Background It is unclear whether breast US screening outcomes for women with dense breasts vary with levels of breast cancer risk. Purpose To evaluate US screening outcomes for female patients with dense breasts and different estimated breast cancer risk levels. Materials and Methods This retrospective observational study used data from US screening examinations in female patients with heterogeneously or extremely dense breasts conducted from January 2014 to October 2020 at 24 radiology facilities within three Breast Cancer Surveillance Consortium (BCSC) registries.
View Article and Find Full Text PDFPurpose To evaluate long-term trends in mammography screening rates and identify sociodemographic and breast cancer risk characteristics associated with return to screening after the COVID-19 pandemic. Materials and Methods In this retrospective study, statewide screening mammography data of 222 384 female individuals aged 40 years or older (mean age, 58.8 years ± 11.
View Article and Find Full Text PDFObjective: This study explores the feasibility of using machine learning to predict accurate versus inaccurate diagnoses made by pathologists based on their spatiotemporal viewing behavior when evaluating digital breast biopsy images.
Materials And Methods: The study gathered data from 140 pathologists of varying experience levels who each reviewed a set of 14 digital whole slide images of breast biopsy tissue. Pathologists' viewing behavior, including zooming and panning actions, was recorded during image evaluation.
Ductal carcinoma in situ (DCIS) and invasive breast cancer share many morphologic, proteomic, and genomic alterations. Yet in contrast to invasive cancer, many DCIS tumors do not progress and may remain indolent over decades. To better understand the heterogenous nature of this disease, we reconstructed the growth dynamics of 18 DCIS tumors based on the geo-spatial distribution of their somatic mutations.
View Article and Find Full Text PDFCrit Rev Eukaryot Gene Expr
October 2023
The enhanced uptake of glucose by cancer cells via aerobic glycolysis occurs when the lactic acid pathway is favored over the citric acid cycle. The lactic acid cycle in cancer cells influences the cytosolic concentration of metabolic fluorophores including NADH (the reduced form of nicotinamide adenine dinucleotide) and flavin adenine dinucleotide (FAD). In particular, the literature has shown that breast cancer influences the relative magnitude of fluorescence from NADH and FAD.
View Article and Find Full Text PDFBackground: There are no consensus guidelines for supplemental breast cancer screening with whole-breast ultrasound. However, criteria for women at high risk of mammography screening failures (interval invasive cancer or advanced cancer) have been identified. Mammography screening failure risk was evaluated among women undergoing supplemental ultrasound screening in clinical practice compared with women undergoing mammography alone.
View Article and Find Full Text PDF: Digital whole slide imaging allows pathologists to view slides on a computer screen instead of under a microscope. Digital viewing allows for real-time monitoring of pathologists' search behavior and neurophysiological responses during the diagnostic process. One particular neurophysiological measure, pupil diameter, could provide a basis for evaluating clinical competence during training or developing tools that support the diagnostic process.
View Article and Find Full Text PDFAn accurate histopathologic diagnosis on surgical biopsy material is necessary for the clinical management of patients and has important implications for research, clinical trial design/enrollment, and public health education. This study used a mixed methods approach to isolate sources of diagnostic error while residents and attending pathologists interpreted digitized breast biopsy slides. Ninety participants, including pathology residents and attending physicians at major United States medical centers reviewed a set of 14 digitized whole-slide images of breast biopsies.
View Article and Find Full Text PDFThe tumor microenvironment is a complex mixture of cell types that bi-directionally interact and influence tumor initiation, progression, recurrence, and patient survival. Mesenchymal stromal cells (MSCs) of the tumor microenvironment engage in crosstalk with cancer cells to mediate epigenetic control of gene expression. We identified CD90+ MSCs residing in the tumor microenvironment of patients with invasive breast cancer that exhibit a unique gene expression signature.
View Article and Find Full Text PDFAdaptive gain theory proposes that the dynamic shifts between exploration and exploitation control states are modulated by the locus coeruleus-norepinephrine system and reflected in tonic and phasic pupil diameter. This study tested predictions of this theory in the context of a societally important visual search task: the review and interpretation of digital whole slide images of breast biopsies by physicians (pathologists). As these medical images are searched, pathologists encounter difficult visual features and intermittently zoom in to examine features of interest.
View Article and Find Full Text PDFContext.—: The International Collaboration on Cancer Reporting (ICCR), supported by major pathology and cancer organizations, aims at the standardization of evidence-based pathology reporting of different types of cancers, with the inclusion of all parameters deemed to be relevant for best patient care and future data collection. Lymph node metastasis is one of the most important prognostic factors in breast cancer.
View Article and Find Full Text PDFBackground: Metacognition is a cognitive process that involves self-awareness of thinking, understanding, and performance. This study assesses pathologists' metacognition by examining the association between their diagnostic accuracy and self-reported confidence levels while interpreting skin and breast biopsies.
Design: We studied 187 pathologists from the Melanoma Pathology Study (M-Path) and 115 pathologists from the Breast Pathology Study (B-Path).
Core facilities have a ubiquitous and increasingly valuable presence at research institutions. Although many shared cores were originally created to provide routine services and access to complex and expensive instrumentation for the research community, they are frequently called upon by investigators to design protocols and procedures to help answer complex research questions. For instance, shared microscopy resources are evolving from providing access to and training on complex imaging instruments to developing detailed innovative protocols and experimental strategies, including sample preparation techniques, staining, complex imaging parameters, and high-level image analyses.
View Article and Find Full Text PDFThe presence of detected metastases in locoregional lymph nodes of women with breast cancer is an important prognostic variable for cancer staging, prognosis, and treatment planning. Systematic and standardized lymph node evaluation with gross and microscopic protocols designed to detect all macrometastases larger than 2.0 mm is the appropriate objective based on clinical outcomes evidence.
View Article and Find Full Text PDFMicroenvironmental and molecular factors mediating the progression of Breast Ductal Carcinoma In Situ (DCIS) are not well understood, impeding the development of prevention strategies and the safe testing of treatment de-escalation. We addressed methodological barriers and characterized the mutational, transcriptional, histological, and microenvironmental landscape across 85 multiple microdissected regions from 39 cases. Most somatic alterations, including whole-genome duplications, were clonal, but genetic divergence increased with physical distance.
View Article and Find Full Text PDFBackground: Elevated mammographic breast density is a strong breast cancer risk factor with poorly understood etiology. Increased deposition of collagen, one of the main fibrous proteins present in breast stroma, has been associated with increased mammographic density. Collagen fiber architecture has been linked to poor outcomes in breast cancer.
View Article and Find Full Text PDFPurpose: Preoperative breast MRI is used to evaluate for additional cancer and extent of disease for newly diagnosed breast cancer, yet benefits and harms of preoperative MRI are not well-documented. We examined whether preoperative MRI yields additional biopsy and cancer detection by extent of breast density.
Methods: We followed women in the Breast Cancer Surveillance Consortium with an incident breast cancer diagnosed from 2005 to 2017.
Background The COVID-19 pandemic reduced mammography use, potentially delaying breast cancer diagnoses. Purpose To examine breast biopsy recommendations and breast cancers diagnosed before and during the COVID-19 pandemic by mode of detection (screen detected vs symptomatic) and women's characteristics. Materials and Methods In this secondary analysis of prospectively collected data, monthly breast biopsy recommendations after mammography, US, or both with subsequent biopsy performed were examined from 66 facilities of the Breast Cancer Surveillance Consortium between January 2019 and September 2020.
View Article and Find Full Text PDFDiagnoses of medical images can invite strikingly diverse strategies for image navigation and visual search. In computed tomography screening for lung nodules, distinct strategies, termed scanning and drilling, relate to both radiologists' clinical experience and accuracy in lesion detection. Here, we examined associations between search patterns and accuracy for pathologists (N = 92) interpreting a diverse set of breast biopsy images.
View Article and Find Full Text PDFBreast cancer is the most common cancer and the second most common cause of cancer mortality among women in the United States. Efforts to promote breast cancer control in rural settings face specific challenges. Access to breast cancer screening, diagnosis, and treatment services is impaired by shortages of primary care and specialist providers, and geographic distance from medical facilities.
View Article and Find Full Text PDFIEEE EMBS Int Conf Biomed Health Inform
July 2021
This paper studies pathologists can misdiagnose diagnostically challenging breast biopsy cases, using a data set of 240 whole slide images (WSIs). Three experienced pathologists agreed on a consensus reference ground-truth diagnosis for each slide and also a consensus region of interest (ROI) from which the diagnosis could best be made. A study group of 87 other pathologists then diagnosed test sets (60 slides each) and marked their own regions of interest.
View Article and Find Full Text PDFBackground: The coronavirus disease 2019 (COVID-19) pandemic led to a near-total cessation of mammography services in the United States in mid-March 2020. It is unclear if screening and diagnostic mammography volumes have recovered to prepandemic levels and whether use has varied by women's characteristics.
Methods: We collected data on 461 083 screening mammograms and 112 207 diagnostic mammograms conducted during January 2019 through July 2020 at 62 radiology facilities in the Breast Cancer Surveillance Consortium.
Proc IAPR Int Conf Pattern Recogn
January 2021
In this study, we propose the Ductal Instance-Oriented Pipeline (DIOP) that contains a duct-level instance segmentation model, a tissue-level semantic segmentation model, and three-levels of features for diagnostic classification. Based on recent advancements in instance segmentation and the Mask RCNN model, our duct-level segmenter tries to identify each ductal individual inside a microscopic image; then, it extracts tissue-level information from the identified ductal instances. Leveraging three levels of information obtained from these ductal instances and also the histopathology image, the proposed DIOP outperforms previous approaches (both feature-based and CNN-based) in all diagnostic tasks; for the four-way classification task, the DIOP achieves comparable performance to general pathologists in this unique dataset.
View Article and Find Full Text PDFIEEE J Biomed Health Inform
June 2021
Objective: Modeling variable-sized regions of interest (ROIs) in whole slide images using deep convolutional networks is a challenging task, as these networks typically require fixed-sized inputs that should contain sufficient structural and contextual information for classification. We propose a deep feature extraction framework that builds an ROI-level feature representation via weighted aggregation of the representations of variable numbers of fixed-sized patches sampled from nuclei-dense regions in breast histopathology images.
Methods: First, the initial patch-level feature representations are extracted from both fully-connected layer activations and pixel-level convolutional layer activations of a deep network, and the weights are obtained from the class predictions of the same network trained on patch samples.
Digital whole slide images are Food and Drug Administration approved for clinical diagnostic use in pathology; however, integration is nascent. Trainees from 9 pathology training programs completed an online survey to ascertain attitudes toward and experiences with whole slide images for pathological interpretations. Respondents (n = 76) reported attending 63 unique medical schools (45 United States, 18 international).
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