BreastScreen WA

ABSTRACTBackgroundThis study investigated the impact of Digital Breast Tomosynthesis (DBT) training workshops on doctors' performance in simultaneous‐double‐reader scenarios.MethodsTen pairs of Vietnamese readers, including radiologists, registrars, and breast physicians, participated in the workshop, which featured lectures and breast image reading sessions provided by Australian experts. The first session included a test set of 30 screening full‐field digital mammograms (FFDM) (10 cancers and 20 normal cases) with DBT images provided during the answer review stage. The second session with 35 cases (15 cancer) and session 3 with 30 cases (11 cancer) consisted of screening FFDM mammograms, DBT slices, and synthesized images. Participants used the BREAST‐VIETRAD platform to view breast images and detect cancer lesions using the RANZCR‐BIRADS scale. The study assessed performance disparities between the first and second DBT sets using the Wilcoxon Signed Rank test and explored the correlation between score changes and reader experience.ResultsThere were significant improvements in the readers' sensitivity (0.553 vs. 0.91; p = 0.005) and lesion sensitivity (0.419 vs. 0.709; p = 0.005) from the first to the second DBT set, matching the sensitivity seen in FFDM sets. This improvement was consistent across both low and high breast density cases. Notable enhancements in lesion sensitivity were also observed for detecting masses (0.340 vs. 0.633; p = 0.011), calcifications, and architectural distortions (0.450 vs. 0.933; p = 0.011). The probability of score improvement (ROC AUC and JAFROC FOM) in DBT of pairs of readers with both less than 3 years of experience in reading mammograms is five times greater than those with over 5 years of experience.ConclusionsTraining sessions with simultaneous‐double readers significantly improved Vietnamese clinicians' breast cancer detection capabilities, highlighting the importance of tailored educational programs to enhance diagnostic accuracy in regions lacking formal screening initiatives.

IntroductionWomen with obesity are less likely to participate in mammographic screening and more likely to develop post-menopausal breast cancer. We describe the co-production of a novel training intervention for breast screening staff, targeting obesity-related barriers to participating in a population-based mammographic screening. MethodsA Stakeholder Consultant Group (SCG) was established to guide the co-production process. A narrative review of the literature was conducted, as well as first person interviews of women with lived experience of obesity, to identify/inform themes for service delivery staff training. ResultsThree themes from the narrative review emerged: (i) enhanced staff-client communication, (ii) promoting compassionate connections during client interactions (iii) tailored mammography positioning for women with obesity. Iterative co-design and consultation with the SCG resulted in six key sessions delivered within an in-service training day: determinants of obesity, weight stigma and healthcare, screening challenges for women living with obesity, empathy ‘mapping’, front-line training for reception staff, and screening challenges for radiographers when screening women with obesity. Subsequent practical workshops for radiographers provided hands-on positioning training using a real-life model and a ‘mammo vest’. Feedback showed that 74 % of staff rated the training as “very good” or “excellent”. ConclusionTraining to improve staff interactions with women with obesity appears to be acceptable. Implications for practiceThe intervention has been successfully implemented in a population-based breast screening program to improve the mammography experience for both clients and staff. Improving the mammogram experience will improve the likelihood of clients returning to screening when next due. Given the prevalence of obesity and body image issues, targeted interventions that optimize client interactions could significantly reduce breast cancer mortality through early detection.

IntroductionWomen in Australia are no longer invited for mammograms through the breast cancer screening program (BreastScreen) after 74 years of age due to uncertain benefits and potential harm. However, few women report knowing why screening invitations cease and suspect ageism, cost or lower risk of breast cancer. We tested the impact of providing older women approaching the upper BreastScreen invitation age (70–74 years) with information about the rationale for breast cancer screening cessation on informed choice.MethodsIn a three-arm online randomised controlled trial, participants read a scenario where they received a letter from BreastScreen indicating their mammogram was clear. They were then randomised to receive 1) no additional information (usual care; control), 2) screening-cessation rationale in text form (e.g., the downsides of screening outweigh the benefits after age 74) or 3) screening-cessation rationale in an animation video. The primary outcome was informed choice defined as adequate knowledge (> within-sample median), and screening attitudes aligned with intention. Data were analysed using chi-square tests.Results372 women were included in the final analysis. Intervention arm participants (text n=128; animation n=128) had higher informed choice compared to controls (n=123); (control: 17.9%, reference; text: 32.0%, relative risk [RR]=1.21, p=.010; animation: 40.5%, RR=1.38, p<.001), higher knowledge (control: 23.6%; text: 60.2%, RR=1.92, p<.001; animation: 66.1%, RR=2.26, p<.001) and reduced screening intention (control: 82.9%; text: 35.9%, RR=1.29, p<.001; animation: 48.8%, RR=1.62, p<.001). Those who received the animation were less likely to report high positive screening attitudes compared to controls (41.3% vs. 62.6%, RR=0.64, p<.001).DiscussionProviding information to older women about the rationale for an upper age limit for the national breast screening program increased their informed decision-making.ConclusionFurther research should explore the impact of these interventions in practice and how to support general practitioners to further explain this information to older women.

IntroductionImpalpable breast lesions generally require image‐guided localisation for breast‐conserving surgery. A standard technique is to place a hook wire (HW) within the lesion. Radioguided occult lesion localisation using iodine seeds (ROLLIS) involves inserting a 4.5 mm iodine‐125 seed (seed) into the lesion. We hypothesised that a seed could be more precisely positioned in relation to the lesion than a HW and that this may be associated with a lower re‐excision rate.MethodsRetrospective review of consecutive participant data from three ROLLIS RCT (ACTRN12613000655741) sites. Participants underwent preoperative lesion localisation (PLL) with seed or HW between September 2013 and December 2017. Lesion and procedural characteristics were recorded. Distances between (1) any part of the seed or thickened segment of the HW (‘TSHW’) and the lesion/clip (‘distance to device’ DTD) and (2) centre of the TSHW/seed and centre of the lesion/clip (device centre to target centre ‘DCTC’) were measured on immediate postinsertion mammograms. Pathological margin involvement and re‐excision rates were compared.ResultsA total of 390 lesions (190 ROLLIS and 200 HWL) were analysed. Lesion characteristics and guidance modality used were similar between groups. Ultrasound‐guided DTD and DCTC for seed were smaller than for HW (77.1% and 60.6%, respectively, P‐value < 0.001). Stereotactic‐guided DCTC for seeds was 41.6% smaller than for HW (P‐value = 0.001). No statistically significant difference in the re‐excision rates was found.ConclusionIodine‐125 seeds can be more precisely positioned for preoperative lesion localisation than HW, however, no statistically significant difference in re‐excision rates was detected.

BackgroundHigh participation in mammographic screening is essential for its effectiveness to detect breast cancers early and thereby, improve breast cancer outcomes. Breast density is a strong predictor of breast cancer risk and significantly reduces the sensitivity of mammography to detect the disease. There are increasing mandates for routine breast density notification within mammographic screening programs. It is unknown if breast density notification impacts the likelihood of women returning to screening when next due (i.e. rescreening rates). This study investigates the association between breast density notification and rescreening rates using individual-level data from BreastScreen Western Australia (WA), a population-based mammographic screening program.MethodsWe examined 981,705 screening events from 311,656 women aged 40+ who attended BreastScreen WA between 2008 and 2017. Mixed effect logistic regression was used to investigate the association between rescreening and breast density notification status.ResultsResults were stratified by age (younger, targeted, older) and screening round (first, second, third+). Targeted women screening for the first time were more likely to return to screening if notified as having dense breasts (Percentunadjusted notified vs. not-notified: 57.8% vs. 56.1%; Padjusted = 0.016). Younger women were less likely to rescreen if notified, regardless of screening round (all P < 0.001). There was no association between notification and rescreening in older women (all P > 0.72).ConclusionsBreast density notification does not deter women in the targeted age range from rescreening but could potentially deter younger women from rescreening. These results suggest that all breast density notification messaging should include information regarding the importance of regular mammographic screening to manage breast cancer risk, particularly for younger women. These results will directly inform BreastScreen programs in Australia as well as other population-based screening providers outside Australia who notify women about breast density or are considering implementing breast density notification.

In many western countries, there is good evidence documenting the performance of radiologists reading digital breast tomosynthesis (DBT) images. However, the diagnostic efficiency of Chinese radiologists using DBT, particularly type of errors being made and type of cancers being missed, is understudied. This study aims to investigate the pattern of diagnostic errors across different lesion types produced by Chinese radiologists diagnosing from DBT images. Australian radiologists will be used as a benchmark. Twelve Chinese radiologists read a DBT test set and located each perceived cancer lesion. True positives, false positives (FP), true negatives and false negatives (FN) were generated. The same test set was also read by 14 Australian radiologists. Z-scores and Pearson correlations were used to compare interpretation of lesions and identification of normal appearances between two groups of radiologists. Architectural distortions (p<.001) and stellate masses (p=.02) were more difficult for Chinese radiologists to correctly diagnose compared to their Australian counterparts. Chinese readers categorised more FPs as discrete masses (p<.001) and fewer FPs as architectural distortions (p<.001) comparing with Australian radiologists. The percentages of FN for each cancer case were not correlated (r=0.37, p=.18) but the percentages of FP for each normal case were moderately correlated (r=0.52, p=.02) between two groups of readers. Architectural distortions and stellate masses were challenging to Chinese radiologists when reading DBT. Our findings proposed the need of development of training and education programs focussing on imaging cases tailored for specific groups of readers with certain interpretation patterns.

Breast magnetic resonance imaging (MRI) use for surgical staging is increasing, though remains controversial. We aimed to evaluate the accuracy of MRI in surgical decision-making to determine if mastectomy prompted by MRI was appropriate. A single-centre observational study in Perth, Western Australia, with the inclusion of all preoperative and postoperative studies (e.g. involved margins after breast-conserving surgery) undergoing staging breast MRI from 1 January 2015 to 26 August 2019. A standard protocol using gadolinium contrast was used. The reference standard was postoperative histopathology or, for studies without additional surgery after MRI following breast-conserving surgery, the next and subsequent annual screening episodes. By reviewing the final histopathology, the medical case notes and multidisciplinary team decision process, we evaluated whether the reported MRI disease extent was accurate in prompting an appropriate upgrade to mastectomy. Outcomes are reported with descriptive statistics. Of 130 cancers staged with MRI; seven were excluded as information was incomplete, 104 were performed preoperatively and 19 postoperatively. The majority (60%) staged lobular carcinoma (invasive 59%, in situ 1%) compared to ductal carcinoma (invasive 31%, in situ 8%). For preoperative MRI, half (54% - 56/104) underwent subsequent mastectomy. Of these, MRI prompted mastectomy in 45% (25/56), all appropriate for disease extent. In the postoperative staging group, two mastectomies were performed, one planned before imaging, the other prompted when MRI diagnosed residual disease and confirmed on histopathology. No false-negative staging MRI was identified. In our cohort, MRI prompted an upgrade to mastectomy in 21% (26/123), appropriate for cancer extent.

Purpose: To correlate ultrasonographic parameters with histopathological findings in renal parenchymal disease.Methods and Materials: This cross sectional hospital based observational study was conducted at Bir Hospital, National academy of Medical Sciences, Kathmandu, Nepal.A total 54 patients admitted in the nephrology ward were included in the study.Sonographic parameters (length, echogenicity, cortical thickness, parenchymal thickness and resistive index) were correlated with the biopsy findings of glomerular sclerosis, tubular atrophy, interstitial fibrosis, and interstitial inflammation.Univariate analysis is presented as Spearman correlation coefficients.Multivariate analysis was done with SPSS 16 software.Results: The mean age of the participants in the study was 32.4 years.Similarly the mean length of kidney was 9.8 cm, cortical thickness 1 cm and parenchymal thickness 2.1 cm.61%of patients with histopathologically proven renal parenchymal disease have right kidney less than 10 cm.Echogenicity showed the strongest correlation with all four histologic parameters (r = 0.5-0.7).Renal parenchymal thickness was r weakly correlated with glomerular sclerosis (r = À0.32).By multivariate analysis, tubular atrophy, interstitial fibrosis, glomerular sclerosis and interstitial inflammation, all four histological findings were significant determinants of cortical echogenicity.Conclusion: Cortical echogenicity is the sonographic parameter that correlates best with renal histopathology.