Characteristics of breast cancer detected by supplementary screening ultrasonography

Breast Cancer Screening: Why Can't Everyone Agree?

Screening mammography and evolving treatments have improved mortality over the last 25 years. However, breast cancer remains the second leading cause of cancer-related mortality for women in the United States. There are several contradictory recommendations regarding breast cancer screening. Familiarity with these recommendations will allow physicians to counsel their patients and ensure well-informed shared decision making.

Follow-up interval for probably benign breast lesions on screening ultrasound in women at average risk for breast cancer with dense breasts

Background Women at high risk for breast cancer and women at average risk have different pretest probabilities. Probably benign lesions on screening ultrasound (US) should be assessed and managed differently for these two risk groups. Purpose To evaluate the effectiveness of short-term follow-up for probably benign lesions on screening US in women at average risk for breast cancer with dense breasts. Material and Methods A total of 445 women at average risk for breast cancer with probably benign lesions on screening US, dense breasts, and negative or benign mammography results were included. Women were classified into the six-month group (n = 345) or 12-month group (n = 100) according to when the first follow-up was performed (3-9 months or 9-15 months). The cancer detection rate, frequencies of newly developed lesions and progressed lesions, and biopsy rate were compared. Results There were no malignancies from three to 15 months. Three cancers newly developed after 15 months. One was a 3-mm ductal carcinoma in situ and two were 10-mm and 18-mm invasive ductal carcinoma without lymph node metastasis. The frequency of newly developed lesions and progressed lesions and biopsy rate were not significantly different between the six-month and 12-month groups ( P = 0.320, 0.621, and >0.999). Conclusion A follow-up at 12 months can be considered for probably benign lesions on screening US in women at average risk for breast cancer with dense breasts. However, a large series prospective study is needed before clinical application.

Medical auditing of whole-breast screening ultrasonography

Since breast ultrasonography (US) has been used as an adjunctive screening modality in women with dense breasts, the need has arisen to evaluate and monitor its possible harm and benefits in comparison with other screening modalities such as mammography. Recently, the fifth edition of the Breast Imaging Reporting and Data System published by the American College of Radiology has suggested auditing methods for screening breast US. However, the method proposed therein is slightly different from how diagnostic performance was calculated in previous studies on screening breast US. In this article, the background and core aspects of medical audits of breast cancer screening will be reviewed to provide an introduction to the medical auditing of screening breast US, with the goal of helping radiologists to understand and identify potential ways to improve outcomes.

Application of the downgrade criteria to supplemental screening ultrasound for women with negative mammography but dense breasts

We investigated whether the application of the downgrade criteria to supplemental screening ultrasound (US) for women with negative mammography but dense breasts can reduce the rate of Breast Imaging Reporting and Data System (BI-RADS) categories 3 to 4a without a loss of cancer detection.This retrospective study was approved by the Institutional Review Board, and the need to obtain informed consent was waived. A total of 3171 consecutive women (978 women, 1173 women, and 1020 women in the first, second, and third year, respectively) with negative mammography but dense breast who underwent radiologist-performed, hand-held supplemental screening US from March 2010 to February 2013 were included. Downgrade criteria for BI-RADS category 2 were complicated cysts ≤5 mm observed as circumscribed, homogeneous, and hypoechoic lesions and circumscribed oval-shaped solid masses ≤5 mm. Changes in the distribution of BI-RADS category, biopsy rate, and cancer detection yield over 3 years were analyzed. Performances of less-experienced (12 fellows with <2 years of experience) and experienced (3 staffs with >12 years of experience) radiologists were compared. Outcomes of initial examinations (prevalence screening) and noninitial examinations (incidence screening) were compared.Application of the downgrade criteria reduced BI-RADS categories 3 to 4a in both less-experienced (from 39.4% to 16.0%, P < 0.001) and experienced radiologists (from 22.6% to 11.1%, P < 0.001) over 3 years. Biopsy rates also significantly decreased from 6.5% to 2.4% (P < 0.001). Cancer detection yield of supplemental screening US was 2.8 per 1000 examinations (9 of 3171: 2 ductal carcinoma in situ and 7 invasive cancers). There were no differences in cancer detection yield per each year (P = 0.539). There was no interval cancer. In noninitial examinations, BI-RADS categories 3 to 4a rates, biopsy rates, and cancer detection rates were lower compared to initial examinations.Application of the downgrade criteria reduced BI-RADS categories 3 to 4a without a loss of cancer detection. We suggest that our downgrade criteria can be used to reduce the false positive rate in the supplemental screening US. Further large-scale, multicenter, prospective studies are needed to validate the effectiveness of the downgrade criteria.