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Jones LI, Marshall A, Geach R, Elangovan P, O'Flynn E, Timlin T, McKeown-Keegan S, Rose J, Vinnicombe S, Taylor-Phillips S, Halling-Brown M, Dunn JA. Optimising the diagnostic accuracy of First post-contrAst SubtracTed breast MRI (FAST MRI) through interpretation-training: a multicentre e-learning study, mapping the learning curve of NHS Breast Screening Programme (NHSBSP) mammogram readers using an enriched dataset. Breast Cancer Res 2024; 26:85. [PMID: 38807211 PMCID: PMC11134713 DOI: 10.1186/s13058-024-01846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/18/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Abbreviated breast MRI (FAST MRI) is being introduced into clinical practice to screen women with mammographically dense breasts or with a personal history of breast cancer. This study aimed to optimise diagnostic accuracy through the adaptation of interpretation-training. METHODS A FAST MRI interpretation-training programme (short presentations and guided hands-on workstation teaching) was adapted to provide additional training during the assessment task (interpretation of an enriched dataset of 125 FAST MRI scans) by giving readers feedback about the true outcome of each scan immediately after each scan was interpreted (formative assessment). Reader interaction with the FAST MRI scans used developed software (RiViewer) that recorded reader opinions and reading times for each scan. The training programme was additionally adapted for remote e-learning delivery. STUDY DESIGN Prospective, blinded interpretation of an enriched dataset by multiple readers. RESULTS 43 mammogram readers completed the training, 22 who interpreted breast MRI in their clinical role (Group 1) and 21 who did not (Group 2). Overall sensitivity was 83% (95%CI 81-84%; 1994/2408), specificity 94% (95%CI 93-94%; 7806/8338), readers' agreement with the true outcome kappa = 0.75 (95%CI 0.74-0.77) and diagnostic odds ratio = 70.67 (95%CI 61.59-81.09). Group 1 readers showed similar sensitivity (84%) to Group 2 (82% p = 0.14), but slightly higher specificity (94% v. 93%, p = 0.001). Concordance with the ground truth increased significantly with the number of FAST MRI scans read through the formative assessment task (p = 0.002) but by differing amounts depending on whether or not a reader had previously attended FAST MRI training (interaction p = 0.02). Concordance with the ground truth was significantly associated with reading batch size (p = 0.02), tending to worsen when more than 50 scans were read per batch. Group 1 took a median of 56 seconds (range 8-47,466) to interpret each FAST MRI scan compared with 78 (14-22,830, p < 0.0001) for Group 2. CONCLUSIONS Provision of immediate feedback to mammogram readers during the assessment test set reading task increased specificity for FAST MRI interpretation and achieved high diagnostic accuracy. Optimal reading-batch size for FAST MRI was 50 reads per batch. Trial registration (25/09/2019): ISRCTN16624917.
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Affiliation(s)
- Lyn I Jones
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK.
| | - Andrea Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK
| | - Rebecca Geach
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK
| | - Premkumar Elangovan
- Scientific Computing Department, Royal Surrey NHS Foundation Trust, Guildford, Surrey, GU2 7XX, UK
| | - Elizabeth O'Flynn
- St George's University Hospitals Foundation Trust, London, SW17 0QT, UK
| | - Tony Timlin
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK
| | - Sadie McKeown-Keegan
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK
| | - Janice Rose
- Independent Cancer Patients' Voice, London, EC1R 0LL, UK
| | - Sarah Vinnicombe
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AS, UK
| | | | - Mark Halling-Brown
- Scientific Computing Department, Royal Surrey NHS Foundation Trust, Guildford, Surrey, GU2 7XX, UK
| | - Janet A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK
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Enogieru IE, Comstock CE, Grimm LJ. Breast Cancer Screening and Treatment Clinical Trials Updated for 2023. JOURNAL OF BREAST IMAGING 2024; 6:14-22. [PMID: 38243862 DOI: 10.1093/jbi/wbad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Indexed: 01/22/2024]
Abstract
There are many active or recently completed breast cancer screening and treatment trials in 2023 that have the potential to fundamentally change the way breast radiologists practice medicine. Breast cancer screening trials may provide evidence to support supplemental screening beyond mammography to include US, contrast-enhanced mammography, and breast MRI. Furthermore, there are multiple efforts to support risk-adaptive screening strategies that would personalize screening modalities, frequencies, and ages of initiation. For breast cancer treatment, aims to reduce overtreatment may provide nonsurgical treatment options for women with low-risk breast cancer. Breast radiologists must be familiar with the study designs, major inclusion and exclusion criteria, and principal endpoints in order to determine when and how the study results should influence clinical care. As multidisciplinary team members, breast radiologists will have major roles in the success or failure of these trials as they transition from research to actual clinical practice.
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Affiliation(s)
- Imarhia E Enogieru
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | | | - Lars J Grimm
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
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Hill H, Kearns B, Pashayan N, Roadevin C, Sasieni P, Offman J, Duffy S. The cost-effectiveness of risk-stratified breast cancer screening in the UK. Br J Cancer 2023; 129:1801-1809. [PMID: 37848734 PMCID: PMC10667489 DOI: 10.1038/s41416-023-02461-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/09/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND There has been growing interest in the UK and internationally of risk-stratified breast screening whereby individualised risk assessment may inform screening frequency, starting age, screening instrument used, or even decisions not to screen. This study evaluates the cost-effectiveness of eight proposals for risk-stratified screening regimens compared to both the current UK screening programme and no national screening. METHODS A person-level microsimulation model was developed to estimate health-related quality of life, cancer survival and NHS costs over the lifetime of the female population eligible for screening in the UK. RESULTS Compared with both the current screening programme and no screening, risk-stratified regimens generated additional costs and QALYs, and had a larger net health benefit. The likelihood of the current screening programme being the optimal scenario was less than 1%. No screening amongst the lowest risk group, and triannual, biennial and annual screening amongst the three higher risk groups was the optimal screening strategy from those evaluated. CONCLUSIONS We found that risk-stratified breast cancer screening has the potential to be beneficial for women at the population level, but the net health benefit will depend on the particular risk-based strategy.
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Affiliation(s)
- Harry Hill
- School of Medicine and Population Health, University of Sheffield, Sheffield, England.
| | - Ben Kearns
- School of Medicine and Population Health, University of Sheffield, Sheffield, England
- Lumanity Inc, Sheffield, England
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, England
| | - Cristina Roadevin
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, England
| | - Peter Sasieni
- Life Sciences & Medicine, King's College London, London, England
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Judith Offman
- Life Sciences & Medicine, King's College London, London, England
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Stephen Duffy
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
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Tsarouchi MI, Hoxhaj A, Mann RM. New Approaches and Recommendations for Risk-Adapted Breast Cancer Screening. J Magn Reson Imaging 2023; 58:987-1010. [PMID: 37040474 DOI: 10.1002/jmri.28731] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/13/2023] Open
Abstract
Population-based breast cancer screening using mammography as the gold standard imaging modality has been in clinical practice for over 40 years. However, the limitations of mammography in terms of sensitivity and high false-positive rates, particularly in high-risk women, challenge the indiscriminate nature of population-based screening. Additionally, in light of expanding research on new breast cancer risk factors, there is a growing consensus that breast cancer screening should move toward a risk-adapted approach. Recent advancements in breast imaging technology, including contrast material-enhanced mammography (CEM), ultrasound (US) (automated-breast US, Doppler, elastography US), and especially magnetic resonance imaging (MRI) (abbreviated, ultrafast, and contrast-agent free), may provide new opportunities for risk-adapted personalized screening strategies. Moreover, the integration of artificial intelligence and radiomics techniques has the potential to enhance the performance of risk-adapted screening. This review article summarizes the current evidence and challenges in breast cancer screening and highlights potential future perspectives for various imaging techniques in a risk-adapted breast cancer screening approach. EVIDENCE LEVEL: 1. TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Marialena I Tsarouchi
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alma Hoxhaj
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ritse M Mann
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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Savaridas SL, Jin H. Costing analysis to introduce a contrast-enhanced mammography service to replace an existing breast MRI service for local staging of breast cancer. Clin Radiol 2023; 78:340-346. [PMID: 36804270 DOI: 10.1016/j.crad.2023.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
AIM To assess the cost impact of switching from contrast-enhanced magnetic resonance imaging (CE-MRI) to contrast-enhanced spectral mammography (CESM) for loco-regional staging of breast cancer from a public healthcare perspective. MATERIALS AND METHODS The CE-MRI cost was obtained from the NHS reference cost. The CESM cost was calculated using a bottom-up approach including use of the machine, pump injector, contrast medium, image storage, and time allocation for staff reporting and cannulation. The cost of upgrading existing machines to CESM or purchasing new mammographic machines was obtained via national procurement. Other costs were obtained from local pharmacy, published unit cost data, or estimated based on surveys. RESULTS For large health boards in Scotland (≥500 cancers diagnosed per annum), the cost savings of switching from CE-MRI to CESM range from £64,069 to £81,570. For small health boards (<500 cancers diagnosed per annum), the cost savings of switching from CE-MRI to CESM range from £6,453 to £23,953. The cost savings are most sensitive to the number of tests conducted per year, and whether the existing mammography machine can be upgraded to CESM or not. CONCLUSION Switching from CE-MRI to CESM for loco-regional staging of breast cancer is likely to be cost saving for both large and small health boards in Scotland. Further research is urgently needed to confirm the non-inferiority of CESM to CE-MRI as a locoregional staging technique. The input data of this analysis can be updated when such results become available.
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Affiliation(s)
- S L Savaridas
- School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK.
| | - H Jin
- King's Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
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Kataoka M, Iima M, Miyake KK, Matsumoto Y. Multiparametric imaging of breast cancer: An update of current applications. Diagn Interv Imaging 2022; 103:574-583. [DOI: 10.1016/j.diii.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022]
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Jones LI, Marshall A, Elangovan P, Geach R, McKeown-Keegan S, Vinnicombe S, Harding SA, Taylor-Phillips S, Halling-Brown M, Foy C, O'Flynn E, Ghiasvand H, Hulme C, Dunn JA. Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation training for mammogram readers: a multi-centre study assessing diagnostic performance, using an enriched dataset. BREAST CANCER RESEARCH : BCR 2022; 24:55. [PMID: 35907862 PMCID: PMC9338668 DOI: 10.1186/s13058-022-01549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022]
Abstract
Background Abbreviated breast MRI (abMRI) is being introduced in breast screening trials and clinical practice, particularly for women with dense breasts. Upscaling abMRI provision requires the workforce of mammogram readers to learn to effectively interpret abMRI. The purpose of this study was to examine the diagnostic accuracy of mammogram readers to interpret abMRI after a single day of standardised small-group training and to compare diagnostic performance of mammogram readers experienced in full-protocol breast MRI (fpMRI) interpretation (Group 1) with that of those without fpMRI interpretation experience (Group 2). Methods Mammogram readers were recruited from six NHS Breast Screening Programme sites. Small-group hands-on workstation training was provided, with subsequent prospective, independent, blinded interpretation of an enriched dataset with known outcome. A simplified form of abMRI (first post-contrast subtracted images (FAST MRI), displayed as maximum-intensity projection (MIP) and subtracted slice stack) was used. Per-breast and per-lesion diagnostic accuracy analysis was undertaken, with comparison across groups, and double-reading simulation of a consecutive screening subset. Results 37 readers (Group 1: 17, Group 2: 20) completed the reading task of 125 scans (250 breasts) (total = 9250 reads). Overall sensitivity was 86% (95% confidence interval (CI) 84–87%; 1776/2072) and specificity 86% (95%CI 85–86%; 6140/7178). Group 1 showed significantly higher sensitivity (843/952; 89%; 95%CI 86–91%) and higher specificity (2957/3298; 90%; 95%CI 89–91%) than Group 2 (sensitivity = 83%; 95%CI 81–85% (933/1120) p < 0.0001; specificity = 82%; 95%CI 81–83% (3183/3880) p < 0.0001). Inter-reader agreement was higher for Group 1 (kappa = 0.73; 95%CI 0.68–0.79) than for Group 2 (kappa = 0.51; 95%CI 0.45–0.56). Specificity improved for Group 2, from the first 55 cases (81%) to the remaining 70 (83%) (p = 0.02) but not for Group 1 (90–89% p = 0.44), whereas sensitivity remained consistent for both Group 1 (88–89%) and Group 2 (83–84%). Conclusions Single-day abMRI interpretation training for mammogram readers achieved an overall diagnostic performance within benchmarks published for fpMRI but was insufficient for diagnostic accuracy of mammogram readers new to breast MRI to match that of experienced fpMRI readers. Novice MRI reader performance improved during the reading task, suggesting that additional training could further narrow this performance gap. Supplementary Information The online version contains supplementary material available at 10.1186/s13058-022-01549-5.
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Affiliation(s)
- Lyn I Jones
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK.
| | - Andrea Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK
| | - Premkumar Elangovan
- Scientific Computing, Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX, UK
| | - Rebecca Geach
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK
| | - Sadie McKeown-Keegan
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK
| | - Sarah Vinnicombe
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AS, UK
| | - Sam A Harding
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK
| | | | - Mark Halling-Brown
- Scientific Computing, Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX, UK
| | - Christopher Foy
- Research Design Service South West Gloucester Office, National Institute for Health Research (NIHR) Leadon House, Gloucestershire Royal Hospital, Gloucester, GL1 3NN, UK
| | - Elizabeth O'Flynn
- St George's University Hospitals Foundation Trust, London, SW17 0QT, UK
| | - Hesam Ghiasvand
- Institute of Health Research, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - Claire Hulme
- Institute of Health Research, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - Janet A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK
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Jones LI, Taylor-Phillips S, Geach R, Harding SA, Marshall A, McKeown-Keegan S, Dunn JA. Re: The potential of abbreviated breast MRI (FAST MRI) as a tool for breast cancer screening: a systematic review and meta-analysis. A reply. Clin Radiol 2021; 77:73-75. [PMID: 34848027 DOI: 10.1016/j.crad.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 11/03/2022]
Affiliation(s)
- L I Jones
- North Bristol NHS Trust, Bristol, UK.
| | | | - R Geach
- North Bristol NHS Trust, Bristol, UK
| | | | - A Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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Jones LI, Dunn JA. Commentary on: Introduction of an abbreviated breast MRI service in the UK as part of the BRAID trial: practicalities, challenges, and future directions. Clin Radiol 2021; 76:434-435. [PMID: 33715828 DOI: 10.1016/j.crad.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Affiliation(s)
- L I Jones
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol BS10 5NB, UK.
| | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
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