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51. Low-Dose Tamoxifen for Mammographic Density Reduction: A Randomized Controlled Trial

Author

Eriksson, Mikael, primary, Eklund, Martin, additional, Borgquist, Signe, additional, Hellgren, Roxanna, additional, Margolin, Sara, additional, Thoren, Linda, additional, Rosendahl, Ann, additional, Lång, Kristina, additional, Tapia, José, additional, Bäcklund, Magnus, additional, Discacciati, Andrea, additional, Crippa, Alessio, additional, Gabrielson, Marike, additional, Hammarström, Mattias, additional, Wengström, Yvonne, additional, Czene, Kamila, additional, and Hall, Per, additional

Published
2021
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58. Interval and Consecutive Round Breast Cancer after Digital Breast Tomosynthesis and Synthetic 2D Mammography versus Standard 2D Digital Mammography in BreastScreen Norway

Author

Hovda, Tone, primary, Holen, Åsne S., additional, Lång, Kristina, additional, Albertsen, Judy Lynn, additional, Bjørndal, Hilde, additional, Brandal, Siri H. B., additional, Sahlberg, Kristine Kleivi, additional, Skaane, Per, additional, Suhrke, Pål, additional, and Hofvind, Solveig, additional

Published
2020
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60. Towards clinical grating-interferometry mammography

Author

Arboleda, Carolina, primary, Wang, Zhentian, additional, Jefimovs, Konstantins, additional, Koehler, Thomas, additional, Van Stevendaal, Udo, additional, Kuhn, Norbert, additional, David, Bernd, additional, Prevrhal, Sven, additional, Lång, Kristina, additional, Forte, Serafino, additional, Kubik-Huch, Rahel Antonia, additional, Leo, Cornelia, additional, Singer, Gad, additional, Marcon, Magda, additional, Boss, Andreas, additional, Roessl, Ewald, additional, and Stampanoni, Marco, additional

Published
2019
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63. Stand-Alone Artificial Intelligence for Breast Cancer Detection in Mammography: Comparison With 101 Radiologists

Author

Rodriguez-Ruiz, Alejandro, primary, Lång, Kristina, additional, Gubern-Merida, Albert, additional, Broeders, Mireille, additional, Gennaro, Gisella, additional, Clauser, Paola, additional, Helbich, Thomas H, additional, Chevalier, Margarita, additional, Tan, Tao, additional, Mertelmeier, Thomas, additional, Wallis, Matthew G, additional, Andersson, Ingvar, additional, Zackrisson, Sophia, additional, Mann, Ritse M, additional, and Sechopoulos, Ioannis, additional

Published
2019
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70. One-view digital breast tomosynthesis as a stand-alone modality for breast cancer detection: do we need more?

Author

Rodriguez-Ruiz, Alejandro, primary, Gubern-Merida, Albert, additional, Imhof-Tas, Mechli, additional, Lardenoije, Susanne, additional, Wanders, Alexander J. T., additional, Andersson, Ingvar, additional, Zackrisson, Sophia, additional, Lång, Kristina, additional, Dustler, Magnus, additional, Karssemeijer, Nico, additional, Mann, Ritse M., additional, and Sechopoulos, Ioannis, additional

Published
2017
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76. Learning density independent texture features

Author

Tingberg, Anders, Lång, Kristina, Timberg, Pontus, Kallenberg, Michiel Gijsbertus J., Nielsen, Mads, Holland, Katharina, Karssemeijer, Nico, Igel, Christian, Lillholm, Martin, Tingberg, Anders, Lång, Kristina, Timberg, Pontus, Kallenberg, Michiel Gijsbertus J., Nielsen, Mads, Holland, Katharina, Karssemeijer, Nico, Igel, Christian, and Lillholm, Martin

Published
2016

77. ESTIMATES OF BREAST CANCER GROWTH RATE FROM MAMMOGRAMS AND ITS RELATION TO TUMOUR CHARACTERISTICS.

Author

Förnvik, Daniel, Lång, Kristina, Andersson, Ingvar, Dustler, Magnus, Borgquist, Signe, Timberg, Pontus, Förnvik, Daniel, Lång, Kristina, Andersson, Ingvar, Dustler, Magnus, Borgquist, Signe, and Timberg, Pontus

Abstract

This study aimed to investigate the growth rate of 31 consecutive invasive breast cancers based on volume measures on at least two serial mammograms and its relation to histopathological findings. The average tumour volume-doubling time in all invasive breast cancer subtypes was 282 d (range 46-749 d). Grade III breast cancers had a significantly shorter average tumour volume-doubling time of 105 d (range 46-157 d) compared with Grade I and II tumours (average of 296 d, range 147-531 d and average of 353 d, range 139-749 d, respectively) (p = 0.002). Multiple linear regression identified that tumour volume-doubling time was positively associated with patient age, histological grade and progesterone receptor expression and inversely associated with axillary lymph node involvement, human epidermal growth factor receptor 2 and Ki-67 expression (p < 0.001). In conclusion, tumour volume-doubling time as estimated on serial mammography may provide important prognostic information relevant for clinical decision-making.

Published
2016

79. Comparison between software volumetric breast density estimates in breast tomosynthesis and digital mammography images in a large public screening cohort.

Author

Förnvik, Daniel, Förnvik, Hannie, Fieselmann, Andreas, Lång, Kristina, and Sartor, Hanna

Subjects
TOMOSYNTHESIS, DIGITAL mammography, BREAST exams, BREAST imaging, RADIOLOGISTS, BREAST tumor diagnosis, BREAST, MAMMOGRAMS, COMPARATIVE studies, COMPUTER software, LONGITUDINAL method, RESEARCH methodology, MEDICAL cooperation, RESEARCH, EVALUATION research, RECEIVER operating characteristic curves, EARLY detection of cancer
Abstract

Objectives: To compare software estimates of volumetric breast density (VBD) based on breast tomosynthesis (BT) projections to those based on digital mammography (DM) images in a large screening cohort, the Malmö Breast Tomosynthesis Screening Trial (MBTST).Methods: DM and BT images of 9909 women (enrolled 2010-2015) were retrospectively analysed with prototype software to estimate VBD. Software calculation is based on a physics model of the image acquisition process and incorporates the effect of masking in DM based on accumulated dense tissue areas. VBD (continuously and categorically) was compared between BT [central projection (mediolateral oblique view (MLO)] and two-view DM, and with radiologists' BI-RADS density 4th ed. scores. Agreement and correlation were investigated with weighted kappa (κ), Spearman's correlation coefficient (r), and Bland-Altman analysis.Results: There was a high correlation (r = 0.83) between VBD in DM and BT and substantial agreement between the software breast density categories [observed agreement, 61.3% and 84.8%; κ = 0.61 and ĸ = 0.69 for four (a/b/c/d) and two (fat involuted vs. dense) density categories, respectively]. There was moderate agreement between radiologists' BI-RADS scores and software density categories in DM (ĸ = 0.55) and BT (ĸ = 0.47).Conclusions: In a large public screening setting, we report a substantial agreement between VBD in DM and BT using software with special focus on masking effect. This automated and objective mode of measuring VBD may be of value to radiologists and women when BT is used as the primary breast cancer screening modality.Key Points: • There was a high correlation between continuous volumetric breast density in DM and BT. • There was substantial agreement between software breast density categories (four groups) in DM and BT; with clinically warranted binary software breast density categories, the agreement increased markedly. • There was moderate agreement between radiologists' BI-RADS scores and software breast density categories in DM and BT. [ABSTRACT FROM AUTHOR]

Published
2019
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82. Breast cancer detection in digital breast tomosynthesis and digital mammography - A side-by-side review of discrepant cases.

Author

Lång, Kristina, Andersson, Ingvar, Zackrisson, Sophia, Lång, Kristina, Andersson, Ingvar, and Zackrisson, Sophia

Abstract

Objective: To analyse discrepant breast cancer detection in digital breast tomosynthesis (DBT) and digital mammography (DM). Methods: From a previous detection study comparing DBT and DM, 26 discrepant cases were extracted, 19 detected by DBT only and 7 by DM only. An expert panel of 3 radiologists reviewed these cases and documented level of discrepancy, lesion visibility, radiographic pattern, lesion conspicuity and assessed the reason for non-detection. Differences between groups were tested using the Wilcoxon Rank Sum test, the Kruskal-Wallis test and visual grading characteristics. Results: The proportion of lesion periphery in fatty tissue was statistically significantly larger, and there were significantly more spiculated masses in DBT compared to DM in the DBT Only group (p=0.018; p=0.015). The main reasons for missing a lesion were poor lesion visibility when using DM and interpretative error when using DBT. Conclusion: Lesion visualization is superior with DBT, particularly of spiculated tumours. A major reason for non-detection in DBT seems to be interpretative error, which may be due to lack of experience.

Published
2014

91. Microbubbles as a contrast agent in grating interferometry mammography: an ex vivo proof-of-mechanism study

Author

Lång, Kristina, Arboleda, Carolina, Forte, Serafino, Wang, Zhentian, Prevrhal, Sven, Koehler, Thomas, Kuhn, Norbert, David, Bernd, Jefimovs, Konstantins, Kubik-Huch, Rahel A., and Stampanoni, Marco

Subjects
Interferometry, Microbubbles, Contrast media, education, Phantoms (imaging), 3. Good health, Mammography
Abstract

Grating interferometry mammography (GIM) is an experimental breast imaging method at the edge of being clinically implemented. Besides attenuation, GIM can measure the refraction and scattering of x-rays resulting in differential phase contrast (DPC) and dark-field (DF) images. In this exploratory study, we assessed the feasibility of using microbubbles as a contrast agent in GIM. Two millilitres of microbubbles and iodine were respectively injected into ex vivo breast phantoms, consisting of fresh chicken breasts. Native and postcontrast images were acquired with a clinically compatible GIM setup, operated at 38 kVp, 14-s acquisition time, and with a dose of 1.3 mGy. The visibility of the contrast agents was analysed in a side-by-side comparison by three radiologists. The contrast-to-noise-ratio (CNR) was calculated for each contrast agent. We found that both contrast agents were judged to be visible by the readers. The mean CNR was 3.1 ± 1.9 for microbubbles in DF and 24.2 ± 6.5 for iodine in attenuation. In conclusion, this is a first proof-of-mechanism study that microbubbles could be used as a contrast agent in clinically compatible GIM, due to their scattering properties, which implies the potential use of a contrast agent with a high safety profile in x-ray-based breast imaging., European Radiology Experimental, 3 (1), ISSN:2509-9280

92. Identification of Women at High Risk of Breast Cancer Who Need Supplemental Screening

Author

Eriksson, Mikael, Czene, Kamila, Strand, Fredrik, Zackrisson, Sophia, Lindholm, Peter, Lång, Kristina, Förnvik, Daniel, Sartor, Hanna, Mavaddat, Nasim, Easton, Doug, and Hall, Per

Subjects
2. Zero hunger, Adult, Breast Neoplasms, Middle Aged, Risk Assessment, 3. Good health, Diagnosis, Differential, Risk Factors, Humans, Mass Screening, Female, Genetic Predisposition to Disease, Prospective Studies, Diagnostic Errors, Life Style, Aged, Mammography
Abstract

Background Mammography screening reduces breast cancer mortality, but a proportion of breast cancers are missed and are detected at later stages or develop during between-screening intervals. Purpose To develop a risk model based on negative mammograms that identifies women likely to be diagnosed with breast cancer before or at the next screening examination. Materials and Methods This study was based on the prospective screening cohort Karolinska Mammography Project for Risk Prediction of Breast Cancer (KARMA), 2011-2017. An image-based risk model was developed by using the Stratus method and computer-aided detection mammographic features (density, masses, microcalcifications), differences in the left and right breasts, and age. The lifestyle extended model included menopausal status, family history of breast cancer, body mass index, hormone replacement therapy, and use of tobacco and alcohol. The genetic extended model included a polygenic risk score with 313 single nucleotide polymorphisms. Age-adjusted relative risks and tumor subtype specific risks were estimated by using logistic regression, and absolute risks were calculated. Results Of 70 877 participants in the KARMA cohort, 974 incident cancers were sampled from 9376 healthy women (mean age, 54 years ± 10 [standard deviation]). The area under the receiver operating characteristic curve (AUC) for the image-based model was 0.73 (95% confidence interval [CI]: 0.71, 0.74). The AUCs for the lifestyle and genetic extended models were 0.74 (95% CI: 0.72, 0.75) and 0.77 (95% CI: 0.75, 0.79), respectively. There was a relative eightfold difference in risk between women at high risk and those at general risk. High-risk women were more likely to be diagnosed with stage II cancers and with tumors 20 mm or larger and were less likely to have stage I and estrogen receptor-positive tumors. The image-based model was validated in three external cohorts. Conclusion By combining three mammographic features, differences in the left and right breasts, and optionally lifestyle factors and family history and a polygenic risk score, the model identified women at high likelihood of being diagnosed with breast cancer within 2 years of a negative screening examination and in possible need of supplemental screening. © RSNA, 2020 Online supplemental material is available for this article.

93. Towards clinical grating-interferometry mammography

Author

Arboleda, Carolina, Wang, Zhentian, Jefimovs, Konstantins, Koehler, Thomas, van Stevendaal, Udo, Kuhn, Norbert, David, Bernd, Prevrhal, Sven, Lång, Kristina, Forte, Serafino, Kubik-Huch, Rahel Antonia, Leo, Cornelia, Singer, Gad, Marcon, Magda, Boss, Andreas, Roessl, Ewald, and Stampanoni, Marco

Subjects
Interferometry, Phase contrast, 3. Good health, Mammography
Abstract

Objectives Grating-interferometry-based mammography (GIM) might facilitate breast cancer detection, as several research works have demonstrated in a pre-clinical setting, since it is able to provide attenuation, differential phase contrast, and scattering images simultaneously. In order to translate this technique to the clinics, it has to be adapted to cover a large field-of-view within a clinically acceptable exposure time and radiation dose. Methods We set up a grating interferometer that fits into a standard mammography system and fulfilled the aforementioned conditions. Here, we present the first mastectomy images acquired with this experimental device. Results and conclusion Our system performs at a mean glandular dose of 1.6 mGy for a 5-cm-thick, 18%-dense breast, and a field-of-view of 26 × 21 cm2. It seems to be well-suited as basis for a clinical-environment device. Further, dark-field signals seem to support an improved lesion visualization. Evidently, the effective impact of such indications must be evaluated and quantified within the context of a proper reader study. Key Points • Grating-interferometry-based mammography (GIM) might facilitate breast cancer detection, since it is sensitive to refraction and scattering and thus provides additional tissue information. • The most straightforward way to do grating-interferometry in the clinics is to modify a standard mammography device. • In a first approximation, the doses given with this technique seem to be similar to those of conventional mammography., European Radiology, 30, ISSN:0938-7994, ISSN:1432-1084

96. Can horizontally oriented breast tomosynthesis image volumes or the use of a systematic search strategy improve interpretation? An eye tracking and free response human observer study

Author

Lång, Kristina, Zackrisson, Sophia, Holmqvist, Kenneth, Nyström, Marcus, Andersson, Ingvar, Förnvik, Daniel, Tingberg, Anders, and Timberg, Pontus

Abstract

Our aim was to evaluate if there is a benefit in diagnostic accuracy and efficiency of viewing breast tomosynthesis (BT) image volumes presented horizontally oriented, but also to evaluate the use of a systematic search strategy where the breast is divided, and analyzed consecutively, into two sections. These image presentations were compared to regular vertical image presentation. All methods were investigated using viewing procedures consisting of free scroll volume browsing, and a combination of initial cine loops at three different frame rates (9, 14, 25 fps) terminated upon request followed by free scroll volume browsing if needed. Fifty-five normal BT image volumes in MLO view were collected. In these, simulated lesions (20 masses and 20 clusters of microcalcifications) were randomly inserted, creating four unique image sets for each procedure. Four readers interpreted the cases in a random order. Their task was to locate the lesions, mark and assign a five level confidence scale. The diagnostic accuracy was analyzed using Jackknife Free Receiver Operating Characteristics (JAFROC). Time efficiency and visual search behavior were also investigated using eye tracking. Results indicate there was no statistically significant difference in JAFROC FOM between the different image presentations, although visual search was more time efficient when viewing horizontally oriented image volumes in medium cine loops.

Published
2011
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97. Optimizing viewing procedures of breast tomosynthesis image volumes using eye tracking combined with a free response human observer study

Author

Lång, Kristina, Zackrisson, Sophia, Holmqvist, Kenneth, Nystrom, Marcus, Andersson, Ingvar, Förnvik, Daniel, Tingberg, Anders, and Timberg, Pontus

Abstract

The purpose of this study was to evaluate four different viewing procedures as part of improving viewing conditions of breast tomosynthesis (BT) image volumes. The procedures consisted of free scroll volume browsing, and a combination of initial cine loops at three different frame rates (9, 14 and 25 fps) terminated upon request followed by free scroll volume browsing. Fifty-five normal BT image volumes in MLO view were collected. In these, simulated lesions (20 masses and 20 clusters of microcalcifications) were randomly inserted, creating four unique image sets for each procedure. Four readers interpreted the cases in a random order. Their task was to locate a lesion, mark and assign a five level confidence scale. The diagnostic accuracy was analyzed using Jackknife Free Receiver Operating Characteristics (JAFROC). Time efficiency and visual search behavior were also investigated using eye tracking. The results indicate that there was no statistically significant difference in JAFROC FOM between the different viewing procedures, however the medium cine loop speed seemed to be the preferred viewing procedure in terms of total analyze time and dwell time.

Published
2011
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98. Contrast Detail Phantoms for X-ray Phase-Contrast Mammography and Tomography

Author

Bliznakova, Kristina, Mettivier, Giovanni, Russo, Paolo, Buliev, Ivan, Hutchison, David, Series editor, Kanade, Takeo, Series editor, Kittler, Josef, Series editor, Kleinberg, Jon M., Series editor, Mattern, Friedemann, Series editor, Mitchell, John C., Series editor, Naor, Moni, Series editor, Pandu Rangan, C., Series editor, Steffen, Bernhard, Series editor, Terzopoulos, Demetri, Series editor, Tygar, Doug, Series editor, Weikum, Gerhard, Series editor, Tingberg, Anders, editor, Lång, Kristina, editor, and Timberg, Pontus, editor

Published
2016
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99. Image Quality and Radiation Dose in Propagation Based Phase Contrast Mammography with a Microfocus X-ray Tube: A Phantom Study

Author

Castriconi, Roberta, Mettivier, Giovanni, Russo, Paolo, Hutchison, David, Series editor, Kanade, Takeo, Series editor, Kittler, Josef, Series editor, Kleinberg, Jon M., Series editor, Mattern, Friedemann, Series editor, Mitchell, John C., Series editor, Naor, Moni, Series editor, Pandu Rangan, C., Series editor, Steffen, Bernhard, Series editor, Terzopoulos, Demetri, Series editor, Tygar, Doug, Series editor, Weikum, Gerhard, Series editor, Tingberg, Anders, editor, Lång, Kristina, editor, and Timberg, Pontus, editor

Published
2016
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100. Improving Breast Mass Segmentation in Local Dense Background: An Entropy Based Optimization of Statistical Region Merging Method

Author

Sajeev, Shelda, Bajger, Mariusz, Lee, Gobert, Hutchison, David, Series editor, Kanade, Takeo, Series editor, Kittler, Josef, Series editor, Kleinberg, Jon M., Series editor, Mattern, Friedemann, Series editor, Mitchell, John C., Series editor, Naor, Moni, Series editor, Pandu Rangan, C., Series editor, Steffen, Bernhard, Series editor, Terzopoulos, Demetri, Series editor, Tygar, Doug, Series editor, Weikum, Gerhard, Series editor, Tingberg, Anders, editor, Lång, Kristina, editor, and Timberg, Pontus, editor

Published
2016
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