Our study showed the rate of screen-detected breast cancer was substantially higher in women who underwent digital breast tomosynthesis and synthetic mammography screening than in women who underwent digital mammography screening. PurposeTo compare the performance of digital breast tomosynthesis (DBT) and two-dimensional synthetic mammography (SM) with that of digital mammography (DM) in a population-based mammographic screening program.Materials and MethodsIn this prospective cohort study, data from 37 185 women screened with DBT and SM and from 61 742 women screened with DM as part of a population-based screening program in 2014 and 2015 were included. Early performance measures, including recall rate due to abnormal mammographic findings, rate of screen-detected breast cancer, positive predictive value of recall, positive predictive value of needle biopsy, histopathologic type, tumor size, tumor grade, lymph node involvement, hormonal status, Ki-67 level, and human epidermal growth factor receptor 2 status were compared in women who underwent DBT and SM screening and in those who underwent DM screening by using χ2 tests, two-sample unpaired t tests, and tests of proportions.ResultsRecall rates were 3.4% for DBT and SM screening ...

Women screened with digital breast tomosynthesis (DBT) in combination with two-dimensional (2D) synthetic mammography (SM) versus standard 2D digital mammography (DM) showed no differences in rates... Background Screening that includes digital breast tomosynthesis (DBT) with two-dimensional (2D) synthetic mammography (SM) or standard 2D digital mammography (DM) results in detection of more breas...

Background: Automatically calculated breast density is a promising alternative to subjective BI-RADS density assessment. However, such software needs a cutoff value for density classification. Purpose: To determine the volumetric density threshold which classifies fatty and dense breasts with highest accuracy compared to average BI-RADS density assessment, and to analyze radiologists’ inter-observer variation. Material and Methods: A total of 537 full field digital mammography examinations were randomly selected from a population based screening program. Five radiologists assessed density using the BI-RADS density scale, where BI-RADS I–II were classified as fatty and III–IV as dense. A commercially available software (Quantra) calculated volumetric breast density. We calculated the cutoff (threshold) values in volumetric density that yielded highest accuracy compared to median and individual radiologists’ classification. Inter-observer variation was analyzed using the kappa statistic. Results: The threshold that best matched the median radiologists’ classification was 10%, which resulted in 87% accuracy. Thresholds that best matched individual radiologist’s classification had a range of 8–15%. A total of 191 (35.6 %) cases were scored both dense and fatty by at least one radiologist. Fourteen (2.6 %) cases were unanimously scored by the radiologists, yet differently using automatic assessment. The agreement (kappa) between reader’s median classification and individual radiologists was 0.624 to 0.902, and agreement between median classification and Quantra was 0.731. Conclusion: The optimal volumetric threshold of 10% using automatic assessment would classify breast parenchyma as fatty or dense with substantial accuracy and consistency compared to radiologists’ BI-RADS categorization, which suffers from high inter-observer variation.

Anti-VEGF (vascular endothelial growth factor) treatment improves response rates, but not progression-free or overall survival in advanced breast cancer. It has been suggested that subgroups of patients may benefit from this treatment; however, the effects of adding anti-VEGF treatment to a standard chemotherapy regimen in breast cancer patients are not well studied. Understanding the effects of the anti-vascular treatment on tumor vasculature may provide a selection of patients that can benefit. The aim of this study was to study the vascular effect of bevacizumab using clinical dynamic contrast-enhanced MRI (DCE-MRI). A total of 70 women were randomized to receive either chemotherapy alone or chemotherapy with bevacizumab for 25 weeks. DCE-MRI was performed at baseline and at 12 and 25 weeks, and in addition 25 of 70 patients agreed to participate in an early MRI after one week. Voxel-wise pharmacokinetic analysis was performed using semi-quantitative methods and the extended Tofts model. Vascular architecture was assessed by calculating the fractal dimension of the contrast-enhanced images. Changes during treatment were compared with baseline and between the treatment groups. There was no significant difference in tumor volume at any point; however, DCE-MRI parameters revealed differences in vascular function and vessel architecture. Adding bevacizumab to chemotherapy led to a pronounced reduction in vascular DCE-MRI parameters, indicating decreased vascularity. At 12 and 25 weeks, the difference between the treatment groups is severely reduced.