mammography how safe & effective screening tool
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Mammography, how safe & effective in screening
&early detection of Breast cancer ?
NEED/SCREENING
• 1million new cases /yr ,cancer is a major health problem
• 18% BC
• 1in 8 US, I in 30 in India
• Advanced Breast Cancer 10-20% US, 30-60% in developing countries.
Goal
• Goal of any screening test is to use a test of sufficient sensitivity to detect a large proportion of a particular disease in population.
HOW
• BSE,BPE,MAMMOGRAPHY can detect benign ,precancers like DCIS,LCIS,PAGET’S DISEASE and early invasive cancers.
• Further evaluation of any suspicious lesion- Diagnostic Mammography ,Sonography, Elastography, MRI, PET.
RECOMMENDATIONS• ACS/ACR – Annual screening from 40• USPSTF2009, 50-74 YRS EVRY 2 YRS:
-Overdiagnosis and unnecessary treatment(10/1life saved)
- Anxiety- Slight increase in radiation induced BC- Below 35 yrs not recommended, Sonography
/MRI.- Cost of screening
ROUTINE SCREENING STILL A MATTEROF DEBATE
• COCHRANE COLLABORATIVE DATABASES 2011(US/ NORDIC)
Universal screening does more harm than good and is not reasonable.
Screening detects 3-13% BC DR in some countries with organized
screening by 2/3rd.Benefit to risk ratio-48.5/1 (safe)
Stagewise survival
0 98%
I 88%
IIA 81%
iiB 74%
IIIA 67%
iiiB 41%
IIIC 49%
IV 15%
WHAT IS MAMMOGRAPHY
• LOW ENERGY XRAY 30 Kv examines the breast & typically finds:
• Lump-( well defined/irregular)
-solid/cystic
• Macro calcifications –Ageing
• Micrcalcifications - spiculated
-clustered
-linear branching
SENSIVITY/SPECIFICITY
• SENSSITIVITY-79%,LESS IN YOUNG(Effective)
• SPECIFICITY:FALSE NEGATIVE 10-30%FALSE POSITIVE -7%(UNNECESSARY
FOLLOW UP SCREENING )
Reporting of mammography findings:
• BIRADS SCORE(BREAST IMAGING REPORTING AND DATA SYSTEM)/ACR
• 0-6=INCOMPLETE-BIOPSY PROVED
A Brief History
- 1913 Albert Salomon, German surgeon
- 1950’s - Jacob Gershon-Cohen began to advocate widespread use of X-rays for screening
- December 2005 – RSNA brings digital mammography to US
Mammography
Past & PresentSimilar equipments were & are still being used,
these can be called as old fashioned equipments
cone
Tube
Breast Stand
Standard views:
45* Medio lateral Oblique (MLO view)/
Lundgren’s view
Craniocaudal view (CC view)
RCC RMLOLCC LMLO
Left Craniocaudal
Right Craniocaudal
Right Mediolateral
Oblique
Left Mediolateral Oblique
PROCEDURE
• Breast compressed between two parallel plates ,reduces the thickness and increases sensitivity
• 2 views –CC,MLO• TALCUM POWDERS/DEODORANTS
DISCOURAGED• 1 WK AFTER MENSES• < 30 MINS
WORK UP
• SCREENING
• DIAGNOSTICMAMMOGRAPHY
• STEROTACTIC OR US GUIDED CORE BIOPSY
LATLeft Axillary Tail
LCV Left Cleavage
LFBLeft From Below
LLMOLeft Lateromedial
Oblique
LMLLet Mediolateral
LRLLeft Roll Lateral
LRMLeft Roll Medial
LLMLeft Lateromedial
CONVENTIONAL CC VIEW EKLUND CC VIEW
Mammography
In digital mammography screen-film system has been replaced by Detectors to give the digital images
Mammography
Present & future
CCD camera
Work station
Equipments look like this
ADVANTAGES
• Improved signal-to-noise ratio
• Ability to magnify, change contrast, or alter the brightness.
• Near instantaneous image acquisition
Digital Mammographic Imaging Screening Trial
(DMIST)
• Retrospective study of 49,500 asymptomatic women• Assessed accuracy of digital vs film mammograms
RESULTS:• Digital mammography significantly more accurate in pre-
and perimenopausal women under 50 with dense breasts
• Nonsignificant trend toward improved accuracy with film mammograms in women over 65 with fatty breasts
cost issues
• Digital mammography is expensive!
• Using digital technology in all women would cost >$300,000 per QALY gained
• Targeted use of digital mammography on basis of age/breast density costs ~$50,000 per QALY gained
Computer-Aided Detection
• Software program that highlights areas of concern on digital mammograms
• Uses image processing algorithms and decision threshold parameters to detect features in an image likely to be of clinical significance
• Very sensitive – detects 90% of all cancers• However, has a high rate of false positives (2-4 per study)
http://www.imagingeconomics.com/issues/articles/2005-12_04.asp
THANK YOU Stay hungry stay foolish-Steve Jobs Dr. Gopa Ghosh, M.D. Dr.O.P. Singh, M.D. FICRO