Breast Imaging Reporting and Data System (BI-RADS®): a success history and particularities of its use in Brazil.

BI-RADS® is a standardization system for breast imaging reports and results created by the American College of Radiology to initially address the lack of uniformity in mammography reporting. The system consists of a lexicon of descriptors, a reporting structure with final categories and recommended management, and a structure for data collection and auditing. It is accepted worldwide by all specialties involved in the care of breast diseases. Its implementation is related to the Mammography Quality Standards Act initiative in the United States (1992) and breast cancer screening. After its initial creation in 1993, four additional editions were published in 1995, 1998, 2003 and 2013. It is adopted in several countries around the world and has been translated into 6 languages. Successful breast cancer screening programs in high-income countries can be attributed in part to the widespread use of BI-RADS®. This success led to the development of similar classification systems for other organs (e.g., lung, liver, thyroid, ovaries, colon). In 1998, the structured report model was adopted in Brazil. This article highlights the pioneering and successful role of BI-RADS®, created by ACR 30 years ago, on the eve of publishing its sixth edition, which has evolved into a comprehensive quality assurance tool for multiple imaging modalities. And, especially, it contextualizes the importance of recognizing how we are using BI-RADS® in Brazil, from its implementation to the present day, with a focus on breast cancer screening.

Utilidad clínica de la mamografía con contraste (CEM): una revisión de la literatura / Clinical utility of contrast-enhanced mammography: A literature review

La mamografía con contraste (CEM) es una nueva y prometedora técnica de imagen basada en la neovascularización de los tumores de manera similar a la resonancia magnética de la mama. Los resultados de los estudios clínicos muestran que su rendimiento diagnóstico es significativamente mejor que el de la mamografía digital convencional, y que sus valores de sensibilidad y especificidad la hacen comparable con la resonancia magnética. Sus usos actuales y los propuestos incluyen la evaluación adicional de pacientes sintomáticos o pacientes con exámenes previos anormales, la evaluación de la extensión local de los cánceres de mama recién diagnosticados, el seguimiento de la quimioterapia neoadyuvante y la detección del cáncer de mama en pacientes de alto riesgo. Aunque la técnica se aprobó para uso clínico en 2010, todavía es poco conocida. En esta revisión, presentamos la técnica CEM y sus resultados de rendimiento de diagnóstico comparados con la mamografía convencional y la resonancia magnética de la mama. También presentamos los diferentes escenarios en los que se puede utilizar con éxito, tanto en el diagnóstico de la enfermedad de mama, como en la estadificación local del cáncer de mama, así como su papel potencial en los programas de detección del cáncer de mama. (AU)

Contrast-enhanced mammography (CEM) is a promising new imaging technique based on neovascularisation of the tumour, similar to magnetic resonance imaging of the breast. The results of clinical studies show that its diagnostic performance is significantly better than that of conventional digital mammography, and that its sensitivity and specificity are comparable to those of magnetic resonance imaging. Its current and proposed uses include further evaluation of symptomatic patients or patients with abnormal results on previous examinations, assessment of the local extension of newly diagnosed breast tumours, follow-up of neoadjuvant chemotherapy and detection of breast cancer in high-risk patients. Although the technique was approved for clinical use in 2010, it is still little known. In this review, we present the technique of CEM and its results in terms of diagnostic performance compared with conventional mammography and breast MRI. We also discuss the various scenarios in which it can be used successfully, both in the diagnosis of breast disease and in the local staging of breast cancer, as well as its potential role in breast cancer screening programmes. (AU)

The development of breast radiology: the Acta Radiologica perspective.

The encouraging results of modern breast cancer care builds on tremendous improvements in diagnostics and therapy during the 20th century. Scandinavian countries have made important footprints in the development of breast diagnostics regarding technical development of imaging, cell and tissue sampling methods and, not least, population screening with mammography. The multimodality approach in combination with multidisciplinary clinical work in breast cancer serve as a role model for the management of many cancer types worldwide. The development of breast radiology is well represented in the research published in this journal and this historical review will describe the most important steps.

Still Controversial: Early Detection and Screening for Breast Cancer in Brazil, 1950-2010s.

Mammographic screening for breast cancer is a widely used public health approach, but is constantly a subject of controversy. Medical and historical research on this topic has been mainly conducted in Western Europe and North America. In Brazil, screening mammography has been an open topic of discussion and a challenge for health care and public health since the 1970s. Effectively, Brazilian public health agencies never implemented a nationwide population-based screening programme for breast cancer, despite the pressures of many specific groups such as advocacy associations and the implementation of local programmes. This article examines the complex process of incorporating mammography as a diagnostic tool and the debates towards implementing screening programmes in Brazil. We argue that debates about screening for breast malignancies, especially those conducted in the late twentieth and early twenty-first centuries, took place in a context of change and uncertainty in the Brazilian health field. These discussions were strongly affected both by tensions between the public and the private health care sectors during the formative period of a new Brazilian health system, and by the growing role of civil society actors. Our study investigates these tensions and their consequences. We use several medical sources that discussed the topic in Brazil, mainly specialised leading oncology journals published between 1950 and 2017, medical congress reports for the same period, books and theses, institutional documents and oral testimonies of health professionals, patients and associations collected in the framework of the 'The History of Cancer' project from the Oswaldo Cruz Foundation and Brazilian National Cancer Institute.

Synchrotron radiation biomedical imaging and radiotherapy: from the UK to the Antipodes.

Although the general public might think of 'X-rays' as they are applied to imaging (radiography) and for the treatment of disease (radiotherapy), the use of synchrotron radiation (SR) X-ray beams in these areas of science was a minor activity 50 years ago. The largest gains in science from SR were seen to be in those areas where signals were weakest in laboratory instruments, such as X-ray diffraction and spectroscopy. As the qualities of SR X-rays were explored and more areas of science adopted SR-based methods, this situation changed. About 30 years ago, the clinical advantages of using SR X-ray beams for radiography, radiotherapy and clinical diagnostics started to be investigated. In the UK, a multi-disciplinary group, consisting of clinicians, medical physicists and other scientists working mainly with the Synchrotron Radiation Source (SRS) in Cheshire, started to investigate techniques for diagnosis and potentially a cure for certain cancers. This preliminary work influenced the design of new facilities being constructed around the world, in particular the Imaging and Medical Beam Line on the Australian Synchrotron in Melbourne. Two authors moved from the UK to Australia to participate in this exciting venture. The following is a personal view of some of the highlights of the early-year SRS work, following through to the current activities on the new facility in Australia. This article is part of the theme issue 'Fifty years of synchrotron science: achievements and opportunities'.

Breast cancer screening: Where have we been and where are we going? A personal perspective based on history, data and experience.

It is important to understand the history of breast cancer screening to better understand the continuing effort to reduce access to screening. Since the randomized, controlled trials have shown a statistically significant mortality reduction for women ages 40-74, the appropriate threshold for initiating screening is age 40 with no data to support the use of the age of 50 as a threshold for screening. All women are at risk for developing breast cancer and all women should have access to screening.

The evolution of breast imaging: past to present.

The practice of breast imaging has transitioned through a wide variety of technologic advances from the early days of direct-exposure film mammography to xeromammography to screen-film mammography to the current era of full-field digital mammography and digital breast tomosynthesis. Along with these technologic advances, organized screening, federal regulations based on the Mammography Quality Standards Act, and the development of the American College of Radiology Breast Imaging Reporting and Data System have helped to shape the specialty of breast imaging. With the development of breast ultrasonography and breast magnetic resonance imaging, both complementary to mammography, additional algorithms for diagnostic workup and screening high-risk subgroups of women have emerged. A substantial part of breast imaging practice these days also involves breast interventional procedures-both percutaneous biopsy to obtain tissue diagnosis and localization procedures to guide surgical excision. This article reviews the evolution of breast imaging starting from a historical perspective and progressing to the present day.

Breast imaging for interventional pathologists.

CONTEXT: Pathologist-performed, ultrasound-guided fine-needle aspiration biopsy is one of the frontiers of pathology. The College of American Pathologists, American Society for Clinical Pathology, and American Society of Cytopathology offer courses and certificate programs for pathologists in this area. The courses emphasize the biopsy of masses in the thyroid and head and neck. There is little training in ultrasound-guided biopsy of breast masses. To successfully perform an imaging-guided biopsy of the breast, pathologists should understand the basics of mammography and breast ultrasound. OBJECTIVE: To review the basics of mammography and breast ultrasound to help interventional pathologists add ultrasound-guided, fine-needle aspiration and core-needle biopsies of the breast to their list of core competencies. DATA SOURCES: Classic and recent literature and textbooks on mammography and breast ultrasound. CONCLUSIONS: The heart of early breast cancer detection is the screening mammogram. Abnormalities detected on screening, such as masses, densities, architectural distortions, nipple retraction, skin thickening, abnormal lymph nodes, and microcalcifications, will lead to a diagnostic mammogram and/or breast ultrasound. Lesions classified as Breast Imaging Reporting and Data System 4 or 5, and a few classified as 3 lesions, require biopsy. If the lesion is visible on ultrasound, ultrasound-guided fine-needle aspiration biopsy and/or core-needle biopsy is the procedure of choice. Suspicious lesions visible only on mammogram require stereotactic x-ray-guided biopsy. Interventional pathologists who understand the values and limitations of mammography and breast ultrasound are ready for the challenges of pathologist-performed, ultrasound-guided, fine-needle aspiration and core-needle biopsies of the breast.

[Screening of breast carcinoma screening in the Czech Republic requires cooperation with surgeons]. / Screening nádoru prsu v Ceské republice potrebuje soucinnost chirurgu.

Mammographic screening is the only reliable method for reduction of mortality resulting from breast cancer. In the Czech Republic, a countrywide mammographic screening has been in function since 2003. Therefore, a total of 3 056 907 women underwent mammography examination by the end of 2010, with 14 914 breast cancers detected. Vast majority of the malignancies was in early stages with a good chance for effective therapy and excellent prognosis. During 2003-2009, regular and health insurance paid examinations were available to women aged 45-69. Since 2010, the age range eligible for mammographic screening has been extended beyond the age of 69, with no upper limit. The rate of Czech women undergoing mammographic screening exceeded 50 percent already in 2008. The effectiveness of screening, increase of rates of early stages and reduction in breast cancer mortality rates have been regularly audited and evaluated based on data collected from all 70 Czech breast cancer screening units.

The emergence of diagnostic imaging technologies in breast cancer: discovery, regulatory approval, reimbursement, and adoption in clinical guidelines.

In this article, we trace the chronology of developments in breast imaging technologies that are used for diagnosis and staging of breast cancer, including mammography, ultrasonography, magnetic resonance imaging, computed tomography, and positron emission tomography. We explore factors that affected clinical acceptance and utilization of these technologies from discovery to clinical use, including milestones in peer-reviewed publication, US Food and Drug Administration approval, reimbursement by payers, and adoption into clinical guidelines. The factors driving utilization of new imaging technologies are mainly driven by regulatory approval and reimbursement by payers rather than evidence that they provide benefits to patients. Comparative effectiveness research can serve as a useful tool to investigate whether these imaging modalities provide information that improves patient outcomes in real-world settings.