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Objective: To evaluate the effectiveness of a new strategy for using artificial intelligence (AI) as supporting reader for the detection of breast cancer in mammography-based double reading screening practice. Methods: Large-scale multi-site, multi-vendor data were used to retrospectively evaluate a new paradigm of AI-supported reading. Here, the AI served as the second reader only if it agrees with the recall/no-recall decision of the first human reader. Otherwise, a second human reader made an assessment followed by the standard clinical workflow. The data included 280 594 cases from 180 542 female participants screened for breast cancer at seven screening sites in two countries and using equipment from four hardware vendors. The statistical analysis included non-inferiority and superiority testing of cancer screening performance and evaluation of the reduction in workload, measured as arbitration rate and number of cases requiring second human reading. Results: Artificial intelligence as a supporting reader was found to be superior or noninferior on all screening metrics compared with human double reading while reducing the number of cases requiring second human reading by up to 87% (245 395/280 594). Compared with AI as an independent reader, the number of cases referred to arbitration was reduced from 13% (35 199/280 594) to 2% (5056/280 594). Conclusion: The simulation indicates that the proposed workflow retains screening performance of human double reading while substantially reducing the workload. Further research should study the impact on the second human reader because they would only assess cases in which the AI prediction and first human reader disagree. [ABSTRACT FROM AUTHOR]

Contrast-enhanced spectral mammography (CESM) breast biopsy has been recently introduced into clinical practice. This short communication describes the technique and potential as an alternative to MRI-guided biopsy. An additional abnormality was detected on a breast MRI examination in a patient with lobular carcinoma. The lesion was occult on conventional mammography, tomosynthesis and ultrasound and required histological diagnosis. Traditionally, this would have necessitated an MRI-guided breast biopsy, but was performed under CESM guidance. A diagnostic CESM study was performed to ensure the lesion visibility with CESM and then targeted under CESM guidance. A limited diagnostic study, CESM scout and paired images for stereotactic targeting were obtained within a 10 min window following a single injection of iodinated contrast agent. The time from positioning in the biopsy device to releasing compression after biopsy and marker clip placement was 15 min. The biopsy confirmed the presence of multifocal breast cancer. CESM-guided breast biopsy is a new technique that can be successfully used as an alternative to MRI-guided breast biopsy. CESM-guided biopsy can be used to sample breast lesions which remain occult on standard mammography and ultrasound. [ABSTRACT FROM AUTHOR]

Aims: To establish whether lower resolution, lower cost viewing devices have the potential to deliver mammographic interpretation training. Methods: On three occasions over eight months, fourteen consultant radiologists and reporting radiographers read forty challenging digital mammography screening cases on three different displays: a digital mammography workstation, a standard LCD monitor, and a smartphone. Standard image manipulation software was available for use on all three devices. Receiver operating characteristic (ROC) analysis and ANOVA (Analysis of Variance) were used to determine the significance of differences in performance between the viewing devices with/without the application of image manipulation software. The effect of reader's experience was also assessed. Results: Performance was significantly higher ( p < .05) on the mammography workstation compared to the other two viewing devices. When image manipulation software was applied to images viewed on the standard LCD monitor, performance improved to mirror levels seen on the mammography workstation with no significant difference between the two. Image interpretation on the smartphone was uniformly poor. Film reader experience had no significant effect on performance across all three viewing devices. Conclusion: Lower resolution standard LCD monitors combined with appropriate image manipulation software are capable of displaying mammographic pathology, and are potentially suitable for delivering mammographic interpretation training. Key points: • This study investigates potential devices for training in mammography interpretation. • Lower resolution standard LCD monitors are potentially suitable for mammographic interpretation training. • The effect of image manipulation tools on mammography workstation viewing is insignificant. • Reader experience had no significant effect on performance in all viewing devices. • Smart phones are not suitable for displaying mammograms. [ABSTRACT FROM AUTHOR]

Objectives Multicentre randomized trials frequently encounter difficulties in meeting their recruitment targets, resulting in extension of the trial and delays in implementation of the findings. We report on recruitment strategies implemented in a randomized evaluation of computer-aided detection in women attending routine screening in the UK Breast Screening Programme. Setting The target population for the trial was identified from an existing NHS database of women aged 50-70 invited for routine mammography in Coventry, Manchester and Nottingham, UK. Women were asked to consent to their mammograms being randomly allocated (in a ratio of 28:1:1) to one of three film-reading protocols. Trial information was mailed to women, along with the invitation to attend screening, and informed consent was obtained at the mammography appointment. Several strategies were implemented to increase recruitment rates. Results Recruitment rate increased significantly over time in the study (P < 0.0010 in all centres) with an overall acceptance rate of 46% of those attending screening. Mailing of the trial information sheet separate from the screening invitation in Coventry and Nottingham increased the recruitment rate, even after adjustment for the trend over time and for socioeconomic status of the attendees (P < 0.001). Extension of recruitment to mobile screening units in Nottingham, and the presence of an additional member of staff also improved recruitment (P < 0.001). Simplification of the trial information sheet had little effect. Increases in recruitment rate were not attributable to socioeconomic status of the attendees. Conclusions In multicentre trials, monitoring of local recruitment protocols is required to ensure that each centre can maximize accrual targets. [ABSTRACT FROM AUTHOR]

Abstract: Radiological investigations of the breast are integral to the assessment of symptomatic breast patients and fundamental to the screening programme. Mammography and ultrasound are the standard imaging modalities, supplemented by magnetic resonance imaging in appropriate situations. Possible pathological findings on mammography include masses, architectural distortion, areas of asymmetry between the right and left breast and microcalcification. Ultrasound is the primary method of imaging the breast in younger women. It provides further information about a clinical or mammographic abnormality and can distinguish between solid, cystic or complex lesions. MRI is used in selected cases, to assist with the diagnosis and local staging of primary or recurrent breast cancer. It is also used to assess implant integrity and to screen for malignancy in high-risk women. Image-guided biopsy enables pre-operative diagnosis in most cases of benign and malignant breast conditions. Larger cores of tissue can be obtained with a vacuum assisted biopsy, which may also be used to excise a biopsy-proven benign lesion. As part of the triple assessment, radiological investigations must be correlated with the clinical examination and with any subsequent histology, to ensure-each member of the team is evaluating the same area of the breast. This enables appropriate reassurance to be given when the findings are normal or benign, and accuracy in the diagnosis and staging of patients with breast cancer. [Copyright &y& Elsevier]

Purpose: This retrospective study determined whether a test-set based assessment scheme (PERFORMS) used in a national breast screening programme could be used to predict real-life performance by investigating if the number of cancers missed by mammography readers in real-life related to the number of cancers missed in the PERFORMS test-set and whether real-life reading volumes affected performance.Method: Data was obtained from consenting readers in the screening programme in England (NHSBSP) where double reading is standard. The rate of cancers missed by individual first readers but correctly identified by second readers was compared with the number of cancers missed in the PERFORMS test-set over a 3-year period. NHSBSP readers are required to interpret at least 1500 cases per year as a first reader, so results were compared between readers who exceeded this target and those that did not. Parametric and non-parametric correlations were calculated.Results: Amongst the 536 readers, there was a highly significant positive correlation between the real-life and PERFORMS test-set missed cancer metrics (Pearson Correlation = 0.228, n = 536, p < .0001, Spearman's rho = 0.265, n = 536, p < .0001). There was no significant difference in rates of missed cancers between the 452 readers who exceeded the 1500 first read per year target and those who did not (t(94.2) = -1.87, p = .0643, r = 0.19).Conclusions: The use of a test-set based assessment scheme accurately reflects real-life mammography reading performance, indicating that it can be a useful tool in identifying poor reader performance. [ABSTRACT FROM AUTHOR]

• Reading time of DBT was double that of 2D FFDM images in the screening setting. • Reading times decreased as readers accrued greater experience in the interpretation of DBT. • Understanding reading times is crucial when considering logistics of DBT implementation in national screening programmes. To analyse digital breast tomosynthesis (DBT) reading times in the screening setting, compared to 2D full-field digital mammography (FFDM), and investigate the impact of reader experience and professional group on interpretation times. Reading time data were recorded in the PROSPECTS Trial, a prospective randomised trial comparing DBT plus FFDM or synthetic 2D mammography (S2D) to FFDM alone, in the National Health Service (NHS) breast screening programme, from January 2019-February 2023. Time to read DBT+FFDM or DBT+S2D and FFDM alone was calculated per case and reading times were compared between modalities using dependent T-tests. Reading times were compared between readers from different professional groups (radiologists and radiographer readers) and experience levels using independent T-tests. The learning curve effect of using DBT in screening on reading time was investigated using a Kruskal-Wallis test. Forty-eight readers interpreted 1,242 FFDM batches (34,210 FFDM cases) and 973 DBT batches (13,983 DBT cases). DBT reading time was doubled compared to FFDM (2.09 ± 0.64 min vs. 0.98 ± 0.30 min; p < 0.001), and DBT+S2D reading was longer than DBT + FFDM (2.24 ± 0.62 min vs. 2.04 ± 0.46 min; p = 0.006). No difference was identified in reading time between radiologists and radiographers (2.06 ± 0.71 min vs. 2.14 ± 0.46 min, respectively; p = 0.71). Readers with five or more years of experience reading DBT were quicker than those with less experience (1.86 ± 0.56 min vs. 2.37 ± 0.65 min; p = 0.008), and DBT reading time decreased after less than 9 months accrued screening experience (p = 0.01). DBT reading times were double those of FFDM in the screening setting, but there was a short learning curve effect with readers showing significant improvements in reading times within the first nine months of DBT experience. ClinicalTrials.gov Identifier: NCT03733106. [ABSTRACT FROM AUTHOR]

Background: The sensitivity of screening mammography for the detection of small breast cancers is higher when the mammogram is read by two readers rather than by a single reader. We conducted a trial to determine whether the performance of a single reader using a computer-aided detection system would match the performance achieved by two readers. Methods: The trial was designed as an equivalence trial, with matched-pair comparisons between the cancer-detection rates achieved by single reading with computer-aided detection and those achieved by double reading. We randomly assigned 31,057 women undergoing routine screening by film mammography at three centers in England to double reading, single reading with computer-aided detection, or both double reading and single reading with computer-aided detection, at a ratio of 1:1:28. The primary outcome measures were the proportion of cancers detected according to regimen and the recall rates within the group receiving both reading regimens. Results: The proportion of cancers detected was 199 of 227 (87.7%) for double reading and 198 of 227 (87.2%) for single reading with computer-aided detection (P=0.89). The overall recall rates were 3.4% for double reading and 3.9% for single reading with computer-aided detection; the difference between the rates was small but significant (P<0.001). The estimated sensitivity, specificity, and positive predictive value for single reading with computer-aided detection were 87.2%, 96.9%, and 18.0%, respectively. The corresponding values for double reading were 87.7%, 97.4%, and 21.1%. There were no significant differences between the pathological attributes of tumors detected by single reading with computer-aided detection alone and those of tumors detected by double reading alone. Conclusions: Single reading with computer-aided detection could be an alternative to double reading and could improve the rate of detection of cancer from screening mammograms read by a single reader. (ClinicalTrials.gov number, NCT00450359.) N Engl J Med 2008;359:1675-84. [ABSTRACT FROM AUTHOR]