Assessing the Relationship of Mammographic Breast Density and Proliferative Breast Disease

Influence of Breast Density on Patient's Compliance during Ultrasound Examination: Conventional Handheld Breast Ultrasound Compared to Automated Breast Ultrasound

Background:

Our aim was to study the influence of breast density on patient's compliance during conventional handheld breast ultrasound (US) or automated breast US (ABUS), which could be used as adjunct screening modalities.

Methods:

Between January 2019 and June 2019, 221 patients (mean age: 53; age range: 24–89 years) underwent both US and ABUS. All participants had independently interpreted US and ABUS regarding patient compliance. The diagnostic experience with US or ABUS was described with a modified testing morbidity index (TMI). The scale ranged from 0 (worst possible experience) to 5 (acceptable experience). Standard statistics was used to compare the data of US and data of ABUS. Breast density was recorded with the Breast Imaging Reporting and Data System (BI-RADS) score.

Results:

The mean TMI score was 4.6 ± 0.5 for US and 4.3 ± 0.8 for ABUS. The overall difference between patients' experience on US and ABUS was statistically significant with P < 0.0001. The difference between patients' experience on US and ABUS in women with BI-RADS C and D for breast density was statistically significant with P < 0.02 in favor of US (4.7 ± 0.4) versus 4.5 ± 0.6 for ABUS. Patients' experience with breast density B was better for US (4.7 ± 0.4) versus 4.3 ± 0.6 for ABUS with P < 0.01. Pain or discomfort occurred during testing, especially in patients >40 years.

Conclusion:

Patient age (>40 years) is a significant predictor of decreased compliance to ABUS. Compliance of ABUS resulted lower that of US independently for breast density.

Features of Microcalcifications on Screening Mammography in Young Women

Background: There is no decrease in the number of breast cancer deaths if screening mammography is performed in women aged <40 years. However, NCCN guidelines recommend screening mammography in young women at risk of hereditary breast cancer. Therefore, more accurate screening mammography for young women is needed. Objective: To evaluate the features of screening mammographic findings, particularly microcalcifications, in women aged <50 years to increase the positive predictive value of screening mammography in young women. Methods: We retrospectively reviewed the data of consecutive women who underwent opportunistic and organized breast cancer screening at the Sakuragaoka Hospital (Shizuoka, Japan) between April 2013 and March 2015. We compared the mammographic findings and features of microcalcifications between women aged <40 and 40–49 years and those aged 50–74 years. Results: The study included 3645 women. Of these 3645 women, 415 (11.4%) were aged <40 years, 1219 (33.4%) were aged 40–49 years, and 2011 (55.2%) were aged 50–74 years. Women aged <50 years were more likely to be recalled for microcalcifications than those aged 50–74 years (<40 years, 4.8%; 40–49 years, 4.3%; 50–74 years, 3.3%). Young women were more likely to be recalled for small round and segmental microcalcifications [<40 years, odds ratio (OR): 1.799 (95% CI: 0.751–2.846); 40–49 years, OR: 1.394 (95% CI: 0.714–2.074)] and less likely to be recalled for small round and grouped microcalcifications [<40 years, OR: 0.603 (95% CI: 0.181–1.025); 40–49 years, OR: 0.961 (95% CI: 0.496–1.428)] compared with women aged 50–74 years. Conclusions: On screening mammography, women aged <50 years had a higher tendency to be recalled for microcalcifications, particularly small round and segmental microcalcifications. False-positive results may be reduced by reflecting the characteristics of microcalcification findings among young women without breast cancer in the future.

Prediction of glandularity and breast radiation dose from mammography results in Japanese women

Glandularity has a marked impact on the incidence of breast cancer and the missed lesion rate of mammography. The aim of this study was to develop a novel model for predicting glandularity and patient radiation dose using physical factors that are easily determined prior to mammography. Data regarding glandularity and mean glandular dose were obtained from 331 mammograms. A stepwise multiple regression analysis model was developed to predict glandularity using age, compressed breast thickness and body mass index (BMI), while a model to predict mean glandular dose was created using quantified glandularity, age, compressed breast thickness, height and body weight. The most significant factor for predicting glandularity was age, the influence of which was 1.8 times that of BMI. The most significant factor for predicting mean glandular dose was compressed breast thickness, the influence of which was 1.4 times that of glandularity, 3.5 times that of age and 6.1 times that of height. Both models were statistically significant (both p < 0.0001). Easily determined physical factors were able to explain 42.8% of the total variance in glandularity and 62.4% of the variance in mean glandular dose. Graphical abstract Validation results of the above prediction model made using physical factors in Japanese women. The plotted points of actual vs. prediction glandularity shown in a are distributed in the vicinity of the diagonal line, and the residual plot for predicted glandularity shows an almost random distribution as shown in b. These distributions indicate the appropriateness of the prediction model.