Here are the top 5 most read ultrasound posts of 2018

With only a few hours left for the calendar year 2018 to come to an end, take a look at the top 5 most read ultrasound posts of the year as we gear up to look forward to another year of medical advances and health research. 

Blob and Bagel sign on Ultrasound can be labeled as definitive for Ectopic Pregnancy

Women with the Blob and Bagel ultrasound sign should be reclassified from having ‘probable’ ectopic pregnancy (EP) to ‘definitive’ EP and should be treated as such reports the result of a large retrospective cohort study published March 11, 2018, in Journal of Ultrasound in Obstetrics and Gynecology.

Ectopic Pregnancy is still the leading cause of first-trimester maternal deaths and constitutes 4% of all pregnancy-related deaths. The incidence of ectopic is highest in women undergoing In-Vitro Fertilization (IVF) and ranges from 4% to 11% of all pregnancies.

https://obgynupdated.blogspot.com/2018/03/blob-and-bagel-sign-on-ultrasound-can.html

Novel cross-over sign in cesarean scar pregnancy helps predicts the risk of invasive placentation

First trimester ultrasound scan evaluating the relationship between the gestational sac and the endometrial line in women with cesarean scar pregnancy(CSP) helps predicts the development of abnormally invasive placenta (AIP) and consecutive intra and post-operative surgical morbidities reports the results of a retrospective case series published in the Journal of International Society of Ultrasound in Obstetrics and Gynecology.

Recent advances in prenatal imaging and increase rate of cesarean sections have led to increased diagnosis of CSP. Although, most of the patients with CSP present with severe hemorrhage or rupture uterus, that requires emergency surgical management, few advances further, evolving into AIP. 

https://obgynupdated.blogspot.com/2018/02/novel-cross-over-sign-in-cesarean-scar.html

Negative sliding sign by ultrasound in repeat cesarean section predicts the presence of severe intrabdominal adhesions

A negative sliding sign by ultrasonography (USG) in patients with previous cesarean section helps alert the surgeon to expect massive intraabdominal adhesions, difficult repeat cesarean section and need of blood transfusion during surgery reports the results of a prospective observational study published ahead of print in the February issue of Journal Obstetrics and Gynecology.

Postoperative adhesion formation is quite prevalent after an abdominal or pelvic surgery and any method which can predict the existence of such adhesion could optimize the outcome of current surgery.

https://obgynupdated.blogspot.com/2018/02/negative-sliding-sign-by-ultrasound-in.html

GE Healthcare introduces its new automated breast ultrasound for dense breast

There could not have been a more appropriate time for the launch of GE Healthcare new Invenia Automated Breast Ultrasound (ABUS) 2.0 than October, which is celebrated as breast cancer awareness month. The Invenia ABUS is the only FDA approved 3D ultrasound system for supplemental screening for breast cancer along with mammography.

In conjunction with mammography, it increases the chances of cancer detection in the dense breast by 55%. All breasts are not the same, the density of breast is determined by a proportion of fat and breast tissue—when the percentage of breast tissue exceeds that of fat, breasts are labeled as being dense.

https://obgynupdated.blogspot.com/2018/10/ge-healthcare-introduces-its-new.html

A practical guide to count ovarian antral follicles by ultrasound

A consensus opinion highlighting the main techniques of ovarian antral follicle count (AFC), and providing recommendations for future research is published in the special issue on Reproductive Medicine of the journal Ultrasound in Obstetrics and Gynecology.

The consensus makes several recommendations for varied methods used in counting the antral follicles, but no single method is superior over others and the choice should make the best use of resources available in a setting.

https://obgynupdated.blogspot.com/2018/02/a-practical-guide-to-count-ovarian.html

GE Healthcare introduces it's new automated breast ultrasound for dense breast

There could not have been more appropriate time for the launch of GE Healthcare new Invenia Automated Breast Ultrasound (ABUS) 2.0 than October, which is celebrated as breast cancer awareness month. The Invenia ABUS is the only FDA approved 3D ultrasound system for supplemental screening for breast cancer along with mammography.

In conjunction with mammography, it increases the chances of cancer detection in the dense breast by 55%. All breasts are not the same, the density of breast is determined by a proportion of fat and breast tissue—when the percentage of breast tissue exceeds that of fat, breasts are labeled as being dense.

Dense breast tissue and cancer both appear white on mammograms, thereby creating a diagnostic dilemma for the radiologists. It is estimated that about 71% of all breast cancers occur in dense breast and 1 in 3 cancers are missed by mammography. 

In the USA, about 40% of women have dense breast; thereby putting them at increased risk of having breast cancer and detection at a late stage. Early detection of breast cancer increases the chance of cure and patients may void chemotherapy.

The Invenia ABUS uses particular software-based graphics processor to capture operator independent, high-quality images making it possible to reproduce consistent images every time the machine is used. Unlike manual device, the focal zone and grain are automatically adjusted eliminating the inter-operator variability.  All these features enable the Invenia to pick-up small cancers that are predominantly invasive but node negative,  culminating into substantial patient benefits.

Invenia ABUS also provides 2-mm thick coronal slices which allow the operator an efficient visualization of the entire breast for architectural distortions and multifocal disease. With the reconstruction of 2-mm thick coronal slices, it is easy to obtain a persistent orientation and location of the lesions relative to the nipple and to scan the entire breast from the skin to chest wall.

The machine is also designed keeping patients comfort at the forefront. The gentle Reverse Curve™ transducer is designed according to the natural contour of breast allowing full contact and effective compression. The operator can customize the examination by programmable scan protocols to personalize it to patient needs.

The windows 10 provides a user-friendly interface to review, interpret patients' results quickly. Compression time can be shortened once tissue acquisition is complete. The three-view layout and Auto Prior Compare enable the physician to compare the results and focus on a region of interest.

“We believe ABUS can help clinicians find significantly more cancers than mammography alone, especially in women with dense breasts,” said Luke Delaney, general manager of Automated Breast Ultrasound at GE Healthcare, in a published statement. “As breast ultrasound technology continues to advance, we are investing to continually improve image quality, workflow, and patient comfort – all of which contribute to early detection and improved outcomes.”

Here is a video about the Invenia ABUS 2.0 acquisition process

Product page

GE press release

Ob/Gyn Updated Facebook page

FDA clears Hologic’s Quantra 2.2 Breast Density Assessment Software during routine screening mammography

Hologic Inc. announced it has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for its Quantra 2.2 Breast Density Assessment Software. The software helps radiologists and clinicians to provide information about breast density to women during routine breast cancer screenings.

Quantra standardizes breast density reporting and helps eliminates the visual subjectivity by radiologists, through a proprietary algorithm powered by machine learning. The software classifies the breast tissue into four density categories based on  ACR Breast Imaging Reporting and Data System( ACRBI-RADS®) Atlas 5^th Edition, based on the distribution of fibroglandular tissue  and texture of breast tissue.

The BI-RADS® Atlas provides standardized breast imaging findings terminology, report organization, assessment structure and a classification system for mammography, ultrasound and MRI of the breast.

The Quantra software is compatible with Hologic's 3D Mammography systems, including the new 3Dimensions mammography system, which is designed to be the fastest, highest resolution breast tomosynthesis system ever, with the 'Intelligent 2D imaging technology'.

Nearly 40% of women between the age of 40 and 74 have dense breasts, which can make it difficult to detect breast cancer during annual screenings and necessitates additional imaging, resulting in increased patient anxiety and unnecessary facility costs. Perhaps most importantly, women with very dense breasts are four to five times more likely to develop breast cancer than women with less dense breasts.

The software is one of several groundbreaking products that is available for demonstration in Hologic's booth (#4705) at the ongoing 103rd ScientificAssembly and Annual Meeting of the Radiological Society of North America (RSNA) at McCormick Place in Chicago from Nov. 26 to 30.

Pete Valenti, Hologic's Division President, Breast and Skeletal Health Solutions said, "As the global leader in breast cancer screening technology, we relentlessly pursue the development of clinically superior products that address the unmet and changing needs of our customers and their patients, especially when it comes to breast density. Quantra software is yet another example of our dedication and we are proud to feature it – along with a number of other new, breakthrough products – for the world's leading radiologists at RSNA this week."

Earlier this year, FDA approved its Genius 3D Tomosynthesis Mammography as the only test superior to 2D mammography for routine breast cancer screening for women with dense breasts. 

Hologic also commercially launched its SmartcCurve breast stabilization system at the same time, that makes mammography experience less painful for women without compromising on image quality and diagnostic accuracy.

Hologic Worldwide Quantra Volumetric Breast Density Assessment

The Future of Breast Cancer Detection is Already Here | Kevin Kelly | TEDx Talk

October is Breast Cancer Awareness month. Dr. Kelly is one of this country’s leading authorities on using ultrasound to detect cancers in women with dense breast tissue and/or implants. Nearly 20 plus years of research have provided sufficient evidence to link dense breast tissue and increased risk of missing cancer diagnosis by screening mammography. As the breast density increases, the reliability of mammogram as a screening tool for picking up breast malignancy decreases.

In his TEDx Talk, Dr Kelly is calling all women with dense breasts or implants to know that  small, curable cancers are often missed by mammography. Following Dr. Papanicolaou’s 30-year struggle to gain acceptance of the Pap smear for detection of cervical cancer, Dr. Kelly is working to do the same for an automated ultrasound technology that finds cancers when they are very small and very curable.

Dr. Kevin Kelly is passionate and dedicated to the early detection of breast cancer. His goal is to educate women about the importance of understanding their breast type so they can make informed decisions about their screening options. Kevin is the Medical Director of The Breast Ultrasound Center in Pasadena, CA, and has been in private practice as a diagnostic radiologist for 34 years.

Related Links on early detection of cancer in dense breast:

ACOG updates its mammography screening guidelines; stressing emphasis on shared decision making.

Are you dense? What every woman and her healthcare provider needs to know.

‘One size fits all’ breast imaging isa thing of past with new personalized breast exams by Automated BreastUltrasound (ABUS).

Innovative Breast Ultrasound system for cancer screening in women with dense breast.

Looking beyond screening mammography in the war against breast cancer.

Here is the TEDx talk: 

Today is World Cancer Research Day: A call to action by ASCO- Don’t Stand Still. We Won’t

September 24th is  World Cancer Research Day. American Society of Clinical Oncology (ASCO)calls upon to continue and heighten research in areas of cancer prevention and treatment, along with discovering new drugs. World Cancer Research Day is a global initiative that aims to raise awareness about the critical importance of cancer research.

It is estimated that by 2030 cancer will be the leading cause of death worldwide with new cases expected to increase to 21.6 million each year. According to the GLOBOCAN report, in 2012 there were 14 million new cases diagnosed and 8.2 million cancer-related deaths worldwide.

Life years and productivity loss, together with disabilities resulting from cancer account for the largest economic cost on a global scale, compared to other causes of death including infectious diseases.

One of the most important areas is to support and promote research on the causes, prevention and early detection of cancer as a key element in controlling the disease. This will lead us towards the discovery of a cure for cancer or transforming the disease into a chronic illness, both approaches translating into higher survival rates.

Some of the important research paper on Obstetrics and Gynecological cancer published recently are:

USPSTF simplifies cervical cancer screening recommendations: Dual testing no longer advised

The US Preventive Services Task Force (USPSTF) has issued new draft recommendations for cervical cancer screening with a major change that it recommends either cervical cytology (CC) or high-risk HPV (hrHPV) test as a screening procedure every 3 years for women aged 30-65 years, and not both ( Grade A)  

https://obgynupdated.blogspot.com/2017/09/uspstf-simplifies-cervical-cancer.html

Magseed, a minimally invasive breast marker for cancer localization during surgery receives clearance in Europe

Endomag, a surgical guidance company received CE clearance for Sentimag+Magseed breast cancer diagnostic system, that guides surgeon for precise location of impalpable tumor during breast lumpectomy. It improves outcome and reduces the amount of radioactive exposure for patients.

https://obgynupdated.blogspot.com/2017/09/magseed-minimally-invasive-breast.html

FDA clears first 2D digital mammography system that allows patients to control the compression

GE Healthcare announced today FDA 510(k) clearance of an industry-first, patient-assisted mammography system, Senographe Pristina Duetathat makes mammography experience more comfortable by putting the control in patients’ own hands.

https://obgynupdated.blogspot.com/2017/09/fda-clears-first-2d-digital-mammography.html

FDA approves world’s first pioneering gene therapy for cancer

The U.S.Food and Drug Administration in its landmark and historic action today approved the world’s first gene therapy, Novartis' Kymriah (tisagenlecleucel) for certain pediatric and young adult patients with a form of acute lymphoblastic leukemia (ALL).

This opens a new frontier in treatment of cancer and other serious and life-threatening diseases.

https://obgynupdated.blogspot.com/2017/09/fda-approves-worlds-first-pioneering.html

Are you dense? What every woman and her healthcare provider needs to know.

Nearly 20 plus years of research have provided sufficient evidence to link dense breast tissue and increased risk of missing cancer diagnosis by screening mammography. As the breast density increases, the reliability of mammogram as a screening tool for picking up breast malignancy decreases.

What is meant by “being dense”? Breast density does not correlate with physically palpated firmness of breast, it is a radiologic finding and cannot be predicted without obtaining a mammogram. 

https://obgynupdated.blogspot.com/2017/08/are-you-dense-what-every-woman-and-her.html

Now Ovarian Tissue paper to support normal hormonal production: Breakthrough in Regenerative Medicine

An accidental Spill has sparked a breakthrough in the field of regenerative medidicne. Scientists and engineers at the Northwestern Medicine have invented a range of bioactive “tissue papers” made from organs combined with a polymer to make them so pliable.

These new “tissue papers” are so thin and pliable that they can be folded into an origami bird. Their clinical application is for wound healing and aid in natural hormone production in young cancer patients.

https://obgynupdated.blogspot.com/2017/08/now-ovarian-tissue-paper-to-support.html

Adjunct Metformin helps reversal of atypical endometrial hyperplasia

Adjunct metformin treatment help reversal of atypical endometrial hyperplasia (AEH) and improves overall survival in endometrial cancer reports the result of a systematic review and meta-analysis published ahead of print in Journal of Gynecologic Oncology.

https://obgynupdated.blogspot.com/2017/08/adjunct-metformin-helps-reversal-of.html

FDA Approves PARP inhibitor Zejula for treatment of recurrent ovarian cancer.

The U.S.Food and Drug Administration today approved Zejula (niraparib) for the maintenance treatment of epithelial ovarian, fallopian tube or primary peritoneal cancer in adult patients who have already responded well to platinum-based chemotherapy.

https://obgynupdated.blogspot.com/2017/03/fda-approves-parp-inhibitor-zejula-for.html

Here is an interesting video about importance of research on World Cancer Research Day 2017

FDA labels Hologic Genius 3D Tomosynthesis Mammography superior for visualization of dense breasts

Hologic, a leading global healthcare and diagnostics company continues to expand its Breast Health portfolio through continued innovation and product development. As a breakthrough, FDA recently approved its Genius 3D Tomosynthesis Mammography as the only test superior to 2D mammography for routine breast cancer screening.

The Genius exams is available to public since 2011, but the newly approved labeling comes in wake of results of clinical studies showing “the exam improves invasive breast cancer detection while reducing unnecessary recalls among women of all breast densities, including those with dense breasts,” according to press release by Hologic.

To find out who offers Genius 3D mammography in your area in USA, click here. 

Among women between the age of 40 to 74 years, nearly 40% to 50% have dense breast. Dense breast also increases the likelihood of developing cancer by 5 to 6 times as compared to women with normal breast density.  Often the cancers are detected very late in women with dense tissue because of imaging difficulty.

Density of breast is a measure of amount of fibrous or glandular tissue in breast and can only be identified by imaging techniques. To make patients aware about it, 31 states in US requires notification to be sent to patients after a mammogram.

"Radiologists and referring physicians needed an answer for how to screen the roughly half of women with dense breasts, because until now, this patient population was confused and frustrated without a clear path forward," said Pete Valenti, Hologic's Division President, Breast and Skeletal Health Solutions. "We are pleased today to provide this definitive guidance from the FDA that the Genius exam is a superior screening solution for women with dense breasts. This is yet another reason referring physicians can feel confident in recommending Hologic's Genius exam."

Although Conventional 2D mammography is currently the gold standard, it has limitations in women with dense breast because the dense tissue can overlay on top of each other and potentially hide small cancers.

The main advantage of 3D tomosynthesis is it can clearly delineate the underlying breast tissue, irrespective of breast density.  This enables the diagnosis at very early stage and reduces false positives results, thereby avoiding unnecessary biopsy.  

It is also a method of choice in women who are at high risk for developing cancer or women who are referred for breast lump.

Another screening modality for women with dense breast is Innovative Breast Ultrasound system: the Invenia Automated Breast Ultrasound System(ABUS).

To get information on personalized breast screening click here 

Here is a video by Hologic about how Genius 3D mammography is performed.

Looking beyond screening mammography in the war against breast cancer.

Courtesy: MariaShriver.com 

Whenever we think of breast imaging, our first thought is mammography. The earliest record of mammography dates back to 1913 when German Surgeon Albert Salomon attempted to visualize cancer through radiogram but it was only in mid 60s that  mammography was introduced as a screening tool on mass scale for early diagnosis of breast cancer.

The technique has substantially evolved in last several decades, from direct-exposure films to digital. Digital mammography exposes the patient to much lower dose of radiation as compared to analog mammography and the images are clearer and can be viewed on computer.

New data analysis R. Edward Hendrick, Ph.D., shows nearly 275,000 breast cancer deaths have been averted since 1990, attributed to increased mammographic screening and improved therapies.

However, like other techniques, mammography is also not perfect and has its own limitations. 

According to ACS screening mammograms do not find about 1 in 5 breast cancers. Chances of missing the disease is higher if the patient have dense breast.

A recent study has shown that nearly 43% patients in USA have dense breast.

Many US states have laws requiring the mammography centers to inform patients about dense fibroglandular breast tissue and its impact on cancer diagnosis and detection rates.

courtesy of Hologic

Digital breast tomosynthesis (DBT) or 3D mammography is a new technique for mammography especially useful for screening women with dense breast. It includes multiple low-dose full-field projection images of the breast obtained from different angles that form an arc. The images are then used to reconstruct a 3D image of the breast, resulting in a clearer view without the distraction of overlapping tissue.

Currently there are four tomosynthesis systems on the market. Hologic’s Selenia Dimensions mammography, GE’s SenoClaire 3-D breast tomosynthesis, Siemens Mammomat Inspiration Prime with Tomosynthesis Option and Fujifilm Medical Systems U.S.A.

Another screening technique is whole breast ultrasound and breast magnetic resonance imaging (MRI).

Whole breast ultrasound is used along with screening mammography to pick up lesions that cannot be felt by hands and also not seen on mammography. It is done in the same sitting as screening mammogram. It is specifically useful for patients whose mammogram reported “Extremely dense breasts” (or density score of 4) or “Heterogeneously dense breasts” (or density score of 3).

It can be performed manually or by using Automated Breast Ultrasound System(ABUS).

GE Introduced a new version of its automated breast ultrasound system ‘the Invenia Automated Breast Ultrasound System(ABUS)’.

Breast MRI is another screening tool, it is not recommended for routine screening because it results in more false positives leading to anxiety and unnecessary breast biopsies.  It is recommended for screening women who are at high risk for breast cancer, usually due to a strong family history and/or a mutation in genes such as BRCA1 or BRCA2.

The American Cancer Society (ACS) recommends that all high-risk women with greater than 20% lifetime risk of breast cancer should have a breast MRI and a mammogram every year. For most women, these combined screenings should start at age 30 and continue as long as the woman is in good health.

Combined these three techniques are able to find another 20-40 percent more cancers than screening mammography alone.

Major American medical organizations with expertise in breast cancer care, including the American Congress of Obstetricians and Gynecologists (ACOG), American College of Radiology (ACR) and Society of Breast Imaging (SBI) continue to recommend that women start getting annual mammograms at age 40 and continue screening till women is in good health or life expectancy is less than 10 years.  

USPSTF advises to start screening at age 50 till 74 years with an interval of 2 years between screening.

Innovative Breast Ultrasound system for cancer screening in women with dense breast.

Courtesy: GE systems

Mammography is the gold standard for early detection and cancer screening for breast cancer, however it may miss the cancer in about one third of patients with dense breast tissue. According to a study about 40% of women in US have dense breast.

Dense breast also increases the likelihood of developing cancer by 5 to 6 times as compared to women with normal breast density.  Often the cancers are detected very late in women with dense tissue because of imaging difficulty.

GE Introduced a new version of its automated breast ultrasound system ‘the Invenia Automated Breast Ultrasound System(ABUS)’.

Courtesy: GE systems

GE says, “Invenia ABUS is a comfortable, non-ionizing alternative to other supplemental screening options for women with dense breast tissue. When used in addition to mammography, Invenia ABUS can improve breast cancer detection by 35.7 percent over mammography alone.” It is not a substitute for mammography but a non-ionizing adjunct to the procedure and can detect early stage, node negative, invasive cancers.

The Invenia ABUS system is designed for screening and it shifts the diagnostic approach from hardware based system to software based system. The system creates a reproducible, fully automated scan that takes 15 minutes to complete. It captures whole breast three dimensional images that are displayed at the workstation as 2mm coronal view slices.

It also adjusts the signals levels in the nipple area so that it looks like surrounding tissue enhancing visualization. Other distinct features helping in better image quality and increasing visualization are Breast Border Detection and Chest Wall Detection.

The reverse curve transducer is designed to enhance the breast coverage and patient’s comfort during examination. Patients also report to be more comfortable because of absence of the pressing and pain sensation so common to mammography.

The system received FDA approval in 2014 and currently 180 hospitals are using it. 

The European Asymptomatic Screening Study screened 1,668 women between the ages of 40-74 with ABUS in a 15-minute exam after they had already undergone digital mammography screening. The results showed a 57 percent relative increase in cancer detection.

The findings were equivalent to 6.6 cancers detected per 1,000 women, compared with 4.2 percent of those who received mammography alone.

In a recent interview with medgadget[1] at the National Consortium of Breast Centers Conference,[2]Dr. Georgia Giakoumis Spear of NorthShore University Health System affirmed that ABUS is complementary to mammography and it is not meant for replacing it.  The NorthShore hospital is using the system for 15 months and is extremely satisfied with the results. They found about 25 cases of occult breast cancer not detected by mammography. 

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[1] http://www.medgadget.com/2017/03/breast-cancer-detection-using-ultrasound-interview-dr-georgia-giakoumis-spear-northshore-university-health-system.html

[2] https://www2.breastcare.org/welcome-to-the-annual-national-interdisciplinary-breast-center-conference/