Breast Cancer
Conditions
Keywords
Breast Cancer, Tomosynthesis, 3D Mammogram, Diagnostic Mammogram
Brief summary
The goal of this study is to evaluate patient comfort during compression with a standard flat mammographic paddle and an investigational curved paddle. This is a study that will be performed with x-ray imaging and will be used to determine if an overall reduction in pain can be appreciated in patients without loss in image quality as compared to the current standard mammogram. Another benefit of the curved paddle may be an increase of perceivable and measurable tissue capture.
Detailed description
The study will be conducted in the United States at up to 5 centers. The study will enroll up to 600 subjects. The number of subjects was chosen to allow evaluation of screening and diagnostic patients with a variety of breast densities (fatty, scattered densities, heterogeneously dense or extremely dense) and women with a range of breasts sizes that fit on the current detector. The evaluation of pain reduction will be the primary endpoint, while examining the potential of increased tissue capture without a compromise in image quality will be assessed as secondary endpoints. The enrollment will be consecutive for subjects who sign informed consent to participate. Women participating in the study will present for a screening or diagnostic imaging exam.
Interventions
X-Ray Mammogram Exam. Each screening subject will receive a 4-view 2D plus 3D combination imaging: Left Cranial Caudal (LCC), Left Medial Oblique (LMO), Right Cranial Caudal (RCC), and Right Medial Oblique (RMLO) with the current standard of care (SOC) flat paddle. Each diagnostic subject will have her prescribed diagnostic 2D plus 3D combination imaging (CC or MLO) with the SOC flat paddle. The image view (CC or MLO) will be based on the visibility of the area of interest for which the diagnostic imaging was ordered. The amount of compression applied in all mammograms will be to achieve tautness.
X-Ray Mammogram Exam. Each screening subject will receive a CC and an MLO in one of her breasts as determined by a randomization scheme with the investigational (INV) curved paddle. Each diagnostic subject will have her prescribed diagnostic 2D plus 3D combination imaging (CC or MLO) with the INV curved paddle. The image view (CC or MLO) will be based on the visibility of the area of interest for which the diagnostic imaging was ordered. The amount of compression applied in all mammograms will be to achieve tautness.
Sponsors
Study design
Eligibility
Inclusion criteria
* Subject is female of any race and ethnicity * Screening Subject is at least 40 years old, Diagnostic subjects are at least 25 years old * Subject will be referred for a screening or a diagnostic work-up with tomosynthesis as part of the exam
Exclusion criteria
* Subjects who are pregnant or who think they may be pregnant * Subjects lactating or presenting with discharge * Women too large for the detector * Subjects who cannot give informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Subject Comfort | 1 day (Day of procedure, No follow-up) | The Universal Pain Assessment Tool (UPAT) was used to assess each subject's comfort perception with each paddle (SOC and INV). The UPAT ranges from 0 to 10, where 0 represents 'no pain' and 10 'worst pain possible'. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Breast Tissue Coverage | 1 Day (Day of procedure, No Follow-up) | An expert technologist evaluated the performance of the SOC and the INV paddles in 388 subjects. For each participant, the technologist answered which paddle was better at pulling in more breast tissue during imaging between SOC and INV (all subjects were imaged with both paddles during the same session). The technologist rated the paddles using a 5-point Likert scale, where -2 and -1 values mean that the SOC paddle performed better or slightly better, 0 means equal performance between paddles, and 2 and 1 mean that the INV performed better or slightly better than the SOC paddle. Note that different technologists were involved in the image acquisition. An acceptable tissue coverage for this study refers to having sufficient breast tissue (a balance between fatty and glandular tissue) in the image acquired so that any potential abnormalities can be effectively identified. |
| Overall Determination of Image Quality | 1 day (Day of procedure, No Follow-up) | An expert radiologist reviewed, side by side, 3D images acquired with the INV and the SOC paddles in 420 subjects. The radiologist rated the images using a 5-point Likert scale, where -2 and -1 values mean that the images acquired with the SOC paddle have better or slightly better quality, 0 means equal quality between the images, and 2 and 1 mean that the images acquired with the INV paddle have better or slightly better quality than the SOC paddle. To determine overall clinical image quality or image acceptability, the radiologist considered whether the images reviewed have fair lesion visibility (when a lesion is present), good breast tissue separations of structures, good breast tissue coverage, no artifacts due to patient motion, and can be used to determine breast tissue density. Note that not all the 420 images were reviewed by the same radiologist. |
Countries
United States
Participant flow
Recruitment details
Subjects were recruited based on inclusion/exclusion criteria from protocol 16-03 at 4 clinical sites between October 2016 and June 2018.
Pre-assignment details
This study involved subjects undergoing a mammogram exam (screening or diagnostic). All subjects were X-ray imaged using the standard of care (SOC) flat paddle and the investigational (INV) curved paddle. Thus, the subjects in the SOC group were the same as those in the INV group. A total of 443 subjects were initially enrolled. Of those, 14 did not complete the study.
Participants by arm
| Arm | Count |
|---|---|
| All Enrolled Subjects This study involves subjects undergoing a mammogram exam (screening or diagnostic).
These subjects were X-ray imaged using the SOC and INV paddles to determine changes in their comfort level and establish a direct comparison between devices.
This means the subjects in the SOC group are the same as those in the INV group.
This section consolidates (combines) all the subjects enrolled as one group rather than two groups because we're evaluating both devices on the same subjects. | 429 |
| Total | 429 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Device failure | 2 | 2 |
| Overall Study | Missing information | 5 | 5 |
| Overall Study | Physician Decision | 1 | 1 |
| Overall Study | Protocol Violation | 2 | 2 |
| Overall Study | Withdrawal by Subject | 4 | 4 |
Baseline characteristics
| Characteristic | All Enrolled Subjects |
|---|---|
| Age, Continuous | 54.6 years STANDARD_DEVIATION 11 |
| BI-RADS Breast Density Assessment Blank (No breast density category was recorded for the subjects) | 12 participants |
| BI-RADS Breast Density Assessment Type A (Breasts are almost entirely fatty) | 47 participants |
| BI-RADS Breast Density Assessment Type B (Breasts are mainly fatty, with some scattered areas of dense tissue) | 192 participants |
| BI-RADS Breast Density Assessment Type C (Breasts are a mixture of fatty and dense tissue) | 147 participants |
| BI-RADS Breast Density Assessment Type D (Breasts are almost entirely dense) | 31 participants |
| Race/Ethnicity, Customized African American/Black | 29 Participants |
| Race/Ethnicity, Customized Asian | 2 Participants |
| Race/Ethnicity, Customized Hispanic/Latino | 20 Participants |
| Race/Ethnicity, Customized Indian/Persian | 3 Participants |
| Race/Ethnicity, Customized Unknown | 1 Participants |
| Race/Ethnicity, Customized White | 374 Participants |
| Region of Enrollment United States | 429 participants |
| Sex: Female, Male Female | 429 Participants |
| Sex: Female, Male Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 429 |
| other Total, other adverse events | 0 / 429 |
| serious Total, serious adverse events | 0 / 429 |
Outcome results
Subject Comfort
The Universal Pain Assessment Tool (UPAT) was used to assess each subject's comfort perception with each paddle (SOC and INV). The UPAT ranges from 0 to 10, where 0 represents 'no pain' and 10 'worst pain possible'.
Time frame: 1 day (Day of procedure, No follow-up)
Population: The number of participants analyzed per group differs from the number provided in the Participant Flow module (429).~Two subjects' pain scores were unclear when imaged with the INV paddle. For this reason, the analysis was done by contemplating 427 subjects.~Three subjects' pain scores were unclear when imaged with the INV paddle. For this reason, the analysis was done by contemplating 426 subjects.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| INVESTIGATIONAL | Subject Comfort | 2.6 score on a scale |
| STANDARD OF CARE | Subject Comfort | 4.0 score on a scale |
Breast Tissue Coverage
An expert technologist evaluated the performance of the SOC and the INV paddles in 388 subjects. For each participant, the technologist answered which paddle was better at pulling in more breast tissue during imaging between SOC and INV (all subjects were imaged with both paddles during the same session). The technologist rated the paddles using a 5-point Likert scale, where -2 and -1 values mean that the SOC paddle performed better or slightly better, 0 means equal performance between paddles, and 2 and 1 mean that the INV performed better or slightly better than the SOC paddle. Note that different technologists were involved in the image acquisition. An acceptable tissue coverage for this study refers to having sufficient breast tissue (a balance between fatty and glandular tissue) in the image acquired so that any potential abnormalities can be effectively identified.
Time frame: 1 Day (Day of procedure, No Follow-up)
Population: The number of participants analyzed per group differs from the number provided in the Participant Flow module (429).~Technologists did not provide an answer to the question about preference for tissue coverage in 41 cases. For this reason, the analysis was done in 388 subjects only.~The same 388 subjects are part of both groups: INV and SOC groups. Therefore, the results are shown combined in the data table.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| INVESTIGATIONAL | Breast Tissue Coverage | Rate -2 or -1 (SOC better or slightly better than INV) | 69 Participants |
| INVESTIGATIONAL | Breast Tissue Coverage | Rate 0 ( SOC equal INV) | 162 Participants |
| INVESTIGATIONAL | Breast Tissue Coverage | Rate 2 or 1 ( INV better or slightly better than SOC) | 157 Participants |
Overall Determination of Image Quality
An expert radiologist reviewed, side by side, 3D images acquired with the INV and the SOC paddles in 420 subjects. The radiologist rated the images using a 5-point Likert scale, where -2 and -1 values mean that the images acquired with the SOC paddle have better or slightly better quality, 0 means equal quality between the images, and 2 and 1 mean that the images acquired with the INV paddle have better or slightly better quality than the SOC paddle. To determine overall clinical image quality or image acceptability, the radiologist considered whether the images reviewed have fair lesion visibility (when a lesion is present), good breast tissue separations of structures, good breast tissue coverage, no artifacts due to patient motion, and can be used to determine breast tissue density. Note that not all the 420 images were reviewed by the same radiologist.
Time frame: 1 day (Day of procedure, No Follow-up)
Population: The number of participants analyzed per group differs from the number provided in the Participant Flow module (429).~Data results related to image quality were unclear in nine subjects. For this reason, the analysis considered only 420 subjects.~These 420 subjects are the same in both groups, INV and SOC, so the images can be comparable.~Therefore, the results shown are combined in the data table.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| INVESTIGATIONAL | Overall Determination of Image Quality | Rate -2 or -1 (SOC better or slightly better than INV) | 27 Participants |
| INVESTIGATIONAL | Overall Determination of Image Quality | Rate 0 (SOC equal INV) | 330 Participants |
| INVESTIGATIONAL | Overall Determination of Image Quality | Rate 2 or 1 (INV better or slightly better than SOC) | 63 Participants |