It has long been said that a national reporting standard is needed in order to ensure all American women receive at least the same basic information regarding breast density, and a spotlight put on the importance of routine breast imaging. Dr. Wendie Berg, a leading breast cancer specialist, shares with ITN what is being done in the fight against breast cancer and the importance of this standardization in reporting for women.

Dr. Berg, MD, PhD, FACR, FSBI, is Professor of Radiology at the University of Pittsburgh School of Medicine and Magee-Womens Hospital of UPMC, specializing in breast imaging. She is also the Chief Scientific Advisor to DenseBreast-info.org. A renowned expert, she writes and co-edits one of the leading textbooks on the topic, Diagnostic Imaging: Breast, currently in its third edition, and has co-authored over 120 peer-reviewed research publications.

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Stamatia Destounis, M.D., FACR, chief of the American College of Radiology (ACR) Breast Commission, managing partner, Elizabeth Wende Breast Care, Rochester, N.Y., explains some of the key trends in breast imaging at the 2021  Radiological Society of North America (RSNA) meeting.

She discusses the trends of 3D mammography seeing rapid growth, adoption of synthetic 2D breast images from the tomosynthesis datasets, contrast-enhanced mammography, and breast MRI to help women with dense breast tissue. Destounis also discusses the use of artificial intelligence (AI) to help radiologists with finding what they needs with larger datasets in 3D mammography, and to help act as a second set of eyes.

Early in 2021, with the roll out of the COVID vaccines, one of the biggest headlines in radiology was that the vaccine can show false positives for cancer because it may cause inflammation of lymph nodes. Destounis explains this issue and how women's health centers have largely overcome this by asking patients about their vaccination status and planning imaging around the vaccination dates.

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Constance "Connie" Lehman, M.D., Ph.D., chief of breast imaging, co-director of the Avon Comprehensive Breast Evaluation Center at the Massachusetts General Hospital, and professor of radiology at Harvard Medical School, explains issues and suggested guidelines for women who receive the COVID-19 vaccine and need to get a mammogram. In the first three months since the vaccines have been released, there have been numerous case reports of the vaccine causing swollen lymph nodes. This is would usually raise a red flag for breast cancer, but is normal for many women receiving the vaccine as their body's immune system gears up against the virus. 

Lehman said cases reports of axillary adenopathy have been identified on breast imaging after coronavirus disease (COVID-19) vaccination and are rising. Lehman et al. proposed a pragmatic management approach in a recent article in the American Journal of Roentgenology (AJR).[1]

In the settings of screening mammography, screening MRI and diagnostic imaging work-up of breast symptoms, with no imaging findings beyond unilateral axillary adenopathy ipsilateral to recent (prior six weeks) vaccination, they report the adenopathy as benign with no further imaging indicated if no nodes are palpable six weeks after the last vaccine dose. 

For patients with palpable axillary adenopathy in the setting of ipsilateral recent vaccination, clinical follow-up of the axilla is recommended. In all these scenarios, axillary ultrasound is recommended if clinical concern persists six weeks after vaccination. 

In patients with recent breast cancer diagnosis in the pre- or peri-treatment setting, prompt recommended imaging is encouraged as well as vaccination (in the thigh or contralateral arm). The recommendations align with the ACR BI-RADS Atlas and aim to: 1) reduce patient anxiety, provider burden, and costs of unnecessary evaluation of enlarged nodes in the setting of recent vaccination, and 2) avoid further delays in vaccinations and breast cancer screening during the pandemic.

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Reference:

1. Constance D. Lehman, Leslie R. Lamb, and Helen Anne D'Alessandro. Mitigating the Impact of Coronavirus Disease (COVID-19) Vaccinations on Patients Undergoing Breast Imaging Examinations: A Pragmatic Approach American Journal of Roentgenology. 10.2214/AJR.21.25688

Professor Christiane Kuhl, M.D., director of radiology, University Hospital Aachen, Germany, explains how breast magnetic resonance imaging (MRI) can be used to clearly identify breast cancers in women with dense breast tissue. In women with dense breasts, it can be very difficult to detect many cancers on standard mammograms because the cancers and dense tissue both appear white. MRI can help clearly define tumors and identify which nodules are cancer and which are benign, which can help greatly reduce the need for biopsies.

Kuhl is an expert in breast imaging and breast MRI. She helped develop an a shortened MRI protocol that allows breast MR images to be created in 3 minutes or less, rather than standard protocols that can take up to 30 minutes. In the interview she shows patient case examples of standard mammograms and the MRI supplemental imaging for the same patient to show the hidden tumors. 

She also explains the differences between standard 2-d mammography, the current standard of care, and the newer 3-D mammogram tomosythnesis technology, breast ultrasound and breast MRI technologies.

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Professor Christiane Kuhl, M.D., director of radiology, University Hospital Aachen, Germany, explains what it means to have dense breasts and how density can hide cancers in mammograms. She offers an explanation describing dense breast tissue and that this occurs in about half of women. Density is itself a risk factor for breast cancer and the fact that dense tissue hides cancers on mammography means that supplemental imaging is needed to accurately diagnose these patients and avoid false positives, or needless tissue biopsies. Breast ultrasound and breast magnetic resonance imaging (MRI) can be used to see through dense tissue to better identify cancers and avoid the need for many biopsies.

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Imaging Technology News Contributing Editor Greg Freiherr interviewed Henry Izawa, vice president of modality solutions, Fujifilm Medical Systems U.S.A., Inc. about Fujifilm's latest innovations in mammography.

In this video, Izawa announces the latest imaging advancements available for the Aspire Cristalle digital mammography system with digital breast tomosynthesis, including S-View, a synthesized 2-D image reconstructed from DBT and other patient enhancements such as the comfort paddle to provide a noticeably more comfortable exam for the patient.

Watch the video to hear all about Fujifilm's updates.

To learn more, visit www.fujimed.com

Gillian Newstead, M.D., director of global breast imaging and former professor at the University of Chicago, explains a large breast MRI screening study presented at the 2019 Radiological Society of North America (RSNA) meeting. 

The DENSE Trial Study Group included 40,000 women from the Netherlands who underwent standard mammography. Of these, 8,061 women were identified as having dense breasts and were offered supplemental MRI screening, and about half took advantage of the additional screening. Dense breast tissue which can obscure cancer on conventional mammograms but not on MRI. The MRI cancer-detection rate among the women who actually underwent MRI screening was 16.5 per 1,000 screenings.

The use of supplemental magnetic resonance imaging (MRI) screening in women with extremely dense breast tissue and normal results on mammography resulted in the diagnosis of significantly fewer interval cancers than mammography alone during a two-year screening period. The results were published in the Nov.  28, 2019, issue of The New England Journal of Medicine and presented earlier at the European Congress of Radiology (ECR) 2019.

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Reference:

Bakker MF, de Lange SV, Pijnappel RM, et al. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. N Engl J Med 2019; 381:2091-2102. DOI: 10.1056/NEJMoa1903986.

At the Society of Breast Imaging (SBI)/American College of Radiology (ACR) 2019 Symposium, Rasu Shrestha, M.D., MBA, chief strategy officer for Atrium Health, discusses his new role with Atrium, the hype cycle of artificial intelligence (AI) and the key elements of getting AI in radiology — and in healthcare — right.

Read the article "Atrium Health Debuts Amazon Alexa Skill to Help Patients Access Medical Care"

Listen to the podcast Is Artificial Intelligence The Doom of Radiology?, a discussion with Shrestha.

Deborah Levine, M.D., professor of radiology at Harvard Medical School and vice chair for academic affairs in the Department of Radiology at Beth Israel Deaconess Medical Center, Boston, describes scenarios where magnetic resonance imaging (MRI) could be more useful than ultrasound in issues with the female pelvis.

At RSNA 2018, iCad showed how its ProFound AI for digital breast tomosynthesis technology might help in the interpretation of tomosynthesis exams. Rodney Hawkins, vice president of marketing for iCad, discusses how this technology can better help detect the cancer.

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ITN Editor Dave Fornell takes a tour of some of the most interesting new medical imaging technologies displayed on the expo floor at the 2018 Radiological Society of North America (RSNA) meeting. The video includes new technologies for fetal ultrasound, CT, MRI, mobile DR X-ray, a new generation of fluoroscopy systems, MRI contrast mapping to better identify tumors, and a new technique to create moving X-ray images from standard DR imaging.

Watch the related VIDEO: Editor’s Choice of the Most Innovative New Artificial Intelligence Technologies at RSNA 2018. This includes a tour of some of the recently FDA-cleared AI technologies for medical imaging at RSNA 2018. 

Stamatia Destounis, M.D., FACR, associate professor, University of Rochester School of Medicine, and attending radiologist, Elizabeth Wende Breast Care, explains the details of a new study showing the benefits of mammography in elderly women at the Radiological Society of North America (RSNA) 2018 annual meeting.

Elizabeth Chabner-Thompson, M.D., MPH, radiation oncologist, Northern Westchester Hospital, Northwell Health, Mt. Kisco, N.Y., and CEO of Masthead, explains an FDA-cleared bra she designed for improved patient positioning of women undergoing radiation therapy. She spoke to ITN at the 2018 ASTRO conference. 

ITN Editorial Director Melinda Taschetta-Millane speaks to DenseBreast-info Executive Director JoAnn Pushkin as the website celebrates three years as an information resource on breast density for patients and providers. Pushkin also discusses the latest developments in breast density notification and screening guidelines.

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ITN and DAIC Editor Dave Fornell takes a tour of some of the most interesting new medical imaging technologies on the expo floor at the 2017 Radiological Society of North America (RSNA) meeting. Watch the editor’s choice video for new health IT technologies at HIMSS 2017, new advances in cardiac ultrasound at ASE 2017, and CT advances at the SCCT 2017 meeting.

Martin Yaffe, Ph.D., FAAPM, senior scientist, physical sciences/imaging research, Sunnybrook Health Sciences Centre, and professor of medical biophysics and medical imaging, University of Toronto, discusses how contrast-enhanced mammography can improve breast cancer detection at the 2017 Radiological Society of North America (RSNA) meeting.

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William Hall, M.D., radiation oncologist in the Department of Radiation Oncology at PeaceHealth St. Joseph Medical Center in Bellingham, Wash., discusses study results presented at theAmerican Society of Radiation Oncology (ASTRO) 2016. Video courtesy of Dr. Hall. You can read Dr. Hall's article on this topic, Breast Cancer Radiation Planning, here. 

Monica Saini, M.D., consultant medical director — ABUS at GE Healthcare, discusses the necessity for personalized breast care, and how Automated Breast Ultrasound (ABUS) helps meet the challenges of screening and diagnostic imaging of dense breast tissue. To learn more about Automated Breast Ultrasound, please visit gehealthcare.com/inveniaabus.

The purpose of this exploratory video roundtable is to examine the state of breast biopsies today and to communicate the current challenges and inefficiencies affecting personnel that perform these important procedures. The video roundtable posed key questions to Key Opinion Leaders from the Cleveland Clinic on obstacles they face when performing stereotactic-guided breast biopsies, and why it is necessary to consider the ramifications. The roundtable discussion was hosted by Imaging Technology News and was funded through a grant from Hologic Inc.

Also, see the related article, Room for Improvement in Women's Health, by Laura Shepardson, M.D.