Radiology in public focus

Press releases were sent to the medical news media for the following articles appearing in a recent issue of Radiology.

Digital Breast Tomosynthesis Significantly Reduces Breast Biopsy Rates

The use of digital breast tomosynthesis (DBT) may significantly reduce the number of women who undergo breast biopsy for a non-cancerous lesion following an abnormal mammogram, according to a new study in Radiology.

Unlike standard or full-field digital mammography (FFDM), which captures two X-ray images of the breast from top-to-bottom and from side-to-side, DBT captures multiple images from different angles that are synthesized into 3D images by a computer. The single-institution prospective study included 30,933 women who had a screening FFDM or screening breast MRI through the U.K.’s National Health Service Breast Screening Programme. Of the study group, 1,470 women were recalled for further imaging (4.8% recall rate) to assess an abnormality.

A final recall group of 827 women after exclusions (mean age 56.7 years) required 571 biopsies, yielding a biopsy rate of 69%. Biopsy detected 142 cancers. In 429 of the biopsies performed, the suspicious lesion detected on screening mammography was not cancerous, for a benign biopsy rate of 75%. The researchers read the DBT images blinded to the original FFDM screening results to determine whether 3D images would have influenced the biopsy recommendation.

The inclusion of DBT imaging would have reduced the number of biopsies performed on recalled women from 571 to 298—while still detecting the 142 cancers—for a biopsy rate of 36%, and a benign biopsy rate of 52%. “DBT allows for improved reader accuracy and confidence in determining if a mammographic abnormality is concerning or not, leading to a reduction in the number of biopsies performed,” said lead researcher Nisha Sharma, MBChB, director of breast screening and clinical lead for breast imaging at Leeds Teaching Hospital NHS Trust, Seacroft Hospital, in Leeds, England.

“Our study validates that DBT can help in the diagnostic workup of mammographic abnormalities and reduce harm to women through fewer false positive biopsies without any reduction in the cancer detection rate."

 

Sharma
Images in a 63-year-old asymptomatic woman who was recalled because a new 8-mm mass was detected in the left breast at screening mammography. (a) Left mediolateral oblique and (b) left mediolateral oblique spot compression mammograms show an 8-mm partly ill-defined mass (arrow) in the upper breast. (c) Left mediolateral oblique digital breast tomosynthesis (DBT) image shows an 8-mm well-defined mass (arrow) in the upper breast. The mass was interpreted as benign at DBT and was coded R2 benign; however, it was indeterminate at full-field digital mammography. Targeted US of the breast revealed normal findings, and stereotactic biopsy yielded a diagnosis of micropapillary ductal carcinoma in situ (DCIS). Wide local surgical excision revealed a 5-mm high-grade DCIS. 

Sharma et al, Radiology 2019 ©RSNA 2019.

WEB EXTRAS

Access the Radiology study, “The Potential Impact of Digital Breast Tomosynthesis on the Benign Biopsy Rate in Women Recalled within the UK Breast Screening Programme,” at RSNA.org/Radiology.

Breast Density Assessment Varies Greatly by Screening Method and Race

Fewer women are assigned to a dense breast category when evaluated with advanced mammographic screening technologies compared to standard digital mammography, according to a new study in Radiology.

In this retrospective study, researchers analyzed data from 24,736 women who underwent mammography screening at the Hospital of the University of Pennsylvania (HUP) between 2010 and 2017. Data collected included the breast density category assigned at the time of the screening using the standardized BI-RADS system, race, age and body mass index (BMI). The study population was 46% white and 54% African-American (mean age 56.3 years). Of the 60,766 imaging exams included in the study, 8,935 were conducted with DM (14.7%), 30,799 (50.7%) were performed with DM/DBT, and 21,052 (34.6%) used SM/DBT.

A statistical analysis of the study data showed breast density assignments varied greatly by the screening method used. Compared to standard DM imaging, the odds of a high-density assessment were reduced by 31% and 57% respectively when mammographic imaging was performed with DM/DBT or SM/DBT. The odds of receiving a high breast density assignment after SM replaced DM were reduced by 38%.

The density downgrade may be due to the perception of less fibroglandular tissue in the 3D display of DBT imaging compared to DM’s flat, 2D display, as well as differences in the appearance of the denser glandular tissue and the fatty tissue in the reconstructed SM imaging.

“Our findings may have direct implications for personalized screening since breast density assignments, which often drive recommendations for supplemental screening, may vary greatly by modality, race and BMI,” said Aimilia Gastounioti, PhD, lead author and research associate in the Radiology Department at HUP’s Perelman School of Medicine.

Gastounioti
Craniocaudal (left) and mediolateral-oblique (right) consecutive digital mammography (DM) digital breast tomosynthesis (DBT) images (top) and, 1.1 years later, the synthetic mammography (SM) and DBT screening images (bottom) of the same postmenopausal white woman interpreted by the same radiologist. The DM and DBT screening examination was assigned Breast Imaging Reporting and Data System (BI-RADS) density category c (ie, dense), whereas the synthetic mammography and DBT screening examination was assigned BI-RADS density category b (ie, nondense). BMI = body mass index.

Gastounioti et al, Radiology 2019 ©RSNA 2019.

WEB EXTRAS

Access the Radiology study, “Effect of Mammographic Screening Modality on Breast Density Assessment: Digital Mammography versus Digital Breast Tomosynthesis,” at RSNA.org/Radiology.

Researchers Use Radiomics to Predict Who Will Benefit from Chemotherapy

Using data from CT images, researchers may be able to predict which lung cancer patients will respond to chemotherapy, according to a new study in Radiology: Artificial Intelligence. Platinum-based chemotherapy is typically the first-line treatment of advancedstage non–small cell lung cancer (NSCLC). However, only about one in four patients responds well to this treatment. Currently, there is no way to predict which patients will benefit most from chemotherapy.

“The aim in this study was to determine whether an early prediction of response to chemotherapy is possible by using computer-extracted measurements of patterns both within and outside the lung nodule, along with the shape of the nodule, on baseline CT scans,” said Mohammadhadi Khorrami, MS, a PhD candidate from the Department of Biomedical Engineering, Case Western Reserve University School of Engineering in Cleveland, Ohio.

Data was analyzed from 125 patients who had been treated with pemetrexed-based platinum doublet chemotherapy at Cleveland Clinic. The patients were divided randomly into two sets with an equal number of responders and non-responders in the training set. The training set comprised 53 patients with NSCLC, and the validation set comprised 72 patients. A computer analyzed the CT images of lung cancer to identify unique patterns of heterogeneity both inside and outside the tumor. These patterns were then compared between CT scans of patients who did and did not respond to chemotherapy. These feature patterns were then used to train a machine learning classifier to identify the likelihood that a lung cancer patient would respond to chemotherapy.

“When we looked at patterns inside the tumor, we got an accuracy of 0.68. But when we looked inside and outside, the accuracy went up to 0.77,” Khorrami said. The results showed that the radiomic features derived from within the tumor and the area around the tumor were able to distinguish patients who responded to chemotherapy from those who did not and predict time to progression and overall survival.

WEB EXTRAS

Access the Radiology: Artificial Intelligence study, “Combination of Peri- and Intratumoral Radiomic Features on Baseline CT Scans Predicts Response to Chemotherapy in Lung Adenocarcinoma,” at RSNA.org/AI.

Media Coverage of RSNA

In February, 431 RSNA-related news stories were tracked in the media. These stories had over 400 million audience impressions.

Coverage included Reader’s Digest, Pittsburgh Post-Gazette, MSN Health, FOX Business, Reuters.com, Drugs.com, Forbes.com, Radiology Business Journal, Auntminnie.com, Radiology Today, Applied Radiology, Health Imaging News and Health Data Management.

Total RSNA 2018 annual meeting media coverage tracked through February 28, 2019, has resulted in 27,916 media placements with more than 13.6 billion impressions.

Notable placements for RSNA 2018 include: “Good Morning America,” NPR, TIME, The New York Times, China Daily, U.S. News & World Report, USA Today, Popular Science, USWeekly, CNN, HLN, CNN International, Yahoo! News, ABCNews.com, Salon, New York Post, Daily Mail, Mirror, The Telegraph, The London Economic, Bloomberg Radio, WNBC-TV (New York), WCBS-TV (New York), WPIX-TV (New York), KTLA-TV (Los Angeles), WLS-TV (Chicago), WMAQ-TV (Chicago), WBBM-AM (Chicago), WGN (Chicago), WFLD-TV (Chicago), WAMU-FM (Washington, D.C.), WFXT-TV (Boston), WBZ-TV (Boston), KPRC-TV (Houston), KLIF-AM (Dallas), Reuters, UPI, Xinhua, Healthday, Politico, Arizona Republic, Atlanta Journal-Constitution, Pittsburgh Post-Gazette, Seattle Post-Intelligencer, Milwaukee Journal-Sentinel, Drugs.com, Medpage Today, ScienceDaily, Medscape, Radiology Business, Health Imaging, Auntminnie.com and Imaging Technology News.

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RadiologyInfo.org Draws Record Number of Visits

RadiologyInfo.org, the RSNA/ACR patient information website, drew a record number of visits in March. The English and Spanish versions of the website drew 2,452,423 visits in March, setting records for the English site, Spanish site and both combined.

Currently, RadiologyInfo.org averages 1.85 million website for the English and Spanish sites combined. The website contains over 245 procedure, exam and disease descriptions. RadiologyInfo.org also contains a Children’s Imaging section highlighting specific pediatric procedures.

June Public Information Outreach Focuses on Men's Health: Abdominal Aortic Aneurysm

In recognition of Men’s Health Month in June, RSNA is distributing public service announcements (PSAs) focusing on abdominal aortic aneurysm and the need for older male smokers to consider ultrasound screening.