Guiding vacuum-assisted biopsy in prone position: digital breast tomosynthesis vs stereotactic

2021 ◽  
pp. 030089162110161
Author(s):  
Gianfranco P. Scaperrotta ◽  
Giulia Boffelli ◽  
Catherine Depretto ◽  
Giovanni Di Leo ◽  
Alessandro Liguori ◽  
...  
Keyword(s):  
Multivariate Regression ◽  
Digital Breast Tomosynthesis ◽  
Institutional Review Board ◽  
Procedure Time ◽  
Chi Square ◽  
Breast Tomosynthesis ◽  
Institutional Review ◽  
Lower Radiation Dose ◽  
Average Glandular Dose ◽  
Age Range

Purpose: To compare the performance of prone digital breast tomosynthesis (DBT)–vacuum-assisted biopsy (VAB) with prone stereotactic-guided VAB (sVAB), focusing on time of procedure, number of expositions, average glandular dose, and complications. Methods: The institutional review board approved this retrospective study and informed consent was waived. From July 2015 to January 2017, 306 patients with 306 suspicious mammographic findings (BI-RADS ⩾4) underwent mammography-guided biopsy, prone sVAB, or prone DBT-VAB. Student t test, chi-square, and multivariate regression statistics were used. Results: During the study period, 155 prone sVAB procedures in 155 patients (mean age, 56 years; age range, 39–84 years) and 151 DBT-VABs in 151 patients (mean age, 57 years; age range, 33–84 years) were performed. Mean procedure time was shorter with DBT-VAB versus sVAB (14.5 versus 17.4 minutes, respectively; p < 0.001), and fewer images were acquired with DBT-VAB versus sVAB (8 vs 11, respectively; p < 0.001); the average glandular dose was significantly lower in DBT-VAB versus sVAB (11.8 mGy versus 18 mGy, respectively; p < 0.001). There were no differences in the distribution of histologic results ( p = 0.74) or breast density ( p = 0.09) between the two groups. No major complications were observed in either group. Conclusion: Performance of prone DBT-VAB was superior to prone sVAB because it allowed a faster procedure with fewer radiologic expositions and lower radiation dose.

scholarly journals Pressure-based Compression Guidance of the Breast in Digital Breast Tomosynthesis Using Flexible Paddles Compared to Conventional Compression

2020 ◽  
Vol 2 (6) ◽  
pp. 541-551
Author(s):  
Monique G J T B van Lier ◽  
Jerry E de Groot ◽  
Serge Muller ◽  
Gerard J den Heeten ◽  
Kathy J Schilling
Keyword(s):  
Digital Breast Tomosynthesis ◽  
Control Device ◽  
Institutional Review Board ◽  
Target Range ◽  
Compression Pressure ◽  
Breast Tomosynthesis ◽  
Breast Compression ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Breast Thickness

Abstract Objective We investigated the effect of introducing a pressure-based flexible paddle on compression parameters and user and patient experience of digital breast tomosynthesis (DBT) combined with patient-assisted compression or technologist compression. Methods After institutional review board approval, women with a DBT appointment who gave informed consent received pressure-based flexible paddle breast compression. Eight lights on the paddle were illuminated (1.9 kPa per light) as pressure was applied, aiming for an 8–13.9 kPa target range. The compression level was applied by the technologist or the participant utilizing a remote control device. The participant’s and technologist’s experiences were assessed by a questionnaire. Compression parameters were compared to previous examinations. Comparative statistics were performed using t-tests. Results Pressure-based compression (PBC) was judged to be similar or more comfortable compared with previous traditional exams (80%, 83/103), and 87% (90/103) of participants would recommend PBC to friends. Pressure variability decreased for craniocaudal (CC) views (-55%, P &lt; 0.001) and mediolateral oblique (MLO) views (-34%, P &lt; 0.0001). Subgroup analysis showed a similar glandular dose for CC views, while breast thickness was reduced (-3.74 mm, P &lt; 0.0001). For MLO views, both glandular dose (-0.13 mGy, P &lt; 0.0001) and breast thickness were reduced (-6.70 mm, P &lt; 0.0001). Mean compression parameters were similar for technologist compression and patient-assisted examinations. Conclusion Use of the pressure-based flexible paddle in DBT, with or without patient-assisted compression, improved participant and technologist experience and reduced compression pressure variability, mean breast thickness, and glandular dose.

scholarly journals Conspicuity and imaging features of breast cancers on digital breast tomosynthesis according to molecular profile

2021 ◽  
Author(s):  
Léa Manse ◽  
Martine Boisserie-Lacroix ◽  
Véronique Brouste ◽  
Marie-Pierre Depetiteville ◽  
Benoît Mesurolle ◽  
...  
Keyword(s):  
Molecular Subtype ◽  
Digital Breast Tomosynthesis ◽  
Wilcoxon Test ◽  
Molecular Profile ◽  
Molecular Characteristics ◽  
Imaging Features ◽  
Breast Cancers ◽  
Breast Tomosynthesis ◽  
Exact Test ◽  
Institutional Review

Abstract Objective To describe BI-RADS features and evaluate conspicuity of breast cancer on digital breast tomosynthesis (DBT) according to their molecular profile. Materials and method Institutional review board was obtained for this retrospective study. Consecutive patients with histologically proven breast cancers who underwent digital breast tomosynthesis (DBT) with 2D synthetic mammography (SM) and digital mammography (DM) at the time of diagnosis were included. Morphological features and conspicuity of cancers on DM, SM and DBT were evaluated in consensus by two breast radiologists. Imaging features were compared across molecular subtypes (luminal, triple negative (TN) and HER2+) using Fisher’s exact test and between DBT and SM and DM using McNemar’s test. Conspicuity was compared between DBT and SM and DM using Wilcoxon matched pairs test and between each molecular subtype using the Wilcoxon test. Results One hundred and eleven consecutive patients were included. On DBT, TN cancers more frequently presented as masses with microlobulated margins (P = 0.04) while HER2 + cancers were more often associated with microcalcifications (P = 0.02). Greater conspicuity on DBT in comparison to DM was observed for cancers with low Ki67 (P = .015), less aggressive tumours (P = .005), positive ER (P = 0.005), positive PR (P = .005) or negative HER2 (P = .024), and for luminal molecular profiles (P = 0.012) while no difference was observed between the two techniques for TN (P = .73) and HER+ (P = .79) tumours. Conclusion DBT reveals specific features of breast cancers according to their molecular characteristics. In comparison with DM, DBT improves conspicuity of luminal subtype cancers and tumours demonstrating less aggressive features on pathology.

scholarly journals Effect of Arrival Quarantine on Subsequent COVID-19 Testing in a Cohort of Military Basic Trainees

2021 ◽  
Author(s):  
Joseph E Marcus ◽  
Dianne N Frankel ◽  
Mary T Pawlak ◽  
Theresa M Casey ◽  
Erin Enriquez ◽  
...  
Keyword(s):  
Public Health Surveillance ◽  
San Antonio ◽  
Military Training ◽  
Health Surveillance ◽  
Institutional Review Board ◽  
Continuous Variables ◽  
Chi Square ◽  
Institutional Review ◽  
Chi Square Test ◽  
Pharmaceutical Interventions

ABSTRACT Introduction Basic Military Training at Joint Base San Antonio-Lackland implemented several sequential non-pharmaceutical interventions in response to coronavirus disease-2019 (COVID-19). One measure, arrival quarantine, has not been studied as a modern military disease prevention strategy. This study aimed to determine the effect of a 14-day arrival quarantine on symptomatic COVID-19 testing. Material and Methods A retrospective cohort study compared symptomatic COVID-19 testing among all trainees who entered Basic Military Training between March 17, 2020, and April 17, 2020, before the implementation of universal arrival COVID-19 testing, during their first 2 weeks in arrival quarantine compared to the rest of their training. Furthermore, symptomatic COVID-19 testing in the last 5 weeks of training in those who completed arrival quarantine was compared to testing in the last 5 weeks for trainees who arrived between February 16, 2020, and March 16, 2020, and did not undergo arrival quarantine. Nominal variables were compared by chi-square test, and continuous variables were compared by Mann–Whitney U test. This study was approved as a public health surveillance project by the 59th Medical Wing Institutional Review Board. Results Five thousand five hundred and seventy-six trainees started training between February 16, 2020, and April 17, 2020, with 2,573 trainees undergoing an arrival quarantine compared to 3,003 trainees who did not. Trainees who underwent arrival quarantine had higher rates of COVID-19 testing while in arrival quarantine (10.5 tests per 1,000 trainee-weeks vs. 2.3, P ≤ .001) and higher rates of concomitant influenza testing (74% vs. 38%, P = .001) compared to after they completed quarantine. Trainees that completed quarantine had less symptomatic COVID-19 testing after day 14 of training (2.3 tests per 1,000 trainee-weeks vs. 14.3, P ≤ .001) and influenza testing (38% vs. 74%, P = .001) compared to trainees that did not undergo arrival quarantine. Conclusion Arrival quarantine appears to be an effective non-pharmaceutical intervention associated with fewer symptomatic COVID-19 tests, especially after completion of quarantine.

scholarly journals The Adjunctive Digital Breast Tomosynthesis in Diagnosis of Breast Cancer

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Tsung-Lung Yang ◽  
Huei-Lung Liang ◽  
Chen-Pin Chou ◽  
Jer-Shyung Huang ◽  
Huay-Ben Pan
Keyword(s):  
Breast Cancer ◽  
Diagnostic Performance ◽  
Digital Breast Tomosynthesis ◽  
Subjective Assessment ◽  
Architectural Distortion ◽  
Breast Cancers ◽  
Chi Square ◽  
Breast Tomosynthesis ◽  
Chi Square Test ◽  
Mass Lesions

Purpose. To compare the diagnostic performance of digital breast tomosynthesis (DBT) and digital mammography (DM) for breast cancers.Materials and Methods. Fifty-seven female patients with pathologically proved breast cancer were enrolled. Three readers gave a subjective assessment superiority of the index lesions (mass, focal asymmetry, architectural distortion, or calcifications) and a forced BIRADS score, based on DM reading alone and with additional DBT information. The relevance between BIRADS category and index lesions of breast cancer was compared by chi-square test.Result. A total of 59 breast cancers were reviewed, including 17 (28.8%) mass lesions, 12 (20.3%) focal asymmetry/density, 6 (10.2%) architecture distortion, 23 (39.0%) calcifications, and 1 (1.7%) intracystic tumor. Combo DBT was perceived to be more informative in 58.8% mass lesions, 83.3% density, 94.4% architecture distortion, and only 11.6% calcifications. As to the forced BIRADS score, 84.4% BIRADS 0 on DM was upgraded to BIRADS 4 or 5 on DBT, whereas only 27.3% BIRADS 4A on DM was upgraded on DBT, as BIRADS 4A lesions were mostly calcifications. A significantPvalue (<0.001) between the BIRADS category and index lesions was noted.Conclusion. Adjunctive DBT gives exquisite information for mass lesion, focal asymmetry, and/or architecture distortion to improve the diagnostic performance in mammography.

scholarly journals Screening Digital Breast Tomosynthesis: Radiation Dose Among Patients With Breast Implants

2021 ◽  
Author(s):  
Nhu Q Vu ◽  
Curran Bice ◽  
John Garrett ◽  
Colin Longhurst ◽  
Daryn Belden ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Cancer Detection ◽  
Digital Breast Tomosynthesis ◽  
Breast Implants ◽  
Recall Rate ◽  
Screening Mammography ◽  
Chi Square ◽  
Breast Tomosynthesis ◽  
Full Field ◽  
Significant Difference

Abstract Objective To compare the mean glandular dose (MGD), cancer detection rate (CDR), and recall rate (RR) among screening examinations of patients with breast implants utilizing various digital breast tomosynthesis (DBT)-based imaging protocols. Methods This IRB-approved retrospective study included 1998 women with breast implants who presented for screening mammography between December 10, 2013 and May 29, 2020. Images were obtained using various protocol combinations of DBT and 2D digital mammography. Data collected included MGD, implant type and position, breast density, BI-RADS final assessment category, CDR, and RR. Statistical analysis utilized type II analysis of variance and the chi-square test. Results The highest MGD was observed in the DBT only protocol, while the 2D only protocol had the lowest (10.29 mGy vs 5.88 mGy, respectively). Statistically significant difference in MGD was observed across protocols (P &lt; 0.0001). The highest per-view MGD was among DBT full-field (FF) views in both craniocaudal and mediolateral oblique projections (P &lt; 0.0001). No significant difference was observed in RR among protocols (P = 0.17). The combined 2D (FF only) + DBT implant-displaced (ID) views protocol detected the highest number of cancers (CDR, 7.2 per 1000), but this was not significantly different across protocols (P = 0.48). Conclusion The combination of 2D FF views and DBT ID views should be considered for women with breast implants in a DBT-based screening practice when aiming to minimize radiation exposure without compromising the sensitivity of cancer detection. Avoidance of DBT FF in this patient population is recommended to minimize radiation dose.

scholarly journals Challenges and lessons learned from the Pediatric Heart Network Normal Echocardiogram Database study

2020 ◽  
Vol 30 (4) ◽  
pp. 456-461 ◽  
Author(s):  
Dongngan Truong ◽  
Leo Lopez ◽  
Peter C. Frommelt ◽  
Jessica Stelter ◽  
Brenda Ni ◽  
...  
Keyword(s):  
Information Disclosure ◽  
Demographic Data ◽  
Lessons Learned ◽  
Institutional Review Board ◽  
Image Transfer ◽  
Chi Square ◽  
Database Study ◽  
Future Studies ◽  
Institutional Review ◽  
Echocardiographic Images

AbstractBackground:The Pediatric Heart Network Normal Echocardiogram Database Study had unanticipated challenges. We sought to describe these challenges and lessons learned to improve the design of future studies.Methods:Challenges were divided into three categories: enrolment, echocardiographic imaging, and protocol violations. Memoranda, Core Lab reports, and adjudication logs were reviewed. A centre-level questionnaire provided information regarding local processes for data collection. Descriptive statistics were used, and chi-square tests determined differences in imaging quality.Results:For the 19 participating centres, challenges with enrolment included variations in Institutional Review Board definitions of “retrospective” eligibility, overestimation of non-White participants, centre categorisation of Hispanic participants that differed from National Institutes of Health definitions, and exclusion of potential participants due to missing demographic data. Institutional Review Board amendments resolved many of these challenges. There was an unanticipated burden imposed on centres due to high numbers of echocardiograms that were reviewed but failed to meet submission criteria. Additionally, image transfer software malfunctions delayed Core Lab image review and feedback. Between the early and late study periods, the proportion of unacceptable echocardiograms submitted to the Core Lab decreased (14 versus 7%, p < 0.01). Most protocol violations were from eligibility violations and inadvertent protected health information disclosure (overall 2.5%). Adjudication committee reviews led to protocol changes.Conclusions:Numerous challenges encountered during the Normal Echocardiogram Database Study prolonged study enrolment. The retrospective design and flaws in image transfer software were key impediments to study completion and should be considered when designing future studies collecting echocardiographic images as a primary outcome.

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