Contrast enhanced mammography in breast cancer surveillance.

PURPOSE: Mammography (MG) is the standard imaging in surveillance of women with a personal history of breast cancer or DCIS (PHBC), supplemented with ultrasound. Contrast Enhanced Mammography (CEM) has higher sensitivity than MG and US. We report the performance of CEM compared with MG ± US. METHODS: A retrospective study of patients undergoing their first surveillance CEM in an Australian hospital setting between June 2006 and October 2020. Cases where a patient was recalled for assessment were identified, recording radiology, pathology and treatment details. Blinded re-reading of recalled cases was performed to determine the contribution of contrast. Use of surveillance US across the board was assessed for the period. RESULTS: 73/1191 (6.1%) patients were recalled. 35 (48%) were true positives (TP), with 26 invasive cancers and 9 cases of DCIS, while 38 (52%) were false positive (FP) with a positive predictive value (PPV) 47.9%. 32/73 were recalled due to MG findings, while 41/73 were only recalled due to Contrast. 14/73 had 'minimal signs' with a lesion identifiable on MG with knowledge of the contrast finding, while 27/73 were visible only with contrast. 41% (17/41) recalled due to contrast were TP. Contrast-only TPs were found with low and high mammographic density (MD). Screening breast US reduced by 55% in the year after CEM was implemented. CONCLUSION: Compared to MG, CEM as a single surveillance modality for those with PHBC has higher sensitivity and comparable specificity, identifying additional malignant lesions that are clinically significant. Investigation of interval cancer and subsequent round outcomes is warranted.

Practicalities of developing a breast magnetic resonance imaging screening service for women at high risk for breast cancer.

BACKGROUND: Demand for screening breast magnetic resonance imaging (MRI) for women with a hereditary predisposition to breast cancer has increased since the introduction of a medicare item number. To aid future service planning, we examined the practicalities of establishing and running a breast MRI screening programme for high risk women and to describe the early outcomes of our screening programme. METHODS: We undertook a retrospective audit of prospectively collected data. Women <50 years of age with an inherited BRCA1 or BRCA2 gene mutation were invited to undergo annual breast screening with MRI in addition to mammography and clinical breast examination. We assessed process times for booking, performing and reporting MRIs; MRI findings and ease of interpretation; patient recall rate; MRI cancer detection rate; and patient satisfaction via questionnaire. RESULTS: From 2006 to 2009, 82 women completed a round one screening MRI and 45, 21 and one women completed second, third and fourth round annual MRI studies, respectively. Median MRI process times were: booking 20 min; attendance in radiology department 90 min; imaging duration 45 min; reporting by one radiologist 30 min. Of the 82 round one studies, 23 (28%) were reported as ≥Breast Imaging Reporting and Data System three requiring further investigation. Of the round two and three studies completed, 13/45 (28%) and 2/21 (9%) have been recalled, respectively. Seven malignancies were detected. Questionnaires revealed women were satisfied with the service. CONCLUSIONS: Significant time, staff and equipment is required to run an effective breast MRI screening programme and this must be considered by future service providers.

Endorectal magnetic resonance imaging staging of prostate cancer.

BACKGROUND: There are important treatment and prognostic implications in distinguishing between organ-confined prostate cancer that has spread locally outside the capsule and that which has spread into the seminal vesicles. This study is the first Australian study to report local accuracy for the locoregional staging of prostate cancer with endorectal magnetic resonance imaging (MRI). METHODS: From July 2002 to December 2005, 129 patients were referred for endorectal MRI for all indications. Inclusion criteria were biopsy-proven prostate cancer, minimum 4 weeks from previous biopsy and radical retropubic prostatectomy within 12 months of MRI. This yielded 47 patients. Those with prior hormonal and neoadjuvant radiotherapy or significant postbiopsy haemorrhage were excluded. In addition, those patients examined with our alternate-contrast-enhanced protocol were also excluded. A total of 38 patients met all inclusion criteria. A General Electric 1.5-T whole-body MR imaging unit with an endorectal coil was used with interpretation by two genito-urinary MR radiologists. Final histopathological report was used for correlation. RESULTS: Median age was 60 years with a range 44-72 years. Median prostate-specific antigen was 6.3 with a range of 2-82, and median Gleason score was 6 with a range of 5-8. Sensitivity, specificity and accuracy for extracapsular extension and seminal vesicle invasion were 69, 82 and 76% and 60, 100 and 95%, respectively. For extraprostatic extension, 71, 86 and 79%, respectively. CONCLUSIONS: Staging accuracy is similar to internationally published standards. Improvements in hardware and software and increased reader experience will add value to the local Australian prostate imaging programme.

A comparison of conventional film, CR hard copy and PACS soft copy images of the chest: analyses of ROC curves and inter-observer agreement.

STUDY OBJECTIVE: The aim of this study was to determine whether the accuracy of diagnosis of a spectrum of chest pathology was affected by the imaging technique used, and to compare conventional film/screen, hard copy computed (phosphor plate) radiography (CR) and soft copy CR (PACS) images. MATERIALS AND METHODS: For each of 44 patients who had a CT examination of the thorax, PA and lateral chest radiographs were produced using conventional film, hard copy CR and soft copy PACS images. Five radiologists independently scored all images for the presence of abnormalities. The data were analysed in two stages using the result of the CT scan as the reference standard diagnosis: firstly, to investigate differences in abnormality scores between image modalities and observers using ROC analysis; secondly, to investigate the agreement of the diagnoses with the reference standard by the analysis of kappa scores. RESULTS: The ROC analyses and comparison of kappa scores showed no differences between image modalities (P=0.72, P=0.87), but highly significant differences between observers (P<0.001, P=0.003). CONCLUSION: The detection of chest lesions did not vary between conventional film, CR hard copy and PACS soft copy images. For all three image types, there were statistically significant differences between observers.

Routine editing of trainee-generated radiology reports: effect on style quality.

RATIONALE AND OBJECTIVES: The authors performed this study to determine the effect of routine editing on the style quality of trainee-generated radiology reports. MATERIALS AND METHODS: Trainee-generated reports of 50 body computed tomographic scans obtained at a tertiary care cancer center were edited in a routine fashion by one of two attending radiologists. Three physicians and four radiologists each independently evaluated the randomized unedited and edited reports (n = 100) and rated each report for clarity, brevity, readability, and quality of the impression by using a five-point scale. RESULTS: Editing significantly improved mean ratings for clarity (4.6 after editing vs 4.2 before editing, P < .007), brevity (4.6 vs 4.2, P < .007), readability (4.4 vs 4.1, P < .007), and quality of the impression (4.5 vs 4.3, P < .007). CONCLUSION: Routine editing of trainee-generated reports significantly improves the perceived report quality. This finding suggests that greater emphasis should be placed on stylistic aspects of reporting during training to improve report style quality at dictation.