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Kwon MR, Chang Y, Ham SY, Cho Y, Kim EY, Kang J, Park EK, Kim KH, Kim M, Kim TS, Lee H, Kwon R, Lim GY, Choi HR, Choi J, Kook SH, Ryu S. Screening mammography performance according to breast density: a comparison between radiologists versus standalone intelligence detection. Breast Cancer Res 2024; 26:68. [PMID: 38649889 PMCID: PMC11036604 DOI: 10.1186/s13058-024-01821-w] [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: 09/05/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI) algorithms for the independent assessment of screening mammograms have not been well established in a large screening cohort of Asian women. We compared the performance of screening digital mammography considering breast density, between radiologists and AI standalone detection among Korean women. METHODS We retrospectively included 89,855 Korean women who underwent their initial screening digital mammography from 2009 to 2020. Breast cancer within 12 months of the screening mammography was the reference standard, according to the National Cancer Registry. Lunit software was used to determine the probability of malignancy scores, with a cutoff of 10% for breast cancer detection. The AI's performance was compared with that of the final Breast Imaging Reporting and Data System category, as recorded by breast radiologists. Breast density was classified into four categories (A-D) based on the radiologist and AI-based assessments. The performance metrics (cancer detection rate [CDR], sensitivity, specificity, positive predictive value [PPV], recall rate, and area under the receiver operating characteristic curve [AUC]) were compared across breast density categories. RESULTS Mean participant age was 43.5 ± 8.7 years; 143 breast cancer cases were identified within 12 months. The CDRs (1.1/1000 examination) and sensitivity values showed no significant differences between radiologist and AI-based results (69.9% [95% confidence interval [CI], 61.7-77.3] vs. 67.1% [95% CI, 58.8-74.8]). However, the AI algorithm showed better specificity (93.0% [95% CI, 92.9-93.2] vs. 77.6% [95% CI, 61.7-77.9]), PPV (1.5% [95% CI, 1.2-1.9] vs. 0.5% [95% CI, 0.4-0.6]), recall rate (7.1% [95% CI, 6.9-7.2] vs. 22.5% [95% CI, 22.2-22.7]), and AUC values (0.8 [95% CI, 0.76-0.84] vs. 0.74 [95% CI, 0.7-0.78]) (all P < 0.05). Radiologist and AI-based results showed the best performance in the non-dense category; the CDR and sensitivity were higher for radiologists in the heterogeneously dense category (P = 0.059). However, the specificity, PPV, and recall rate consistently favored AI-based results across all categories, including the extremely dense category. CONCLUSIONS AI-based software showed slightly lower sensitivity, although the difference was not statistically significant. However, it outperformed radiologists in recall rate, specificity, PPV, and AUC, with disparities most prominent in extremely dense breast tissue.
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Affiliation(s)
- Mi-Ri Kwon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, 04514, Seoul, South Korea.
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Soo-Youn Ham
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoosun Cho
- Center for Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, 04514, Seoul, South Korea
| | - Eun Young Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeonggyu Kang
- Center for Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, 04514, Seoul, South Korea
| | | | | | - Minjeong Kim
- Lunit Inc, Seoul, Republic of Korea
- Department of Statistics, Ewha Womans University, Seoul, Republic of Korea
| | | | | | - Ria Kwon
- Center for Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, 04514, Seoul, South Korea
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Ga-Young Lim
- Center for Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, 04514, Seoul, South Korea
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Hye Rin Choi
- Center for Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, 04514, Seoul, South Korea
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - JunHyeok Choi
- School of Mechanical Engineering, Sunkyungkwan University, Seoul, Republic of Korea
| | - Shin Ho Kook
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seungho Ryu
- Center for Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, 04514, Seoul, South Korea.
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea.
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Kwon MR, Chang Y, Youn I, Kook SH, Cho Y, Park B, Ryu S. Diagnostic performance of screening mammography according to menstrual cycle among Asian women. Breast Cancer Res Treat 2023; 202:357-366. [PMID: 37642882 DOI: 10.1007/s10549-023-07087-8] [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: 06/21/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To investigate the performance metrics of screening mammography according to menstrual cycle week in premenopausal Asian women. METHODS This retrospective study included 69,556 premenopausal Asian women who underwent their first screening mammography between 2011 and 2019. The presence or absence of a breast cancer diagnosis within 12 months after the index screening mammography served as the reference standard, determined by linking the study data to the national cancer registry data. Menstrual cycles were calculated, and participants were assigned to groups according to weeks 1-4. The performance metrics included cancer detection rate (CDR), sensitivity, specificity, and positive predictive value (PPV), with comparisons across menstrual cycles. RESULTS Among menstrual cycles, the lowest CDR at 4.7 per 1000 women (95% confidence interval [CI], 3.8-5.8 per 1000 women) was observed in week 4 (all P < 0.05). The highest sensitivity of 72.7% (95% CI, 61.4-82.3) was observed in week 1, although the results failed to reach statistical significance. The highest specificity of 80.4% (95% CI, 79.5-81.3%) was observed in week 1 (P = 0.01). The lowest PPV of 2.2% (95% CI, 1.8-2.7) was observed in week 4 (all P < 0.05). CONCLUSION Screening mammography tended to show a higher performance during week 1 and a lower performance during week 4 of the menstrual cycle among Asian women. These results emphasize the importance of timing recommendations that consider menstrual cycles to optimize the effectiveness of screening mammography for breast cancer detection.
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Affiliation(s)
- Mi-Ri Kwon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, Seoul, 04514, Republic of Korea.
| | - Inyoung Youn
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Shin Ho Kook
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoosun Cho
- Center for Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
- Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Republic of Korea
| | - Seungho Ryu
- Center for Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, Seoul, 04514, Republic of Korea.
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Kim H, Choi JS, Kim K, Ko ES, Ko EY, Han BK. Effect of artificial intelligence-based computer-aided diagnosis on the screening outcomes of digital mammography: a matched cohort study. Eur Radiol 2023; 33:7186-7198. [PMID: 37188881 DOI: 10.1007/s00330-023-09692-z] [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: 06/21/2022] [Revised: 02/21/2023] [Accepted: 03/09/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To investigate whether artificial intelligence-based computer-aided diagnosis (AI-CAD) can improve radiologists' performance when used to support radiologists' interpretation of digital mammography (DM) in breast cancer screening. METHODS A retrospective database search identified 3158 asymptomatic Korean women who consecutively underwent screening DM between January and December 2019 without AI-CAD support, and screening DM between February and July 2020 with image interpretation aided by AI-CAD in a tertiary referral hospital using single reading. Propensity score matching was used to match the DM with AI-CAD group in a 1:1 ratio with the DM without AI-CAD group according to age, breast density, experience level of the interpreting radiologist, and screening round. Performance measures were compared with the McNemar test and generalized estimating equations. RESULTS A total of 1579 women who underwent DM with AI-CAD were matched with 1579 women who underwent DM without AI-CAD. Radiologists showed higher specificity (96% [1500 of 1563] vs 91.6% [1430 of 1561]; p < 0.001) and lower abnormal interpretation rates (AIR) (4.9% [77 of 1579] vs 9.2% [145 of 1579]; p < 0.001) with AI-CAD than without. There was no significant difference in the cancer detection rate (CDR) (AI-CAD vs no AI-CAD, 8.9 vs 8.9 per 1000 examinations; p = 0.999), sensitivity (87.5% vs 77.8%; p = 0.999), and positive predictive value for biopsy (PPV3) (35.0% vs 35.0%; p = 0.999) according to AI-CAD support. CONCLUSIONS AI-CAD increases the specificity for radiologists without decreasing sensitivity as a supportive tool in the single reading of DM for breast cancer screening. CLINICAL RELEVANCE STATEMENT This study shows that AI-CAD could improve the specificity of radiologists' DM interpretation in the single reading system without decreasing sensitivity, suggesting that it can benefit patients by reducing false positive and recall rates. KEY POINTS • In this retrospective-matched cohort study (DM without AI-CAD vs DM with AI-CAD), radiologists showed higher specificity and lower AIR when AI-CAD was used to support decision-making in DM screening. • CDR, sensitivity, and PPV for biopsy did not differ with and without AI-CAD support.
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Affiliation(s)
- Haejung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Ji Soo Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea.
| | - Kyunga Kim
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
- Department of Data Convergence & Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sook Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
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Kim Y, Kim HK, Lim C, Kim S, Ahn KG, Noh DY. The usefulness of a three-protein signature blood assay (Mastocheck®) for follow-up after breast cancer surgery. J Cancer Res Clin Oncol 2023; 149:5733-5741. [PMID: 36564525 PMCID: PMC10356646 DOI: 10.1007/s00432-022-04550-9] [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: 11/02/2022] [Accepted: 12/18/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Mastocheck®, a proteomic-based blood assay, has been developed for early diagnosis of breast cancer. The purpose of this study is whether Mastocheck® is useful as a postoperative follow-up. METHODS A total of 255 patients were analyzed. The patients were classified into longitudinal monitoring and recurrence/nonrecurrence cohorts. The longitudinal monitoring cohort consisted of 111 patients. In this cohort, blood analyses were performed three times (before surgery, 8 weeks after surgery, and between 6 months and one year after surgery), and a comparative analysis of the values of Mastocheck® and individual proteins at each time point was performed. The recurrence/nonrecurrence cohort consisted of 144 patients who had been followed up for more than 1 year, and the blood marker values at the time of local recurrence were compared to those of nonrecurrence patients. RESULTS In the longitudinal monitoring cohort analysis, in 81 of 111 patients were diagnosed with breast cancer with Mastocheck® and the sensitivity was 73.0%. Of 111 patients in the longitudinal monitoring cohort, 108 had two blood analyses (before and 8 weeks after surgery), and three serial blood analyses were performed on 53 patients. The Mastocheck® value that were in the cancer range of 73.0% (in 81 of 111 patients) of patients before surgery, was within the normal range of 68.5% (in 74 of 108 patients) at 8 weeks after surgery and 88.7% (in 47 of 53 patients) from 6 months to 1 year after surgery. The value of Mastocheck® was significantly decreased after surgery compared to before surgery (p < 0.001). In the recurrence/nonrecurrence cohort analysis, the Mastocheck® values were in the cancer range in 38 out of 63 recurrence patients and within the normal range in 66 of 81 nonrecurrence patients (sensitivity of 60.3% and specificity of 80.2%). CONCLUSIONS Mastocheck® is expected to be used as a blood marker tool to aid in the early detection of recurrence during follow-up after breast cancer surgery.
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Affiliation(s)
- Yumi Kim
- Department of Surgery, CHA Gangnam Medical Center, CHA University School of Medicine, 566, Gangnam-gu, Seoul, Republic of Korea
| | - Hong-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Changjin Lim
- Department of Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | | | | | - Dong-Young Noh
- Department of Surgery, CHA Gangnam Medical Center, CHA University School of Medicine, 566, Gangnam-gu, Seoul, Republic of Korea.
- Bertis Inc., Seoul, Republic of Korea.
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Razali NF, Isa IS, Sulaiman SN, Abdul Karim NK, Osman MK, Che Soh ZH. Enhancement Technique Based on the Breast Density Level for Mammogram for Computer-Aided Diagnosis. Bioengineering (Basel) 2023; 10:bioengineering10020153. [PMID: 36829647 PMCID: PMC9952042 DOI: 10.3390/bioengineering10020153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
Mass detection in mammograms has a limited approach to the presence of a mass in overlapping denser fibroglandular breast regions. In addition, various breast density levels could decrease the learning system's ability to extract sufficient feature descriptors and may result in lower accuracy performance. Therefore, this study is proposing a textural-based image enhancement technique named Spatial-based Breast Density Enhancement for Mass Detection (SbBDEM) to boost textural features of the overlapped mass region based on the breast density level. This approach determines the optimal exposure threshold of the images' lower contrast limit and optimizes the parameters by selecting the best intensity factor guided by the best Blind/Reference-less Image Spatial Quality Evaluator (BRISQUE) scores separately for both dense and non-dense breast classes prior to training. Meanwhile, a modified You Only Look Once v3 (YOLOv3) architecture is employed for mass detection by specifically assigning an extra number of higher-valued anchor boxes to the shallower detection head using the enhanced image. The experimental results show that the use of SbBDEM prior to training mass detection promotes superior performance with an increase in mean Average Precision (mAP) of 17.24% improvement over the non-enhanced trained image for mass detection, mass segmentation of 94.41% accuracy, and 96% accuracy for benign and malignant mass classification. Enhancing the mammogram images based on breast density is proven to increase the overall system's performance and can aid in an improved clinical diagnosis process.
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Affiliation(s)
- Noor Fadzilah Razali
- Centre for Electrical Engineering Studies, Universiti Teknologi MARA, Cawangan Pulau Pinang, Permatang Pauh Campus, Bukit Mertajam 13500, Pulau Pinang, Malaysia
| | - Iza Sazanita Isa
- Centre for Electrical Engineering Studies, Universiti Teknologi MARA, Cawangan Pulau Pinang, Permatang Pauh Campus, Bukit Mertajam 13500, Pulau Pinang, Malaysia
- Correspondence:
| | - Siti Noraini Sulaiman
- Centre for Electrical Engineering Studies, Universiti Teknologi MARA, Cawangan Pulau Pinang, Permatang Pauh Campus, Bukit Mertajam 13500, Pulau Pinang, Malaysia
- Integrative Pharmacogenomics Institute (iPROMISE), Universiti Teknologi MARA Cawangan Selangor, Puncak Alam Campus, Puncak Alam 42300, Selangor, Malaysia
| | - Noor Khairiah Abdul Karim
- Department of Biomedical Imaging, Advanced Medical and Dental Institute, Universiti Sains Malaysia Bertam, Kepala Batas 13200, Pulau Pinang, Malaysia
- Breast Cancer Translational Research Programme (BCTRP), Advanced Medical and Dental Institute, Universiti Sains Malaysia Bertam, Kepala Batas 13200, Pulau Pinang, Malaysia
| | - Muhammad Khusairi Osman
- Centre for Electrical Engineering Studies, Universiti Teknologi MARA, Cawangan Pulau Pinang, Permatang Pauh Campus, Bukit Mertajam 13500, Pulau Pinang, Malaysia
| | - Zainal Hisham Che Soh
- Centre for Electrical Engineering Studies, Universiti Teknologi MARA, Cawangan Pulau Pinang, Permatang Pauh Campus, Bukit Mertajam 13500, Pulau Pinang, Malaysia
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Alatawi YM, Alshomrani HA, Baeshen SM, Alkhamisi HH, Almazrui RM, Alghamdi MS, Bugshan SM, Alafif TK, Hijazi HA, Alahmadi JR, Ashoor SA, Alamri AM, Alkhilaiwi F. Evaluation of participation and performance indicators in a breast cancer screening program in Saudi Arabia. Saudi Med J 2022; 43:1260-1264. [PMID: 36379533 PMCID: PMC10043913 DOI: 10.15537/smj.2022.43.11.20220269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To evaluate early performance indicators for breast cancer screening at the King Abdulaziz University Hospital in Saudi Arabia. METHODS This study retrospectively evaluated data from women who underwent their first breast cancer screening program in Jeddah, Saudi Arabia between 2012 and 2019. Data on screening results were used to estimate performance indicators and generate descriptive statistics. RESULTS Of the 16000 women invited from 2012 to 2019, a total of 1911 (11.9%) participated. The majority of women (68.8%) were between 40 and 55 years old. Based on the screening process results, 26.6%, 40.1%, 9.7%, 1.3%, 0.7%, and 5.2% of women had BI-RADS scores of R1, R2, R3, R4, R5, and R0 respectively. The remaining 16.3% did not have mammogram records. The recall rate, or the percentage of women who underwent further evaluation, was 19.9%; 18.9% underwent a biopsy procedure. In addition, 1.6% of women had cancer screen-detected, although only 0.7% were diagnosed with breast cancer. CONCLUSION In light of the low participation and high recall rates, it is essential that the screening program utilizes performance indicators to optimize resource utilization and ensure the quality of the service provided. Additionally, a national framework and standardized performance indicators could mitigate this problem for other cancer screening programs.
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Affiliation(s)
- Yasser M. Alatawi
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Hala A. Alshomrani
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Sara M. Baeshen
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Hayat H. Alkhamisi
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Roaa M. Almazrui
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Mohammed S. Alghamdi
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Sara M. Bugshan
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Tarik K. Alafif
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Hussam A. Hijazi
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Jawaher R. Alahmadi
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Sawsan A. Ashoor
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Ahmad M. Alamri
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Faris Alkhilaiwi
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
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Choi E, Jun JK, Suh M, Jung KW, Park B, Lee K, Jung SY, Lee ES, Choi KS. Effectiveness of the Korean National Cancer Screening Program in reducing breast cancer mortality. NPJ Breast Cancer 2021; 7:83. [PMID: 34183679 PMCID: PMC8238931 DOI: 10.1038/s41523-021-00295-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
High incidences of breast cancer (BC) are reported in Asian women in their forties, and it is not clear whether mammographic screening reduces mortality among them. This study evaluated the effect of BC screening on mortality in Korea. We conducted a nationwide prospective cohort study of women invited to the Korean National Cancer Screening Program (KNCSP) between 2002 and 2003 (N = 8,300,682), with data linkage to the Korea Central Cancer Registry and death certificates through 2014 and 2015, respectively. Exposure to mammographic screening was defined using a modified never/ever approach. The primary study outcome was adjusted mortality rate ratio (MRR) for BC among screened and non-screened women estimated by Poisson regression. An adjusted MRR for all cause-death other than BC was examined to account for selection bias in the cohort. BC incidence rates for screened and non-screened women were 84.41 and 82.88 per 100,000 women-years, respectively. BC mortality rates for screened and non-screened women were 5.81 and 13.43 per 100,000 women-years, respectively, with an adjusted MRR for BC of 0.43 (95% CI, 0.41-0.44). The adjusted MRR for all-cause death excluding BC was 0.52 (95% CI, 0.52-0.52). The greatest reduction in BC mortality was noted for women aged 45-54 years, and there was no observable reduction in mortality after the age of 70 years. In conclusion, the KNCSP has been effective in reducing BC mortality among Korean women aged 40-69 years.
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Affiliation(s)
- Eunji Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Kyu-Won Jung
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Boyoung Park
- Department of Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Kyeongmin Lee
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - So-Youn Jung
- Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Eun Sook Lee
- Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
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8
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Choi WJ, Kim SH, Shin HJ, Bang M, Kang BJ, Lee SH, Chang JM, Moon WK, Bae K, Kim HH. Automated breast US as the primary screening test for breast cancer among East Asian women aged 40-49 years: a multicenter prospective study. Eur Radiol 2021; 31:7771-7782. [PMID: 33779816 DOI: 10.1007/s00330-021-07864-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To prospectively evaluate the diagnostic performance of screening ABUS as the primary screening test for breast cancer among Korean women aged 40-49 years. METHODS This prospective, multicenter study included asymptomatic Korean women aged 40-49 years from three academic centers between February 2017 and October 2019. Each participant underwent ABUS without mammography, and the ABUS images were interpreted at each hospital with double-reading by two breast radiologists. Biopsy and at least 1 year of follow-up was considered the reference standard. Diagnostic performance of ABUS screening and subgroup analyses according to patient and tumor characteristics were evaluated. RESULTS Reference standard data were available for 959 women. The recall rate was 9.8% (95% confidence interval [CI]: 7.9%, 11.7%; 94 of 959 women) and the cancer detection yield was 5.2 per 1000 women (95% CI: -0.6, 11.1; 5 of 959 women). There was only one interval cancer. The sensitivity was 83.3% (95% CI: 53.5%, 100%; 5 of 6 cancers) and the specificity was 90.7% (95% CI: 88.8%, 92.5%; 864 of 95. women). The positive predictive values of biopsies performed (PPV3) was 20.0% (95% CI: 4.3%, 35.7%; 5 of 25 women). Women with heterogeneous background echotexture had a higher recall rate (p = .009) and lower specificity (p = .036). Women with body mass index values < 25 kg/m2 had a higher mean recall rate (p = .046). CONCLUSION In East Asia, screening automated breast US may be an alternative to screening mammography for detecting breast cancers in women aged 40-49 years. KEY POINTS • Automated breast US screening for breast cancer in asymptomatic women aged 40-49 is effective with 5.2 per 1000 cancer detection yield. • Women with heterogeneous background echotexture had a higher recall rate and lower specificity. • Women with body mass index < 25 kg/m2 had a higher recall rate.
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Affiliation(s)
- Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Minseo Bang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Bong Joo Kang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Su Hyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyoungkyg Bae
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
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9
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Kim SH, Kim HH, Moon WK. Automated Breast Ultrasound Screening for Dense Breasts. Korean J Radiol 2020; 21:15-24. [PMID: 31920025 PMCID: PMC6960307 DOI: 10.3348/kjr.2019.0176] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/04/2019] [Indexed: 11/25/2022] Open
Abstract
Mammography is the primary screening method for breast cancers. However, the sensitivity of mammographic screening is lower for dense breasts, which are an independent risk factor for breast cancers. Automated breast ultrasound (ABUS) is used as an adjunct to mammography for screening breast cancers in asymptomatic women with dense breasts. It is an effective screening modality with diagnostic accuracy comparable to that of handheld ultrasound (HHUS). Radiologists should be familiar with the unique display mode, imaging features, and artifacts in ABUS, which differ from those in HHUS. The purpose of this study was to provide a comprehensive review of the clinical significance of dense breasts and ABUS screening, describe the unique features of ABUS, and introduce the method of use and interpretation of ABUS.
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Affiliation(s)
- Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Hak Hee Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Choi BH, Lee EH, Jun JK, Kim KW, Park YM, Kim HW, Kim YM, Shin DR, Lim HS, Park JS, Kim HJ. Effect of Different Types of Mammography Equipment on Screening Outcomes: A Report by the Alliance for Breast Cancer Screening in Korea. Korean J Radiol 2020; 20:1638-1645. [PMID: 31854151 PMCID: PMC6923210 DOI: 10.3348/kjr.2019.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/29/2019] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the effects of different types of mammography equipment on screening outcomes by comparing the performance of film-screen mammography (FSM), computed radiography mammography (CRM), and digital mammography (DM). Materials and Methods We retrospectively enrolled 128756 sets of mammograms from 10 hospitals participating in the Alliance for Breast Cancer Screening in Korea between 2005 and 2010. We compared the diagnostic accuracy of the types of mammography equipment by analyzing the area under the receiver operating characteristic curve (AUC) with a 95% confidence interval (CI); performance indicators, including recall rate, cancer detection rate (CDR), positive predictive value1 (PPV1), sensitivity, specificity, and interval cancer rate (ICR); and the types of breast cancer pathology. Results The AUCs were 0.898 (95% CI, 0.878–0.919) in DM, 0.860 (0.815–0.905) in FSM, and 0.866 (0.828–0.903) in CRM (p = 0.150). DM showed better performance than FSM and CRM in terms of the recall rate (14.8 vs. 24.8 and 19.8%), CDR (3.4 vs. 2.2 and 2.1 per 1000 examinations), PPV1 (2.3 vs. 0.9 and 1.1%), and specificity (85.5 vs. 75.3 and 80.3%) (p < 0.001) but not in terms of sensitivity (86.3 vs. 87.4 and 86.3%) and ICR (0.6 vs. 0.4 and 0.4). The proportions of carcinoma in situ (CIS) were 27.5%, 13.6%, and 11.8% for DM, CRM, and FSM, respectively (p = 0.003). Conclusion In comparison to FSM and CRM, DM showed better performance in terms of the recall rate, CDR, PPV1, and specificity, although the AUCs were similar, and more CISs were detected using DM. The application of DM may help to improve the quality of mammography screenings. However, the overdiagnosis issue of CIS using DM should be evaluated.
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Affiliation(s)
- Bo Hwa Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Eun Hye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Keum Won Kim
- Department of Radiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Young Mi Park
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hye Won Kim
- Department of Radiology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - You Me Kim
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Dong Rock Shin
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Hye Jung Kim
- Department of Radiology, Kyungpook National University Medical Center, Kyungpook National University College of Medicine, Daegu, Korea
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11
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Kim SH, Lee EH, Jun JK, Kim YM, Chang YW, Lee JH, Kim HW, Choi EJ. Interpretive Performance and Inter-Observer Agreement on Digital Mammography Test Sets. Korean J Radiol 2019; 20:218-224. [PMID: 30672161 PMCID: PMC6342756 DOI: 10.3348/kjr.2018.0193] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/09/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate the interpretive performance and inter-observer agreement on digital mammographs among radiologists and to investigate whether radiologist characteristics affect performance and agreement. Materials and Methods The test sets consisted of full-field digital mammograms and contained 12 cancer cases among 1000 total cases. Twelve radiologists independently interpreted all mammograms. Performance indicators included the recall rate, cancer detection rate (CDR), positive predictive value (PPV), sensitivity, specificity, false positive rate (FPR), and area under the receiver operating characteristic curve (AUC). Inter-radiologist agreement was measured. The reporting radiologist characteristics included number of years of experience interpreting mammography, fellowship training in breast imaging, and annual volume of mammography interpretation. Results The mean and range of interpretive performance were as follows: recall rate, 7.5% (3.3–10.2%); CDR, 10.6 (8.0–12.0 per 1000 examinations); PPV, 15.9% (8.8–33.3%); sensitivity, 88.2% (66.7–100%); specificity, 93.5% (90.6–97.8%); FPR, 6.5% (2.2–9.4%); and AUC, 0.93 (0.82–0.99). Radiologists who annually interpreted more than 3000 screening mammograms tended to exhibit higher CDRs and sensitivities than those who interpreted fewer than 3000 mammograms (p = 0.064). The inter-radiologist agreement showed a percent agreement of 77.2–88.8% and a kappa value of 0.27–0.34. Radiologist characteristics did not affect agreement. Conclusion The interpretative performance of the radiologists fulfilled the mammography screening goal of the American College of Radiology, although there was inter-observer variability. Radiologists who interpreted more than 3000 screening mammograms annually tended to perform better than radiologists who did not.
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Affiliation(s)
- Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Hye Lee
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Korea.
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - You Me Kim
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Yun Woo Chang
- Department of Radiology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jin Hwa Lee
- Department of Radiology, Dong-A University Hospital, Busan, Korea
| | - Hye Won Kim
- Department of Radiology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Eun Jung Choi
- Department of Radiology, Chonbuk National University Hospital, Jeonju, Korea
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12
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Lee JS, Kim HA, Cho SH, Lee HB, Park MH, Jeong J, Park HK, Oh M, Yi O. Five-Year Overall Survival of Interval Breast Cancers is Better than Non- Interval Cancers from Korean Breast Cancer Registry. Asian Pac J Cancer Prev 2019; 20:1717-1726. [PMID: 31244292 PMCID: PMC7021595 DOI: 10.31557/apjcp.2019.20.6.1717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 04/05/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: Interval breast cancer (IC) is a limitation of breast cancer screening. We investigated data from a large scaled breast cancer dataset of patients with breast cancer who underwent breast cancer screening in order to recapitulate the overall survival (OS) of patients with ICs compared to those with non-ICs. Methods: A total of 27,141 patients in the Korean breast cancer registry with breast cancer who had ever participated in biannual national breast cancer screening programs between 2009 and 2013 were enrolled. We compared the social, pregnancy-associated, and pathologic characteristics between the IC and non-IC groups and identified the significant prognostic factors for OS. Results: The proportion of ICs was 1.3% (370/27,141) in this study population. ICs were correlated with age 45-55 years at diagnosis, higher levels of education, early menopause (<50 years), hormone replacement therapy, specific provinces (Kangwon, Kyungnam, Jeju, and Dae-jeon), and family history of breast cancer. Low-to-intermediate nuclear grade, early stage (stage 0-I), and low Ki-67 level were also correlated with IC proportion. Non-ICs were associated with an increased risk of five-year mortality (hazard ratio [HR] 7.4; 95% confidence interval [CI]:1.85-29.66; p = 0.005) compared to ICs. Lymph node metastasis, residence (Kyung-nam province), low education status, high histologic grade, and asymptomatic cancers increased the HR of five-year OS. Conclusion: ICs occurred unequally in specific province and relatively high-educated women in Korea. They were also diagnosed with early-stage breast cancer with a favorable recurrence risk, and their outcome was better than those of patients with other breast cancers in breast cancer screening.
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Affiliation(s)
- Jung Sun Lee
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea.
| | - Hyun-Ah Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Se-Heon Cho
- Department of Surgery, College of Medicine, Dong- A University, Busan, Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Min Ho Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University Medical College, Seoul, Korea
| | - Heung Kyu Park
- Department of Surgery, Breast Cancer Center, Gachon University Gill Medical Center, Incheon, Korea
| | - Minkyung Oh
- Department of Pharmacology, Inje University College of medicine, Clinical Trial Center, Inje University Busan Paik Hospital, Busan, Korea
| | - Onvox Yi
- Department of Surgery, Dongnam Institution of Radiological and Medical Science, Busan, Korea
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13
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Jo HM, Lee EH, Ko K, Kang BJ, Cha JH, Yi A, Jung HK, Jun JK. Prevalence of Women with Dense Breasts in Korea: Results from a Nationwide Cross-sectional Study. Cancer Res Treat 2019; 51:1295-1301. [PMID: 30699499 PMCID: PMC6790853 DOI: 10.4143/crt.2018.297] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 01/27/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose Women with dense breast are known to be at high risk for breast cancer, but their prevalence and number of Korean women are unknown. The current study was to investigate the distribution of mammographic breast density by age of women undergoing screening mammography, and to estimate the prevalence of Korean women with dense breasts, quantitatively. Materials and Methods For obtaining a nationwide representative sample, 6,481 mammograms were collected from 86 screening units participated in the National Cancer Screening Program for breast cancer. Based on the American College of Radiology Breast Imaging Reporting and Data System classification, breast density was evaluated by six breast radiologists, qualitatively. We applied these breast density distributions to age-specific counts of the Korean women population derived to mid-year 2017 to estimate the number of Korean women with dense breasts. Results Overall, 54.4% (95% confidence interval [CI], 52.9% to 55.8%) of women 40 to 69 years of age had heterogeneously or extremely dense breasts, and this proportion was inversely associated with age. Based on the age distribution of Korean women, we estimated that 6,083,000 women (95% CI, 5,919,600 to 6,245,600) age 40-69 years in Korean have dense breasts. Women aged 40-49 years (n=3,450,000) accounted for 56.7% of this group. Conclusion More than half of Korean women aged 40 and over have dense breasts. To prevent breast cancer effectively and efficiently, it is necessary to develop a new personalized prevention strategy considering her status of breast density.
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Affiliation(s)
- Hye-Mi Jo
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eun Hye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Kyungran Ko
- Center for Breast Cancer, National Cancer Center Hospital, National Cancer Center, Goyang, Korea
| | - Bong Joo Kang
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joo Hee Cha
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ann Yi
- Department of Radiology, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Hae Kyoung Jung
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
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- National Cancer Control Institute, National Cancer Center, Goyang, Korea
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14
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Kang JH, Kim DH, Park SH, Baek JH. Age of Data in Contemporary Research Articles Published in Representative General Radiology Journals. Korean J Radiol 2018; 19:1172-1178. [PMID: 30386148 PMCID: PMC6201984 DOI: 10.3348/kjr.2018.19.6.1172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/01/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To analyze and compare the age of data in contemporary research articles published in representative general radiology journals. Materials and Methods We searched for articles reporting original research studies analyzing patient data that were published in the print issues of the Korean Journal of Radiology (KJR), European Radiology (ER), and Radiology in 2017. Eligible articles were reviewed to extract data collection period (time from first patient recruitment to last patient follow-up) and age of data (time between data collection end and publication). The journals were compared in terms of the proportion of articles reporting the data collection period to the level of calendar month and regarding the age of data. Results There were 50, 492, and 254 eligible articles in KJR, ER, and Radiology, respectively. Of these, 44 (88%; 95% confidence interval [CI]: 75.8-94.8%), 359 (73%; 95% CI: 68.9-76.7%), and 211 (83.1%; 95% CI: 78-87.2%) articles, respectively, provided enough details of data collection period, revealing a significant difference between ER and Radiology (p = 0.002). The age of data was significantly greater in KJR (median age: 826 days; range: 299-2843 days) than in ER (median age: 570 days; range: 56-4742 days; p < 0.001) and Radiology (median age: 618; range: 75-4271 days; p < 0.001). Conclusion Korean Journal of Radiology did not fall behind ER or Radiology in reporting of data collection period, but showed a significantly greater age of data than ER and Radiology, suggesting that KJR should take measures to improve the timeliness of its data.
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Affiliation(s)
- Ji Hun Kang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Dong Hwan Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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