What’s New In Breast Imaging – October 2021

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Kim, G. R., Cho, N., Kim, S., Han, W., & Moon, W. K. (2021). Interval Cancers after Negative Supplemental Screening Breast MRI Results in Women with a Personal History of Breast Cancer. Radiology, 300(2), 314-323. doi:10.1148/radiol.2021203074

 In this study, authors sought to investigate the effectiveness of screening breast MRI in women with a personal history of breast cancer. Screening breast MRI data from approximately 2,800 women was retrospectively reviewed. Of the 6,603 MRI examinations included in the study, the interval cancer rate was 1.5 per 1,000 screening examinations and the cancer detection rate was 8.3 per 1,000 screening examinations. Specificity was 88.3% and sensitivity was 85% for cancer detection. Women diagnosed with interval cancers were associated with estrogen and progesterone receptor-negative initial primary cancers, moderate to marked background parenchymal enhancement, and first-degree family history of breast cancer. The authors concluded that supplemental screening breast MRI for women with a personal history of breast cancer is an effective strategy for detecting interval cancers.


Lee, J. M., Ichikawa, L. E., Wernli, K. J., Bowles, E., Specht, J. M., Kerlikowske, K., . . . Buist, D. S. (2021). Digital Mammography and Breast Tomosynthesis Performance in Women with a Personal History of Breast Cancer, 2007–2016. Radiology, 300(2), 290-300. doi:10.1148/radiol.2021204581

In this study, authors sought to compare the diagnostic performance of digital and screen-film surveillance mammography in women with a personal history of breast cancer. In this observational cohort study, approximately 32,000 women with AJCC stage 0-III primary breast cancer underwent nearly 118,000 surveillance mammograms (either digital mammography or digital breast tomosynthesis) between 2007-2016. This data was compared to performance metrics from screen-film mammography collected between 1996-2007. For the digital mammography group, interval cancer and cancer detection rates were 3.6 and 8.5 per 1,000 examinations. When compared to interval cancer rates for mammograms from 1996-2007, there was no significant difference in the digital mammography group. The authors concluded that surveillance mammography for women with a personal history of breast cancer has not significantly improved after transitioning to digital mammography from screen-film mammography.



Chikarmane, S. A., Cochon, L. R., Khorasani, R., Sahu, S., & Giess, C. S. (2021). Screening Mammography Performance Metrics of 2D Digital Mammography Versus Digital Breast Tomosynthesis in Women With a Personal History of Breast Cancer. American Journal of Roentgenology, 217(3), 587-594. doi:10.2214/ajr.20.23976

In this study, authors sought to compare diagnostic performance between screening digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in patients with a personal history of breast cancer. Approximately 5,700 FFDM exams between 2014-2016 and 4,400 DBT exams between 2017-2018 were retrospectively reviewed. In the DBT group, recall rate was significantly lower, and specificity and sensitivity were significantly higher compared to FFDM. Recall rates remained significantly lower in women with nondense breasts when patients were stratified by breast density. The authors concluded that women with nondense breasts and a personal history of breast cancer may benefit from DBT with a greater reduction in false-positive findings.


Yüzkan, S., Cengiz, D., Hekimsoy, I., Okçu, Ö S., & Oktay, A. (2021). Diagnostic Performance of Contrast-enhanced Mammography: Comparison With MRI and Mammography. Journal of Breast Imaging, 3(4), 448-454. doi:10.1093/jbi/wbab028

In this study, authors sought to compare diagnostic efficacy of contrast-enhanced mammography (MGM) to conventional MGM and breast MRI. Forty patients with suspicious lesions seen on breast ultrasound between March 2018 and August 2018 were included in the study. Imaging findings were compared to histopathological results for radiology-pathology correlation. Out of the 62 lesions evaluated in the study, 66% were malignant. Sensitivities for contrast-enhanced MGM and MRI were significantly higher than conventional MGM (p=0.03). When compared to MRI, contrast-enhanced MGM had a significantly lower false-positive rate (p<0.001). Of note, conventional MGM missed 19% of malignant lesions and had the highest false-positive rate. The authors concluded that contrast-enhanced MGM and MRI had similar diagnostic performance, and both modalities were superior to conventional MGM.


Ma, X., Shen, L., Hu, F., Tang, W., Gu, Y., & Peng, W. (2021). Predicting the pathological grade of breast phyllodes tumors: A nomogram based on clinical and magnetic resonance imaging features. The British Journal of Radiology, 94(1124), 20210342. doi:10.1259/bjr.20210342

 In this study, authors sought to investigate clinical and imaging features of breast phyllodes tumors that correlate with pathological grade. Between January 2015 and January 2020, 182 patients with pathology-proven phyllodes tumors underwent preoperative breast MRI. Forty-eight patients had malignant lesions. Features that were significantly different between benign and non-benign phyllodes tumors included BI-RADS category, time-signal intensity curve, cystic component, lobulation, intensity on T2 fat saturated MRI imaging, tumor diameter and family history. Authors used this data to construct a normogram for predicting pathological grade with AUC value of 0.795. The authors concluded that various clinical and imaging features were associated with non-benign breast phyllodes tumors and that a prediction normogram may aid in preoperative risk assessment.


Tang, W., Chen, L., Jin, Z., Liang, Y., Zuo, W., Wei, X., . . . Jiang, X. (2021). The diagnostic dilemma with the plateau pattern of the time–intensity curve: Can the relative apparent diffusion coefficient (rADC) optimise the ADC parameter for differentiating breast lesions? Clinical Radiology, 76(9), 688-695. doi:10.1016/j.crad.2021.04.015

In this study, authors sought to evaluate the diagnostic efficacy of apparent diffusion coefficient (ADC) and relevant ADC (rADC) in patients with Type II time-intensity curves (plateau pattern) to distinguish between benign and malignant lesions. MRI data from 408 patients, including ADC and rADC values calculated by placing regions of interest over the breast lesion, normal breast parenchyma, and pectoralis musculature, was used to construct ROC curves. Both ADC and rADC values were significantly different in benign and malignant lesions. Both sensitivity and specificity for lesion ADC and muscle rADC values were similar. The area under the receiver operator curve for muscle rADC in patients with masslike enhancement (MLE) was the highest at 0.96, and this value did not vary in pre- and postmenopausal patients. The authors concluded that in patients with Type II time-intensity curves, lesion ADC and muscle rADC values can assist in differentiating between malignant and benign lesions.

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