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«PacifiCare’s medical management guidelines represent the recommendation of the PacifiCare Medical Management Guideline (MMG) committee. They are ...»

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Breast Imaging- Commercial Medical Management Guideline

development of the CAD system or they include samples of women that are highly selective and usually have far more cases of cancer than would be encountered in a screening population. There is insufficient evidence to assess whether the use of CAD systems would maintain or increase the sensitivity, specificity, and recall rates of MRI of the breast. Given the inability to evaluate these intermediate outcomes, it is not possible to assess the impact of CAD on health outcomes such as treatment success among breast cancer patients or survival (TEC, 2006c)

Computer-Aided Detection for Ultrasound:

A retrospective study evaluated ultrasound images with or without the use of CAD in 101 women.

When a 2% likelihood of malignancy was used as the threshold for biopsy recommendation, the average sensitivity of radiologists increased from 96% to 98% with CAD, while the average data set decreased form 22% to 19%. The investigators concluded that use of a computer algorithm may improve accuracy in identifying malignant from benign breast masses. (Sahiner, et al., 2007) The results of several uncontrolled studies suggest that CAD systems for ultrasounds may be useful for evaluating breast masses. (Huang et al., 2005; Chang et al., 2005; Joo et al., 2004; Chen et al., 2003) However, published evidence has not yet demonstrated that CAD improves patient outcomes or reduces breast cancer mortality when added to ultrasonography.

References and Resources Resources Agency for Healthcare Research and Quality (AHRQ) [Web site] Effectiveness of Noninvasive

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Breast Imaging- Commercial Medical Management Guideline

American College of Radiology (ACR) [Web site]. ACR Practice Guideline for the Performance of

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AJR Am J Roentgenol. 2006 Jun;186(6):1723-32.

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Birdwell RL, Bandodkar P, Ikeda DM. Computer-aided detection with screening mammography in a university hospital setting. Radiology. 2005 Aug;236(2):451-7 Breast Imaging- Commercial Medical Management Guideline Boetes C, Veltman J, van Die L, Bult P, Wobbes T, Barentsz JO. The role of MRI in invasive lobular carcinoma. Breast Cancer Res Treat. 2004 Jul;86(1):31-7.

Boyd NF, Guo H, Martin LJ, Sun L, Stone J, Fishell E, Jong RA, Hislop G,Chiarelli A, Minkin S, Yaffe MJ. Mammographic density and the risk and detection of breast cancer. N Engl J Med. 2007 Jan 18;356(3):227-36.

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Buchberger W, Niehoff A, Obrist P, DeKoekkoek-Doll P, Dunser M. Clinically and mammographically occult breast lesions: detection and classification with high-resolution sonography. Semin Ultrasound CT MR. 2000 Aug;21(4):325-36.

CAD Science [Website] 3TP. Available at http://www.cadsciences.com / Accessed May 11, 2007.

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2007 May-Jun;31(3):155-61.

CareCore National. Criteria for Medical Imaging. 2007.

Centers for Medicare & Medicaid Services (CMS) [Web site]. Medicare Coverage Database National Coverage Determination for Magnetic Resonance Imaging. 1994. Available at: http://www.cms.hhs.

gov/mcd/viewncd.asp? ncd_id=220.2&ncd_version= 1&basket=ncd%3A220%2E2%3 A1%3AMagnetic+Resonance+ Imaging+%28MRI%29. Accessed February 2008.

Cher DJ, Conwell JA, Mandel JS. MRI for detecting silicone breast implant rupture: meta-analysis and implications. Ann Plast Surg. 2001 Oct;47(4):367-80.

Chiou, SY, Chou, YH, Chiou, HJ, Wang, HK, Tiu, CM, Tseng, LM, and Chang, CY. Sonographic features of nonpalpable breast cancer: a study based on ultrasound-guided wire-localized surgical biopsies. Ultrasound Med Biol. 2006;32(9):1299-1306.

Breast Imaging- Commercial Medical Management Guideline Confirma [Website] CADStream Available at http://www.confirma.com/ Accessed February 2008.

Corsetti V, Ferrari A, Ghirardi M, Bergonzini R, Bellarosa S, Angelini O, Bani C, Ciatto S. Role of ultrasonography in detecting mammographically occult breast carcinoma in women with dense breasts. Radiol Med (Torino). 2006 Apr;111(3):440-8.

Crystal P, Strano SD, Shcharynski S, Koretz MJ. Using sonography to screen women with mammographically dense breasts. AJR Am J Roentgenol. 2003 Jul;181(1):177-82.

Cupples TE, Cunningham JE, Reynolds JC. Impact of computer-aided detection in a regional screening mammography program. AJR Am J Roentgenol. 2005 Oct;185(4):944-50.

Dean JC, Ilvento CC. Improved cancer detection using computer-aided detection with diagnostic and screening mammography: prospective study of 104 cancers. AJR Am J Roentgenol. 2006 Jul;187(1):20-8.

Demartini WB, Lehman CD, Peacock S, Russell MT. Computer-aided detection applied to breast MRI: assessment of CAD-generated enhancement and tumor sizes in breast cancers before and after neoadjuvant chemotherapy. Acad Radiol. 2005 Jul;12(7):806-14.

Deurloo EE, Peterse JL, Rutgers EJ et al. Additional breast lesions in patients eligible for breastconserving therapy by MRI: impact on preoperative management and potential benefit of computerized analysis. Eur J Cancer 2005;41(10):1393-401.

Deurloo, EE, Klein Zeggelink, WF, Teertstra, HJ, Peterse, JL, Rutgers, et al. Contrast-enhanced MRI in breast cancer patients eligible for breast-conserving therapy: complementary value for subgroups of patients. Eur Radiol 2006;16(3):692-701.

ECRI Institute. Custom Hotline Response. Computer-aided Detection with Full-field Digital Mammography. May 2006.

ECRI Institute. Custom Hotline Response. Dedicated Breast Camera Dilon 6800 for Diagnosis and Screening. August 2005.

ECRI Institute. Custom Hotline Response. Ultrasound for Breast Cancer Screening. May 2007.

ECRI Institute. Health Technology Forecast. Breast MRI for screening. August 2007.

ECRI Institute. Health Technology Forecast. Full-field digital mammography. August 2007.

ECRI Institute. Hotline Response. Scintimammography for Diagnosis of Suspicious Breast Lesions.

Breast Imaging- Commercial Medical Management Guideline May 2007.

ECRI Institute. Hotline Response. Magnetic Resonance Imaging (MRI) for Diagnosis of Suspicious Breast Lesions. May 2007.

ECRI Institute. Hotline Response. Ultrasound for Diagnosis of Suspicious Breast Lesions. May 2007 ECRI Institute Target Database. Computer-assisted detection with magnetic resonance imaging (MRI) to detect breast cancer. October 2007..

ECRI Institute. Target Database. Full-field digital mammography for breast cancer screening. July 2007.

ECRI Institute. Target Database. Mammography computer-aided detection (CAD) systems for breast cancer screening. May 2002.

ECRI Institute. Target Database. MRI screening for breast cancer. June 2007.

ECRI Institute. Target Database. Scintimammography for diagnosis of suspicious breast lesions.

August 2000.

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Fasching, PA, Heusinger, K, Loehberg, CR, Wenkel, E, Lux, MP, Schrauder, M, Koscheck, T, Bautz, W, Schulz-Wendtland, R, Beckmann, MW, and Bani, MR. Influence of mammographic density on the diagnostic accuracy of tumor size assessment and association with breast cancer tumor characteristics. Eur J Radiol. 2006;60(3):398-404.

Fenton JJ, Taplin SH, Carney PA, et al. Influence of computer-aided detection on performance of screening mammography. N Engl J Med. 2007 Apr 5;356(14):1399-409.

Fischer U, Baum F, Obenauer S, et al. Comparative study in patients with microcalcifications: fullfield digital mammography vs screen-film mammography. Eur Radiol. 2002;12(11):2679-2683.

Fowble B, Hanlon A, Freedman G, et al. Second cancers after conservative surgery and radiation for stages I-II breast cancer: identifying a subset of women at increased risk. Int J Radiat Oncol Biol Phys 2001;51:679-690.

Freer TW, Ulissey MJ. Screening mammography with computer-aided detection: prospective study of 12,860 patients in a community breast center. Radiology. 2001;220(3):781-786.

Breast Imaging- Commercial Medical Management Guideline Frei KA, Kinkle K, Bonel HM et al. MR imaging of the breast in patients with positive margins after lumpectomy: influence of the time interval between lumpectomy and MR imaging. AJR 2000;175:1577-84.

Gilbert FJ, Astley SM, McGee MA, et al.. Single reading with computer-aided detection and double reading of screening mammograms in the United Kingdom National Breast Screening Program.

Radiology. 2006 Oct;241(1):47-53.

Gommans, GM, van der Zant, FM, van, DA, Boer, RO, Teule, GJ, and de Waard, JW.

(99M)Technetium-sestamibi scintimammography in non-palpable breast lesions found on screening X-ray mammography. Eur J Surg Oncol. 2007;33(1):23-27.

Griebsch I, Brown J, Boggis C, Dixon A, Dixon M, et al; UK Magnetic Resonance Imaging in Breast Screening (MARIBS) Study Group. Cost-effectiveness of screening with contrast enhanced magnetic resonance imaging vs X-ray mammography of women at a high familial risk of breast cancer. Br J Cancer. 2006 Oct 9;95(7):801-10.

Gromet M. Comparison of computer-aided detection to double reading of screening mammograms:

review of 231,221 mammograms. AJR Am J Roentgenol. 2008 Apr;190(4):854-9.

Gur D, Sumkin JH, Rockette HE, et al. Changes in breast cancer detection and mammography recall rates after the introduction of a computer-aided detection system. Natl Cancer Inst. 2004 Feb 4;96(3):185-90.

Hauth EA, Stockamp C, Maderwald S, Muhler A, Kimmig R, Jaeger H, Barkhausen J, Forsting M.

Evaluation of the three-time-point method for diagnosis of breast lesions in contrast-enhanced MR mammography. Clin Imaging. 2006 May-Jun;30(3):160-5.

Hayes Inc. Medical Technology Directory. Computer-Aided Detection for Screening Mammography.

December 2007.

Hayes Inc. Medical Technology Directory. Digital Mammography. December 2007.

Hayes Inc. Medical Technology Directory. Magnetic Resonance Imaging for Breast Cancer Screening in Women at High Risk. May 2007.

Hayes Inc. Medical Technology Directory. Magnetic Resonance Imaging for Presurgical Planning for Breast Cancer. December 15, 2005b. Last update search January 16, 2007.

Hayes Inc. Medical Technology Directory. Magnetic Resonance Imaging for Evaluation of Response Breast Imaging- Commercial Medical Management Guideline to Neoadjuvant Chemotherapy in Breast Cancer. November 7, 2005c. Last update search December 6, 2006.

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