Monitoring and evaluation of breast cancer screening programmes : Selecting candidate performance indicators

In the scope of the European Commission Initiative on Breast Cancer (ECIBC) the Monitoring and Evaluation (M&E) subgroup was tasked to identify breast cancer screening programme (BCSP) performance indicators, including their acceptable and desirable levels, which are associated with breast cancer (BC) mortality. This paper documents the methodology used for the indicator selection. The indicators were identified through a multi-stage process. First, a scoping review was conducted to identify existing performance indicators. Second, building on existing frameworks for making well-informed health care choices, a specific conceptual framework was developed to guide the indicator selection. Third, two group exercises including a rating and ranking survey were conducted for indicator selection using pre-determined criteria, such as: relevance, measurability, accurateness, ethics and understandability. The selected indicators were mapped onto a BC screening pathway developed by the M&E subgroup to illustrate the steps of BC screening common to all EU countries. A total of 96 indicators were identified from an initial list of 1325 indicators. After removing redundant and irrelevant indicators and adding those missing, 39 candidate indicators underwent the rating and ranking exercise. Based on the results, the M&E subgroup selected 13 indicators: screening coverage, participation rate, recall rate, breast cancer detection rate, invasive breast cancer detection rate, cancers > 20 mm, cancers ≤10 mm, lymph node status, interval cancer rate, episode sensitivity, time interval between screening and first treatment, benign open surgical biopsy rate, and mastectomy rate. This systematic approach led to the identification of 13 BCSP candidate performance indicators to be further evaluated for their association with BC mortality

Value of second-look ultrasound of suspicious breast lesion detected on MRI

Cilj. Svrha ovog rada jest utvrditi kliničku vrijednost dodatnoga ultrazvučnog (UZV) pregleda u evaluaciji sumnjivih lezija dojke inicijalno otkrivenih na pregledu magnetskom rezonancijom (MR) u pacijentica s invazivnim karcinomom dojke. Ispitanici i metode. Ovo retrospektivno istraživanje provedeno je analizom radioloških nalaza 277 bolesnica s karcinomom dojke kojima je u sklopu preoperativne obrade učinjen pregled MR-om na Kliničkom zavodu za dijagnostičku i intervencijsku radiologiju Kliničkoga bolničkog centra Zagreb. Na pregledu MR-om otkrivene su nove lezije koje su dodatno analizirane na ciljanom, dodatnom UZV pregledu. Učinjena je biopsija širokom iglom ili citološka punkcija UZV-om otkrivenih sumnjivih lezija kako bi se učinila patohistološka, odnosno citološka analiza. Uspoređena je korelacija MR i UZV nalaza s obzirom na tip i veličinu lezije. Rezultati. Preoperativnim MR pregledom otkrivene su 33 nove lezije. Dodatnim UZV pregledom verificirano je 25 lezija (75,8%), od kojih je 10 lezija (40,0%) pokazivalo benigne karakteristike. Zbog suspektnih obilježja kod 15 lezija (60,0%) učinjena je patohistološka ili citološka analiza. Među lezijama koje su ultrazvučno verificirane ukupno je otkriveno devet (36,0%) karcinoma i 16 lezija (64,0%) benignih karakteristika. Nije zabilježen niti jedan slučaj karcinoma tijekom dvogodišnjeg praćenja lezija benignih karakteristika. Postotak korelacije UZV i MR nalaza značajno je veći za lezije koje su se na MR-u prikazale kao tvorbe u usporedbi s korelacijom za zone imbibicije (p<0,05). Za fokus imbibicije nije zabilježena niti jedna korelacija. Veličina tvorbi i zona imbibicije ne utječe na uspjeh korelacije. Zaključak. Sumnjive lezije otkrivene MR-om mogu se analizirati dodatnim UZV pregledom, odnosno postotak korelacije UZV i MR nalaza je visok, pri čemu tvorbe pokazuju viši postotak korelacije od zona imbibicije. Za tvorbe i zone imbibicije veličina nema utjecaja na uspjeh korelacije. Dodatni UZV koristan je dodatak dijagnostičkoj obradi pacijentica s MR-om otkrivenom lezijom u dojci te se njegovom uporabom mogu izbjeći nepotrebne biopsije.Aim. The purpose of this study is to determine the clinical utility of an additional ultrasound examination in the evaluation of suspicious breast lesions detected initially on magnetic resonance imaging (MRI) in the patients with invasive breast cancer. Patients and Methods. This retrospective study was conducted by analysing the radiology reports of 277 patients with breast cancer who underwent MRI as a part of the preoperative workup at the University Hospital Centre Zagreb, Department of Radiology. MRI scan detected new lesions were subsequently evaluated by ultrasound examination. Percutaneous biopsy or fine needle aspiration (FNA) was performed on suspicious lesions to obtain pathohistological or cytological confirmation. Correlation of MRI and ultrasound findings was compared with respect to the lesion type and size. Results. A total of 33 new lesions were detected on preoperative MRI. Ultrasound correlation was made in 25 lesions (75.8%). Ten lesions (40.0%) had benign characteristics. Fifteen lesions (60.0%) underwent biopsy or FNA. In total, nine lesions (36.0%) were confirmed as malignant and 16 (64.0%) had benign characteristics. There was no recorded case of carcinoma in the group of lesions with benign appearance that were followed up for two years. Correlation rate of MRI and ultrasound findings was significantly higher in mass lesions (p<0.05). No correlation was found for foci. The size of other lesions did not affect correlation rate. Conclusion. Suspicious lesions detected on MRI can be successfully analysed on additional ultrasound examination. Correlation rate of MRI and ultrasound findings is high, with mass lesions exhibiting a higher percentage of correlation than non-mass lesions. The size of those lesions does not affect correlation rate. Additional ultrasound is useful in diagnostic workup of patients with MRI-detected breast lesion and can reduce the number of unnecessary biopsies

Uncertainties and controversies in axillary management of patients with breast cancer

The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prioritized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Subsequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the most relevant endpoints in axillary management should encompass a meta-analysis to identify knowledge gaps, followed by a Delphi process to prioritize and a consensus conference to refine recommendations for specific trial designs. Finally, treatment of residual nodal disease after surgery was recommended to be assessed in a prospective register

Sonoelastografske karakteristike lezija dojke visokog rizika i duktalnog karcinoma in situ - probno istraživanje

The aim of this study was to evaluate the quantitative sonoelastographic values recorded on shear-wave sonoelastography (SWE) of high-risk breast lesions and ductal carcinoma in situ (DCIS). We retrospectively analyzed histopathologic and SWE data (quantitative maximum, minimum and mean stiffness, lesion-to-fat ratio (E-ratio), lesion size) of 228 women referred to our Department for core needle breast biopsy during a four-year period. Among 230 lesions, histopathologic findings showed 34 high-risk breast lesions and 29 DCIS, which were compared with 167 ductal invasive carcinomas. High-risk lesions had lower values of all sonoelastographic features than ductal in situ and invasive carcinoma, however, only E-ratio showed a statistically significant difference in comparison to DCIS (3.7 vs. 6, p<0.001). All sonoelastographic features showed significant difference between in situ and invasive carcinoma. There was a significant correlation between lesion size and stiffness (r=0.36; p<0.001). Stiffness measured by SWE is an effective predictor of the histopathologic severity of sonographically detectable breast lesions. Elasticity values of high-risk lesions are significantly lower than those of malignant lesions. Furthermore, we showed that along with the sonographic appearance, which in most cases shows typical microcalcifications, DCIS had significantly different elasticity parameters than invasive carcinoma.Cilj ove studije bio je izmjeriti kvantitativne vrijednosti tvrdoće lezija dojke visokog rizika i duktalnog karcinoma in situ (DKIS) pomoću shear-wave sonoelastografije. Retrospektivno smo analizirali patohistološke, ultrazvučne i elastografske podatke (maksimalna, srednja i minimalna tvrdoća, omjer tvrdoće lezije i masnog tkiva (E-omjer), veličina lezije) 228 bolesnica upućenih tijekom četvorogodišnjeg razdoblja na naš odjel radi biopsije dojke širokom iglom. Patohistološki su među 230 lezija dojke dijagnosticirane 34 lezije dojke visokog rizika, 29 duktalnih karcinoma in situ te 167 invazivnih duktalnih karcinoma dojke. Lezije visokog rizika pokazale su niže vrijednosti svih elastografskih parametara u usporedbi s duktalnim in situ i invazivnim karcinomima, no u usporedbi s DKIS jedino je E-omjer pokazao značajnu razliku tvrdoće (3,7 prema 6; p<0,001). Sve su se sonoelastografske vrijednosti značajno razlikovale pri usporedbi duktalnih in situ i invazivnih karcinoma. Nađena je značajna povezanost veličine i tvrdoće lezije (r=0,36; p<0,001). Tvrdoća mjerena shear-wave sonoelastografijom dobro korelira s patohistološkim nalazom lezija dojke koje se mogu otkriti ultrazvukom. Vrijednosti tvrdoće lezija visokog rizika su značajno niže od onih kod malignih lezija. Također smo pokazali da DKIS, uz ultrazvučni nalaz tipičnih mikrokalcifikata u najvećem broju slučajeva, ima i značajno manje vrijednosti tvrdoće od invazivnih karcinoma

RESONANCIA MAGNÉTICA EN EL DIAGNÓSTICO Y SEGUIMIENTO DEL CÁNCER DE MAMA

El cáncer de mama es el tumor con mayor incidencia y prevalencia en mujeres de nuestro medio. Presenta una etiopatogenia multifactorial con factores de riesgo modificables y no modificables, entre los que destacan los genes de alto riesgo, cuya presencia va a condicionar el diagnóstico y seguimiento de sus portadoras. En el proceso diagnóstico la radiología juega un papel fundamental siendo la mamografía y la ecografía las técnicas convencionales en el manejo inicial. La resonancia magnética es la técnica de imagen con mayor sensibilidad, razón por la que ha ido ganando protagonismo en los últimos años, ya que nos permite una valoración más exacta de la patología mamaria y una mejor planificación terapéutica.La resonancia magnética basa su funcionamiento en la creación de un campo magnético muy potente a través de un imán. La posterior aplicación de ondas de radiofrecuencia permitirá obtener imágenes con gran resolución espacial y temporal. Sus indicaciones diagnósticas están muy bien establecidas, entre las que destacan: la estadificación loco-regional en pacientes con cáncer de mama candidatas a cirugía conservadora, la valoración de respuesta al tratamiento neoadyuvante, el diagnóstico diferencial entre recidiva local y cambios postquirúrgicos, la enfermedad de Paget del pezón, el diagnóstico de complicaciones de implantes mamarios y los hallazgos no concluyentes con el resto de las técnicas radiológicas. La resonancia magnética está especialmente indicada en el cribado de mujeres de alto riesgo: por antecedentes personales o familiares de cáncer de mama o por ser portadoras de mutaciones tipo BRCA1/2, cuyo screening comienza a los 25 años con una resonancia magnética anual. La resonancia magnética constituye un avance en diagnóstico por imagen, gracias a su alta sensibilidad y a la información anatómica y funcional que nos proporciona. De esta manera, nos va a permitir acercarnos a un mejor conocimiento sobre la biología celular del cáncer de mama.<br /