Journal of Breast Imaging最新文献

Health services research (HSR) is a multidisciplinary field of inquiry that examines how health care is structured, providing valuable data on health care outcomes and delivery. Over the past few decades, a shift in the U.S. health care system toward value-based care has placed a priority on health services topics. Health services research has been central to the evolution of breast imaging over this period, with increased emphasis placed on the following: (1) design of appropriate-use criteria for imaging services; (2) determination of cost-effectiveness of imaging protocols and screening regimens guiding policy; and (3) evaluation of policy related to reimbursement for diagnostic imaging and image-guided procedures. Examples of HSR topics that can be applied directly to breast imaging include evaluation of health care availability and accessibility, analysis of health care use patterns, exploration of patient preferences, assessment of technological innovation, development and implementation of clinical practice guidelines and screening strategies, and examination of health care organization and delivery models. Breast imaging radiologists who perform HSR are uniquely positioned to advocate for patients, to promote transformative health care interventions, and to influence policy changes and public health initiatives in breast imaging through analysis of health care data and translation of their research findings. In this Training and Professional Development article, we aim to provide practical approaches to explore interest in HSR and to describe a framework for successful integration of HSR into a breast imaging career.

Beyond the technical aspects, success and long-term patient outcomes of image-guided breast biopsies depend on the overall patient experience. Patient experience in turn is influenced by intangible factors, such as environmental features during the procedure; patient-centered communication prior to, during, and subsequent to the procedure; and management of expectations and biopsy complications. Here, we review evidence-based literature and results of a national Society of Breast Imaging survey on approaches to both mitigate and manage common image-guided core biopsy complications as well as nontechnical strategies to improve the patient biopsy experience.

Objective: To assess features of automated breast US (ABUS) use in women with dense breasts. The number of additional cancers found by ABUS not detected by mammography was also determined.

Methods: This study was approved by the IRB and is HIPAA compliant. Automated breast US use was defined as completing at least 1 ABUS examination during the study. Data from 51 086 women who presented for a mammogram from October 1, 2017, to September 30, 2022, were extracted from the electronic health record. Descriptive statistics of ABUS use were performed to assess the significance of difference between age and race categories. Pairwise analysis with Bonferroni correction was performed to assess differences between each race and the White category.

Results: Automated breast US was used for 9865/24 637 (40%) patients with dense breasts. Patients with ABUS use were older than those without. Among women with dense breasts, White patients (4943/10 667 [46%]) were more likely to use ABUS than Black/African American (2604/6843 [38%]), Hispanic/Latino (1466/4278 [34%]), Asian (521/1590 [33%]), and other (331/1249 [26%]) patients (P <.05). Approximately 3025/9865 (31%) of patients using ABUS had their first ABUS within 90 days of their mammogram. By the third annual mammogram, 2684/3160 (85%) of patients who used ABUS had their ABUS and mammogram scheduled on the same day. For every 1000 ABUS exams, 2.4 additional cancers were found and were primarily early-stage tumors.

Conclusion: Among women with dense breasts, 9865/24 637 (40%) used ABUS, and they were more likely to be older and White.

Objective: Our objective was to compare the efficacy of digital breast tomosynthesis (DBT) and digital mammography (DM) in breast cancer screening and their impact on long-term overall survival (OS).

Methods: The study involved 48 549 consecutive mammography examinations between 2011 and 2015 at a medical center in Taiwan, identifying 545 women who were screened and diagnosed with breast cancer. Digital mammography and DBT examinations were alternated on different days. Patients were categorized based on mammographic modality, breast density, and American Joint Committee on Cancer (AJCC) stage. To determine the long-term outcome until August 2021, survival rates were analyzed using the Kaplan-Meier (K-M) survival analysis.

Results: The mean age at breast cancer diagnosis was 53.2 years. Digital breast tomosynthesis examinations were significantly associated with early breast cancer (AJCC stage 0 to 2) (P = .022). The 5- and 9-year OS rates for all patients were 96.8% and 93.0%, respectively. The 5- and 9-year OS was significantly greater in the DBT group (98.4% and 96.8%) compared with the DM group (95.0% and 90.4%) (P = .030 for all). The K-M survival analysis demonstrated a significantly higher OS in the DBT group than the DM group (P = .037). Furthermore, DBT significantly improved OS in a cohort of women with stage II and III cancer (P = .032) and heterogeneously dense breasts (P = .045).

Conclusion: Screening with DBT is associated with early breast cancer diagnosis and higher survival rates compared with DM.

In evidence-based medicine frameworks, the highest level of evidence is derived from quantitative synthesis of double-masked, high-quality, randomly assigned controlled trials. Meta-analyses of randomly assigned controlled trials have demonstrated that screening mammography reduces breast cancer deaths. In the United States, every major guideline-producing organization has recommended screening mammography in average-risk women; however, there are controversies about age and frequency. Carefully controlled observational research studies and statistical modeling studies can address evidence gaps and inform evidence-based, contemporary screening practices. As breast imaging radiologists develop and evaluate existing and new screening tests and technologies, they will need to understand the key methodological considerations and scientific criteria used by policy makers and health service researchers to support dissemination and implementation of evidence-based screening tests. The Wilson and Jungner principles and the U.S. Preventive Services Task Force general analytic framework provide structured evaluations of the effectiveness of screening tests. Key considerations in both frameworks include public health significance, natural history of disease, cost-effectiveness, and characteristics of screening tests and treatments. Rigorous evaluation of screening tests using analytic frameworks can maximize the benefits of screening tests while reducing potential harms. The purpose of this article is to review key methodological considerations and analytic frameworks used to evaluate screening studies and develop evidence-based recommendations.

The nipple-areolar complex (NAC) is an anatomically unique region from which several normal variants and pathologies arise. Understanding its anatomy is crucial for accurate clinical and imaging assessments, aiding with differential diagnosis, and ensuring radiologic-pathologic concordance. Mammography and US are commonly used for NAC evaluation; however, these are susceptible to technical limitations such as tissue superimposition and artifacts, compromising visualization of abnormalities in this area. Although MRI offers higher sensitivity, it is not the initial evaluation modality. A comprehensive clinical inspection is necessary because it may reveal abnormalities not apparent on imaging. This article offers an anatomical approach to the NAC evaluation, simplifying differential diagnoses by reviewing imaging techniques and clinical features of common NAC abnormalities.

Objective: To assess utilization and perceptions of 2D synthesized mammography (SM) for digital breast tomosynthesis (DBT) among practicing U.S. breast radiologists.

Methods: An IRB-exempt 23-question anonymized survey was developed by the Society of Breast Imaging (SBI) Patient Care and Delivery Committee and emailed to practicing U.S. radiologist SBI members on October 9, 2023. Questions assessed respondents' demographics, current mammographic screening protocol, confidence interpreting SM for mammographic findings, and perceived advantages and disadvantages of SM.

Results: Response rate was 13.4% (371/2771). Of 371 respondents, 208 were currently screening with DBT/SM (56.1%), 98 with DBT/SM/digital mammography (DM) (26.4%), 61 with DBT/DM (16.4%), and 4 with DM (1.1%). Most respondents felt confident using DBT/SM to evaluate masses (254/319, 79.6%), asymmetries (247/319, 77.4%), and distortions (265/318, 83.3%); however, confidence was mixed for calcifications (agreement 130/320, 40.6%; disagreement 156/320, 48.8%; neutral 34/320, 10.6%). The most frequently cited disadvantage and advantage of SM were reconstruction algorithm false-positive results (199/347, 57.4%) and lower radiation dose (281/346, 81.2%), respectively. Higher confidence and fewer disadvantages were reported by radiologists who had more SM experience, screened with DBT/SM, or exclusively used Hologic vendor (all P <.05).

Conclusion: For most survey respondents (56.1%), SM has replaced DM in DBT screening. Radiologists currently screening with DBT/SM or with more SM experience reported greater confidence in SM with fewer perceived disadvantages.