Digital mammography image enhancement using improved unsharp masking approach

Objective: To compare the population characteristics, the positive rate of screening, the detection rate of breast cancer, early diagnosis rate and the cost between the mass screening group and opportunistic screening group of breast cancer. Methods: This study is a prospective multicenter cohort study conducted from January 1, 2014 to December 31, 2016. The participants were enrolled for mass screening or opportunistic screening of breast cancer. After completing the questionnaire, all the participants received breast physical examination and breast ultrasound examination every year for 3 rounds by year. The participants' characteristics and screening results of the two groups were compared by χ2 test, Fisher exact test or Wilcoxon rank-sum test. Results: A total of 20 080 subjects were enrolled. In the mass screening group, 9 434 (100%), 8 111 (85.98%) and 3 940 (41.76%) cases completed the 3 rounds of screening, and 10 646 (100%), 6 209 (58.32%) and 2 988 (28.07%) cases in the opportunistic screening group, respectively. In the opportunistic screening group, the proportions of less than 3 months lactation (1 275/9 796 vs. 1 061/8 860, χ²=4.597, P=0.032), non-fertility (850/10 646 vs. 574/9 434, χ²=27.400, P<0.01), abortion history (6 384/10 646 vs. 5 062/9 434, χ²=81.232, P<0.01), postmenopausal (2 776/10 646 vs. 2 217/9 434, χ²=17.757, P<0.01), long-term oral contraceptives(>6 months) (171/10 646 vs. 77/9 434, χ²=25.593, P<0.01) and family history of breast cancer in first-degree relatives (464/10 646 vs. 236/9 434, χ²=51.257, P<0.01) were significantly higher than those in mass screening group. The positive rate of screening (514/10 646 vs. 128/9 434, χ²=194.736, P<0.01), the detection rate of breast cancer (158/10 646 vs. 13/9 434, χ²=107.374, P<0.01), and positive rate of biopsy (158/452 vs. 13/87, χ²=13.491, P<0.01) in the opportunistic screening group were significantly higher than those of the mass screening group. The early diagnosis rate of the mass screening group was significantly higher than the opportunistic screening group (10/12 vs. 66/141, χ²=5.902, P=0.015). The average cost for detecting each breast cancer case of the mass screening group was 215 038 CNY, which was 13.6 times of the opportunistic screening group (15 799 CNY/case). In the opportunistic screening group, the positive rate of biopsy in primary hospitals was significantly lower than that in large-volume hospitals (79/267 vs. 79/185, χ²=8.267, P=0.004), but there was no significant difference in the mass screening group (6/37 vs. 7/50, χ²=0.082, P=0.774). Conclusions: Breast cancer screening can improve early detection rate. Compared with the mass screening mode, the opportunistic screening mode has the advantages of higher proportion of high-risk factors, higher positive rate of screening, higher detection rate of breast cancer, higher positive rate of biopsy, and lower cost of screening. However, the early diagnosis rate of breast cancer of opportunistic screening is lower than that of mass screening. The positive rate of opportunistic screening in primary hospitals is lower than that of large-volume hospitals. The two screening modes have their own advantages and should be chosen according to local conditions of different regions in China.

Breast cancer screening plays an important role in the early detection, diagnosis and treatment of breast cancer. The aim of this study was to evaluate the screening results and explore the influencing factors of breast cancer detection rate in Guangdong. This cross-sectional study was conducted among 2,024,960 women aged 35-64 in Guangdong Province during 2017-2021. The data about breast cancer screening information were collected from the Guangdong maternal and child health information system. Descriptive statistical analysis was used to explain demographic characteristics and results of breast cancer screening. The generalized linear regression model was applied to analyze the related influencing factors of breast cancer detection rate. The estimated detection rate of breast cancer in Guangdong Province is 70.32/105, with an early diagnosis rate of 82.06%. After adjusting covariates, those women with older age (45-55 [OR (95% CI) 2.174 (1.872, 2.526)], 55-65 [OR (95% CI) 2.162 (1.760, 2.657)]), education for high school ([OR (95% CI) 1.491 (1.254, 1.773)]) and older age at first birth ([OR (95% CI) 1.632 (1.445, 1.844)]) were more likely to have higher detection rate of breast cancer. No history of surgery or biopsy ([OR (95% CI) 0.527 (0.387, 0.718)]), no history of breast cancer check ([OR (95% CI) 0.873 (0.774, 0.985)]) and no family history of breast cancer ([OR (95% CI) 0.255 (0.151, 0.432)]) women were more likely to screen negative for breast cancer (P < 0.05). The detection rate of breast cancer in screening showed an increasing trend year by year in Guangdong Province. Older age, education for high school and older age at first birth were risk factors for breast cancer detection rate, while no surgery or biopsy history, no family history of breast cancer and no history of breast cancer check were protective factors.

The aim of this study was to investigate the detection rate of breast cancer by positron emission tomography cancer screening using a breast positioning device. Between January 2004 and January 2006, 1,498 healthy asymptomatic individuals underwent cancer screening by fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) at our institution; 660 of 1498 asymptomatic healthy women underwent breast PET imaging in the prone position using the breast positioning device to examine the mammary glands in addition to whole-body PET imaging. All subjects that showed abnormal (18)F-FDG uptake in the mammary glands were referred for further examination or surgery at our institution or a local hospital. Our data were compared with the histopathological findings or findings of other imaging modalities in our institution and replies from the doctors at another hospital. Of the 660 participants, 7 (1.06%) were found to have breast cancers at a curable stage. All the seven cancers were detected by breast PET imaging, but only five of these were detected by whole-body PET imaging; the other two were detected by breast PET imaging using the breast positioning device. In cancer screening, prone breast imaging using a positioning device may help to improve the detection rate of breast cancer. However, overall cancer including mammography and ultrasonography screening should be performed to investigate the false-negative cases and reduce false-positive cases. The effectiveness of prone breast PET imaging in cancer screening should be investigated using a much larger number of cases in the near future.

Digital image enhancement with DStretch®: Is complexity always necessary for efficiency?

Coherent and digital image enhancement, their basic differences and constraints

A cohort study to compare mass screening with and without mammography was conducted in Miyagi Prefecture, Japan in order to establish whether the effectiveness of breast cancer screening would be improved when mammography was combined with physical examination. A trial of mass screening combined with mammography was carried out in 9634 women aged over 50. Lateral imaging of the breast using single‐view film mammography was performed at the first stage of mass screening in addition to physical examination of the breast. Results in the trial were compared with those obtained in 35511 age‐matched subjects without mammography. Thirty breast cancers were found in the trial with a detection rate of 0.31%, which was much higher than that (0.08%) obtained by physical examination without mammography. In 15 of the 30 patients the breast tumor was not palpated at the first screening, but abnormal findings were detected in the mammography. A higher rate (73%) of early breast cancer was obtained in the screening trial with mammography than that (39%) obtained in the screening with physical examination alone. Mass screening combined with mammography is superior to that without mammography for breast cancer screening, especially for the detection of non‐palpable, early breast cancer.

To estimate the extent of variability in screening mammography cancer detection rates and its effect on a hypothetical clinical trial of a new screening modality used to measure changes in cancer detection rate. Each registry and the statistical coordinating center received institutional review board approval along with approval for consenting processes or a waiver of consent to enroll participants, link data, and perform analytic studies. This study was HIPAA compliant. The authors estimated the distribution of individual radiologists' breast cancer detection rates for 2,289,132 screening mammograms (9030 cancers) read by 510 radiologists in the United States who participated in the Breast Cancer Surveillance Consortium from 1996 through 2002. They then computed the distributions of breast cancer detection rates expected from a trial of screening mammography and multiple radiologists, as well as similar distributions for a hypothetical new modality that depicts one additional cancer per reader per 1000 screening examinations. Statistical power was calculated. The mean screening mammography cancer detection rate for individual radiologists was 3.91 cancers (standard deviation, 1.93; range, 0.25-13.75) per 1000 examinations. To achieve 80% power to detect a hypothetical increase of one additional cancer detected per reader per 1000 screening examinations, a trial in which a new modality was compared with standard mammography would require at least 25 radiologists each reading the images of at least 8000 screening examinations or 91 radiologists each reading the images of 1000-2000 examinations. The low breast cancer prevalence in an average-risk screening population and the large interradiologist variability in the observed cancer detection rate suggest that for new technologies to demonstrate significant improvement in cancer detection rate in a clinical trial, very large samples of both radiologists and patients will be required.

OP0008 Insights from the national breast cancer screening programme of 1 million Chinese women

Television image enhancement has long been accomplished by using analog circuits to operate on the analog television signal and thereby emphasize both horizontal and vertical transitions. Now it is feasible to perform comparable image enhancement by digital techniques operating in real time on a pulse-code-modulated NTSC television signal. Several algorithms have been developed to generate vertical and horizontal video details from PCM NTSC television signals encoded at a 10.7-MHz rate (three times the color subcarrier frequency) and at a 14.3-MHz rate (four time the subcarrier frequency). Practical design concepts are presented to implement digital image enhancers. In addition to ensuring the stability, accuracy and reliability that are the usual advantages of digital systems, digital image enhancement will enable video processing techniques to be used that can actually be performed best by digital means. In particular, more nearly optimum coring or “crispening” circuits will be possible and the detail signals will be easily programmable, which may permit automatic adaptive enhancement.

Digital Imaging: Enhancement and Authentication

Introduction The use of magnetic resonance imaging (MRI) in preoperative staging of breast cancer remains arbitrary. The high sensitivity together with the somewhat lower specificity of MRI provides a unique balance between finding true extent/new lesions and overdiagnostics/overtreatment. This study aims to assess a cohort of breast cancer patients examined with preoperative MRI and estimate the potential benefits and negative effects. Method This retrospective, single center cohort study included patients examined with preoperative MRI before primary surgery for breast cancer between 2019 and 2022. Result In total, 94 patients were included. Median age was 54 years, 37.2% were premenopausal and 35.1% had invasive lobular carcinoma. The detection rate of occult contralateral breast cancer was 9.6%. Reoperation rate due to positive margins was 6.4%. Bland-Altman statistics showed higher agreement between estimated extent by MRI and postoperative histopathological extent, compared to estimation by ultrasound or mammography. MRI contributed to correct change of operation method in 18.1%, but also less favorable choice of surgery in 5.3% of patients (such as unnecessary mastectomy). The total mastectomy rate was 54.3%. Unnecessary biopsies of benign lesions after MRI were performed in 11.7% of patients. Discussion In this cohort, breast MRI had a clear impact on the surgical treatment of breast cancer, affecting choice of operation method. About a fifth of patients examined with MRI received a benefit with a better management of their breast cancer, however an equally large part received less optimal diagnostics and treatment.

Digital image enhancement techniques provide a multitude of choices for improving the visual quality of diagnostic images. Appropriate choice of such techniques is greatly influenced by the imaging modality, task at hand and viewing conditions. This sequence of two articles will provide an overview of underlying concepts, along with algorithms commonly used for radiographic image enhancement. The first article focuses on spatial domain techniques for radiographic image enhancement, with particular reference to point processing methods, histogram modification and unsharp masking.

Objective To evaluate the influencing factors of mammography versus ultrasonography in detecting early stage breast cancer and epidemiological characteristics. Methods A retrospective analysis was performed on stage T1 (tumor diameter ≤2 cm) and Tis (ductal carcinoma in situ) breast cancer confirmed by histopathology from July 2011 to July 2013, 959 patients (971 lesions) had mammography, ultrasonography, and epidemiological data. According to the BI-RADS, the lesions of BI-RADS categories 1, 2, 3, 4A were negative, the lesions of BI-RADS categories 4B, 4C, 5 were positive. A face to face interview questionnaire collected information regarding epidemiological data, including age, body mass index, age at menarche, age at first live birth, history of pregnancy, number of live births, history of lactation, history of abortion, and menopausal status. The χ2 test was used to compare the efficacy of mammography and ultrasound in detecting early stage breast cancer. Logistic regression was used to analyze the relative factors influencing the detection rate of two modalities. Results The detection rate of mammography and ultrasound was 90.1% (875/971) and 92.6% (899/971) respectively with statistical significance (χ2=150.34, P=0.000). Breast density, lesion types, age, and postmenopausal status were risk factors for the detection rate of early stage breast cancer on mammography, the odds ratios (OR) was 0.315, 6.669, 2.609, and 2.236 and the 95% CI was 0.136—0.731, 2.841—15.658, 1.681—4.048, and 1.453—3.439, respectively. Lesion types and age were risk factors for the detection rate of early stage breast cancer on ultrasonography, the OR was 0.204, 1.798, and 95%CI was 0.103—0.405, 1.107—2.920, respectively. More than patients with less than 50 years old showed only-calcification type breast cancer on mammography (OR=2.256, 95%CI:1.348—3.773) , women with lower number of live birth showed not only-calcification type breast cancer on mammography (OR=0.467, 95% CI:0.250—0.872) . Conclusion Breast density, age, postmenopausal status and lesion types were risk factors for epidemiological characteristics associated with detection rate of early stage breast cancer for mammography versus ultrasonography. Key words: Breast neoplasms; Mammography; Ultrasonography; Epidemiologic factors

1529 Background: High number of long-term survivors after irradiation develop a second cancer. The aim of this prospective study was to evaluate the long-term risk to develop breast cancer following exposure to ionizing radiation at pediatric age and to compare the sensitivity of clinical breast examination (CBE), mammography (MX) and ultrasonography (US) for screening of such young women. Methods: We identified 86 patients from an institutional database that received chest wall radiotherapy for pediatric cancer. They accepted to be enrolled for an intensive surveillance program: CBE, US and MX were yearly performed. A screening event, that is constituted by three diagnostic procedures (two under 25 years old), takes place in a single day. Overall detection rate of breast cancer per year and sensitivity of the three diagnostic procedures were calculated. Results: Among these women, from April 2004 to May 2007, we identified 8 breast cancers. The age at diagnosis ranged between 26 to 49 yrs. Two cases were...

Energy resolved photon-counting mammography is a new technology, which counts the number of photons that passes through an object, and presents it as a pixel value in an image of the object. Silicon semiconductor detectors are currently used in commercial mammography. However, the disadvantage of silicon is the low absorption efficiency for high X-ray energies. A cadmium telluride (CdTe) series detector has a high absorption efficiency over a wide energy range. In this study, we proposed a method to estimate the composition of the mammary gland using a CdTe series detector as a photon-counting detector. The fact that the detection rate of breast cancer in mammography is affected by mammary gland composition is now widely accepted. Assessment of composition of the mammary gland has important implications. An important advantage of our proposed technique is its ability to discriminate photons using three energy bins. We designed the CdTe series detector system using the MATLAB simulation software. The phantom contains nine regions with the ratio of glandular tissue and adipose varying in increments of 10%. The attenuation coefficient for each bin’s energy was calculated from the number of input and output photons possessed by each. The evaluation results obtained by plotting the attenuation coefficient μ in a three-dimensional (3D) scatter plot show that the plots had a regular composition order congruent with that of the mammary gland. Consequently, we believe that our proposed method can be used to estimate the composition of the mammary gland.