• Korean Journal of Radiology
• /
• v.25 no.4
• /
• pp.343-350
• /
• 2024

Objective: Artificial intelligence-based computer-aided diagnosis (AI-CAD) is increasingly used in mammography. While the continuous scores of AI-CAD have been related to malignancy risk, the understanding of how to interpret and apply these scores remains limited. We investigated the positive predictive values (PPVs) of the abnormality scores generated by a deep learning-based commercial AI-CAD system and analyzed them in relation to clinical and radiological findings. Materials and Methods: From March 2020 to May 2022, 656 breasts from 599 women (mean age 52.6 ± 11.5 years, including 0.6% [4/599] high-risk women) who underwent mammography and received positive AI-CAD results (Lunit Insight MMG, abnormality score ≥ 10) were retrospectively included in this study. Univariable and multivariable analyses were performed to evaluate the associations between the AI-CAD abnormality scores and clinical and radiological factors. The breasts were subdivided according to the abnormality scores into groups 1 (10-49), 2 (50-69), 3 (70-89), and 4 (90-100) using the optimal binning method. The PPVs were calculated for all breasts and subgroups. Results: Diagnostic indications and positive imaging findings by radiologists were associated with higher abnormality scores in the multivariable regression analysis. The overall PPV of AI-CAD was 32.5% (213/656) for all breasts, including 213 breast cancers, 129 breasts with benign biopsy results, and 314 breasts with benign outcomes in the follow-up or diagnostic studies. In the screening mammography subgroup, the PPVs were 18.6% (58/312) overall and 5.1% (12/235), 29.0% (9/31), 57.9% (11/19), and 96.3% (26/27) for score groups 1, 2, 3, and 4, respectively. The PPVs were significantly higher in women with diagnostic indications (45.1% [155/344]), palpability (51.9% [149/287]), fatty breasts (61.2% [60/98]), and certain imaging findings (masses with or without calcifications and distortion). Conclusion: PPV increased with increasing AI-CAD abnormality scores. The PPVs of AI-CAD satisfied the acceptable PPV range according to Breast Imaging-Reporting and Data System for screening mammography and were higher for diagnostic mammography.

• Journal of Korean Public Health Nursing
• /
• v.18 no.1
• /
• pp.187-194
• /
• 2004

The purpose of this study was to explain mammography screening behavior of Korean women using components of Health Belief Model. A total of 310 women aged 30 and older participated in the study. Of the participants. 155 women who obtained a mammogram during the data collection period were classified as the mammography group and the other 155 who had never had a mammogram were classified as the non-mammography group. The researcher developed instrument used in the study. which included demographic variables and questions measuring the concepts of the HBM components. Trained data collectors administered the questionnaire employing a face-to-face survey method in the waiting areas of hospitals and health promotion centers. The study results indicated that age. knowledge. perceived susceptibility. and self-efficacy were identified as the significant variables in explaining Korean women's mammography screening behavior, whereas, perceived severity, perceived benefits, and perceived barriers were not significantly related to mammography screening behavior of the participants. The findings from this study can be used to guide the design and implementation of health education and health promotion programs in order to promote mammography utilization among Korean women.

• Korean Journal of Adult Nursing
• /
• v.16 no.1
• /
• pp.72-81
• /
• 2004

Purpose: The purpose of this study was to examine factors related to different stages of mammography screening based on the transtheoretical model (TTM) and health belief model (HBM). Method: 143 women were recruited from community centers in W city. The mean age was 44.08 (SD=7.78) and 74 (51.7%) had experienced education on preventative behavior related to breast cancer. The Decisional Balance Scale (Pros and Cons of mammography) and Stages of Adoption of Mammography Scale by Rakowski et al. (1992) and the revised Health Belief Model Scale (Perceived Seriousness, Perceived Susceptibility and Health Motivation) by Champion (1993) were used. Result: According to the stage of adoption of mammography, 17.4% of the women were In pre-contemplation, 45.5% in contemplation, 24.5% in action, and 12.6% in maintenance. The mean differences for pros, and the decisional balances between the stages of mammography adoption were significant (F=8.84, p=.000; F=7.20, p=.000). Education related to prevention of breast cancer was the most important variable. Prevention education, history of breast disease and pros of mammography explained the stages of mammography adoption ($R^{2}=26%$). Conclusion: Findings support TTM as a useful tool for improving mammography adherence. Behavioral interventions that target decisional balance and health belief can effectively promote adherence to mammography.

• Asian Pacific Journal of Cancer Prevention
• /
• v.17 no.sup3
• /
• pp.135-141
• /
• 2016

Since the mean age of breast cancer in women living in developing countries, compared with those in developed countries, is lower by about 10 years, repetition of mammography can play an important role in reducing morbidity and mortality. Hence, this study aimed to investigate the relationship between family history of breast cancer and risk perception and its impact on repetition of mammography. In this cross-sectional study, 1,507 women aged 50 years and older, referred to the mammography center of Regions 1 and 6 in Tehran, Iran, were enrolled. Data were collected using a self-report questionnaire and analyzed using SPSS and LISREL. According to our findings, knowledge about the time interval of mammography was found to have the highest correlation with repetition of mammography (r=0.4). Among the demographic variables, marital status (${\beta}$= -0.1) and family history of breast cancer (${\beta}$=0.1) had the most direct and significant impact on repetition of mammography (P <0.05). Among the other variables studied, knowledge (${\beta}$=-0.5) had the highest direct and significant impact on repetition of mammography (P <0.05). Family history of breast cancer was one of the predictors of repetition of mammography, but the results did not prove any relationship with risk perception. Further studies are needed to assess the effect of risk perception and knowledge about time interval on the initiation and continuation of mammography.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.14
• /
• pp.5759-5765
• /
• 2014

Electrical impedance tomography (EIT) is a potential supplement for mammogram screening. This study aimed to evaluate and feasibility of EIT as opposed to mammography and to determine pain perception with both imaging methods. Women undergoing screening mammography at the Radiology Department of National University of Malaysia Medical Centre were randomly selected for EIT imaging. All women were requested to give a pain score after each imaging session. Two independent raters were chosen to define the image findings of EIT. A total of 164 women in the age range from 40 to 65-year-old participated and were divided into two groups; normal and abnormal. EIT sensitivity and specificity for rater 1 were 69.4% and 63.3, whereas for rater 2 they were 55.3% and 57.0% respectively. The reliability for each rater ranged between good to very good (p<0.05). Quantitative values of EIT showed there were significant differences in all values between groups (ANCOVA, p<0.05). Interestingly, EIT scored a median pain score of $1.51{\pm}0.75$ whereas mammography scored $4.15{\pm}0.87$ (Mann Whitney U test, p<0.05). From these quantitative values, EIT has the potential as a health discriminating index. Its ability to replace image findings from mammography needs further investigation.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.3
• /
• pp.2137-2139
• /
• 2013

Breast cancer is the most common cancer among females, worldwide, accounting for 22.9% of all cancers (excluding non-melanoma skin cancer) in females. Mammography is a sensitive (77-95%) and specific (94-97%) screening method for breast cancer. Previously, females between the 40-50 years old were recommended to have mammograms every one to two years. However, based on current evidence, in 2009, USPSTF recommended that the decision to start regular, biennial screening mammography for females younger than 50 years should be an individual decision and take patient context into account, including the patient's values regarding specific benefits and harms. This decision was based on findings regarding radiation exposure, false-positive and false-negative rates, over-diagnosis, and pain and psychological responses. The goal of this paper is to focus on evidence for updating the U.S. Preventive Services Task Force (USPSTF) recommendation against routine mammography for females between 40-49 years of age.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.2
• /
• pp.853-857
• /
• 2013

Objectives: Breast cancer is a leading cause of morbidity and mortality in women worldwide. Breast screening in normal and/or asymptomatic women is essential to reduce the burden of breast malignancies. Our study aimed to identify possible risk- and/or co-factors associated with breast screening in North Indian women. Methods: A public health research survey was conducted among 100 women of North Indian ethnicity during clinic visits in a 6-month timeline (April-October 2012). Demographic and clinical data, including mammography screening, were recorded in the questionnaire-based proforma after conducting a 10 minute interview. Written informed consent was taken from all the participants. Results: The mean age of the participants was $32.2{\pm}9.9$ years. Out of 100 women, 6% had family history of breast disease. Breast-related complaints/malignancy, including galactorrhoea, mastitis, axillary lump, fibrocystic disease, fibroadenosis and adenocarcinoma were observed in 41% participants; age stratification revealed that 82.9% of this group (n=41) were <30 years, while 9.7% and 7.3% were >30 years and 30 years of age, respectively. 32% participants underwent mammography screening and 8% had breast ultrasound imaging. Age stratification in the mammography screening group demonstrated that 24 women were <40 years, while 7 women were >40 years. Conclusions: Our pilot study identified possible co-factors affecting breast screening in North Indian women. These findings may be beneficial in early detection of breast abnormalities, including malignancies in women susceptible to breast cancer, and thus aid in future design of cost-effective screening strategies to reduce the increasing burden of breast carcinoma in women worldwide.

• Journal of the Korean Society of Radiology
• /
• v.17 no.5
• /
• pp.743-749
• /
• 2023

Breast ductal carcinoma in situ(DCIS) refers to cases in which breast epithelial cells have become malignant but are still limited to normal ducts, and has been increasing rapidly in recent years. In this case, a two-year follow-up revealed findings on mammography and ultrasonography that indicated a small mass classified as BI-RADS Category 3, However far from typical malignant tumor these findings were. In the second year of follow-up, a hypoechoic mass with an indistinct boundary of the right breast in the 6 o'clock direction, on mammography appeared to be about 2.1×1.3 cm in size, and biopsy diagnosed it as ductal carcinoma. Since ductal endothelial cancer has no characteristic clinical findings and can show positive clinical and imaging findings in the early stages, regular follow-up is considered important for early diagnosis, and detection of ductal endothelial cancer through mammography and ultrasound is important for improving the prognosis of all breast cancer patients. During the initial examination conducted four years ago, we reported cases of intra ductal cancer in which asymmetric shading, microcalcification, and branched mass, indicative of intra ductal cancer, were observed during follow-up. It is advisable to concurrently explore methods for reducing X-ray dosage to mitigate potential side effects of contrast medium.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.11
• /
• pp.6857-6862
• /
• 2013

Background: Breast cancer is the most common cancer in women. All ages are susceptible and more than 90% of the patients can be cured with early diagnosis. Breast self-examination (BSE) and mammography can be useful for this aim. In this study we examined the components of the Champion health belief model to identify if they could predict the intentions of women to perform such screening. Materials and Methods: A total of 380 women aged 30 and above who had referred to health-care centers were assessed for use of breast cancer screening over the past year with a modified health belief model questionnaire. Logistic regression was applied to identify leading independent predictors. Results: In this study 27% of the women performed BSE in the last year but only 6.8% of them used mammography as a way of screening. There were significant differences regarding all components of the model except for perceived severity between women that underwent BSE. over the past year and those that did not. Findings were similar for mammography. Regression analysis revealed that intentions to perform BSE were predicted by perceived self-efficacy and perceived barriers to BSE while intentions to perform mammography were predicted by perceived barriers. Conclusions: This study indicated that self-efficacy can support performance of BSE while perceived barriers are important for not performing both BSE and mammography. Thus we must educate women to increase their self-efficacy and decrease their perceived barriers.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.8
• /
• pp.3555-3559
• /
• 2014

Background: The triple-negative breast cancer (TNBC) is an aggressive cancer characterized by the absence of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). Preoperative mammography and ultrasound features of TNBC may potentially suggest characteristics of the disease and assist in treatment decisions. Materials and Methods: The study covered 153 patients with TNBC from May 2011 to May 2012 who were confirmed by postoperative pathology results in our hospital. We compared the radiological findings among the patients and sought to determine the significant iconographic features. The biomarkers p53 and Ki-67 are regarded as significant factors in TNBC. They were therefore used to divide the TNBC into four groups for assessment of relationships with TNBC imaging features. Results: On mammography, most TNBCs exhibit obscure (44.3%) masses. On ultrasound, the majority of masses (95.4%) were predominantly indistinct (50.7%), irregular (76.0%) or featuring posterior echo enhancement/shadowing. Color Doppler flow imaging (CDFI) emphasized hypervascular (32.9%) masses. Differences in CDFI by ultrasound among the four groups were statistically significant (p=0.009). There were obvious differences in the percentages of spiculated margin (p=0.049) and intensive posterior echo (p=0.006) with spotty flow imaging by ultrasound between the Ki-67 (+) p53 (+) and other groups. Conclusions: A combination of mammography and ultrasound revealed the imaging characteristics of TNBC included an obscure mass with less attenuated posterior echoes and some vascularity. A worse prognosis was associated with spiculated margin and intensive posterior echoes with spotty flow imaging.