What’s new in Breast Imaging – April 2021

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Imaging Surveillance of Breast Cancer Survivors with Digital Mammography versus Digital Breast Tomosynthesis

Bahl, M., Mercaldo, S., Mccarthy, A. M., & Lehman, C. D. (2021).

Radiology, 298(2), 308-316. doi:10.1148/radiol.2020201854

https://pubs.rsna.org/doi/full/10.1148/radiol.2020201854

In this study, the authors sought to compare the performance of two-dimensional digital mammography (DM) versus digital breast tomosynthesis (DBT) for imaging surveillance of breast cancer survivors. DM and DBT examinations of 8,170 women obtained from 2008 to 2017 were retrospectively reviewed by breast radiologists with the assistance of computer-aided detection. It was determined that the specificity rate was higher and the abnormal interpretation rate was lower in the DBT group. There was not a statistically significant difference in cancer detection rate between DBT and DM groups. The authors concluded that among breast cancer survivors, screening DBT resulted in higher specificity and lower false positives without affecting cancer detection rate when compared to digital mammography.

 

False-Negative Rates of Breast Cancer Screening with and without Digital Breast Tomosynthesis

Durand, M. A., Friedewald, S. M., Plecha, D. M., Copit, D. S., Barke, L. D., Rose, S. L., . . . Conant, E. F. (2021).

Radiology, 298(2), 296-305. doi:10.1148/radiol.2020202858

https://pubs.rsna.org/doi/10.1148/radiol.2020202858

In this study, the authors sought to compare various parameters between screening digital breast tomosynthesis (DBT) and digital mammography (DM), including false negative (FN) rates and detection of cancers with more favorable outcomes. Approximately 380,000 screening examinations were retrospectively reviewed. Although FN rates trended lower in the DBT group, there was no statistically significant difference when compared to DM. However, both specificity and sensitivity rates were higher in the DBT group (P<.001 and P=.004, respectively). In addition, cancers seen on DBT were more often invasive with fewer distant metastases or positive lymph nodes compared to cancers seen on DM. The authors concluded that improved sensitivity and specificity, as well as detection of cancers with more favorable prognoses, were detected with screening DBT.

 

Addition of Screening Breast US to Digital Mammography and Digital Breast Tomosynthesis for Breast Cancer Screening in Women at Average Risk

Yi, A., Jang, M., Yim, D., Kwon, B. R., Shin, S. U., & Chang, J. M. (2021).

Radiology, 298(3), 568-575. doi:10.1148/radiol.2021203134

https://pubs.rsna.org/doi/10.1148/radiol.2021203134

In this study, the authors sought to determine the value of adding whole breast ultrasound screening to combined digital breast tomosynthesis and digital mammography (DBT/DM) in average risk women. Between 2016 and 2018, 1,003 women underwent combined DBT/DM and simultaneous whole breast screening ultrasound. Cancer detection rates per 1,000 cases were 9.0 and 12.0 for DBT/DM alone and DBT/DM with screening ultrasound, respectively. In women with negative DBT/DM evaluations, screening breast ultrasound resulted in a cancer detection rate of 3.2 per 1,000 examinations. Of note, these 3 cancers were detected in women with dense breasts. The authors concluded that the addition of supplementary breast ultrasound to DBT/DM modestly increased the cancer detection rate and that a larger prospective study may further characterize women who would benefit from supplementary US screening.

 

Factors Associated With Background Parenchymal Enhancement on Contrast-Enhanced Mammography

Karimi, Z., Phillips, J., Slanetz, P., Lotfi, P., Dialani, V., Karimova, J., & Mehta, T. (2021).

American Journal of Roentgenology, 216(2), 340-348. doi:10.2214/ajr.19.22353

https://www.ajronline.org/doi/abs/10.2214/AJR.19.22353

In this study, the authors sought to determine the relationship between a variety of patient factors, including risk factors for breast cancer, endocrine therapy, menstrual status, and breast tissue density, in relation to background parenchymal enhancement (BPE) on contrast-enhanced mammography (CEM). CEM studies from 202 patients were retrospectively reviewed by five breast radiologists. It was determined that factors associated with high BPE on CME included no history of endocrine therapy, premenopausal status, dense breasts and younger age. There was no substantial association between time of CME and last menstrual period for premenopausal patients. The authors concluded that greater BPE is seen in patients of premenopausal status, younger age, and dense breasts. The authors also determined that coordinating CME with patients’ menstrual periods may not be necessary.

 

High-Risk Lesions Detected by MRI-Guided Core Biopsy: Upgrade Rates at Surgical Excision and Implications for Management

Michaels, A. Y., Ginter, P. S., Dodelzon, K., Naunheim, M. R., & Abbey, G. N. (2021).

American Journal of Roentgenology, 216(3), 622-632. doi:10.2214/ajr.20.23040

https://www.ajronline.org/doi/abs/10.2214/AJR.20.23040

In this study, the authors sought to determine the upgrade rates to malignancy of high-risk lesions (including atypical ductal hyperplasia, lobular carcinoma in situ, radial scar, papilloma, flat epithelial atypia, and atypical lobular hyperplasia) diagnosed with MRI-guided core biopsy. One hundred and fifty-nine high risk lesions diagnosed by MRI-guided biopsy were included in the study and retrospectively reviewed. Approximately 8% of lesions were upgraded to carcinoma at the time of surgical excision. Pathologies with the highest malignancy upgrade rates included atypical ductal hyperplasia (22.5%) and flat epithelial atypia (33.3%). It also determined that atypical ductal hyperplasia lesions had a statistically significant higher upgrade rate than non-atypical ductal hyperplasia lesions (p=.005). The authors concluded that of these high risk lesions, atypical ductal hyperplasia necessitates surgical excision. The remaining high risk lesions may warrant imaging surveillance instead of surgical excision given lower malignancy upgrade rates.

 

Frequency and Outcomes of New Suspicious Lesions on Breast MRI in the Setting of Neoadjuvant Therapy

Eckstein, D. A., Price, E. R., Hayward, J. H., Joe, B. N., & Lee, A. Y. (2021).

American Journal of Roentgenology, 216(3), 633-639. doi:10.2214/ajr.20.22979

https://www.ajronline.org/doi/abs/10.2214/AJR.20.22979

In this study, the authors sought to quantify and characterize new concerning findings on breast MRI in patients who underwent neoadjuvant chemotherapy. Breast MRIs of 297 women were retrospectively reviewed, and 23 MRI examinations with new BI-RADS 4 lesions were included in the study. Approximately half of new suspicious lesions seen on breast MRI were contralateral to the primary breast cancer (56.5%), and the majority of lesions were classified as masses (69.6%).  Of note, all suspicious lesions were determined to be benign based on pathologic correlation or follow up imaging. The authors concluded that in patients undergoing neoadjuvant chemotherapy, 5.5% of follow up breast MRIs showed a new suspicious lesion. However, no suspicious lesions were malignant. The authors suggest that larger studies are necessary to determine if these types of suspicious lesions can forgo biopsy in this specific breast cancer population.

 

Outcomes by Race in Breast Cancer Screening With Digital Breast Tomosynthesis Versus Digital Mammography

Alsheik, N., Blount, L., Qiong, Q., Talley, M., Pohlman, S., Troeger, K., . . . Conant, E. (2021).

Journal of the American College of Radiology. doi:10.1016/j.jacr.2020.12.033

https://www.jacr.org/article/S1546-1440(21)00006-5/fulltext

In this study, the authors sought to examine racial disparities among breast cancer screening modalities. Nearly 400,000 women were included in the study, and both digital breast tomosynthesis (DBT) and digital mammography (DM) studies were evaluated. It was determined that black women comprised the lowest proportion of screening with combined DBT and DM (44% compared to 61% for Caucasian women). Non-Caucasian women were more likely to have only one mammographic screening modality, and recall rates were higher in women with only one mammogram. It was also determined that positive predictive value for recall and cancer detection rates were similar or higher for women undergoing combined DBT and DM overall and based on age and race (P<.0001 and P=.0005, respectively). The authors concluded that all racial groups demonstrated improved screening outcomes with combined DBT and DM. However, non-Caucasian women, particularly black women, were less likely to receive combined screening. The authors suggest that increasing access to combined DBT and DM modalities can improve breath cancer screening inequity and efficacy.

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