do not coincide with the survival advantage presented in the long-term follow-up of patients who go through the screening. In order to assess the survival benefit of women who have been screened, Cady and the team examined data on 7,703 patients who were newly diagnosed with breast cancer from 1991 to 1999; with a follow-up continuation to 2007. The study also analyzed the time between screening intervals, stipulating that biennial screening should be intervals of no more than two years. Women who had their last screen more than two years ago were accounted for in the unscreened group. The information consisted of demographics, use of mammography, surgical and pathology reports, disease recurrence, and death. Researchers credited mammograms as screening or diagnostic on the basis of nonexistence or presence of signs and symptoms of breast cancer. The researchers calculated that 1,705 out of 7,703 women died during follow-up, 609 of which were related to breast cancer deaths. Analysis of breast cancer deaths based on screening rate revealed that tumors identified via screen contributed to 118 deaths, most of which (111) included women whose tumors were spotted following two mammogram screening that took place no more than two years apart. Furthermore, 60 deaths were caused by ‘interval cancers,’ a term used to describe tumors that occurred in women who had one negative mammogram performed no more than two years previously. Unscreened women were the result of 395 breast cancer deaths. Another 36 deaths were due to ‘off-program’ women, a term used to describe patients who had a history of mammography, but had not been screened for more than two years. All in all, interval cancers contributed to 34% of breast cancer deaths in screened women. However, researchers discovered an inverse relationship among age during the time of diagnosis and the percentage of deaths involving interval cancers, diminishing to 47% among women  aged 40 to 49, 28% in women aged 50 to 59, 26% in women aged 60 to 69, and 24% in women aged 70 or older. Researchers also examined breast cancer and non-breast cancer deaths by the factor of age. Half of all breast cancer deaths happened in women younger than 50 and 69% prior to 60. The results fall in line with the controversy that argues whether mammography screenings should take place at age 50 or earlier. President of the American Society of Clinical Oncology, Clifford Hudis, MD, said that the results are in agreement with much of the writing detailing that mammography screenings lowers the stage at cancer recognition. Earlier stage, smaller tumors, and lower nodal involvement are all connected with improved outcomes in breast cancer. "Some would argue that cancers are cancers, and whether they are detected early or late, the outcome is the same. This study suggests that is not true, that the stage really matters, even if you have changed the stage at detection,” said Hudis. "This provides a little more support for the routine use of mammography, which is important because of the ongoing circular debates about screening," he ... Read more

Based on a new study, an abbreviated breast MRI procedure expressed accuracy for cancer detection equivalent to that of full diagnostic MRI procedures, pointing to a possible screening method in high-risk women. Both the abbreviated and full breast procedures detected 11 invasive breast cancers that initially went undetected by digital mammography in 443 women. “The full MRI protocol required 21 minutes to complete, as compared with about 3 minutes for the abbreviated protocol,” said Christiane K. Kuhl, MD, of the University of Aachen in Germany, at the Breast Cancer Symposium. “The brief protocol had a negative predictive value (NPV) just less than 100%, and specificity was equivalent to that of the full protocol,” she continued. "In this preliminary proof-of-principle study, an MR table time of less than 3 minutes can help rule out breast cancer with a negative predictive values of 98.9%An MR table time of less than 3 minutes and a radiologist reading time of less than 30 seconds yielded a diagnostic accuracy that was equivalent to the regular, full diagnostic MRI protocol.” "Abbreviated screening compares favorably with mammographic screening with regards to time needed to acquire and review images. It allowed a substantial additional yield of biologically relevant invasive cancers and ductal carcinoma in situ (DCIS) in this cohort of women at moderately or slightly increased risk of breast cancer,” she added. Kuhl noted that breast MRI manages to identify more invasive cancers and DCIS on a regular basis than mammography does. The clinical importance of the supplementary cancers continues to be up for debate, as well as the contribution of MRI-detected cancers to overdiagnosis. Following decades of mammographic screening, breast cancer remains a leading cause of cancer death in Europe and the U.S. in women younger than 50, Kuhl mentions.Furthermore, breast cancer remains the leading source of life-years lost in women. Mammography identifies breast cancer on the basis of architectural distortions, spiculations, and calcifications, which echo regressive fluctuations such as hypoxia, necrosis, and fibrosis. As a result, mammography has a detection bias toward slow-growing cancers, Kuhl explained. However, MRI detection of breast cancer is determined by angiogenic and protease activity, tissue alterations that have a direct association with carcinogenesis, cell proliferation, and metastatic growth. "MRI detection of cancers and DCIS is biased toward biologically active, prognostically relevant disease," said Kuhl. In order to verify such a claim, Kuhl referenced a study expressing mammography's sensitivity for DCIS decreases as grade increases. MRI's sensitivity began at 80% for low-grade DCIS (in contrast with 61% for mammography) and increased to 98% for high-grade DCIS with or without necrosis. Recognizing cost and limited availability as restrictions on the use of breast MRI, Kuhl explained that breast MRI procedures for screening and diagnosis are quite similar. The utilization of MRI as an accurate screening system would call for reducing acquisition time and reading time, as well as dependency on radiologists with wide-ranging experience reading MR images. Her team performed a study aiming to determine the possible exchange in MRI sensitivity with use of an abbreviated protocol appropriate for screening uses. The study included 443 women with an increased risk of breast cancer and negative digital mammograms. The patients received a total of 606 MRI studies. Radiologists whose expertise lie in breast MRI reading carried out three readings for each MRI study: the first post contrast-subtracted images (FAST), maximum intensity projection (MIP), and results of the complete breast protocol. The full protocol took 21 minutes to complete, including reading. FAST and MIP took 3 minutes for image attainment, 2.8 seconds for MIP reading, and 28 seconds for FAST readingInvestigators discovered 11 cancers missed by mammography (an additional yield of 18.3 per 1,000). All tumors were Tis or T1 cancers with no nodal involvement or distant metastases. MIP images were positive in nine out of 11 cases (82%), and the FAST and full-protocol studies were positive in 11 out of 12 cases (91%). While NPV for MIP readings was 99.6%, which slightly rose to 99.8% with FAST images. FAST imaging attained a sensitivity of 94.4%, similar to the full protocol, as 33 false-positives occurred with FAST and 35 with the full protocol. “The results could be interpreted as suggesting that DCIS detected by MRI is different from DCIS detected by mammography, “said Monica Morrow, MD, of Memorial Sloan-Kettering Cancer Center in New York City. Kuhl stated that the lesions weren’t so different, but that MRI has a detection prejudice against clinically unimportant DCIS. Morrow questioned the legitimacy of using low-grade DCIS as a proxy for "not important." "We have to keep in mind that every single prospective randomized trial of DCIS -- radiotherapy versus not -- showed that the risk of progression to invasive cancer was equal, regardless of the grade of DCISI'm not sure that, in and of itself, is a surrogate,” said ... Read more

Based on a new study published online in the journal Cancer, a large number of deaths caused by breast cancer happen in young women who do not undergo or receive regular mammograms. The Centers for Disease Control and Prevention (CDC) first reported that there were more than 18.7 million mammograms performed or provided throughout 2010. However, in this most recent study, researchers claim that there is a great shortage of mammograms provided to women under the age of 50. Researchers from Harvard Medical School in Boston carried out an examination on the value of mammography screening, employing a method called "failure analysis.” This method assesses breast cancer cases in reverse, beginning from death, in order to determine links at diagnosis, rather than looking forward from the beginning of a study. Invasive breast cancer cases that were diagnosed at Partners HealthCare Hospitals in Boston between 1990 and 1999 were evaluated for the study. The researchers analyzed the patients': •    Demographics •    Mammography use •    Surgical and pathology reports, and •    Recurrence and death dates From 609 verified deaths caused by breast cancer, only 29% of the women were revealed to have been screened with mammography, while the remaining 71% went unscreened. Out of all breast cancer related deaths, 13% happened in women older than the age of 70, while 50% occurred in women younger than the age of 50. The women diagnosed with breast cancer who later died were an average age of 49 at the time of diagnosis. While those women who died from other ailments had their diagnosis at an average age of 72. "The biological nature of breast cancer in young women is more aggressive, while breast cancer in older women tends to be more indolent. This suggests that less frequent screening in older women, but more frequent screening in younger women, may be more biologically based, practical, and cost effective,” said professor of surgery (emeritus) of Harvard Medical School, Dr. Blake Cady. Moreover, the study revealed that since the introduction of breast cancer screening in 1969, survival from the disease has dramatically increased. In 1969, 50% of women diagnosed with breast cancer died 12.5 years following diagnosis, compared with only 9.3% of women from this study, who were diagnosed between 1990 and 1999. "This is a remarkable achievement, and the fact that 71% of the women who died were women who were not participating in screening clearly supports the importance of early detection," noted Daniel Kopans of Harvard Medical School and Massachusetts General Hospital. In 2009, the US Preventive Services Task Force suggested that mammography should be limited to women aged between 50 and 74. However, research presented by the Mayo Clinic last year showed that the number of women in their 40s who have mammographies has dropped by 6% across the country since the proposition. Researchers say that because of the findings of this recent study, there should be less focus on ensuring older patients are screened, and more focus on younger women being screened, or striking a suitable balance between the two. "Detecting and treating breast cancer in younger women to prevent death may further increase the disease-free life years saved. Our findings suggest decreasing the intensity of efforts to screen women older than 69 years while concomitantly emphasizing efforts to screen younger women in particular,” said the researchers. Yet, other studies have refuted the claim over screening more mammograms, as research from The Dartmouth Institute for Healthy Policy & Clinical Practice in Lebanon contested that mammograms do not effectively reduce breast cancer death rates and excessive mammography screening can lead to unnecessary ... Read more

According to a study published in the journal Breast Cancer Research and Treatment, older women diagnosed with breast cancer are undergoing preoperative MRIs more frequently, which is resulting in a higher rate of bilateral cancer diagnoses and more invasive surgical procedures. Researchers from the Yale University of Medicine carried out a study to determine certain tendencies in MRI using age and type of surgery as preliminary blueprints. “Patient concern about recurrence and survival must be balanced with the increased risk for complications associated with more aggressive cancer surgery, particularly when there is no proven benefit of the more aggressive option,” said lead author and associate professor of internal medicine at Yale Cancer Center, Cary Gross, MD. The researchers re-assessed the files of 72,461 women aged 67 to 94, who were diagnosed with breast cancer between 2000 and 2009. All were Medicare beneficiaries. Information was obtained and based on: •  Association between MRI and surgical approach; •  Breast-conserving surgery (BCS) versus mastectomy; •  Bilateral versus unilateral mastectomy; and •  Use of contralateral prophylactic mastectomy. The findings reveal that 10.1 percent of the group received breast MRI and preoperative MRIs increased from 0.8 percent in 2000 to 2001 to 25.2 percent in 2008 to 2009. Researchers discovered that women who were administered an MRI were more likely to consequently undergo more aggressive surgical treatment. Among the women who had mastectomies, having received a preoperative MRI was notably linked with an increased probability of being diagnosed with bilateral cancer (9.7 percent) as opposed to women who did not undergo an MRI (3.7 percent). Women who received the MRIs were also more likely to have bilateral mastectomy (12.5 percent) as opposed to women who did not have an MRI (4.1 percent). Furtehrmore, women who were administered MRIs were more likely to have a prophylactic mastectomy of the unaffected breast (6.9 percent) as opposed to women who did not have MRIs (1.8 percent). "There has been no randomized controlled clinical trial demonstrating improved outcomes for women who undergo preoperative breast MRI at any age. Breast conserving therapy, when feasible, remains the preferred approach for women with early stage breast cancer,” said assistant professor of surgery at Yale and first author on the study, Brigid Killelea, ... Read more

Screening, diagnosing, and treating cancer has been a heated debate among the medical community. One argument states that patients are being over-screened, over-diagnosed and over-treated for the disease. And most recently, a newly conducted study offers supplemental evidence to this claim. Published in the journal Radiology, a recent study found that abnormal breast tissue (lesions) referred as “probably benign” (non-cancerous) rarely turned out to be cancer tumors. From the results of the study, its authors stipulate that less follow-up testings and exams may be the best way to go for women with such lesions; stating that in doing so, such a counter-action will significantly reduce patient anxiety and lower healthcare costs. Lead researcher of the study and professor radiology at the Northeast Ohio Medical University in Youngstown, Ohio, Richard G. Barr, MD, PhD, and his team examined records from the American College of Radiology Imaging Network (ACRIN) trial 6666 in which women with dense breasts were subjected to mammography and ultrasound screenings. Since dense breasts have more fibrous tissue than fat, imaging tests of dense breasts are often more difficult to read and interpret. Ultrasound, an imaging technology that utilizes sound waves to produce pictures, is being employed more frequently along with mammography to detect tumors that aren’t detectable on mammograms. For this study, the research team primarily focused on lesions visible on ultrasound and determined as “probably benign” or category 3 of the Breast Imaging-Reporting and Data System (BI-RADS 3). The researchers then analyzed ultrasound exams and follow-up data of 2,662 participants registered between 2004 and 2006. A total of 519 women had 745 BI-RADS 3 lesions. In follow-up screenings over a period of three-years, the study revealed that six (0.8 percent) of the 745 BI-RADS 3 lesions were in fact cancerous. Only two cancerous tumors were detected in follow-up screenings during the first year. Present guidelines recommend that women with BI-RADS 3 lesions should have supplementary imaging studies at intervals of 6, 12, and 24 months to check for any suspicious change. Barr also suggested that because of the low number of malignancies discovered among these lesions, yearly follow-up screenings of these lesions may be a suitable course of action. Professor of radiology at Harvard Medical School and senior radiologist of the Breast Imaging Division at Massachusetts General Hospital, Daniel B. Kopans, MD, also found it significant to point out that the BI-RADS 3 lesions in the study, were detected by ultrasound and not mammography. “ACRIN 6666 clearly showed that ultrasound can find some breast cancers that are not visible on screening mammograms. Since ACRIN 6666 was not a randomized trial it is not certain that finding these cancers will save lives,” said ... Read more

According to a new study published in the journal Cancer, researchers have managed to develop a new screening approach for ovarian cancer, which could possibly lead to an earlier detection of the disease. Researchers from the University of Texas MD Anderson Cancer Center in Houston have created a "two-stage" ovarian cancer screening strategy that measures fluctuations in a blood protein called CA125, a protein known as an indicator for tumors. Researches believe that if this new screening strategy comes to fruition and is implemented across medical platforms, it could help save the lives of thousands of women. The study, which was carried out over an 11 year period, examined and analyzed 4,051 post-menopausal women. All women received a yearly CA125 blood test at the baseline of the study. The researchers then used a calculation method called the "Risk of Ovarian Cancer Algorithm" to separate the women into three groups, which were: 1-    Women who should receive another CA125 test 1 year later (low risk) 2-    Women who should receive a repeat CA125 test in 3 months (intermediate risk) 3-    Women who should receive a transvaginal ultrasound and be referred to a gynecologic oncologist (high risk). Results of the screening demonstrated that, on average during every year of the study, around 5.8% of the women were found to be at an intermediate risk. About 0.9% of the women were to receive a transvaginal ultrasound and review by a gynecologic oncologist annually. From this, ten of the women required surgery. Four of the women had invasive ovarian cancers, while two women had ovarian tumors of "low malignant potential," one had endometrial cancer, and three had benign ovarian tumors.  The researchers claim that these findings illustrate a "positive predictive value of 40% for predicting invasive ovarian cancer." “The specificity of the screening method was 99.9%. This means that the percentage of patients who could be falsely identified as having the cancer would be just 0.1%,” they noted.In addition, researchers also claim that such findings reveal that the new screening strategy achieves "high specificity with very few false-positive results" in post-menopausal women. "The results from our study are not practice-changing at this time. However, our findings suggest that using a longitudinal (or change over time) screening strategy may be beneficial in post-menopausal women with an average risk of developing ovarian cancer,” said University of Texas and lead author of the study, Dr. Karen Lu. Lu also mentioned she and her team are awaiting another study’s results of a bigger randomized UK study that implements the same "Risk of Ovarian Cancer Algorithm" method in a similar population of women. "If the results of this study are also positive, then this will result in a change in practice," she said. Yet healthcare projects manager at Ovarian Cancer Action in the UK, Abi Begho contends that this new screening approach may not be fully accurate in detecting the sensitivity of ovarian cancer. "While the specificity of this screening strategy is very good, the research was not designed to detect sensitivity. They did measure the sensitivity to be 60%, so there is room for improvement, but the researchers did note that no cases of invasive ovarian cancer were missed so the sensitivity could be better than actually reported,” said Begho. According to the National Cancer Institute, there will be about 22,240 new cases of ovarian cancer in the US this year, approximately resulting in 14,030 deaths. For the time being, there are no effective methods for detecting ovarian cancer in its early stages. One issue is that early symptoms of ovarian cancer, such as abdominal pain and feeling bloated and full, are sometimes mistakenly diagnosed as other problems. Because of this, the majority of women are diagnosed when they are in the late stages of the ... Read more

According to data gathered from a multi-site imaging trial including more than 2,600 women, researchers say breast lesions categorized as 'probably benign' on additional screening ultrasound could be re-assessed with imaging in one year, leading to a decrease in patient anxiety, follow-up exams and superfluous biopsies. Findings of the study have gone on to be published online in the journal Radiology. During the course of the study, researchers examined data from the American College of Radiology Imaging Network (ACRIN) trial 6666, in which both annual mammography and ultrasound screenings were carried out on women with dense breasts at 21 different locations around the country. Ultrasound is gradually being used as a supplement to screening mammography because it has the ability to identify breast cancers that would otherwise go undetected with mammography, especially in dense breasts. "Supplemental ultrasound screening increases cancer detection beyond mammography alone, but may also result in an increased number of additional tests. Both screening ultrasound and screening mammography have similar issues: to find breast cancers, a large number of biopsies must be performed, most of which turn out to be negative,” said lead researcher and professor of radiology at the Northeast Ohio Medical University in Youngstown, Ohio, Richard G. Barr, M.D., Ph.D. Barr and his peers examined the trial’s ultrasound-detected lesions determined as most likely benign or category 3 of the Breast Imaging-Reporting and Data System (BI-RADS), a standardized system of evaluating breast lesions and their likelihood of malignancy based on appearance, to determine the prevalence and malignancy rate of these lesions. Guidelines point out that BI-RADS 3 lesions should be observed for any wary changes with supplemental imaging at time periods of six, 12, and 24 months. "BI-RADS 3 lesions are common on screening ultrasound and often lead to unnecessary biopsies and additional imaging, causing substantial cost and anxiety for patients. We wanted to study these BI-RADS 3 lesions to look for ways to perform fewer biopsies without missing breast cancers,” said Barr. Researchers investigated the screening ultrasound tests and follow-up data of 2,662 trial participants enrolled between 2004 and 2006. From the 2,662 women, 519 had a total of 745 BI-RADS 3 lesions, representing 25 percent of all ultrasound-detected lesions in the study. From the 745 BI-RADS 3 lesions, six were malignant for a total malignancy rate of 0.8 percent. The median size of the detected cancers among the BI-RADS 3 lesions was 10 millimeters. During the six-month follow-up interval imaging, shady changes were observed in only one of the 745 BI-RADS 3 lesions. At 12-month follow-up imaging, suspicious changes were observed in a second BI-RADS 3 lesion, revealing an invasive breast cancer that had not yet extended passed the breast. "As a result of the low malignancy rate of BI-RADS 3 lesions and the low rate of suspicious changes at six-month follow-up imaging, yearly follow-up for these lesions may be appropriate. The cancers detected due to changes at one year had not spread beyond the breast, with similar prognosis if the lesion was biopsied on initial detection,” said Barr. Barr noted that extending the follow-up imaging interval from six to 12 months for BI-RADS 3 lesions detected by screening ultrasound would significantly lower the number of follow-up examinations and biopsies performed. The researchers also discovered that women included in the study with BI-RADS 3 lesions were more probable to be younger than 50 years of age, of Hispanic or Latino ethnicity and pre-menopausal. As of now Barr is conducting further studies on ultrasound screening and research on the use of elastography, an advanced method that enables distinction from benign and cancerous ... Read more

VuCOMP Inc. which is a corporation that designs, develops, and markets software systems for automatic analysis of medical images; recently announced that it has just installed an advanced M-Vu computer-aided detection (CAD) system at The Rose, which is a leading nonprofit breast health organization in southeast Texas. This nonprofit organization offers advanced breast cancer screening and provides a wide range of diagnostic services such as mammograms, ultrasounds, biopsies and access to treatment to more than 33,000 women on a year by year basis. The organization is comprised of board certified radiologists, specialized technical staff, two mammography and diagnostic imaging centers, and an assortment of mobile mammography vans; all geared to meet and fulfill the needs of insured and uninsured women in Houston and surrounding areas. Since its inception in 1987, The Rose has served more than 385,000 patients, making it the leading nonprofit breast health care organization in southeast Texas. VuCOMP’s CAD is designed to supply an unparalleled level of performance to aid radiologists in detecting breast cancer earlier. This new enhanced system allows The Rose to fulfill its promise on providing state of the art health care to women regardless of their current financial situation. VuCOMP’s M-Vu system analyzes mammographic images and highlights suspicious areas using sophisticated mathematical algorithms. “I’ve had experience with several CAD systems, and VuCOMP’s product is proving to be superior. Additionally, VuCOMP has shown itself to be invested in continual improvement, and has been receptive to suggestions from radiologists, which means better outcomes all around,” said lead interpreting physician at The Rose, Ward Parsons, MD, RT, RDMS. "Our mission is to remove the barriers to cancer screening and provide quality health care for all women in the region. Our insistence on quality care includes physician and staff expertise and experience along with compassionate interactions with patients as well as the use of advanced technology. VuCOMP is a critical component that allows us to serve more women more quickly—and we can hopefully save more lives,” stated The Rose co-founder and CEO, Dorothy Weston Gibbons. The VuCOMP system was granted FDA approval to work with film mammography in January 2012, and an additional approval for digital mammography in October 2012. While CAD systems have been utilized in clinical practice since the mid-1990s, recent FDA guidelines have considerably raised the standard for CAD performance requirements, and now recommend comprehensive reader studies proving that radiologists are more effective when they use CAD. The VuCOMP system is the only FDA-approved mammography CAD product in the world that meets these specific performance requirements. “With The Rose’s emphasis on quality and excellence in the services it provides to all women, we are pleased that our technology was selected for their digital mammography practice. VuCOMP and The Rose share the same goal: to detect breast cancer earlier, which can lead to earlier intervention and better outcomes,” said President and CEO of VuCOMP, Jeff ... Read more

A new mammography workstation is offering top of the line image loading times, consistent, up to date reading, and an instinctive user interface, comprising of the latest evaluation of dynamic breast magnetic resonance imaging (MRI) studies. Aycan Medical Systems’ (Rochester, NY, USA) US Food and Drug Administration (FDA)-have approved and cleared the mammography workstation, powered by aycan OsiriX Pro with its advanced hanging protocol plug-in, is optimized for mammography workflow. Appropriate for mammography workstations, the optional hanging protocols plug-in for aycan OsiriX Pro permits the user to save display layouts and settings in the two-dimensional (2D) viewer, therefore when reopening or revisiting a study (or similar studies), the user will always attain the same view. This kind of standardization ushers in greater overall effectiveness to routine diagnoses. In addition, the plug-in automatically opens up earlier studies, which helps further increase the overall speed of the daily workflow. With this plug-in, aycan OsiriX Pro can now be used as a mammography workstation in the field of curative treatment and screening. Special features of the system include: easy to use; faster workflow with aycan OsiriX Pro; easy to reconfigure; hanging protocol import/export; change layout with just one click or keyboard short cut; image parameters: pre-define zoom, window width/window level (WW/WL), image numbers, screen layout; and group and tile similar ... Read more

A new 3D mammography system will now provide women in rural North Louisiana an in-depth explanation to suspicious lumps. The machine is one of only two 3D systems available in the state. The system is designed to be transported via a mobile cancer screening van unit from Partners in Wellness, which serves uninsured and underinsured residents. Feist-Weiller Cancer Center at LSU Health Shreveport operates the program through grants, donations, and funding collected from a foundation dedicated to cancer screening and care. “More precise images will give radiologists a better view of possible tumors and decrease the number of false positive results,” said Feist-Weiller cancer control and prevention director, Dr. Jerry McLarty. “The van also has computers that can send the images to a radiologist right away for reading in cases where immediate diagnosis can make a life-or-death difference. The program’s older van will start visiting eastern Louisiana parishes along the Mississippi River. A lot of those parishes have no mammography anywhere,” he said. “Some don’t even have a clinic,” added McLarty. Moreover, rural residents won’t be the only ones waiting outside the mobile van to receive 3D mammography screenings; but Partners in Wellness are scheduled to pay a visit to Martin Luther King Health Center in Shreveport once a month for the free clinic’s women’s health program; which can receive up to 20 women who get mammograms each month. “We probably could fill it up more than that, but they are pretty booked up. It is a valuable service for our patients,” said health center director Janet Mentesane.  Women at the center are set to receive a physical, pap smear and mammogram upon visitation. The health center can also manage mammogram services with partner agencies in other locations. “It enables patients to have their annual women’s screening done in a one-stop shop, which is very convenient for our patients, who often have difficulty arranging transportation to multiple service points,” said ... Read more