Scielo RSS <![CDATA[SA Journal of Radiology ]]> vol. 22 num. 2 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Measuring breast density: Comparing computer-automated breast density quantification with an observer-based method in a South African academic context</b>]]> BACKGROUND: Dense breast tissue may not only 'mask' small, non-calcified cancers but also represents an independent risk factor for the development of breast cancer. Computer-automated breast density quantification (CABD) software tools have been developed for the calculation of volumetric breast density. OBJECTIVES: This study sought: (1) to compare observer-based breast density scores, using the fifth edition of the Breast Imaging Reporting and Data System (BI-RADS), with the breast density scores calculated using CABD quantification software tools, (2) to determine inter-reader variability in breast density scoring between qualified radiologists, between radiologists in training (registrars) and between these two groups and (3) to determine intra-reader reliability in breast density scoring. METHODS: A cross-sectional study was performed using the data of 100 patients (200 breasts). Three qualified radiologists and three registrars were asked to review the mammograms in question and to assign a breast density score according to the fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) reporting system. Two readings took place at a minimum of 30 days apart. The percentage agreement between the automated and observer-based scores was calculated and intra-reader and inter-reader reliability values were determined. RESULTS: The study found that there was poor agreement between the breast densities calculated by CABD and the more subjective observer-based BI-RADS density scores. These results further reflect a statistically significant degree of inter-reader and intra-reader variability in the evaluation of breast density. CONCLUSION: We conclude that the use of automated breast density quantification (i.e. CABD) is a valuable tool for the reduction of variability in breast density ratings. <![CDATA[<b>Human immunodeficiency virus infection in breast cancer patients: The prevalence thereof and its effect on breast cancer characteristics at Dr. George Mukhari Academic Hospital Breast Clinic, Ga-Rankuwa, South Africa</b>]]> BACKGROUND: Since the advent of highly active anti-retroviral therapy, improved immune functioning and prolonged survival of Human immunodeficiency virus (HIV)-positive patients has been accompanied by an increased incidence of non-AIDS-defining cancers (NADC). Breast cancer is the most prevalent NADC among HIV-positive women. However, data regarding the interaction between these two diagnoses remain limited. OBJECTIVES: To determine the effect of HIV status on the presentation of breast cancer patients at Dr. George Mukhari Academic Hospital (DGMAH). METHODS: The age, gender, HIV status, CD4 count and tumour node metastases stage at presentation were recorded from the files of patients with histologically proven breast carcinoma, who had presented to the breast clinic at DGMAH from 01 January 2013 to 30 November 2017. Histological subtypes and molecular markers were retrieved from the National Health Laboratory Service. Prevalence of HIV among breast cancer patients was calculated. Cross-tabulations compared the variables between HIV-positive and HIV-negative groups. Statistical significance was assessed using Fisher's Exact Test RESULTS: HIV status was determined in 129 breast cancer patients. Eighty (62.02%) were HIV-negative and 49 (37.98%) were HIV-positive. All patients were female. The mean age at presentation with breast cancer in the HIV-positive group was approximately 10 years younger, compared to the entire population and to the HIV-negative group (p < 0.0001). No further statistically significant associations were observed concerning HIV status and other variables. CONCLUSION: HIV-positive women present with breast cancer at a significantly younger mean age. Breast cancer screening protocols may need to be adjusted accordingly in such patients. <![CDATA[<b>Are you dense? The implications and imaging of the dense breast</b>]]> Mammography relies on a visual interpretation of imaging results that is often confounded by dense breast tissue. Dense tissue affects the ability and accuracy with which the radiologist is able to detect cancer. Dense tissue may mask the presence of a breast cancer, and breast density is well recognised as an independent risk factor for the development of breast cancer. In the dense breast, detected cancers tend to be larger, more often lymph node positive and of a higher stage than those diagnosed in fatty tissue. The incidence of tumour multifocality and multicentricity is higher, decreasing the chances for breast conserving treatment. The literature convincingly supports the use of supplemental imaging modalities in women who present with increased breast density. There are clear advantages and disadvantages to each set of diagnostic imaging tests. However, there is no simple, cost-effective solution for women with dense breasts to obtain a definitive detection status through imaging. Suggestions are put forward as to what supplemental imaging choices should be included for the imaging of the dense breast with reference to the current South African setting. Use of supplemental screening modalities should be tailored to individual risk assessment. In a resource-constrained environment, international recommendations may need to be adjusted.