Publications by authors named "Fiona Gilbert"

Background Deep learning (DL) algorithms have shown promising results in mammographic screening either compared to a single reader or, when deployed in conjunction with a human reader, compared with double reading. Purpose To externally validate the performance of three DL algorithms as mammographic screen readers in an independent UK data set. Materials and Methods Three commercial DL algorithms (DL-1, DL-2, and DL-3) were retrospectively investigated from January 2022 to June 2022 using consecutive full-field digital mammograms collected at two UK sites during 1 year (2017).

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Importance: Breast cancer is one of the leading causes of negligence claims in radiology. The objective of this document is to describe the specific main causes of errors in breast imaging and provide European Society of Breast Imaging (EUSOBI) recommendations to try to minimize these.

Observations: Technical failures represent 17% of all mammographic diagnostic negligence claims.

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Importance: Misdiagnosis in breast imaging can have significant implications for patients, healthcare providers, and the healthcare system as a whole.

Observations: Some of the potential implications of misdiagnosis in breast imaging include delayed diagnosis or false reassurance, which can result in a delay in treatment and potentially a worse prognosis. Misdiagnosis can also lead to unnecessary procedures, which can cause physical discomfort, anxiety, and emotional distress for patients, as well as increased healthcare costs.

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Background: Integrating artificial intelligence (AI) into mammography screening can support radiologists and improve programme metrics, yet the potential of different strategies for integrating the technology remains understudied. We compared programme-level performance metrics of seven AI integration strategies.

Methods: We performed a retrospective comparative evaluation of seven strategies for integrating AI into mammography screening using datasets generated from screening programmes in Germany (n=1 657 068), the UK (n=223 603) and Sweden (n=22 779).

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Population screening for breast cancer (BC) is currently offered in the UK for women aged 50 to 71 with the aim of reducing mortality. There is additional screening within the national programme for women identified as having a very high risk of BC. There is growing interest in further risk stratification in breast screening, which would require a whole population risk assessment and the subsequent offer of screening tailored to the individual's risk.

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Article Synopsis
  • - Digital breast tomosynthesis (DBT), when used with a synthetic 2D mammogram (S2D), exposes women to higher radiation but may enhance cancer detection compared to full-field digital mammography (FFDM) alone.
  • - A review of 17 studies, including 13 for meta-analysis, found that DBT plus S2D provided a higher cancer detection rate compared to FFDM alone, while also showing similar accuracy to DBT with FFDM.
  • - The findings suggest that integrating S2D with DBT in breast cancer screening is effective and maintains the safety and performance of the imaging process.
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Background Artificial intelligence (AI) systems can be used to identify interval breast cancers, although the localizations are not always accurate. Purpose To evaluate AI localizations of interval cancers (ICs) on screening mammograms by IC category and histopathologic characteristics. Materials and Methods A screening mammography data set (median patient age, 57 years [IQR, 52-64 years]) that had been assessed by two human readers from January 2011 to December 2018 was retrospectively analyzed using a commercial AI system.

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Article Synopsis
  • Breast complaints like pain, lumps, and nipple discharge are common reasons for patients to visit primary care or breast clinics, with some less common symptoms needing specific diagnostic methods.
  • Imaging the breast should be done by trained radiologists, using techniques like ultrasound, full-field digital mammography, and digital breast tomosynthesis based on the patient's age and symptoms.
  • It's crucial to accurately diagnose breast issues to identify potential malignancies while minimizing false positives and unnecessary procedures, ensuring a cost-effective and less anxiety-inducing process for patients.
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Objectives: To assess the performance of breast cancer screening by category of breast density and age in a UK screening cohort.

Methods: Raw full-field digital mammography data from a single site in the UK, forming a consecutive 3-year cohort of women aged 50 to 70 years from 2016 to 2018, were obtained retrospectively. Breast density was assessed using Volpara software.

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Background: To study the reproducibility of Na magnetic resonance imaging (MRI) measurements from breast tissue in healthy volunteers.

Methods: Using a dual-tuned bilateral Na/H breast coil at 3-T MRI, high-resolution Na MRI three-dimensional cones sequences were used to quantify total sodium concentration (TSC) and fluid-attenuated sodium concentration (FASC). B-corrected TSC and FASC maps were created.

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In the mid-1990s, the identification of BRCA1/2 genes for breast cancer susceptibility led to testing breast MRI accuracy in screening women at increased risk. From 2000 onwards, ten intraindividual comparative studies showed the marked superiority of MRI: the sensitivity ranged 25-58% for mammography, 33-52% for ultrasound, 48-67% for mammography plus ultrasound, and 71-100% for MRI; specificity 93-100%, 91-98%, 89-98%, and 81-98%, respectively. Based on the available evidence, in 2006-2007, the UK National Institute for Clinical Excellence and the American Cancer Society recommended MRI screening of high-risk women, followed by other international guidelines.

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Introduction: Breast lesions of uncertain malignant potential (B3) include atypical ductal and lobular hyperplasias, lobular carcinoma in situ, flat epithelial atypia, papillary lesions, radial scars and fibroepithelial lesions as well as other rare miscellaneous lesions. They are challenging to categorise histologically, requiring specialist training and multidisciplinary input. They may coexist with in situ or invasive breast cancer (BC) and increase the risk of subsequent BC development.

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Article Synopsis
  • The study looked at how having an MRI before surgery affects the chances of needing a mastectomy or having to have more surgery for women with ductal carcinoma in situ (DCIS), a type of breast cancer.
  • They compared two groups of patients: one that had MRIs before surgery and one that didn't, looking closely at various factors that could affect the results.
  • The results showed that women who had the MRI were more likely to have a mastectomy but were less likely to need additional surgeries afterwards.
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Background Breast screening enables early detection of cancers; however, most women have normal mammograms, resulting in repetitive and resource-intensive reading tasks. Purpose To investigate if deep learning (DL) algorithms can be used to triage mammograms by identifying normal results to reduce workload or flag cancers that may be overlooked. Materials and Methods In this retrospective study, three commercial DL algorithms were investigated using consecutive mammograms from two UK Breast Screening Program sites from January 2015 to December 2017 and January 2017 to December 2018 on devices from two mammography vendors.

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Cross-institution collaborations are constrained by data-sharing challenges. These challenges hamper innovation, particularly in artificial intelligence, where models require diverse data to ensure strong performance. Federated learning (FL) solves data-sharing challenges.

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Article Synopsis
  • Photoacoustic imaging (PAI) shows promise in clinical applications, particularly for inflammatory diseases and cancer, and has recently gained regulatory approval for its use.
  • Despite this progress, the integration of PAI into healthcare faces challenges, including the need for education, training, and improved data acquisition and interpretation skills.
  • In 2022, the International Photoacoustic Standardisation Consortium (IPASC) identified these barriers and proposed strategic plans to address them, detailing efforts needed in the short, medium, and long term for successful implementation.
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Objectives: Quality assurance (QA) of image interpretation plays a key role in screening and diagnostic mammography, maintaining minimum standards and supporting continuous improvement in interpreting images. However, the QA structure across Europe shows considerable variation. The European Society of Breast Imaging (EUSOBI) conducted a survey among the members to collect information on radiologists' preferences regarding QA measures in mammography.

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Axillary lymphadenopathy is a common side effect of COVID-19 vaccination, leading to increased imaging-detected asymptomatic and symptomatic unilateral axillary lymphadenopathy. This has threatened to negatively impact the workflow of breast imaging services, leading to the release of ten recommendations by the European Society of Breast Imaging (EUSOBI) in August 2021. Considering the rapidly changing scenario and data scarcity, these initial recommendations kept a highly conservative approach.

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Article Synopsis
  • There is growing interest in using AI for mammographic screening, but its performance needs thorough evaluation before it can be used independently for diagnosis.
  • A systematic review analyzed data from 16 studies involving over a million mammogram examinations to compare AI's performance with that of radiologists in interpreting digital mammography and digital breast tomosynthesis (DBT).
  • Results showed that AI had better standalone performance (higher AUC) in most reader studies on digital mammography and in DBT, though its sensitivity was higher and specificity lower compared to radiologists, indicating promise but also some drawbacks in using AI for screening.
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  • This study investigates the link between hypoxia and vascular function in estrogen receptor-positive breast cancer using advanced imaging techniques and immunohistochemical markers.
  • The research involved treatment-naive women who underwent [F]-FMISO-PET/MRI, measuring variables like vessel diameter and microvessel density to assess hypoxia.
  • Results showed a negative correlation between hypoxia and vascular metrics, indicating that lower blood vessel density and smaller vessel sizes are linked to increased hypoxia in breast tumors.
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Objectives: To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes.

Methods: The MIPA observational study enrolled women aged 18-80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis.

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Background: Assessing inflammatory disease activity in large vessel vasculitis (LVV) can be challenging by conventional measures.

Objectives: We aimed to investigate somatostatin receptor 2 (SST) as a novel inflammation-specific molecular imaging target in LVV.

Methods: In a prospective, observational cohort study, in vivo arterial SST expression was assessed by positron emission tomography/magnetic resonance imaging (PET/MRI) using Ga-DOTATATE and F-FET-βAG-TOCA.

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Background: Magnetic resonance imaging (MRI) can be used to diagnose breast cancer. Diffusion weighted imaging (DWI) and the apparent diffusion coefficient (ADC) can reflect tumor microstructure in a non-invasive manner. The correct prediction of response of neoadjuvant chemotherapy (NAC) is crucial for clinical routine.

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