What’s new in Breast Imaging – December 2020

2 years ago

 

Identification of Women at High Risk of Breast Cancer Who Need Supplemental Screening

Eriksson, M., Czene, K., Strand, F., Zackrisson, S., Lindholm, P., Lång, K., . . . Hall, P. (2020).

Radiology, 297(2), 327-333. doi:10.1148/radiol.2020201620

https://pubs.rsna.org/doi/10.1148/radiol.2020201620

In this study, authors created a risk model to identify women more likely to be diagnosed with breast cancer before or at their next screening appointment. This study collected data from a prospective screening cohort of nearly 71,000 women from 2011-2017. The authors developed an image-based risk model using mammographic data from computer-aided detection, including age, differences between right and left breasts, calcifications, masses, and density. Lifestyle and genetic supplemental risk models were also created utilizing factors such as menopausal status and family history. The authors determined that the image-based risk model had an AUC of 0.73 for predicting a breast cancer diagnosis within 2 years of a negative screening mammogram. This study sheds light on a high-risk population that would benefit from supplemental screening for earlier detection of breast cancer.

 

US as the Primary Imaging Modality in the Evaluation of Palpable Breast Masses in Breastfeeding Women, Including Those of Advanced Maternal Age.

Chung, M., Hayward, J. H., Woodard, G. A., Knobel, A., Greenwood, H. I., Ray, K. M., . . . Lee, A. Y. (2020).

Radiology, 297(2), 316-324. doi:10.1148/radiol.2020201036

https://pubs.rsna.org/doi/full/10.1148/radiol.2020201036

In this study, the authors sought to investigate the diagnostic efficacy of targeted breast ultrasound as the first line imaging modality for evaluation of a palpable breast mass in breastfeeding women, including patients over 30 years old. Data was collected retrospectively from 167 women between 2000 and 2017. Targeted breast ultrasound was 100% sensitive and 70% specific for detecting malignancy in this patient population. Fifty-nine percent of patients underwent mammography at the radiologists’ discretion. The addition of mammography increased the false positive rate but did not reveal additional breast cancer diagnoses. The authors concluded that targeted breast ultrasound is an efficacious imaging modality for detection of breast cancer in breastfeeding women with a palpable breast mass, including patients over age 30.

 

Outcomes of Foci on Breast MRI: Features Associated With Malignancy.

Myers, K. S., Oluyemi, E. T., Mullen, L. A., Ambinder, E. B., Kamel, I. R., & Harvey, S. C. (2020).

American Journal of Roentgenology, 215(4), 1012-1019. doi:10.2214/ajr.19.22423

https://www.ajronline.org/doi/abs/10.2214/AJR.19.22423

In this study, authors sought to evaluate outcomes for patients with foci detected on breast MRI and determine malignancy-associated imaging characteristics. One hundred and seventy-nine patients with 200 eligible foci on breast MRI (assigned BI-RADS 3 or 4) were evaluated retrospectively from 2004 to 2018. Malignancy rates for BI-RADS 3 and 4 foci were 1.6% and 17.6%, respectively. Most malignant foci were biopsy-proven invasive breast cancer. Washout kinetics and size were shown to be statistically significant in their association with malignancy. The authors concluded that foci on breast MRI, especially BI-RADS 4 abnormalities, should not be disregarded due to high malignancy rates. Associated features like size and washout kinetics can aid radiologists in establishing suspicion for malignancy.

 

Prone Versus Upright Digital Tomosynthesis–Guided Biopsy.

Choudhery, S., Johnson, M., & Fazzio, R. T. (2020). Prone Versus Upright Digital Tomosynthesis–Guided Biopsy. American Journal of Roentgenology, 215(3), 760-764. doi:10.2214/ajr.19.22735

https://www.ajronline.org/doi/abs/10.2214/AJR.19.22735

In this study, authors sought to evaluate the overall performance of prone versus upright breast biopsies using digital breast tomosynthesis (DBT). Two hundred and eighty-two patients who underwent breast biopsy between May 2018 and July 2019 were retrospectively reviewed. Data points including number of exposures taken, number of samples obtained, and biopsy complications were compared between the two biopsy techniques. Patients undergoing upright biopsies had significantly less exposures taken compared to prone biopsies (p<0.001). Otherwise, there were no additional statistically significant differences between the two techniques, including procedure time, samples acquired, and biopsy complications. The authors concluded that prone and upright DBT-guided breast biopsies have similar clinical performance and factors such as patient comfort and procedure room logistics should determine biopsy technique.

 

Breast-specific gamma imaging or ultrasonography as adjunct imaging diagnostics in women with mammographically dense breasts.

Zhang, Z., Wang, W., Wang, X., Yu, X., Zhu, Y., Zhan, H., . . . Huang, J. (2020).

European Radiology, 30(11), 6062-6071. doi:10.1007/s00330-020-06950-2

https://pubmed.ncbi.nlm.nih.gov/32524221/

In this study, authors sought to compare the diagnostic performance of mammography (MMG) plus ultrasound (US) versus MMG plus breast-specific gamma imaging (BSGI) in detecting breast cancer in patients with dense breasts. Three hundred and sixty-four women who underwent mammography and adjunctive US or BSGI between April 2013 and April 2016 were retrospectively reviewed. There was no difference in sensitivity between adjunctive US and BSGI. However, BSGI was more specific and accurate when compared to US. The authors concluded that BSGI could be utilized as an adjunctive imaging modality to diagnose breast cancer in patients with dense breasts.

 

Reader characteristics and mammogram features associated with breast imaging reporting scores.

Trieu, P. D., Lewis, S. J., Li, T., Ho, K., Tapia, K. A., & Brennan, P. C. (2020).

The British Journal of Radiology, 93(1114), 20200363. doi:10.1259/bjr.20200363

https://pubmed.ncbi.nlm.nih.gov/32730088/

In this study, authors sought to determine characteristics and reading accuracy of radiologists in diagnosing breast cancer with BI-RADS classification. One hundred and seventeen Australian radiologists each read a total of 300 screening mammograms and assigned BI-RADS categories to breast lesions (⅓ of cases were pathology-proven malignancy). Thirty-eight percent of malignant mammograms were assigned BI-RADS 3, while 32.2% were assigned BI-RADS 4. False negative rates for BI-RADS 1 and 2 lesions were lower in female readers, Breast Screen readers (national breast cancer screening program in Australia), and readers who completed a breast imaging fellowship. The most common features associated with BI-RADS 3 category were asymmetric density and discrete mass. Stellate lesion and spiculated mass were most commonly associated with BI-RADS 5 category. The authors concluded that certain factors, including fellowship completion, reading at a dedicated breast imaging center, and gender, influenced BI-RADS category assignment and diagnostic accuracy.

 

Unprovoked venous thromboembolism in women over 40: Is screening for occult malignancy with mammography and abdominopelvic CT of benefit?

Healy, N., Daley, F., & Sinnatamby, R. (2020).

Clinical Radiology, 75(10), 757-762. doi:10.1016/j.crad.2020.05.022

https://www.clinicalradiologyonline.net/article/S0009-9260(20)30220-8/fulltext

In this study, authors sought to establish outcomes in patients with unprovoked venous thromboembolism (VTE) who underwent subsequent mammogram to detect a primary breast malignancy. One hundred and thirty-nine patients referred for mammogram after unprovoked VTE were retrospectively reviewed from January 2016 to September 2019. Ten percent of patients were called back for additional imaging, and there were two cases of confirmed malignancy (1.4%). The authors concluded that the cancer detection rate in women with unprovoked VTE is low on mammography. In addition, false positive mammographic findings can induce patient anxiety without beneficial diagnostic yield.

 

Risk for Upgrade to Malignancy After Breast Core Needle Biopsy Diagnosis of Lobular Neoplasia: A Systematic Review and Meta-Analysis.

Shehata, M. N., Rahbar, H., Flanagan, M. R., Kilgore, M. R., Lee, C. I., Ryser, M. D., & Lowry, K. P. (2020).

Journal of the American College of Radiology, 17(10), 1207-1219. doi:10.1016/j.jacr.2020.07.036

https://pubmed.ncbi.nlm.nih.gov/32861602/

In this study, the authors conducted a systematic review and meta-analysis to quantify the risk for upgrade to malignancy in patients with biopsy-proved classic lobular neoplasia (LN), including atypical lobular hyperplasia (ALH) and classic lobular carcinoma in situ (LCIS). Sixty-five studies were included in this systematic review (16 of which were included in the meta-analysis), and variant LCIS and image-discordant lesions were excluded. Pooled risks for upgrade to any malignancy in all LN, ALH, and LCIS were 3.1%, 2.5% and 5.8%, respectively. The authors concluded that the risk for upgrade to malignancy in patients with biopsy-proven LN is relatively low, particularly in ALH. These findings may allow patients to undergo imaging surveillance instead of conventional surgical excision.

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