Effects of delayed callback from screening mammography due to the COVID-19 pandemic.

OBJECTIVE: To determine the frequency and distinguishing imaging characteristics of breast cancers detected on screening mammography which was initially evaluated as a probably benign lesion and the workup was delayed due to the COVID-19 pandemic. MATERIALS AND METHODS: REB-approved multicenter retrospective screening mammography studies and patient's chart review carried out between February 2020 and March 2020. According to an institutional decision, the frequency and imaging findings deemed probably benign on screening mammography after review by a breast fellowship-trained radiologist with workup deferred until after the first pandemic wave plateau in late July 2020 were recorded. Results were correlated with histopathology if tissue sample performed or an uneventful 2 years follow-up. Descriptive statistical analysis was used to describe the retrieved data set. RESULTS: Out of 1816 mammography screening between February 2020 and March 2020, 99 women, median age 58 years (range 35-84), 99 mammography had possibly benign findings with workup delayed, and two patients, age 49 and 56, had cancers (2.02%), misinterpreted as benign findings. Both malignant cases were focal asymmetries, with pathology of invasive ductal carcinoma, 12 mm and 9 mm in size. No in-situ carcinoma was detected. CONCLUSION: The low rate of cancer detected suggests that a delay callback may be a reasonable option for some likely benign findings when immediate callback is not an option, such as during a pandemic. Larger studies would be helpful to support our findings and may allow us to translate the adoption of such a model during potential future pandemic. CLINICAL RELEVANCE: The results of this study may be helpful for a future situation when delaying a call back from screening mammography is again required.

Radiological and clinicopathological findings of breast cancer during the COVID-19 pandemic: a comparative study with the pre-pandemic era.

PURPOSE: The diagnosis and surgical treatment delays that occurred during the coronavirus disease-2019- (COVID-19) pandemic may have affected breast cancer presentation. This study aimed to determine whether there was a difference in the clinicopathological characteristics of breast cancers during the pandemic by comparing them with similar cases from the previous year. The study also aimed to determine the radiological findings of breast cancers during the pandemic. METHODS: A retrospective review was made of patients who underwent surgery for breast cancer between March 11, 2020, and December 11, 2020 (the pandemic group). These patients were compared with similar patients from the previous year (the pre-pandemic group). The postoperative histopathology results of both groups were compared, and the preoperative radiological findings of the pandemic group were defined. RESULTS: There were 71 patients in the pandemic group and 219 patients in the pre-pandemic group. The tumor size was significantly greater, lymph node involvement was more frequent, and waiting time for surgery was longer in the pandemic group (P < 0.001, P = 0.044, P = 0.001, respectively). There was no significant difference between the groups in respect of in situ/invasive tumor distribution, histological type and histological grade of tumor, the presence of lymphovascular/perineural invasion, multifocal/multicentric focus, and Breast Imaging Reporting and Data System Classification (P > 0.15). The radiologic findings of breast cancer during the pandemic typically showed characteristics of malignancy. CONCLUSION: Patients diagnosed with breast cancer during the COVID-19 pandemic had larger tumor sizes, more frequent lymph node involvement and longer waiting time for surgical treatment. Screening programs should be continued as soon as possible by taking necessary precautions.

Advanced Stage Breast Cancer on Initial Presentation Following One Year Hiatus in Screening Mammography Due to COVID-19 Pandemic.

Breast cancer is the second most common cancer and second leading cause of cancer death affecting women in the U.S., behind only skin and lung cancers, respectively. Modern screening mammography methods have contributed, in part, to a 40 percent decrease in breast cancer mortality since it was introduced in 1976. Therefore, regular breast cancer screening is vital to women's health. The COVID-19 Pandemic posed many challenges to healthcare systems worldwide. One challenge was the discontinuation of routine screening tests. We present a female patient who consistently participated in annual screening mammography and was confirmed negative for malignancy between 2014 and 2019. She did not get her mammogram in 2020 due to the COVID-19 pandemic and was subsequently diagnosed with stage IIIB breast cancer when she resumed her screening mammogram in 2021. This case illustrates one of the consequences of delayed breast cancer screening.

Breast exam use during the protracted COVID-19 pandemic, by age, race, and geography.

In this study we analyzed data collected from the onset of the COVID-19 pandemic through March 31, 2022, to identify temporal shifts in breast exam volume. Screening mammography volume stabilized toward the end of the study period, and diagnostic exam volume varied over time and by age. Older women experienced a decline in diagnostic exam volume between August 2020 and April 2021 that was not observed among women aged younger than 50 years (50-69 years: monthly percentage change [MPC] = -6.5%; and 70 years and older: MPC = -15.7%). With respect to breast biopsy volume, women aged younger than 70 years had increased exam volume beginning in April 2020 and June 2020, whereas a corresponding increase among older women was delayed until April 2021 (70 years and older: MPC = 9.3%). Findings from our study suggest a temporal shift in the use of breast exams that could result in differential detection of breast cancer by age.

Contrast-enhanced Ultrasound Using Intradermal Microbubble Sulfur Hexafluoride for Identification of Sentinel Lymph Nodes During Breast Cancer Surgery: A Clinical Trial.

BACKGROUND/AIM: Sentinel lymph node (SLN) procedures have gained popularity in early breast cancer thanks to the reduction of surgical side-effects. The standard SLN mapping procedure uses 99mTc-nanocolloid human serum albumin with/without blue dye; limitations include logistical challenges and adverse reactions. Recently, contrast-enhanced ultrasound (CEUS) using sulfur hexafluoride has emerged as a promising technique for SLN mapping. Our study aimed to compare the CEUS technique with the standard isotope method. MATERIALS AND METHODS: AX-CES, a prospective, monocentric, single-arm phase-3 study was designed (EudraCT: 2020-000393-20). Inclusion criteria were histologically diagnosed early breast cancer eligible for upfront surgery and SLN resection, bodyweight 40-85 kg, and no prior history of ipsilateral surgery or radiotherapy. All patients underwent CEUS prior to surgery and blue dye injection was performed in areas with contrast accumulation. After the experimental procedure, all patients underwent the standard mapping procedure and SLN frozen section assessment was performed. Data on the success rate, systemic reactions, mean procedure time, CEUS appearance, SLN number, and concordance with standard mapping procedure were collected. RESULTS: Among 16 cases, a median of two SLNs were identified during CEUS. In all cases, at least one SLN was identified by CEUS (100%). In six cases, SLNs were classified during CEUS as abnormal, which was confirmed by definitive staining in four cases. After the standard mapping technique, in 15 out of the 16 cases (87.50%), at least one SLN from the standard mapping procedure was marked with blue dye in the CEUS procedure. In our series, sensitivity and specificity of SLN detection by CEUS were 75% and 100%, respectively. CONCLUSION: CEUS is a safe and manageable intraoperative procedure. When compared with standard techniques, US appearance during CEUS may provide additional information when associated with histological assessment.

The role of facility and patient mix factors on recovery of screening and diagnostic mammography volumes following the initial COVID-19 pandemic wave.

INTRODUCTION: The goal of this study was to understand the extent to which mammography facilities were able to recover monthly screening and diagnostic mammography volumes to their prepandemic levels and to determine what facility and patient mix factors were associated with recovery. METHOD: Facilities, located in and adjacent to Cook County, Illinois, were eligible. In all, 58 screening and 30 diagnostic mammogram facilities submitted mammogram volumes by month with a cross-listing of patient ZIP codes by screening volumes. Monthly screening and diagnostic volumes for the 6-month immediate postpandemic period (July-December 2020) and for the subsequent postpandemic period (January-June 2021) were compared with the same months in 2019. ZIP code distributions were used to define patient mix characteristics related to disadvantage. RESULTS: Compared with the prepandemic period, Breast Imaging Centers of Excellence conducted roughly 50 fewer monthly screening mammograms (95% CI: -91, -9) but 50 more diagnostic mammograms (95% CI: 24, 82) on average in the immediate postpandemic period. Facilities serving a predominantly Black population conducted roughly 50 fewer monthly screens (95% CI: -93, -13) without any increase in monthly diagnostics. CONCLUSION: Highly accredited (and typically higher volume) facilities appeared to actively triage diagnostics, whereas lower resource facilities appeared to struggle to recover to prepandemic volumes without triage to diagnostics. The pandemic disproportionally impacted minority populations already affected by differential access to and utilization of high-quality mammography. Potential explanations are discussed. Policies should be strengthened to facilitate triaging of services during times of stress to the healthcare system.

The Negative Impact of the New Coronavirus Pandemic on the Trend of Breast Biopsies and Their Direct Costs: Interrupted Time Series Analysis.

OBJECTIVES: The overload of health services because of the COVID-19 pandemic has reduced the population's access to treatment and prevention of other diseases. This study aimed to identify whether there was a change in the trend of breast biopsies and their direct costs during the COVID-19 pandemic in a developing country's public and universal healthcare system. METHODS: This was an ecological time series study of mammograms and breast biopsies in women aged 30 years or older from an open-access data set of the Public Health System of Brazil from 2017 to July 2021. RESULTS: In 2020, there was a reduction of -40.9% in mammograms and -7.9% in breast biopsies compared with the prepandemic period. From 2017 to 2020, there was an increase in the breast biopsies ratio per mammogram (1.37%-2.55%), the percentage of Breast Imaging-Reporting and Data System (BI-RADS) IV and V mammograms (0.79%-1.14%), and the annual direct cost of breast biopsies (Brazilian Real 3 477 410.00 to Brazilian Real 7 334 910.00). In the time series, the negative impact of the pandemic was lower on BI-RADS IV to V mammograms than on BI-RADS 0 to III. There was an association between the trend of breast biopsies and BI-RADS IV to V mammography. CONCLUSIONS: The COVID-19 pandemic harmed the increasing trend of breast biopsies, their total direct costs, BI-RADS 0 to III and IV to V mammograms, observed in the prepandemic period. Furthermore, there was a tendency to screen women at a higher risk for breast cancer during the pandemic.

Live Mammographic Screening Interpretation Versus Offline Same-Day Screening Interpretation at a Tertiary Cancer Center.

OBJECTIVES: The aim of this study was to compare screening mammography performance metrics for immediate (live) interpretation versus offline interpretation at a cancer center. METHODS: An institutional review board-approved, retrospective comparison of screening mammography metrics at a cancer center for January 1, 2018, to December 31, 2019 (live period), and September 1, 2020, to March 31, 2022 (offline period), was performed. Before July 2020, screening examinations were interpreted while patients waited (live period), and diagnostic workup was performed concurrently. After the coronavirus disease 2019 shutdown from March to mid-June 2020, offline same-day interpretation was instituted. Patients with abnormal screening results returned for separate diagnostic evaluation. Screening metrics of positive predictive value 1 (PPV1), cancer detection rate (CDR), and abnormal interpretation rate (AIR) were compared for 17 radiologists who interpreted during both periods. Statistical significance was assessed using χ2 analysis. RESULTS: In the live period, there were 7,105 screenings, 635 recalls, and 51 screen-detected cancers. In the offline period, there were 7,512 screenings, 586 recalls, and 47 screen-detected cancers. Comparison of live screening metrics versus offline metrics produced the following results: AIR, 8.9% (635 of 7,105) versus 7.8% (586 of 7,512) (P = .01); PPV1, 8.0% (51 of 635) versus 8.0% (47 of 586); and CDR, 7.2/1,000 versus 6.3/1,000 (P = .50). When grouped by >10% AIR or <10% AIR for the live period, the >10% AIR group showed a significant decrease in AIR for offline interpretation (from 12.7% to 9.7%, P < .001), whereas the <10% AIR group showed no significant change (from 7.4% to 6.7%, P = .17). CONCLUSIONS: Conversion to offline screening interpretation from immediate interpretation at a cancer center was associated with lower AIR and similar CDR and PPV1. This effect was seen largely in radiologists with AIR > 10% in the live setting.

The location of unilateral axillary lymphadenopathy after COVID-19 vaccination compared with that of metastasis from breast cancer without vaccination.

PURPOSE: Unilateral axillary lymphadenopathy is known to occur after coronavirus disease (COVID-19) vaccination. Post-vaccination lymphadenopathy may mimic the metastatic lymph nodes in breast cancer, and it is challenging to distinguish between them. This study investigated whether the localization of axillary lymphadenopathy on magnetic resonance imaging (MRI) could be used to distinguish reactive lymphadenopathy after COVID-19 vaccines from metastatic nodes. MATERIALS AND METHODS: We retrospectively examined preoperative MRI images of 684 axillae in 342 patients who underwent breast cancer surgery from June to October 2021. Lymphadenopathy was defined as cortical thickening or short axis ≥ 5 mm. The axilla was divided into ventral and dorsal parts on the axial plane using a perpendicular line extending from the most anterior margin of the muscle group, including the deltoid, latissimus dorsi, or teres major muscles, relative to a line along the lateral chest wall. We recorded the presence or absence of axillary lymphadenopathy in each area and the number of visible lymph nodes. RESULTS: Of 80 axillae, 41 and 39 were included in the vaccine and metastasis groups, respectively. The median time from the last vaccination to MRI was 19 days in the vaccine group. The number of visible axillary lymph nodes was significantly higher in the vaccine group (median, 15 nodes) than in the metastasis group (7 nodes) (P < 0.001). Dorsal lymphadenopathy was observed in 16 (39.0%) and two (5.1%) axillae in the vaccine and metastasis groups, respectively (P < 0.001). If the presence of both ventral and dorsal lymphadenopathy is considered indicative of vaccine-induced reaction, this finding has a sensitivity of 34.1%, specificity of 97.4%, and positive and negative predictive values of 93.3％ and 58.5%, respectively. CONCLUSION: The presence of deep axillary lymphadenopathy may be an important factor for distinguishing post-vaccination lymphadenopathy from metastasis. The number of axillary lymph nodes may also help.

An update on the status of breast cancer screening in Brazil after the covid-19 pandemic.

We have previously reported the impact of covid-19 pandemic on breast cancer screening, in Brazil: among women aged 50-69 years, mammography attendance decreased by 42% in public healthcare (SUS), comparing 2019 and 2020. In this short communication, we wish to present: a) an update of the number of mammograms performed, in 2021; b) an exploratory analysis of the characteristics of the screened population between 2019 and 2021. A total of 1.675.307 mammograms were performed in 2021, nearly 15% lower than pre-pandemic levels. Almost a third, 29.5% of them, had intervals greater than three years. In accordance with our previous study, the number of patients with palpable lumps on physical exam increased. The consequences of postponing breast cancer screening during the pandemic are still uncertain. Unfortunately, as of December 2021, screening attendance has not resumed. On the contrary, our results show an increase in the fraction of women with mammography delayed beyond three years.

The impact of the SARS-COV-2 pandemic on the quality of breast cancer care in EUSOMA-certified breast centres.

AIMS: We analysed the impact of the SARS-CoV-2 pandemic (COVID-19) on the quality of breast cancer care in certified EUSOMA (European Society of Breast Cancer Specialists) breast centres. MATERIALS AND METHODS: The results of the EUSOMA quality indicators were compared, based on pseudonymised individual records, for the periods 1 March 2020 till 30 June 2020 (first COVID-19 peak in most countries in Europe) and 1 March 2019 till 30 June 2019. In addition, a questionnaire was sent to the participating Centres for investigating the impact of the COVID-19 pandemic on the organisation and the quality of breast cancer care. RESULTS: Forty-five centres provided data and 31 (67%) responded to the questionnaire. The total number of new cases dropped by 19% and there was a small significant higher tumour (p = 0.003) and lymph node (p = 0.011) stage at presentation. Comparing quality indicators (12,736 patients) by multivariable analysis showed mostly non-significant differences. Surgery could be performed in a COVID-free zone in 94% of the centres, COVID testing was performed before surgery in 96% of the centres, and surgical case load was reduced in 55% of the centres. Modifications of the indications for neoadjuvant endocrine therapy, chemotherapy, and targeted therapy were necessary in 23%, 23%, and 10% of the centres; changes in indications for adjuvant endocrine, chemo-, targeted, immune, and radiotherapy in 3%, 19%, 3%, 6%, and 10%, respectively. CONCLUSION: Quality of breast cancer care was well maintained in EUSOMA breast centres during the first wave of the COVID-19 pandemic. A small but significantly higher tumour and lymph node stage at presentation was observed.

Axillary lymph node characteristics in breast cancer patients versus post-COVID-19 vaccination: Overview of current evidence per imaging modality.

BACKGROUND: Axillary lymph node characteristics on axillary ultrasound (US), breast MRI and 18F-FDG PET/CT are relevant at breast cancer diagnosis. Axillary lymphadenopathy after COVID-19 vaccination has been frequently reported. This may cause a diagnostic dilemma, particularly in the ipsilateral axilla in women who have a either a recent diagnosis of breast cancer or a history of breast cancer. This review provides an overview of the current evidence regarding axillary lymph node characteristics at breast cancer diagnosis versus "post-COVID-19 vaccination". METHODS: A non-systematic narrative review was performed. Studies describing axillary lymph node characteristics per imaging modality (axillary US, breast MRI and 18F-FDG PET/CT) in breast cancer patients versus post-COVID-19 vaccination were selected and used for the current study. RESULTS: The morphologic characteristics and distribution of abnormal nodes on US may differ from the appearance of metastatic adenopathy since diffuse cortical thickening of the lymph nodes is the most observed characteristic after vaccination, whereas metastases show as most suspicious characteristics focal cortical thickening and effacement of the fatty hilum. Current evidence on MRI and 18F-FDG on morphologic characteristics of axillary lymphadenopathy is missing, although it was suggested that vaccine related lymphadenopathy is more likely to be present in level 2 and 3 nodes than metastatic nodes. Reported frequencies of lymphadenopathy post-COVID-19 vaccination range from 49% to 85% (US), 29% (breast MRI) and 14.5% to 53.9% (18F-FDG PET/CT). Several factors may impact the presence or extent of lymphadenopathy post-COVID-19 vaccination: injection site, type of vaccine (i.e., mRNA versus vector), time interval (days) between vaccination and imaging, previous history of COVID-19 pneumonia, and first versus second vaccine dose. CONCLUSION: Although lymph node characteristics differ at breast cancer diagnosis versus post-COVID-19 vaccination, clinical information regarding injection site, vaccine type and vaccination date needs to be documented to improve the interpretation and guide treatment towards the next steps of action.

Evaluation of clinically involved lymph nodes with deformable registration in breast cancer radiotherapy.

OBJECTIVES: Modern radiotherapy (RT) techniques require careful delineation of the target. There is no particular RT contouring guideline for patients receiving neoadjuvant chemotherapy (NACT). In this study, we examined the distribution of pre-chemotherapy clinically positive nodal metastases. METHODS: We explored the coverage rate of the RTOG breast contouring guideline by deformable fusion of 18-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scan. We retrospectively evaluated neoadjuvant chemotherapy patients. All PET-CT images were imported into the planning software. We combined the planning CT and the CT images of PET-CT with rigid and then a deformable registration. We manually contoured positive lymph nodes on the CT component of the PET-CT data set and transferred them to planning CT after fusion. We evaluated whether previously contoured lymphatic CTVs, according to the RTOG breast atlas, include GTV-LNs. RESULTS: All breast cancer patients between October 2018 and February 2021 were evaluated from the electronic database. There were 142 radiologically defined positive lymph nodes in 31 patients who were irradiated after NACT. Most LNs (70%) were in the level I axilla. Only 71.1% (n:101) of the whole lymph nodes in 10 patients were totally covered, 22.5% (n:32) partially covered and 6.4% %(n:9) totally undercovered. CONCLUSIONS: The extent of regional nodal areas in the RTOG atlas may be insufficient to cover positive lymph nodes adequately. For patients with nodal involvement undergoing neoadjuvant chemotherapy, PET-CT image fusions can be helpful to be sure that positive lymph nodes are in the treatment volume. ADVANCES IN KNOWLEDGE: RTOG contouring atlas may be insufficient to cover all involved lymph nodes after NACT. For patients with nodal involvement undergoing neoadjuvant chemotherapy, PET-CT image fusions may help to be sure that positive lymph nodes are in the treatment volume.

Screening Mammography Recovery After COVID-19 Pandemic Facility Closures: Associations of Facility Access and Racial and Ethnic Screening Disparities.

BACKGROUND. Screening mammography facilities closed during the COVID-19 pandemic in spring 2020. Recovery of screening volumes has varied across patient subgroups and facilities. OBJECTIVE. We compared screening mammography volumes and patient and facility characteristics between periods before COVID-19 and early and later postclosure recovery periods. METHODS. This retrospective study included screening mammograms performed in the same 2-month period (May 26-July 26) in 2019 (pre-COVID-19), 2020 (early recovery), and 2021 (late recovery after targeted interventions to expand access) and across multiple facility types (urban, suburban, community health center). Suburban sites had highest proportion of White patients and the greatest scheduling flexibility and expanded appointments during initial reopening. Findings were compared across years. RESULTS. For White patients, volumes decreased 36.6% from 6550 in 2019 (4384 in 2020) and then increased 61.0% to 6579 in 2021; for patients with races other than White, volumes decreased 53.9% from 1321 in 2019 (609 in 2020) and then increased 136.8% to 1442 in 2021. The percentage of mammograms in patients with races other than White was 16.8% in 2019, 12.2% in 2020, and 18.0% in 2021. The proportion performed at the urban center was 55.3% in 2019, 42.2% in 2020, and 45.9% in 2021; the proportion at suburban sites was 34.0% in 2019, 49.2% in 2020, and 43.5% in 2021. Pre-COVID-19 volumes were reached by the sixth week after reopening for suburban sites but were not reached during early recovery for the other sites. The proportion that were performed on Saturday for suburban sites was similar across periods, whereas the proportion performed on Saturday for the urban site was 7.6% in 2019, 5.3% in 2020, and 8.8% in 2021; the community health center did not offer Saturday appointments during recovery. CONCLUSION. After reopening, screening shifted from urban to suburban settings, with a disproportionate screening decrease in patients with races other than White. Initial delayed access at facilities serving underserved populations exacerbated disparities. Interventions to expand access resulted in late recovery volumes exceeding prepandemic volumes in patients with races other than White. CLINICAL IMPACT. Interventions to support equitable access across facilities serving diverse patient populations may mitigate potential widening disparities in breast cancer diagnosis during the pandemic.

Impact of COVID-19 and Socioeconomic Factors on Delays in High-Risk MRI Breast Cancer Screening.

The purpose of this study is to investigate if there was a delay in high-risk MRI breast cancer screening in our local region, if this delay is ongoing despite COVID-19 vaccinations, and if demographic and socioeconomic factors are associated with these delays. Six-hundred and sixty-five high-risk breast patients from 23 January 2018-30 September 2021 were included. Delays were determined by comparing the time in between each patients' MRI screening exams prior to the COVID-19 pandemic to the time in between MRI screening exams during the height of the COVID-19 pandemic as well as the time in between exams when our patients started receiving vaccinations. Delays were analyzed via logistical regression with demographic and socioeconomic factors to determine if there was an association between these factors and delays. Significant time delays in between MRI screening exams were found between the pre-COVID timeframe compared to during the height of COVID. Significant time delays also persisted during the timeframe after patients started getting vaccinations. There were no associations with delays and socioeconomic or demographic factors. Significant time delays were found in between MRI high-risk breast cancer screening examinations due to the COVID-19 pandemic. These delays were not exacerbated by demographic or socioeconomic factors.

The Early Impact of the COVID-19 Pandemic on Lung, Colorectal, and Breast Cancer Screening and Treatment at a Tertiary Cancer Center.

OBJECTIVES: During the coronavirus-19 pandemic, experts recommended delaying routine cancer screening and modifying treatment strategies. We sought to understand the sequalae of these recommendations. MATERIALS AND METHODS: We performed a retrospective single-center analysis of screening, diagnosis, and treatment of lung, colorectal, and breast cancer. Data was collected from our institutional cancer registry. Prepandemic (2016-2019) was compared with pandemic (2020) data. RESULTS: Three thousand three sixty one screening chest computed tomography scans (CTs), 35,917 colonoscopies, and 48,093 screening mammograms were performed. There was no difference in CTs [81.0 (SEM10.0) vs. 65.6 (SEM3.29), P =0.067] or mammograms [1017.0 (SEM171.8) vs. 809.4 (SEM56.41), P =0.177] in 2020 versus prepandemic. There were fewer colonoscopies in 2020 [651.4 (SEM103.5) vs. 758.91 (SEM11.79), P =0.043]. There was a decrease in cancer diagnoses per month in 2020 of lung [22.70 (SEM1.469) vs. 28.75 (SEM0.8216), P =0.003] and breast [38.56 (SEM6.133) vs. 51.82 (SEM1.257), P =0.001], but not colorectal [13.11 (SEM1.467) vs. 15.88 (SEM0.585), P =0.074] cancer. There was no change in stage at presentation for lung ( P =0.717), breast ( P =0.115), or colorectal cancer ( P =0.180). Lung had a shorter time-to-treatment in 2020 [38.92 days (SEM 2.48) vs. 66 (SEM1.46), P =0.002]. CONCLUSIONS: In 2020, there was no difference in screening studies for lung and breast cancer but there was a decrease in new diagnoses. Although there were fewer colonoscopies performed in 2020, there was no change in new colorectal cancer diagnoses. Despite changes in guidelines during the pandemic, the time-to-treatment for lung cancer was shorter and was unchanged for colorectal and breast cancer. These findings highlight the importance of continuing care for a vulnerable patient population despite a pandemic.

Impact of the COVID-19 Pandemic on Breast Imaging: An Analysis of the National Mammography Database.

PURPOSE: The aim of this study was to quantify the initial decline and subsequent rebound in breast cancer screening metrics throughout the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Screening and diagnostic mammographic examinations, biopsies performed, and cancer diagnoses were extracted from the ACR National Mammography Database from March 1, 2019, through May 31, 2021. Patient (race and age) and facility (regional location, community type, and facility type) demographics were collected. Three time periods were used for analysis: pre-COVID-19 (March 1, 2019, to May 31, 2019), peak COVID-19 (March 1, 2020, to May 31, 2020), and COVID-19 recovery (March 1, 2021, to May 31, 2021). Analysis was performed at the facility level and overall between time periods. RESULTS: In total, 5,633,783 screening mammographic studies, 1,282,374 diagnostic mammographic studies, 231,390 biopsies, and 69,657 cancer diagnoses were analyzed. All peak COVID-19 metrics were less than pre-COVID-19 volumes: 36.3% of pre-COVID-19 for screening mammography, 57.9% for diagnostic mammography, 47.3% for biopsies, and 48.7% for cancer diagnoses. There was some rebound during COVID-19 recovery as a percentage of pre-COVID-19 volumes: 85.3% of pre-COVID-19 for screening mammography, 97.8% for diagnostic mammography, 91.5% for biopsies, and 92.0% for cancer diagnoses. Across various metrics, there was a disproportionate negative impact on older women, Asian women, facilities in the Northeast, and facilities affiliated with academic medical centers. CONCLUSIONS: COVID-19 had the greatest impact on screening mammography volumes, which have not returned to pre-COVID-19 levels. Cancer diagnoses declined significantly in the acute phase and have not fully rebounded, emphasizing the need to increase outreach efforts directed at specific patient population and facility types.

Quantitative ultrasound image analysis of axillary lymph nodes to differentiate malignancy from reactive benign changes due to COVID-19 vaccination.

PURPOSE: The aim of this study is to assess the potential of quantitative image analysis and machine learning techniques to differentiate between malignant lymph nodes and benign lymph nodes affected by reactive changes due to COVID-19 vaccination. METHOD: In this institutional review board-approved retrospective study, we improved our previously published artificial intelligence model, by retraining it with newly collected images and testing its performance on images containing benign lymph nodes affected by COVID-19 vaccination. All the images were acquired and selected by specialized breast-imaging radiologists and the nature of each node (benign or malignant) was assessed through a strict clinical protocol using ultrasound-guided biopsies. RESULTS: A total of 180 new images from 154 different patients were recruited: 71 images (10 cases and 61 controls) were used to retrain the old model and 109 images (36 cases and 73 controls) were used to evaluate its performance. The achieved accuracy of the proposed method was 92.7% with 77.8% sensitivity and 100% specificity at the optimal cut-off point. In comparison, the visual node inspection made by radiologists from ultrasound images reached 69.7% accuracy with 41.7% sensitivity and 83.6% specificity. CONCLUSIONS: The results obtained in this study show the potential of the proposed techniques to differentiate between malignant lymph nodes and benign nodes affected by reactive changes due to COVID-19 vaccination. These techniques could be useful to non-invasively diagnose lymph node status in patients with suspicious reactive nodes, although larger multicenter studies are needed to confirm and validate the results.