ESR Essentials: screening for breast cancer - general recommendations by EUSOBI.

Breast cancer is the most frequently diagnosed cancer in women accounting for about 30% of all new cancer cases and the incidence is constantly increasing. Implementation of mammographic screening has contributed to a reduction in breast cancer mortality of at least 20% over the last 30 years. Screening programs usually include all women irrespective of their risk of developing breast cancer and with age being the only determining factor. This approach has some recognized limitations, including underdiagnosis, false positive cases, and overdiagnosis. Indeed, breast cancer remains a major cause of cancer-related deaths in women undergoing cancer screening. Supplemental imaging modalities, including digital breast tomosynthesis, ultrasound, breast MRI, and, more recently, contrast-enhanced mammography, are available and have already shown potential to further increase the diagnostic performances. Use of breast MRI is recommended in high-risk women and women with extremely dense breasts. Artificial intelligence has also shown promising results to support risk categorization and interval cancer reduction. The implementation of a risk-stratified approach instead of a "one-size-fits-all" approach may help to improve the benefit-to-harm ratio as well as the cost-effectiveness of breast cancer screening. KEY POINTS: Regular mammography should still be considered the mainstay of the breast cancer screening. High-risk women and women with extremely dense breast tissue should use MRI for supplemental screening or US if MRI is not available. Women need to participate actively in the decision to undergo personalized screening. KEY RECOMMENDATIONS: Mammography is an effective imaging tool to diagnose breast cancer in an early stage and to reduce breast cancer mortality (evidence level I). Until more evidence is available to move to a personalized approach, regular mammography should be considered the mainstay of the breast cancer screening. High-risk women should start screening earlier; first with yearly breast MRI which can be supplemented by yearly or biennial mammography starting at 35-40 years old (evidence level I). Breast MRI screening should be also offered to women with extremely dense breasts (evidence level I). If MRI is not available, ultrasound can be performed as an alternative, although the added value of supplemental ultrasound regarding cancer detection remains limited. Individual screening recommendations should be made through a shared decision-making process between women and physicians.

Linear Regression Modeling Based Scoring System to Reduce Benign Breast Biopsies Using Multi-parametric US with Color Doppler and SWE.

RATIONALE AND OBJECTIVES: To develop a simple ultrasound (US) based scoring system to reduce benign breast biopsies. MATERIALS AND METHODS: Women with BI-RADS 4 or 5 breast lesions underwent shear-wave elastography (SWE) imaging before biopsy. Standard US and color Doppler US (CDUS) parameters were recorded, and the size ratio (SzR=longest/shortest diameter) was calculated. Measured/calculated SWE parameters were minimum (SWVMin) and maximum (SWVMax) shear velocity, velocity heterogeneity (SWVH=SWVMax-SWVMin), velocity ratio (SWVR=SWVMin/SWVMax), and normalized SWVR (SWVRn=(SWVMax-SWVMin)/SWVMin). Linear regression analysis was performed by converting continuous parameters into categorical corresponding equivalents using decision tree analyses. Linear regression models were fitted using stepwise regression analysis and optimal coefficients for the predictors in the models were determined. A scoring model was devised from the results and validated using a different data set from another center consisting of 187 cases with BI-RADS 3, 4, and 5 lesions. RESULTS: A total of 418 lesions (238 benign, 180 malignant) were analyzed. US and CDUS parameters exhibited poor (AUC=0.592-0.696), SWE parameters exhibited poor-good (AUC=0.607-0.816) diagnostic performance in benign/malignant discrimination. Linear regression models of US+CDUS and US+SWE parameters revealed an AUC of 0.819 and 0.882, respectively. The developed scoring system could have avoided biopsy in 37.8% of benign lesions while missing 1.1% of malignant lesions. The scoring system was validated with a 100% NPV rate with a specificity of 74.6%. CONCLUSION: The linear regression model using US+SWE parameters performed better than any single parameter alone. The developed scoring method could lead to a significant decrease in benign biopsies.

Analysis of breast cancer screening among rural women in Qinba area / 肿瘤研究与临床

Objective:To analyze the results of the free breast cancer screening project for rural women in Qinba area, and to investigate intervention measures for the improvement of screening rate.Methods:The data of 5 974 rural women aged 35 to 64 years old with breast cancer in Qinba area during two cancer screening in 3201 Hospital Affiliated to Xi'an Jiaotong University College of Medicine and Nanjiang County Women and Children Hospital between August 2021 and March 2022 were retrospectively analyzed. The characteristics of the screened population, the results of breast ultrasonography, mammography and pathological examination were statistically analyzed.The differences in the positive rates of breast ultrasonography and breast ultrasonography supplemented with mammography in the clinical screening of breast cancer among different age groups were compared.Results:The highest participation rate was found in those aged 45 to 49 years old, accounting for 29.56% (1 766/5 974); the lowest participation rate was those aged 60 to 64 years old, accounting for 3.65% (218/5 974). According to breast ultrasonography screening, 976 (16.34%) cases were suspected positive, 282 (4.72%) cases were positive; 84 (1.41%) were screened for mammography, 18 (21.43%) cases were suspected positive and 6 (7.14%) cases were positive; and the detection rate of breast cancer was 66.96/ 100 000 (4/5 974). There were statistically significant differences in the positive rate of clinical breast cancer screening by breast ultrasonography and breast ultrasonography supplemented with mammography among different age groups (all P < 0.05). Conclusions:Breast cancer screening in Qinba area has achieved some good results. The screening mode of physical examination combined with breast ultrasound supplemented with mammography is suitable for this area, but the compliance of the population is poor. The scientific awareness of breast cancer in rural women should be improved.

Application progress of ultrasound examination in the diagnosis and treatment of breast cancer / 中国基层医药

Breast cancer ranks first in incidence in female malignant tumors, which obviously endangers patients' health. There is an increasing number of young female patients with breast cancer. If a breast lump is discovered early, and its benign or maligant nature can be identified, then the patient can be treated in time, and therefore the risk of breast cancer death can be greatly reduced. In recent years, with the continuous development of contrast-enhanced ultrasound and other technologies, breast cancer diagnosis is increasing, which provides an auxiliary role for clinical treatment. This review summarizes ultrasound examination, in particular contrast-enhanced ultrasound, for diagnosis and treatment of breast cancer and helps provide evidence for clinical treatment of this disease

Presentación clínica y hallazgos radiográficos de pacientes con diagnóstico histopatológico de mastitis granulomatosa idiopática / Clinical presentation and radiological findings of patients with histopathological diagnosis of idiopathic granulomatous mastitis

INTRODUCCIÓN. La mastitis granulomatosa idiopática es una patología inflamatoria benigna de mama con clínica y hallazgos imagenológicos no específicos; usualmente confundida con cáncer de mama. El síntoma más frecuente es una masa mamaria palpable. El diagnóstico es histopatológico. OBJETIVO. Describir el perfil demográfico, presentación clínica y hallazgos radiográficos de pacientes con diagnóstico histopatológico de mastitis granulomatosa idiopática. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, retrospectivo. Población de 1130 y muestra de 49 datos de historias clínicas electrónicas de pacientes con diagnóstico histológico de mastitis granulomatosa idiopática con el código CIE10 N61x Trastornos Inflamatorios de la mama, atendidas en la Unidad Técnica de Imagenología del Hospital de Especialidades Carlos Andrade Marín en la ciudad de Quito entre enero 2019 hasta diciembre 2021. El criterio de inclusión fue la confirmación histopatológica de mastitis granulomatosa idiopática. Los criterios de exclusión: antecedentes de neoplasia maligna de mama, antecedentes de HIV, patología inflamatoria sistémica como granulomatosis de Wegener, sarcoidosis, infecciones granulomatosas crónicas como tuberculosis, brucelosis, histoplasmosis, sífilis y reacciones a cuerpos extraños como material de implantes mamarios. Se analizaron datos demográficos, presentación clínica, hallazgos mamográficos, ecográficos y la categorización BIRADS. Se efectuó un análisis univarial; para las variables cualitativas se realizó frecuencias y porcentajes; para las variables cuantitativas se realizó medidas de tendencia central. La información recolectada fue analizada en el programa estadístico International Business Machines Statistical Package for the Social Sciences. RESULTADOS La mediana de la edad fue 36 años. El 94,00% de pacientes tenían por lo menos un hijo; 77,50% presentaron con una masa palpable; 55,10% se acompañaron de signos inflamatorios; 16,00% asociaron fístulas y 24,40% presentaron secreción. Solo 1 caso presentó afectación bilateral. CONCLUSIÓN En este estudio, la mastitis granulomatosa idiopática afecta a mujeres en edad reproductiva sin antecedentes de malignidad quienes presentan una masa mamaria palpable que puede estar acompañada de signos inflamatorios, colecciones y fístulas. La realización de una biopsia core eco guiada, para confirmar su diagnóstico.

INTRODUCTION. Idiopathic granulomatous mastitis is a benign inflammatory breast pathology with nonspecific clinical and imaging findings; usually mistaken for breast cancer. The most frequent symptom is a palpable breast mass. The diagnosis is histopathologic. OBJECTIVE. To describe the demographic profile, clinical presentation and radiographic findings of patients with histopathologic diagnosis of idiopathic granulomatous mastitis. MATERIALS AND METHODS. Observational, descriptive, retrospective study. Population of 1130 and sample of 49 data from electronic medical records of patients with histological diagnosis of idiopathic granulomatous mastitis with ICD10 code N61x Inflammatory disorders of the breast, attended at the Technical Imaging Unit of the Carlos Andrade Marín Specialties Hospital in the city of Quito between January 2019 and December 2021. The inclusion criterion was histopathological confirmation of idiopathic granulomatous mastitis. Exclusion criteria: history of malignant breast neoplasia, history of HIV, systemic inflammatory pathology such as Wegener's granulomatosis, sarcoidosis, chronic granulomatous infections such as tuberculosis, brucellosis, histoplasmosis, syphilis and reactions to foreign bodies such as breast implant material. Demographic data, clinical presentation, mammographic and ultrasound findings and BIRADS categorization were analyzed. Univariate analysis was performed; frequencies and percentages were used for qualitative variables; measures of central tendency were used for quantitative variables. RESULTS. The median age was 36 years. 94,00% of patients had at least one child; 77,50% presented with a palpable mass; 55,10% were accompanied by inflammatory signs; 16,00% were associated with fistulas and 24,40% presented with discharge. Only 1 case presented bilateral involvement. CONCLUSION. In this study, idiopathic granulomatous mastitis affects women of reproductive age with no history of malignancy who present with a palpable breast mass that may be accompanied by inflammatory signs, collections and fistulas. The performance of an echo-guided core biopsy to confirm the diagnosis.

Diagnostic accuracy of contrast-enhanced ultrasound to differentiate benign and malignant breast lesions: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the pooled diagnostic accuracy of contrast-enhanced ultrasound (CEUS) to differentiate benign and malignant breast lesions. MATERIALS AND METHODS: Electronic databases of PubMed, Embase, and the Cochrane Library were searched for potentially eligible studies throughout January 2022. The potential effects of publication year, country, mean age, and contrast agents on the diagnostic accuracy of CEUS were also assessed. RESULTS: Twenty-nine studies involving 3050 lesions were selected for the meta-analysis. The pooled sensitivity and specificity for CEUS diagnosing malignant breast lesions were 0.87 [95% confidence intervals (CI), 0.81-0.90] and 0.79 (95% CI, 0.73-0.84), respectively. The positive and negative likelihood ratios were 4.17 (95% CI, 3.21-5.42) and 0.17 (95% CI, 0.12-0.24), respectively. The summary diagnostic odds ratio of CEUS to differentiate benign and malignant breast lesions was 20.55 (95% CI, 14.11-29.93), and the Lambda of CEUS for detecting malignant breast lesions was 3.18 (95% CI, 2.71-3.64). Subgroup analyses showed that patients' age and contrast agents (Levovist, SonoVue, or other) might affect the diagnostic accuracy of CEUS used to differentiate benign and malignant breast lesions. CONCLUSIONS: CEUS had a relatively high diagnostic accuracy to differentiate benign and malignant breast lesions. Moreover, the diagnostic value of CEUS in younger patients or those using SonoVue as contrast agents was higher than that in the corresponding subgroups.

Fully automatic classification of automated breast ultrasound (ABUS) imaging according to BI-RADS using a deep convolutional neural network.

PURPOSE: The aim of this study was to develop and test a post-processing technique for detection and classification of lesions according to the BI-RADS atlas in automated breast ultrasound (ABUS) based on deep convolutional neural networks (dCNNs). METHODS AND MATERIALS: In this retrospective study, 645 ABUS datasets from 113 patients were included; 55 patients had lesions classified as high malignancy probability. Lesions were categorized in BI-RADS 2 (no suspicion of malignancy), BI-RADS 3 (probability of malignancy < 3%), and BI-RADS 4/5 (probability of malignancy > 3%). A deep convolutional neural network was trained after data augmentation with images of lesions and normal breast tissue, and a sliding-window approach for lesion detection was implemented. The algorithm was applied to a test dataset containing 128 images and performance was compared with readings of 2 experienced radiologists. RESULTS: Results of calculations performed on single images showed accuracy of 79.7% and AUC of 0.91 [95% CI: 0.85-0.96] in categorization according to BI-RADS. Moderate agreement between dCNN and ground truth has been achieved (κ: 0.57 [95% CI: 0.50-0.64]) what is comparable with human readers. Analysis of whole dataset improved categorization accuracy to 90.9% and AUC of 0.91 [95% CI: 0.77-1.00], while achieving almost perfect agreement with ground truth (κ: 0.82 [95% CI: 0.69-0.95]), performing on par with human readers. Furthermore, the object localization technique allowed the detection of lesion position slice-wise. CONCLUSIONS: Our results show that a dCNN can be trained to detect and distinguish lesions in ABUS according to the BI-RADS classification with similar accuracy as experienced radiologists. KEY POINTS: • A deep convolutional neural network (dCNN) was trained for classification of ABUS lesions according to the BI-RADS atlas. • A sliding-window approach allows accurate automatic detection and classification of lesions in ABUS examinations.

Research progress of artificial intelligence in ultrasound diagnosis of breast cancer / 中国医师杂志

Breast cancer is the cancer with the largest number of new cases in the world, and ranks first in the incidence spectrum and cause of death among women in most countries. In recent years, artificial intelligence (AI), especially deep learning and computer-aided diagnosis, has shown remarkable performance in image analysis and processing, computer vision and other aspects, and has great development potential in the field of medical and health lesions identification, disease diagnosis and other aspects. This paper mainly discusses the application and progress of AI in ultrasound diagnosis of breast cancers.

Application value of artificial intelligence model based on deep learning in Breast Ultrasound Imaging Reporting and Data System: breast nodules classification / 肿瘤研究与临床

Objective:To explore the application value of artificial intelligence (AI) model based on deep learning in breast nodules classification of Breast Imaging Reporting and Data System of ultrasound (BI-RADS-US).Methods:The ultrasound images of 2 426 breast nodules from 1 558 female patients with breast diseases at Beijing Tongren Hospital, Capital Medical University between December 2006 and December 2019 were collected . The image data sets were divided into training (63%), verification (7%), and test (30%) subsets for the construction of AI model. The diagnostic efficiencies of AI model, doctors' arbitration results and doctors' diagnosis with or without AI model assistance were analyzed by using receiver operating characteristic (ROC) curve. The Cohen weighted Kappa statistic was used to compare the consistency of BI-RADS-US classification among 5 ultrasound doctors' diagnosis with or without AI model assistance. And the changes of BI-RADS-US classification were analyzed before and after each doctor adopted AI model assistance.Results:The differences in diagnostic efficiencies of AI model, doctors' arbitration results and doctors' diagnosis with or without AI model assistance were statistically significant (all P > 0.05). The consistency among 5 ultrasound doctors was improved due to AI model assistance and Kappa value was increased from 0.433 (category 3), 0.600 (category 4a), 0.614 (category 4b), 0.570 (category 4c) and 0.495 (category 5) to 0.812, 0.704, 0.823, 0.690 and 0.509 (all P < 0.05), respectively. The upgrade and downgrade of BI-RADS-US classification occurred in 5 doctors after the classification of AI model assistance. Downgrade from category 4 to 3 in benign nodules of 56.6% (47/76) and upgrade from category 4 to 5 in malignant nodules of 69.4% (34/49) were mostly observed. Conclusions:AI-assisted BI-RADS-US classification can effectively improve the consistency of classification among the doctors without reducing the diagnostic efficiency. AI model shows clinical values in reducing unnecessary biopsy of partial benign lesions and increasing diagnostic accuracy of partial malignant lesions through the adjustment of breast nodule classification.

Is there any added value to substitute the 2D digital MLO projection for a MLO tomosynthesis projection and its synthetic view when a 2D standard digital mammography is used in a one-stop-shop immediate reading mammography screening?

OBJECTIVES: Breast cancer screening consists of batch interpretation of two-view (cranio-caudal CC- and medio-lateral oblique MLO) digital mammography (DM) per breast. The DM-MLO view was substituted by an MLO-digital breast tomosynthesis (DBT) and its synthetic (2D-synthetic mammography (SM)-MLO) view. The performance of this hybrid protocol was evaluated in a one-stop-shop screening visit, providing immediate reading and additional work up. METHODS: Retrospective, observational review, comparing the cancer detection rate (CDR), breast US rates, and biopsy rates in 13,048 women screened with DM from June 2015 to November 2016 and 8639 women screened with SM-DBT/DM from January 2017 to July 2018. Chi-square tests or Fisher's exact tests were used to compare proportions between the two screening imaging methods. RESULTS: SM + DBT/DM significantly increased the overall CDR (10.8‰) versus DM (7.5‰) (p = 0.0120) with more invasive lobular carcinoma (14% versus 4%) (p = 0.0357) detected and overall more invasive cancers among women with breast density type B (p = 0.0411) and those aged between 60 and 70 (p = 0.0306). This was achieved at the expense of additional sonographic examinations performed (33.5% in DBT group versus 26.7% in DM group) (p < 0.0001), more BI-RADS category III assigned (1.8% in SM-DBT/DM group versus 1.5% in DM group) (p = 0.0443) and more biopsy rates (3.0 % in SM-DBT/DM group versus 1.7% in DM group) (p < 0.0001). CONCLUSIONS: Hybrid mammographic protocol replacing 2D-MLO by DBT-MLO and SM-MLO views in a one-stop-shop screening visit improved CDR, at the expense of more sonographic examinations, biopsies, and BI-RADS III lesions. Breast US alone detected 9.2% of all breast cancers in this cohort. KEY POINTS: • Hybrid protocol including MLO (DBT + SM) with 2D DM CC may improve CDR compared to standard 4 views 2D DM in a screening program providing immediate interpretation. • Adding screening breast US, when perceived necessary, in the same visit of a screening mammography, increases cancer detection rate of 9.2%. • Based on our results, hybrid protocol including DBT + SM in MLO plane and DM in CC plane could be safely implemented as a transition towards DBT and SM alone, without any compromise in the cancer detection ability. Our results may vary according to the properties of machines from different vendors.

Evaluation of the FUSION-X-US-II prototype to combine automated breast ultrasound and tomosynthesis.

OBJECTIVE: The FUSION-X-US-II prototype was developed to combine 3D automated breast ultrasound (ABUS) and digital breast tomosynthesis in a single device. We evaluated the performance of ABUS and tomosynthesis in a single examination in a clinical setting. METHODS: In this prospective feasibility study, digital breast tomosynthesis and ABUS were performed using the FUSION-X-US-II prototype without any change of the breast position in patients referred for clarification of breast lesions with an indication for tomosynthesis. The tomosynthesis and ABUS images of the prototype were interpreted independently from the clinical standard by a breast diagnostics specialist. Any detected lesion was classified using BI-RADS® scores, and results of the standard clinical routine workup (gold standard) were compared to the result of the separate evaluation of the prototype images. Image quality was rated subjectively and coverage of the breast was measured. RESULTS: One hundred one patients received both ABUS and tomosynthesis using the prototype. The duration of the additional ABUS acquisition was 40 to 60 s. Breast coverage by ABUS was approximately 80.0%. ABUS image quality was rated as diagnostically useful in 86 of 101 cases (85.1%). Thirty-three of 34 malignant breast lesions (97.1%) were identified using the prototype. CONCLUSION: The FUSION-X-US-II prototype allows a fast ABUS scan in combination with digital breast tomosynthesis in a single device integrated in the clinical workflow. Malignant breast lesions can be localized accurately with direct correlation of ABUS and tomosynthesis images. The FUSION system shows the potential to improve breast cancer screening in the future after further technical improvements. KEY POINTS: • The FUSION-X-US-II prototype allows the combination of automated breast ultrasound and digital breast tomosynthesis in a single device without decompression of the breast. • Image quality and coverage of ABUS are sufficient to accurately detect malignant breast lesions. • If tomosynthesis and ABUS should become part of breast cancer screening, the combination of both techniques in one device could offer practical and logistic advantages. To evaluate a potential benefit of a combination of ABUS and tomosynthesis in screening-like settings, further studies are needed.

The delay of breast cancer diagnosis during the COVID-19 pandemic in São Paulo, Brazil / O atraso no diagnóstico do câncer de mama durante a pandemia da COVID-19 em São Paulo, Brasil

ABSTRACT Objective To evaluate the impact of COVID-19 pandemic on breast cancer diagnosis in a breast imaging center. Methods This was a retrospective cohort study that included women submitted to breast exams and procedures in a private hospital in São Paulo, SP, Brazil, as from the period of most strict social isolation measures, in 2020 (separated in first period of social isolation, March 24 to June 21, 2020, and second period, June 22 to December 31, 2020), as compared to the same period in 2019. The number of exams, cancer detection rates, pathologic findings and risk factors were analyzed. Results A total of 32,144 patients were included in the study. Breast imaging exams and procedures decreased by 78.9% in the first period, and 2.7% in the second period, in 2020. By the end of 2020, the number of breast cancer lesions detected was just six cases less than in 2019, although the number of patients submitted to mammograms was 35% lower. Conclusion There was a drop in number of breast exams and cancer diagnoses in the first 90 days of the pandemic. The decrease in diagnosis of cancer was partially compensated in the second period, but the number of patients submitted to mammograms by the end of 2020 was lower, still considering a large number of patients with delayed exams.

RESUMO Objetivo Avaliar o impacto da pandemia da COVID-19 no diagnóstico de câncer de mama em um centro de imagem de mama. Métodos Estudo de coorte retrospectivo que incluiu mulheres submetidas a exames e procedimentos de mama em um hospital privado em São Paulo, SP, Brasil, no período de medidas mais rigorosas de isolamento social em 2020 (dividido em primeiro período, de 24 de março a 21 de junho de 2020, e em segundo período, de 22 de junho a 31 de dezembro de 2020), comparado com o mesmo período de 2019. Foram analisados o número de exames, as taxas de detecção de câncer, os achados patológicos e os fatores de risco. Resultados Foram incluídas 32.144 pacientes. Os exames e os procedimentos de imagem da mama em 2020 tiveram redução de 78,9% no primeiro período e 2,7% no segundo período. Ao final de 2020, foram diagnosticadas com câncer de mama seis pacientes a menos do que em 2019, embora o número de pacientes submetidas à mamografia tenha sido 35% menor. Conclusão Houve queda no número de exames de mama e de diagnósticos de câncer nos primeiros 90 dias da pandemia. A redução dos diagnósticos de câncer foi parcialmente compensada no segundo período, mas o número de pacientes submetidas a exames de mamografia até o final do ano foi menor, considerando ainda um grande número de pacientes com exames atrasados.

Ultrasound-guided minimally invasive mammotomy versus conventional surgery for benign breast tumors / 中国基层医药

Objective:To investigate the clinical efficacy of ultrasound-guided mammotomy versus conventional surgery in the treatment of benign breast tumors. Methods:Sixty patients with benign breast tumors who received treatment in Jiamusi Central Hospital from September 2018 to September 2019 were included in this study. They were randomly assigned to undergo either conventional surgery (control group, n = 30) or ultrasound-guided mammotomy (treatment group, n = 30). Intraoperative blood loss, operative time, incision length, and the incidence of complications were compared between the two groups. Results:Intraoperative blood loss, operative time, and incision length in the treatment group were (4.25 ± 1.23) mL, (15.36 ± 3.21) minutes, (0.41 ± 0.05) cm, respectively, which were significantly lower or shorter than those in the control group [(10.75 ± 2.12) mL, (29.68 ± 7.23) minutes, (2.9 ± 0.8) cm, t = 14.526, 9.915, 17.015, all P < 0.05]. In the treatment group, the incidence of complications was 3.33% (local hematoma n = 1, skin depression n = 0, flap necrosis n = 0, postoperative bleeding n = 0), which was significantly lower that 23.00% in the control group (local hematoma n = 2, skin depression n = 1, flap necrosis n = 1, postoperative bleeding n = 3, χ2 = 5.192, P < 0.05). Conclusion:Compared with the traditional treatment, ultrasound-guided minimally invasive mastectomy is more effective in the treatment of benign breast tumors.

Preliminary study of the technical limitations of automated breast ultrasound: from procedure to diagnosis.

OBJECTIVE: To evaluate the main technical limitations of automated breast ultrasound and to determine the proportion of examinations excluded. MATERIALS AND METHODS: We evaluated 440 automated breast ultrasound examinations performed, over a 12-month period, by technicians using an established protocol. RESULTS: In five cases (1.1%), the examination was deemed unacceptable for diagnostic purposes, those examinations therefore being excluded. CONCLUSION: Automated breast ultrasound is expected to overcome some of the major limitations of conventional ultrasound in breast cancer screening. In Brazil, this new method can be accepted for inclusion in routine clinical practice only after its advantages have been validated in the national context.

OBJETIVO: O objetivo deste estudo foi avaliar as principais limitações técnicas e a porcentagem de exames excluídos de ultrassonografia automatizada. MATERIAIS E MÉTODOS: Foram realizados 440 exames de ultrassonografia automatizada das mamas no período 12 meses, por técnicas, com protocolo estabelecido. RESULTADOS: Em cinco casos (1,1%) a interpretação do estudo foi inaceitável, sendo o exame excluído do presente estudo para fins de diagnóstico. CONCLUSÃO: A ultrassonografia automatizada das mamas apresenta a expectativa de resolver importantes limitações da ultrassonografia convencional no rastreamento do câncer de mama, sendo necessária uma maior validação de dados brasileiros, para que este novo método seja aceito na prática clínica de rotina.

Preliminary study of the technical limitations of automated breast ultrasound: from procedure to diagnosis / Estudo preliminar das limitações técnicas da ultrassonografia automatizada da mama: do procedimento ao diagnóstico

Abstract Objective: To evaluate the main technical limitations of automated breast ultrasound and to determine the proportion of examinations excluded. Materials and Methods: We evaluated 440 automated breast ultrasound examinations performed, over a 12-month period, by technicians using an established protocol. Results: In five cases (1.1%), the examination was deemed unacceptable for diagnostic purposes, those examinations therefore being excluded. Conclusion: Automated breast ultrasound is expected to overcome some of the major limitations of conventional ultrasound in breast cancer screening. In Brazil, this new method can be accepted for inclusion in routine clinical practice only after its advantages have been validated in the national context.

Resumo Objetivo: O objetivo deste estudo foi avaliar as principais limitações técnicas e a porcentagem de exames excluídos de ultrassonografia automatizada. Materiais e Métodos: Foram realizados 440 exames de ultrassonografia automatizada das mamas no período 12 meses, por técnicas, com protocolo estabelecido. Resultados: Em cinco casos (1,1%) a interpretação do estudo foi inaceitável, sendo o exame excluído do presente estudo para fins de diagnóstico. Conclusão: A ultrassonografia automatizada das mamas apresenta a expectativa de resolver importantes limitações da ultrassonografia convencional no rastreamento do câncer de mama, sendo necessária uma maior validação de dados brasileiros, para que este novo método seja aceito na prática clínica de rotina.

Breast ultrasound: automated or hand-held? Exploring patients' experience and preference.

BACKGROUND: Our aim was to compare women's experience with automated breast ultrasound (ABUS) versus breast hand-held ultrasound (HHUS) and to evaluate their acceptance rate. METHODS: After ethical approval, from October 2017 to March 2018, 79 consecutive patients were enrolled in this prospective study. On the same day, patients underwent HHUS followed by ABUS. Each patient's experience was assessed using the modified testing morbidities index (TMI) (the lower the score, the better is the experience). Nine items were assessed for both techniques: seven directly related to the examination technique (pain or discomfort immediately before (preparation), during and after testing, fear or anxiety immediately before (preparation) and during testing, physical and mental function after testing) and two indirectly related to the examination technique (embarrassment during testing and overall satisfaction). Finally, we asked patients to choose between the two techniques for a potential next breast examination. Wilcoxon signed ranks test was used. RESULTS: The median TMI score for the seven items was found to be significantly better for HHUS (8, interquartile range [IQR] 7-11) compared to ABUS (9, IQR 8-12) (p = 0.003). The item 'pain/discomfort during the test' (p < 0.001) was significantly higher for ABUS compared to HHUS. Instead, the item 'fear/anxiety before the test' was higher for HHUS (p = 0.001). Overall, 40.5% of the patients chose HHUS, 29.1% chose ABUS, and 30.4% were unable to choose. CONCLUSIONS: ABUS and HHUS exams were well tolerated and accepted. However, HHUS was perceived to be less painful than ABUS.

Diagnosis of breast architectural distortion with digital breast tomosynthesis / 中国医学影像技术

Objective: To compare the value of digital breast tomosynthesis (DBT) and flly-field digital mammography (FFDM) in evaluating breast architectural distortion (AD) lesions, and the value of DBT and ultrasound in differentiating benign and malignant breast AD. Methods: DBT, FFDM and ultrasound data of 58 patients with AD lesions detected with DBT were retrospectively analyzed. Taken pathological outcomes as standards, the sensitivity, specificity and accuracy of DBT and FFDM in evaluating breast AD were compared and analyzed. The consistency of results of DBT and ultrasound in differentiating benign and malignant breast AD with pathological results was analyzed. ROC curve of DBT and ultrasound for differentiating benign and malignant breast AD were drawn, and the diagnostic efficacies were compared. Results: All patients underwent FFDM, and 41 of them also underwent ultrasound examination. Among 58 cases of breast AD detected with DBT, only 23 AD were found with FFDM (χ2=33.03, P0.05). Median consistency of DBT and ultrasound results was observed in differentiating benign and malignant breast AD and pathological results (Kappa=0.65, 0.71, both P0.05). Conclusion: The sensitivity and accuracy of DBT in evaluating breast AD are higher than FFDM. DBT is comparable to ultrasound in differentiating benign and malignant breast AD. AD detected with DBT has relatively high malignancy, so it is recommended to conduct timely biopsy for correct diagnosis.

SONOELASTOGRAPHIC FEATURES OF HIGH-RISK BREAST LESIONS AND DUCTAL CARCINOMA IN SITU - A PILOT STUDY.

The aim of this study was to evaluate the quantitative sonoelastographic values recorded on shear-wave sonoelastography (SWE) of high-risk breast lesions and ductal carcinoma in situ (DCIS). We retrospectively analyzed histopathologic and SWE data (quantitative maximum, minimum and mean stiffness, lesion-to-fat ratio (E-ratio), lesion size) of 228 women referred to our Department for core needle breast biopsy during a four-year period. Among 230 lesions, histopathologic findings showed 34 high-risk breast lesions and 29 DCIS, which were compared with 167 ductal invasive carcinomas. High-risk lesions had lower values of all sonoelastographic features than ductal in situ and invasive carcinoma, however, only E-ratio showed a statistically significant difference in comparison to DCIS (3.7 vs. 6, p<0.001). All sonoelastographic features showed significant difference between in situ and invasive carcinoma. There was a significant correlation between lesion size and stiffness (r=0.36; p<0.001). Stiffness measured by SWE is an effective predictor of the histopathologic severity of sonographically detectable breast lesions. Elasticity values of high-risk lesions are significantly lower than those of malignant lesions. Furthermore, we showed that along with the sonographic appearance, which in most cases shows typical microcalcifications, DCIS had significantly different elasticity parameters than invasive carcinoma.

Image quality and artifacts in automated breast ultrasonography.

Three-dimensional automated breast ultrasonography (ABUS) has been approved for screening Epub ahead of print studies as an adjunct to mammography. ABUS provides proper orientation and documentation, resulting in better reproducibility. Optimal image quality is essential for a proper diagnosis, and high-quality images should be ensured when ABUS is used in clinical settings. Image quality in ABUS is highly dependent on the acquisition procedure. Artifacts can interfere with the visibility of abnormalities, reduce the overall image quality, and introduce clinical and technical problems. Nipple shadow and reverberation artifacts are some of the artifacts frequently encountered in ABUS. Radiologists should be familiar with proper image acquisition techniques and possible artifacts in order to acquire high-quality images.

Image quality and artifacts in automated breast ultrasonography

Three-dimensional automated breast ultrasonography (ABUS) has been approved for screening Epub ahead of print studies as an adjunct to mammography. ABUS provides proper orientation and documentation, resulting in better reproducibility. Optimal image quality is essential for a proper diagnosis, and high-quality images should be ensured when ABUS is used in clinical settings. Image quality in ABUS is highly dependent on the acquisition procedure. Artifacts can interfere with the visibility of abnormalities, reduce the overall image quality, and introduce clinical and technical problems. Nipple shadow and reverberation artifacts are some of the artifacts frequently encountered in ABUS. Radiologists should be familiar with proper image acquisition techniques and possible artifacts in order to acquire high-quality images.