PubMed Health⌕ Search

Biomedical subjects

Roberta A Jong

Publications and source records attributed to Roberta A Jong.

7 recordsLinked to original sources
PubMed2007

Mammographic density and the risk and detection of breast cancer.

BACKGROUND: Extensive mammographic density is associated with an increased risk of breast cancer and makes the detection of cancer by mammography difficult, but the influence of density on risk according to method of cancer detection is unknown. METHODS: We carried out three nested case-control studies in screened populations with 1112 matched case-control pairs. We examined the association of the measured percentage of density in the baseline mammogram with risk of breast cancer, according to method of cancer detection, time since the initiation of screening, and age. RESULTS: As compared with women with density in less than 10% of the mammogram, women with density in 75% or more had an increased risk of breast cancer (odds ratio, 4.7; 95% confidence interval [CI], 3.0 to 7.4), whether detected by screening (odds ratio, 3.5; 95% CI, 2.0 to 6.2) or less than 12 months after a negative screening examination (odds ratio, 17.8; 95% CI, 4.8 to 65.9). Increased risk of breast cancer, whether detected by screening or other means, persisted for at least 8 years after study entry and was greater in younger than in older women. For women younger than the median age of 56 years, 26% of all breast cancers and 50% of cancers detected less than 12 months after a negative screening test were attributable to density in 50% or more of the mammogram. CONCLUSIONS: Extensive mammographic density is strongly associated with the risk of breast cancer detected by screening or between screening tests. A substantial fraction of breast cancers can be attributed to this risk factor.

Adult↗
PubMed2006

MR imaging-guided breast localization system with medial or lateral access.

PURPOSE: To evaluate the degree of error of the authors' magnetic resonance (MR) imaging-guided needle localization system for biopsy of suspicious lesions visualized only with MR imaging, by using both prospectively recorded and retrospectively reviewed data, including MR imaging lesion coordinates as the reference standard, and to determine whether any lesion or breast characteristics affect this error. MATERIALS AND METHODS: Institutional review board approval, along with informed consent, was obtained as directed by the board. In 31 patients (age range, 34-64 years; mean age, 54.5 years), 38 wires were placed for 35 lesions by means of an MR-guided needle localization system with medial or lateral access and computer software assistance for needle placement calculation. Needle and wire placement error measurements were calculated before and after necessary placement correction, accounting for tissue shift in the z plane. The error was statistically correlated with MR imaging lesion variables, breast density, and histopathologic findings by means of univariate and multivariate linear regression analyses or two-tailed paired t test. Procedure times and the frequency of medial or lateral approaches were recorded. RESULTS: Eleven of 35 localizations (31%) were medial, and 24 of 35 (69%) were lateral. The mean total magnet time was 61.6 minutes, and the mean needle deployment time was 9 minutes (range, 4-17 minutes). Sixteen of 35 lesions (46%) were malignant (seven ductal carcinoma in situ, six invasive ductal, two invasive lobular, and one lymphoma). The mean uncorrected needle placement error was 1.3 mm (range, 0-6 mm) for the x plane, 2.4 mm (range, 0-6.5 mm) for the y plane, and 5.6 mm (range, 0-15.6 mm) for the z plane. Fourteen of 38 needles (37%) required repositioning for z-plane error. The corrected z-plane error improved to 3.2 mm (range, 0-10.0 mm). Factors that significantly increased the uncorrected error included tissue shift in the z plane (R = 0.7), small lesion size (R = -0.59), and fatty breast density (P = .029). CONCLUSION: The authors' system is accurate for performing MR-guided needle localizations for both medial and lateral approaches. Factors that increased the uncorrected needle placement error included small lesion size, fatty breast density, and tissue shift in the z plane.

Adult↗
PubMed2005

American College of Radiology Imaging Network digital mammographic imaging screening trial: objectives and methodology.

This study was approved by the Institutional Review Board (IRB) of the American College of Radiology Imaging Network (ACRIN) and each participating site and by the IRB and the Cancer Therapy Evaluation Program at the National Cancer Institute. The study was monitored by an independent Data Safety and Monitoring Board, which received interim analyses of data to ensure that the study would be terminated early if indicated by trends in the outcomes. The ACRIN, which is funded by the National Cancer Institute, conducted the Digital Mammographic Imaging Screening Trial (DMIST) primarily to compare the diagnostic accuracy of digital and screen-film mammography in asymptomatic women presenting for screening for breast cancer. Over the 25.5 months of enrollment, a total of 49 528 women were included at the 33 participating sites, which used five different types of digital mammography equipment. All participants underwent both screen-film and digital mammography. The digital and screen-film mammograms of each subject were independently interpreted by two radiologists. If findings of either examination were interpreted as abnormal, subsequent work-up occurred according to the recommendations of the interpreting radiologist. Breast cancer status was determined at biopsy or follow-up mammography 11-15 months after study entry. In addition to the measurement of diagnostic accuracy by using the interpretations of mammograms at the study sites, DMIST included evaluations of the relative cost-effectiveness and quality-of-life effects of digital versus screen-film mammography. Six separate reader studies using the de-identified archived DMIST mammograms will also assess the diagnostic accuracy of each of the individual digital mammography machines versus screen-film mammography machines, the effect of breast density on diagnostic accuracy of digital and screen-film mammography, and the effect of different rates of breast cancer on the diagnostic accuracy in a reader study.

Breast Neoplasms↗
PubMed2004

Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination.

CONTEXT: Current recommendations for women who have a BRCA1 or BRCA2 mutation are to undergo breast surveillance from age 25 years onward with mammography annually and clinical breast examination (CBE) every 6 months; however, many tumors are detected at a relatively advanced stage. Magnetic resonance imaging (MRI) and ultrasound may improve the ability to detect breast cancer at an early stage. OBJECTIVE: To compare the sensitivity and specificity of 4 methods of breast cancer surveillance (mammography, ultrasound, MRI, and CBE) in women with hereditary susceptibility to breast cancer due to a BRCA1 or BRCA2 mutation. DESIGN, SETTING, AND PARTICIPANTS: A surveillance study of 236 Canadian women aged 25 to 65 years with BRCA1 or BRCA2 mutations who underwent 1 to 3 annual screening examinations, consisting of MRI, mammography, and ultrasound at a single tertiary care teaching hospital between November 3, 1997, and March 31, 2003. On the day of imaging and at 6-month intervals, CBE was performed. MAIN OUTCOME MEASURES: Sensitivity and specificity of each of the 4 surveillance modalities, and sensitivity of all 4 screening modalities vs mammography and CBE. RESULTS: Each imaging modality was read independently by a radiologist and scored on a 5-point Breast Imaging Reporting and Data System scale. All lesions with a score of 4 or 5 (suspicious or highly suspicious for malignancy) were biopsied. There were 22 cancers detected (16 invasive and 6 ductal carcinoma in situ). Of these, 17 (77%) were detected by MRI vs 8 (36%) by mammography, 7 (33%) by ultrasound, and 2 (9.1%) by CBE. The sensitivity and specificity (based on biopsy rates) were 77% and 95.4% for MRI, 36% and 99.8% for mammography, 33% and 96% for ultrasound, and 9.1% and 99.3% for CBE, respectively. There was 1 interval cancer. All 4 screening modalities combined had a sensitivity of 95% vs 45% for mammography and CBE combined. CONCLUSIONS: In BRCA1 and BRCA2 mutation carriers, MRI is more sensitive for detecting breast cancers than mammography, ultrasound, or CBE alone. Whether surveillance regimens that include MRI will reduce mortality from breast cancer in high-risk women requires further investigation.

Adult↗
PubMed2003

Contrast-enhanced digital mammography: initial clinical experience.

PURPOSE: To investigate the potential of using intravenous contrast material with full-field digital mammography to facilitate the detection and characterization of lesions in the breast. MATERIALS AND METHODS: Twenty-two women scheduled for biopsy because they were suspected of having abnormalities at breast imaging underwent imaging with contrast material-enhanced digital mammography. Six sequential images of the affected breast were obtained, with a contrast agent injected intravenously between the time the first and second images were obtained. Image processing included registration and logarithmic subtraction. Lesions were evaluated for the presence, morphology, and kinetics of enhancement. Lesion type, size, and pathologic findings were correlated with the findings at contrast-enhanced digital mammography. RESULTS: At contrast-enhanced digital mammography, enhancement was observed in eight of 10 patients with biopsy-proved cancers. In one case of ductal carcinoma in situ and one case of invasive ductal carcinoma, enhancement was not observed. No enhancement was seen in seven of 12 cases in which lesions were suspected of being malignant at initial imaging but were benign. Morphology generally correlated with the pathologic diagnosis. The kinetics of lesion enhancement showed similarity to that seen with gadolinium-enhanced magnetic resonance imaging but was not consistent. CONCLUSION: The results of this preliminary study suggest that contrast-enhanced digital mammography potentially may be useful in identification of lesions in the mammographically dense breast. Further investigation of contrast-enhanced digital mammography as a diagnostic tool for breast cancer is warranted.

Adult↗
PubMed2003

Diagnostic accuracy of digital mammography in patients with dense breasts who underwent problem-solving mammography: effects of image processing and lesion type.

PURPOSE: To determine effects of lesion type (calcification vs mass) and image processing on radiologist's performance for area under the receiver operating characteristic curve (AUC), sensitivity, and specificity for detection of masses and calcifications with digital mammography in women with mammographically dense breasts. MATERIALS AND METHODS: This study included 201 women who underwent digital mammography at seven U.S. and Canadian medical centers. Three image-processing algorithms were applied to the digital images, which were acquired with Fischer, General Electric, and Lorad digital mammography units. Eighteen readers participated in the reader study (six readers per algorithm). Baseline values for reader performance with screen-film mammograms were obtained through the additional interpretation of 179 screen-film mammograms. A repeated-measures analysis of covariance allowing unequal slopes was used in each of the nine analyses (AUC, sensitivity, and specificity for each of three machines). Bonferroni correction was used. RESULTS: Although lesion type did not affect the AUC or sensitivity for Fischer digital images, it did affect specificity (P =.0004). For the General Electric digital images, AUC, sensitivity, and specificity were not affected by lesion type. For Lorad digital images, the results strongly suggested that lesion type affected AUC and sensitivity (P <.0001). None of the three image-processing methods tested affected the AUC, sensitivity, or specificity for the Fischer, General Electric, or Lorad digital images. CONCLUSION: Findings in this study indicate that radiologist's interpretation accuracy in interpreting digital mammograms depends on lesion type. Interpretation accuracy was not influenced by the image-processing method.

Area Under Curve↗