Overcoming the limitations of screening mammography in Japan and Korea: a paradigm shift to personalized breast cancer screening based on ultrasonography

Batch effect correction for LIBS-FTIR spectral fusion in breast cancer serum detection based on gradient reversal adversarial network

Breast cancer is the most prevalent malignancy among women, necessitating rapid, non-invasive, and cost-effective diagnostic technologies for early detection. Spectroscopic techniques like laser-induced breakdown spectroscopy (LIBS) and Fourier transform infrared spectroscopy (FTIR) have shown promise in the area. However, batch effects caused by factors like operator variability and instrument fluctuations can compromise the generalization ability of trained models across different sample batches. In this study, we combined LIBS and FTIR to analyze breast cancer serum samples from different batches and developed a Gradient Reversal Adversarial Network (GRAN) to correct batch effects. The GRAN model incorporated an adversarial mechanism between a batch classifier and a label classifier, enabling it to learn batch-invariant features. The results demonstrated that GRAN substantially enhanced classification accuracy across different batches, achieving a test accuracy of 89.7 % when trained on one batch and tested on another. This represents a significant improvement over traditional models, which achieved test accuracies of 63.7 % under comparable conditions. The findings of this research lay the foundation for a robust and non-invasive breast cancer detection method by leveraging the GRAN model for spectral fusion.

Sonographic Glandular Tissue Component: A Potential Imaging Marker for Upgrading BI-RADS 4A Breast Masses

PURPOSE

To investigate whether sonographic glandular tissue component (GTC) can optimize the management of breast imaging reporting and data system (BI-RADS) 4A breast masses.

MATERIALS AND METHODS

We reviewed the patients with BI-RADS 4A breast masses confirmed by ultrasound and pathology reports from January to December 2020. Based on conventional breast ultrasound images, GTC was categorized into GTC-Low and GTC-High. The consistency of the GTC classification between two radiologists was evaluated using a kappa test. Propensity score matching (PSM) was applied to adjust for unbalanced characteristics between the two groups. Logistic regression was used to analyze the relationship between sonographic GTC and the likelihood of BI-RADS 4A masses being benign or malignant.

RESULTS

Of the 319 patients included finally in the study, the agreement between the two radiologists regarding the GTC classification was good (weighted kappa: 0.736/0.716). The malignancy rate in the GTC-High group (32.7%, 16/49) was significantly higher than that in the overall cohort (14.1%, 45/319; P=0.001). After PSM adjustment to balance relevant covariates between the GTC-High and GTC-Low groups, 45 GTC-High patients were matched with 45 GTC-Low patients. After matching, univariate and multivariate logistic regression analyses identified sonographic GTC as an independent variable associated with malignancy in BI-RADS 4A masses (P=0.012). After matching, the malignancy rate in the GTC-High group (35.6%,16/45) was significantly higher (P=0.014) than that in the GTC-Low group (13.3%, 6/45).

CONCLUSION

Sonographic GTC is an independent predictor of malignancy in BI-RADS 4A breast masses. Masses initially classified as BI-RADS 4A may warrant reclassification to BI-RADS 4B when identified as GTC-High.

Review of mammography screening guidelines of the 5 largest global economies

Breast cancer is the number one cancer among women globally. Breast imaging-based screening is important for the early detection of breast cancer and decreases mortality rates significantly. Breast cancer screening guidelines vary worldwide, and it is important to know about the variations in screening guidelines in different countries. Japan, China, and Germany are three countries with national screening programs only while, the United States and India have nationally recommended guidelines but not national screening programs. In this review, we aim to outline the screening guidelines in the 5 countries with the highest Gross Domestic Product and offer insights into relevant screening practices across different nations.

Transforming cancer screening: the potential of multi-cancer early detection (MCED) technologies

Early cancer detection substantially improves the rate of patient survival; however, conventional screening methods are directed at single anatomical sites and focus primarily on a limited number of cancers, such as gastric, colorectal, lung, breast, and cervical cancer. Additionally, several cancers are inadequately screened, hindering early detection of 45.5% cases. In contrast, Multi-Cancer Early Detection (MCED) assays offer simultaneous screening of multiple cancers from a single liquid biopsy and identify molecular changes before symptom onset. These tests assess DNA mutations, abnormal DNA methylation patterns, fragmented DNA, and other tumor-derived biomarkers, indicating the presence of cancer and predicting its origin. Moreover, MCED assays concurrently detect multiple cancers without recommended screening protocols, potentially revolutionizing cancer screening and management. Large trials have reported promising results, achieving 50-95% sensitivity and 89-99% specificity for multiple cancer types. However, challenges, regarding improving accuracy, addressing ethical issues (e.g., psychosocial impact assessment), and integrating MCED into healthcare systems, must be addressed to achieve widespread adoption. Furthermore, prospective multi-institutional studies are crucial for demonstrating the clinical benefits in diverse populations. This review provides an overview of the principles, development status, and clinical significance of MCED tests, and discusses their potential and challenges.

Automated Breast Ultrasound With Remote Reading for Primary Breast Cancer Screening: A Prospective Study Involving 46 Community Health Centers in China

BACKGROUND. China has faced barriers to implementation of a population-based mammographic screening program. Breast ultrasound provides an alternative screening modality to mammography in low-resource settings. OBJECTIVE. The purpose of this study was to evaluate the performance of automated breast ultrasound (ABUS) with remote reading as the primary screening modality for breast cancer. METHODS. This prospective study enrolled asymptomatic women 35-69 years old from 46 community health centers across 18 provinces representing all six regions of China from January 2021 to December 2021. Participants underwent screening ABUS as the sole breast cancer screening modality, with images acquired by a technologist at a community health center. The 3D volumetric data were transferred via cloud-based software to a single remote reading center, where examinations were interpreted independently in batches by two subspecialized breast radiologists using BI-RADS; a third radiologist at the remote reading center resolved discrepancies. Diagnostic reports were returned to the community centers, and patients sought follow-up care at local hospitals. The reference standard incorporated a combination of histopathology and 24-month follow-up. Outcome measures included cancer detection rate, abnormal interpretation rate (AIR), sensitivity, specificity, biopsy rate, and PPV. RESULTS. The final analysis included 5978 enrolled participants (median age, 46 years [IQR, 40-52 years]) who underwent screening ABUS at the community health centers with subsequent remote reading. A total of 24 ABUS-detected cancers and two interval cancers were diagnosed. The cancer detection rate was 4.0 per 1000 women (95% CI: 2.7-5.9), and the AIR was 11.9% (95% CI: 11.1-12.7%). A total of 95.8% (23/24) of ABUS-detected cancers were invasive. The 23 invasive cancers had a median diameter of 10.0 mm, and 73.9% (17/23) were node-negative. Sensitivity was 92.3% (95% CI: 75.9-97.9%), and specificity was 88.4% (95% CI: 87.6-89.2%). The biopsy rate was 1.7% (95% CI: 1.4-2.0%), and the PPV of biopsy was 24.0% (95% CI: 16.7-33.2%). CONCLUSION. ABUS screening with remote reading met benchmark performance for cancer detection in comparison with mammography, with infrequent interval cancers. CLINICAL IMPACT. ABUS with remote reading holds promise in enhancing access to breast cancer screening and early detection in low-resource settings or underserved regions where mammographic screening is not established. TRIAL REGISTRATION. ClinicalTrials.gov NCT04527510.

A New Breast Density Assessment Method Using Portable Document Format

PURPOSE

Breast density assessment is an essential component of risk-stratified and supplemental breast cancer screenings for the future generation. International collaborative research and cooperation are required to determine global trends and differences in mammographic breast density. Due to the cost and energy associated with the use of film or digital mammograms, international breast density assessment studies tend to be challenging. A novel breast density assessment method using portable document format (PDF) is currently explored and the justification is needed. This study aimed to investigate the inter-method agreement between two viewing platforms - mammograms on PDF and mammograms on a workstation - for a subjective breast density assessment.

METHODS

Three radiologists assessed 100 cases with 200 normal bilateral mediolateral oblique view images twice at 1-month interval using mammograms on PDF and mammograms on a workstation. Further, to assess intra-reader agreement, one reader performed two readings of the PDF set at 1-month interval. The reading order of the images was changed each time. Weighted kappa coefficient (κw) was used to assess inter-method and intra-observer agreements.

RESULTS

The average inter-method agreement was substantial (κw = 0.74, range = 0.73-0.76) on a four-grade scale (fatty, scattered, heterogeneously dense, or extremely dense) and almost perfect (κw = 0.81, range = 0.78-0.84) on a two-grade scale (non-dense or dense). The intra-observer agreement was almost perfect on a four-grade scale (κw = 0.85) and two-grade scale (κw = 0.90).

CONCLUSION

The PDF and mammography workstation readings for breast density assessment had almost perfect inter-method agreements. Moreover, the intra-observer agreement of PDF reading was almost perfect.

Preliminary study of standardized semiquantitative method for ultrasonographic breast composition assessment

PURPOSE

To develop a classification tree via semiquantitative analysis for ultrasonographic breast composition assessment using routine breast ultrasonography examination images.

METHODS

This study retrospectively enrolled 100 consecutive normal women who underwent screening mammography and supplemental ultrasonography. Based on sonographic breast composition, the patients' breasts were classified as nondense or dense, which were correlated with mammographic breast composition. Ultrasonographic breast composition was classified based on the fibroglandular tissue (FGT) thickness-to-subcutaneous fat and retromammary fat (FAT) thickness ratio. In addition, the presence of a high glandular tissue component (GTC) in FGT or the presence of evident fat lobules in FGT was investigated. The cutoff point between the nondense and dense breasts was calculated from the area under the curve (AUC).

RESULTS

All cases with a high GTC were dense breasts, and all cases with evident fat lobules in the FGT were nondense breasts. The AUC of the FGT thickness-to-FAT ratio of all cases, the group without a high GTC, the group without evident fat lobules in the FGT, and the group without a high GTC or evident fat lobules in the FGT were 0.93, 0.94, 0.99, and 1, respectively.

CONCLUSION

The presence of a high GTC indicated dense breasts, and the presence of evident fat lobules in the FGT represented nondense breasts. For the remaining cases, the cutoff point of the FGT thickness-to-FAT thickness ratio was 0.93 for ultrasonographic two-grade scale breast composition assessment with 100% accuracy.

Cancer Screening: Present Recommendations, the Development of Multi-Cancer Early Development Tests, and the Prospect of Universal Cancer Screening

Cancer continues to pose a considerable challenge to global health. In the search for innovative strategies to combat this complex enemy, the concept of universal cancer screening has emerged as a promising avenue for early detection and prevention. In contrast to targeted approaches that focus on specific populations or high-risk individuals, universal screening seeks to cast a wide net to detect incipient malignancies in different demographic groups. This paradigm shift in cancer care underscores the importance of comprehensive screening programs that go beyond conventional boundaries. As our understanding of the complex molecular and genetic basis of cancer deepens, the need to develop comprehensive screening methods becomes increasingly apparent. In this article, we look at the rationale and potential benefits of universal cancer screening.

Beyond BI-RADS: Nonmass Abnormalities on Breast Ultrasound

Abnormalities on breast ultrasound (US) images which do not meet the criteria for masses are referred to as nonmass lesions. These features and outcomes have been investigated in several studies conducted by Asian researchers. However, the term "nonmass" is not included in the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) 5th edition for US. According to the Japan Association of Breast and Thyroid Sonology guidelines, breast lesions are divided into mass and nonmass. US findings of nonmass abnormalities are classified into five subtypes: abnormalities of the ducts, hypoechoic areas in the mammary glands, architectural distortion, multiple small cysts, and echogenic foci without a hypoechoic area. These findings can be benign or malignant; however, focal or segmental distributions and presence of calcifications suggest malignancy. Intraductal, invasive ductal, and lobular carcinomas can present as nonmass abnormalities. For the nonmass concept to be included in the next BI-RADS and be widely accepted in clinical practice, standardized terminologies, an interpretation algorithm, and outcome-based evidence are required for both screening and diagnostic US.