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Rachel F Brem

Publications and source records attributed to Rachel F Brem.

18 recordsLinked to original sources
PubMed2005

Evaluation of breast cancer with a computer-aided detection system by mammographic appearance and histopathology.

BACKGROUND: The objective of this study was to evaluate the performance of a computer-aided detection (CAD) system for the detection of breast cancer, based on mammographic appearance and histopathology. METHODS: From 1000 consecutive screening mammograms from women with biopsy-proven breast carcinoma, 273 mammograms were selected randomly for retrospective evaluation by CAD. The sensitivity of the CAD system for breast cancer was assessed from the proportion of masses and microcalcifications detected. The corresponding tumor histopathologies also were evaluated. Normal mammograms (n = 155 patients) were used to determine the false-positive rate of the system. RESULTS: Of the 273 breast carcinomas, 149 appeared mammographically as masses, and 88 appeared as microcalcifications, including 36 carcinomas that presented as mixed lesions. The CAD system marked 125 of 149 masses correctly (84%), marked 86 of 88 microcalcifications correctly (98%), and marked 32 of 36 of mixed lesions correctly (89%.). The system showed a high sensitivity for the detection of ductal carcinoma in situ (95%; 73 of 77 lesions), invasive lobular carcinoma (95%; 18 of 19 lesions), invasive ductal carcinoma (85%; 125 of 147 lesions), and invasive mammary carcinoma (90%; 27 of 30 lesions). The highest CAD system sensitivity was for all invasive carcinomas that presented as microcalcifications (100%). On normal mammograms, there was an average of 1.3 false-positive CAD marks per image. CONCLUSIONS: The CAD system correctly marked a large majority of biopsy-proven breast cancers, with a greater sensitivity for lesions with microcalcifications and without significant impact of performance based on tumor histopathology. CAD was highly effective in detecting invasive lobular carcinoma (sensitivity, 95%) and ductal carcinoma in situ (sensitivity, 95%). CAD represents a useful tool for the detection of breast cancer.

Adult↗
PubMed2005

Occult breast cancer: scintimammography with high-resolution breast-specific gamma camera in women at high risk for breast cancer.

PURPOSE: To prospectively evaluate a high-resolution breast-specific gamma camera for depicting occult breast cancer in women at high risk for breast cancer but with normal mammographic and physical examination findings. MATERIALS AND METHODS: Institutional Review Board approval and informed consent were obtained. The study was HIPAA compliant. Ninety-four high-risk women (age range, 36-78 years; mean, 55 years) with normal mammographic (Breast Imaging Reporting and Data System [BI-RADS] 1 or 2) and physical examination findings were evaluated with scintimammography. After injection with 25-30 mCi (925-1110 MBq) of technetium 99m sestamibi, patients were imaged with a high-resolution small-field-of-view breast-specific gamma camera in craniocaudal and mediolateral oblique projections. Scintimammograms were prospectively classified according to focal radiotracer uptake as normal (score of 1), with no focal or diffuse uptake; benign (score of 2), with minimal patchy uptake; probably benign (score of 3), with scattered patchy uptake; probably abnormal (score of 4), with mild focal radiotracer uptake; and abnormal (score of 5), with marked focal radiotracer uptake. Mammographic breast density was categorized according to BI-RADS criteria. Patients with normal scintimammograms (scores of 1, 2, or 3) were followed up for 1 year with an annual mammogram, physical examination, and repeat scintimammography. Patients with abnormal scintimammograms (scores of 4 or 5) underwent ultrasonography (US), and those with focal hypoechoic lesions underwent biopsy. If no lesion was found during US, patients were followed up with scintimammography. Specific pathologic findings were compared with scintimammographic findings. RESULTS: Of 94 women, 78 (83%) had normal scintimammograms (score of 1, 2, or 3) at initial examination and 16 (17%) had abnormal scintimammograms (score of 4 or 5). Fourteen (88%) of the 16 patients had either benign findings at biopsy or no focal abnormality at US; in two (12%) patients, invasive carcinoma was diagnosed at US-guided biopsy (9 mm each at pathologic examination). CONCLUSION: High-resolution breast-specific scintimammography can depict small (<1-cm), mammographically occult, nonpalpable lesions in women at increased risk for breast cancer not otherwise identified at mammography or physical examination.

Adult↗
PubMed2005

Tc-99m sestamibi uptake in the chest mimicking a malignant lesion of the breast.

The use of nuclear medicine imaging of the breast has resulted in the improved diagnosis of breast cancer (Radiology 196 (1995) 421; J. Nucl. Med. 36 (1995) 1758). It's use is becoming more widespread, particularly as breast optimized scintigraphy with a high-resolution, breast-specific gamma camera has been developed (J. Nucl. Med. 43 (2002) 909; J. Nucl. Med. 45 (2004) 553). With the increasing use of breast-optimized scintigraphy, pitfalls in the interpretation of breast-optimized scintigraphy are being recognized. This report describes a previously unrecognized cause for a false positive interpretation of scintimammography due to tumor uptake of the radiotracer in the chest as a result of physiologic activity in the auricular aspect of the right atrium.

Aged↗
PubMed2005

Impact of breast density on computer-aided detection for breast cancer.

OBJECTIVE: Our aim was to determine whether breast density affects the performance of a computer-aided detection (CAD) system for the detection of breast cancer. MATERIALS AND METHODS: Nine hundred six sequential mammographically detected breast cancers and 147 normal screening mammograms from 18 facilities were classified by mammographic density. BI-RADS 1 and 2 density cases were classified as nondense breasts; BI-RADS 3 and 4 density cases were classified as dense breasts. Cancers were classified as either masses or microcalcifications. All mammograms from the cancer and normal cases were evaluated by the CAD system. The sensitivity and false-positive rates from CAD in dense and nondense breasts were evaluated and compared. RESULTS: Overall, 809 (89%) of 906 cancer cases were detected by CAD; 455/505 (90%) cancers in nondense breasts and 354/401 (88%) cancers in dense breasts were detected. CAD sensitivity was not affected by breast density (p=0.38). Across both breast density categories, 280/296 (95%) microcalcification cases and 529/610 (87%) mass cases were detected. One hundred fourteen (93%) of the 122 microcalcifications in nondense breasts and 166 (95%) of 174 microcalcifications in dense breasts were detected, showing that CAD sensitivity to microcalcifications is not dependent on breast density (p=0.46). Three hundred forty-one (89%) of 383 masses in nondense breasts, and 188 (83%) of 227 masses in dense breasts were detected-that is, CAD sensitivity to masses is affected by breast density (p=0.03). There were more false-positive marks on dense versus nondense mammograms (p=0.04). CONCLUSION: Breast density does not impact overall CAD detection of breast cancer. There is no statistically significant difference in breast cancer detection in dense and nondense breasts. However, the detection of breast cancer manifesting as masses is impacted by breast density. The false-positive rate is lower in nondense versus dense breasts. CAD may be particularly advantageous in patients with dense breasts, in which mammography is most challenging.

Adult↗
PubMed2005

A computer-aided detection system for the evaluation of breast cancer by mammographic appearance and lesion size.

OBJECTIVE: The purpose of our study was to evaluate the performance of a computer-aided detection (CAD) system in the detection of breast cancer based on mammographic appearance and lesion size. CONCLUSION: The CAD system correctly marked most biopsy-proven breast cancers, with a greater sensitivity for microcalcification than for mass lesions but with no significant difference in performance based on cancer size. CAD was highly effective in detecting even the smallest lesions, with a sensitivity of 92% for lesions of 5 mm or less. CAD is a useful tool for the detection of breast cancer.

Adult↗
PubMed2003

Improvement in sensitivity of screening mammography with computer-aided detection: a multiinstitutional trial.

OBJECTIVE: Our study evaluated radiologist detection of breast cancer using a computer-aided detection system. MATERIALS AND METHODS: Three radiologists reviewed 377 screening mammograms interpreted as showing normal or benign findings 9-24 months before cancer diagnosis from 17 of the 18 participating centers. In 313 cases, study radiologists recommended additional mammographic evaluation. In 177 cases, the area warranting additional workup precisely correlated with the subsequently diagnosed cancer. These 177 missed cancers were evaluated with computer-aided detection. The proportion of radiologists identifying the missed cancers was used to determine radiologist sensitivity without computer-aided detection. RESULTS: The study radiologists determined that 123 of the 377 missed cancer cases warranted workup. Therefore, 123 additional cancers cases could have been found. The calculated radiologist sensitivity without computer-aided detection was therefore 75.4% (377 / [377 + 123]). Similarly, using the performance of the system on the missed cancers, we estimated that 80 (65.0%) of these 123 missed cancer cases would have been identified with the use of computer-aided detection. Consequently, the estimated sensitivity of radiologists using computer-aided detection was 91.4% ([377 + 80] / [377 + 123])-resulting in a 21.2% ([91.4% / 75.4%] - 1) increase in radiologist sensitivity with computer-aided detection. CONCLUSION: Use of the computer-aided detection system significantly improved the detection of breast cancer by increasing radiologist sensitivity by 21.2%. Therefore, for every 100,000 women with breast cancer identified without the use of computer-aided detection, an estimated additional 21,200 cancers would be found with the use of computer-aided detection.

Adult↗
PubMed2002

Determining efficacy of mammographic CAD systems.

Computer-aided detection (CAD) system sensitivity estimates without a radiologist in the loop are straightforward to measure but are extremely data dependent. The only relevant performance metric is improvement in CAD-assisted radiologist sensitivity. Unfortunately, this is difficult to accurately assess. Without a large study measuring the improvement in CAD-assisted radiologist sensitivity over the same cases, it is not possible to make valid comparisons between systems. As multiple CAD systems become commercially available, comparison issues need to be explored and resolved. Data from clinical trials of 2 systems are examined. Statistical hypothesis tests are applied to these data. Additionally, sensitivities of 2 systems are compared from an experiment testing over the same 120 cases. Even with large databases, there is not sufficient evidence to conclude performance differences exist between the 2 systems. It is prohibitively expensive to show conclusive sensitivity differences between commercially available mammographic CAD systems.

Breast Neoplasms↗
PubMed2002

Use of ultrasound in breast disease.

Ultrasound in the most frequently used adjunct imaging modality to mammography for the evaluation of the breast. This review discusses the history of breast ultrasound and its current use, including equipment, appropriate method of scanning, and normal breast anatomy. Sonographic characteristics for lesion assessment as well as appropriate uses for breast ultrasound are reviewed. The use of ultrasound to guide minimally invasive breast biopsy as well as emerging technologies and applications for ultrasound are also discussed.

Journal Article↗
PubMed2002

High-resolution scintimammography: a pilot study.

UNLABELLED: This study evaluated a novel high-resolution breast-specific gamma camera (HRBGC) for the detection of suggestive breast lesions. METHODS: Fifty patients (with 58 breast lesions) for whom a scintimammogram was clinically indicated were prospectively evaluated with a general-purpose gamma camera and a novel HRBGC prototype. The results of conventional and high-resolution nuclear studies were prospectively classified as negative (normal or benign) or positive (suggestive or malignant) by 2 radiologists who were unaware of the mammographic and histologic results. All of the included lesions were confirmed by pathology. RESULTS: There were 30 benign and 28 malignant lesions. The sensitivity for detection of breast cancer was 64.3% (18/28) with the conventional camera and 78.6% (22/28) with the HRBGC. The specificity with both systems was 93.3% (28/30). For the 18 nonpalpable lesions, sensitivity was 55.5% (10/18) and 72.2% (13/18) with the general-purpose camera and the HRBGC, respectively. For lesions < or = 1 cm, 7 of 15 were detected with the general-purpose camera and 10 of 15 with the HRBGC. Four lesions (median size, 8.5 mm) were detected only with the HRBGC and were missed by the conventional camera. CONCLUSION: Evaluation of indeterminate breast lesions with an HRBGC results in improved sensitivity for the detection of cancer, with greater improvement shown for nonpalpable and < or =1-cm lesions.

Breast↗
PubMedDate not supplied

Surgical and mammographic follow-up of papillary lesions and atypical lobular hyperplasia diagnosed with stereotactic vacuum-assisted biopsy.

The purpose of this study was to assess the accuracy of stereotactic vacuum-assisted biopsy (SVAB) for the diagnosis of high-risk lesions, which include papillary lesions and atypical lobular hyperplasia (ALH). Retrospective review was performed of 212 consecutive SVABs at our institution between May 1, 2000 and February 28, 2001. Biopsies were performed using an 8-gauge SVAB probe, with the patient prone on a dedicated stereotactic table. Eleven to 17 cores (mean 12.4) were harvested from each lesion. Radiography of core specimens was performed in cases in which the targeted lesion contained microcalcifications. Six of the lesions (2.8%) demonstrated intraductal papilloma, 1 (16.7%) of which had features suggestive of a radial scar, and 7 (3.3%) demonstrated ALH. Surgical excision was performed on 3 of the 6 (50%) papillomas and all 7 (100%) cases of ALH. Histopathologic analysis at surgical excision demonstrated benign breast tissue in 1 of the papillomas (33.3%), radial scar in 1 (33.3%), and atypical ductal hyperplasia (ADH) in 1 (33.3%). One papilloma not surgically excised underwent repeat mammography at 6 months and demonstrated no change. Of the surgically excised lesions with ALH, 4 (57.1%) retained the diagnosis of ALH, though one of these (25%) also demonstrated a coexisting radial scar. One lesion (14.3%) demonstrated ductal carcinoma in situ (DCIS), 1 (14.3%) demonstrated lobular carcinoma in situ (LCIS), and 1 (14.3%) demonstrated fibrocystic change. Lesions diagnosed as papillomas at SVAB did not demonstrate malignancy, but 2 (66.7%) were found to contain high-risk lesions that may impact surveillance or prophylactic therapy (i.e., tamoxifen). Because of the relatively small series reported, additional studies are necessary to further assess the accuracy of SVAB in the diagnosis of benign papillary lesions. ALH diagnosed with SVAB that underwent subsequent surgical excision demonstrated cancer in 1 of 7 lesions (14.3%). This rate of cancer underestimation is similar to that seen with ADH diagnosed with SVAB, which warrants surgical excision to rule out malignancy. Therefore we recommend that lesions demonstrating ALH at SVAB be considered for surgical excision to rule out malignancy.

Adult↗
PubMedDate not supplied

Bilateral plasmacytoma of the breast: a case report.

Plasmacytoma of the breast is a rare condition that may occur as a solitary finding or in association with multiple myeloma. Of the cases of plasmacytoma of the breast that have been described, nearly half have been bilateral. We report a case of bilateral plasmacytoma of the breast detected on a routine screening mammogram in a patient with a recent diagnosis of multiple myeloma.

Biopsy, Needle↗
PubMedDate not supplied

Development of malignant breast microcalcifications after neoadjuvant chemotherapy in advanced breast cancer.

The increased interest in the use of neoadjuvant chemotherapy for patients with locally advanced or large tumors at initial presentation necessitates the recognition of sequelae of this therapy. This article describes the interval appearance of malignant, linear-branching, microcalcifications during neoadjuvant chemotherapy for locally advanced breast cancer. Mammographically the malignant microcalcifications appeared only in the region of the breast where the primary tumor was found. Pathologically only a subpopulation of malignant cells responded to the chemotherapy, demonstrating viability of the majority of the tumor, with cell death only in the subpopulation. With the increased use of neoadjuvant chemotherapy, it is important to recognize previously undescribed mammographic findings secondary to this therapeutic approach.

Adult↗