Comparison of automated breast ultrasound and hand-held breast ultrasound in the screening of dense breasts / Comparação entre a ultrassonografia automatizada e a ultrassonografia convencional no rastreio de mamas densas

Abstract Objective To compare hand-held breast ultrasound (HHBUS) and automated breast ultrasound (ABUS) as screening tool for cancer. Methods A cross-sectional study in patients with mammographically dense breasts was conducted, and both HHBUS and ABUS were performed. Hand-held breast ultrasound was acquired by radiologists and ABUS by mammography technicians and analyzed by breast radiologists. We evaluated the Breast Imaging Reporting and Data System (BI-RADS) classification of the exam and of the lesion, as well as the amount of time required to perform and read each exam. The statistical analysis employed was measures of central tendency and dispersion, frequencies, Student t test, and a univariate logistic regression, through the odds ratio and its respective 95% confidence interval, and with p<0.05 considered of statistical significance. Results Atotal of 440 patientswere evaluated. Regarding lesions,HHBUS detected 15 (7.7%) BI-RADS 2, 175 (89.3%) BI-RADS 3, and 6 (3%) BI-RADS 4, with 3 being confirmed by biopsy as invasive ductal carcinomas (IDCs), and 3 false-positives. Automated breast ultrasound identified 12 (12.9%) BI-RADS 2, 75 (80.7%) BI-RADS 3, and 6 (6.4%) BI-RADS 4, including 3 lesions detected by HHBUS and confirmed as IDCs, in addition to 1 invasive lobular carcinoma and 2 high-risk lesions not detected by HHBUS. The amount of time required for the radiologist to read the ABUS was statistically inferior compared with the time required to read the HHBUS (p<0.001). The overall concordance was 80.9%. A total of 219 lesions were detected, from those 70 lesions by both methods, 126 only by HHBUS (84.9% not suspicious by ABUS) and 23 only by ABUS. Conclusion Compared with HHBUS, ABUS allowed adequate sonographic study in supplemental screening for breast cancer in heterogeneously dense and extremely dense breasts.

Resumo Objetivo Comparar a ultrassonografia convencional das mamas (US) com a ultrassonografia automatizada das mamas (ABUS) no rastreio do câncer. Métodos Realizamos um estudo transversal com pacientes com mamas mamograficamente densas, sendo avaliadas pela US e pela ABUS. A US foi realizada por radiologistas e a ABUS por técnicos de mamografia e analisada por radiologistas especializados em mama. A classificação Breast Imaging Reporting and Data System (BIRADS) do exame e das lesões o tempo de leitura e de aquisição foram avaliados. A análise estatística foi realizada através de medidas de tendência central, dispersão e frequências, teste t de Student e regressão logística univariada, através do odds ratio, com intervalo de confiança de 95%, e com p<0,05 sendo considerado estatisticamente significante. Resultados Foram avaliadas 440 pacientes. Em relação às lesões, a US detectou 15 (7,7%) BI-RADS 2, 175 (89,3%) BI-RADS 3 e 6 (3%) BI-RADS 4, das quais 3 foram confirmadas, por biópsia, como carcinomas ductais invasivos e 3 falso-positivos. A ABUS identificou 12 (12,9%) BI-RADS 2, 75 (80,7%) BI-RADS 3 e 6 (6,4%) BI-RADS 4, incluindo 3 lesões detectadas pela US e confirmadas como carcinomas ductais invasivos, além de 1 carcinoma lobular invasivo e 2 lesões de alto risco não detectadas pela US. O tempo de leitura dos exames da ABUS foi estatisticamente inferior ao tempo do radiologista para realizar a US (p<0,001). A concordância foi de 80,9%. Um total de 219 lesões foram detectadas, das quais 70 por ambos os métodos, 126 observadas apenas pela US (84,9% não eram lesões suspeitas no ABUS) e 23 apenas pela ABUS. Conclusão Comparado à US, a ABUS permitiu adequado estudo complementar no rastreio do câncer de mamas heterogeneamente densas e extremamente densas.

Automated Breast Ultrasound Screening for Dense Breasts

The contribution of contrast-enhanced spectral mammography in detecting breast carcinoma of dense breasts / 中华放射学杂志

Objective To assess the contribution of contrast-enhanced spectral mammography (CESM) in detecting breast carcinoma of dense breasts. Methods To retrospectively analyze the imaging and clinical data of 52 female patients with breast carcinoma which were confirmed by pathology in Tai'an Central Hospital of Shandong Province from April 2017 to April 2018.All cases classified as dense or uneven dense breasts by DM examination underwent Ultrasound (US), digital mammography (DM), CESM, dynamic contrast enhanced MRI (DCE-MRI).The breast imaging report and data system (BI-RADS) and breast density classification were both evaluated using the 5th edition of BI-RADS. The efficacy of US, DM, DM+CESM, DCE-MRI in detecting breast carcinoma (BI-RADS 5) was evaluated by χ2 test. Results Histopathology confirmed that 87 lesions were malignant and 35 lesions were benign. The sensitivity of US, DM, DM +CESM, DCE-MRI were 66.67％(58/87), 64.37％(56/87), 100.00％(87/87), 100.00％(87/87) and the specificity were 94.28％(33/35), 74.28％(26/35), 85.71％(30/35), 51.43％(18/35), respectively. There was statistically significant difference in specificity (χ2=9.545, P=0.002) and BI-RADS 5 category, detection 39.08％(34/87), 22.99％(20/87), respectively (χ2=5.263, P=0.022) between the DM + CESM group and DCE-MRI group. Conclusion In dense breasts, CESM has a high application value in breast carcinoma diagnosis.

Comparative study of the findings in thick dense breasts based on two target-filters in digital mammography : a phantom study / 中华放射医学与防护杂志

Objective To investigate the radiation dose to phantoms of thick dense breasts (compression thickness ＞ 65 mm) and the influence of Molybdenum-Rhodium (Mo-Rh) and Wolfram Rhodium (W-Rh)) target-filter combination on image quality in full field digital mammography (FFDM).Methods An aluminium plate was placed on polymethyl methacrylate (PMMA) plates to simulate dense breasts.Two of 68 mm in-depth phantoms were used to simulate photography condition of thick dense breasts with 0.1 and 0.2 mm aluminium plates respectively.The two phantoms were exposed automatically,half-automatically and manually.The parameters were recorded for each exposure including the target-filter(T-F),tube voltage (kV),tube current (mAs),average glandular dose (AGD),entrance surface dose (ESD) and the image quality figure inverse (IQFInv).Pearson correlation and regression was used to analyze the influence of AGD on IQFInv.Paired sample t-test was used to analyze the influence of different target-filters on IQFInv and AGD.Results AGD had a positive correlation with IQFInv (r =0.806-0.953,P ＜ 0.05).For the phantom of 0.1 mm aluminium,when the tube current was fixed at 100 mAs or the tube voltage was fixed at 28 kVp,AGD and IQFInv had statistically significant difference for two target-filters(t =3.162-8.028,P ＜0.05).For the phantom with 0.2 mm aluminium,when the tube current was fixed at 100 mAs under different tube voltage,AGD and IQFInv had statistically significant difference for two target-filters(t =4.768-8.028,P ＜ 0.05);when tube voltage was fixed at 28 kVp under different tube current,AGD had statistically significant difference for two target-filters(t =7.730,P ＜ 0.05),while there was no statistical difference in IQFInv(P ＞ 0.05).In addition,when tube current was 100 mAs,IQFInv had statistically significant difference for two phantoms in W-Rh(t =2.345,P ＜ 0.05).Conclusions W-Rh target-filter combination can achieve lower radiation dose under the guarantee of the image quality compared with Mo-Rh target-filter combination.At the same tube current,W-Rh target-filter combination can provide a better image quality under a relatively high tube voltage.

Progresses of ultrasonography and digital breast tomosynthesis in dense breast / 中国介入影像与治疗学

The dense breast notification legislation,which was passed by Connecticut in 2009,has attracted more attention to the dense breast.Now there is still no unified criterion nor global guide for reference to indicate additional supplemental screening tool suitable for women with dense breast.Ultrasonography and digital breast tomosynthesis became research focus.The progresses of these two technologies in dense breast were reviewed in this article.

Abbreviated MRI Protocols for Detecting Breast Cancer in Women with Dense Breasts

OBJECTIVE: To evaluate the validity of two abbreviated protocols (AP) of MRI in breast cancer screening of dense breast tissue. MATERIALS AND METHODS: This was a retrospective study in 356 participants with dense breast tissue and negative mammography results. The study was approved by the Nanjing Medical University Ethics Committee. Patients were imaged with a full diagnostic protocol (FDP) of MRI. Two APs (AP-1 consisting of the first post-contrast subtracted [FAST] and maximum-intensity projection [MIP] images, and AP-2 consisting of AP-1 combined with diffusion-weighted imaging [DWI]) and FDP images were analyzed separately, and the sensitivities and specificities of breast cancer detection were calculated. RESULTS: Of the 356 women, 67 lesions were detected in 67 women (18.8%) by standard MR protocol, and histological examination revealed 14 malignant lesions and 53 benign lesions. The average interpretation time of AP-1 and AP-2 were 37 seconds and 54 seconds, respectively, while the average interpretation time of the FDP was 3 minutes and 25 seconds. The sensitivities of the AP-1, AP-2, and FDP were 92.9, 100, and 100%, respectively, and the specificities of the three MR protocols were 86.5, 95.0, and 96.8%, respectively. There was no significant difference among the three MR protocols in the diagnosis of breast cancer (p > 0.05). However, the specificity of AP-1 was significantly lower than that of AP-2 (p = 0.031) and FDP (p = 0.035), while there was no difference between AP-2 and FDP (p > 0.05). CONCLUSION: The AP may be efficient in the breast cancer screening of dense breast tissue. FAST and MIP images combined with DWI of MRI are helpful to improve the specificity of breast cancer detection.

El ultrasonido como método diagnóstico de patología mamaria oculta en mujeres con mama densa: serie clínica / Ultrasound as a Diagnostic Method of Hidden Breast Pathology in Women with Dense Breasts (case series)

Objetivo: Determinar la importancia y utilidad del ultrasonido mamario como método de imagen complementario en pacientes con mamas densas, ACR 3 y 4. Materiales y métodos: Estudio observacional longitudinal de tipo prospectivo. Se evaluaron 483 pacientes femeninas que asistieron a la Clínica de Mamas (San Cristóbal, Estado Táchira) durante el periodo de febrero de 2010 a febrero de 2011 con mamas densas en mamografía, sin hallazgo clínico ni radiológico, con evaluación ultrasonográfica complementaria y posterior estudio histopatológico según grado de sospecha de lesión por categorización BI-RADS. Resultados: La edad promedio de las pacientes fue de 45,15 años, menarquía a los 12,57 años y mamas densas ACR 3, la mayoría sin antecedentes de cáncer de mama ni uso de terapia de reemplazo hormonal. Se diagnosticaron 304 lesiones ocultas, el 10,8% con características ultrasonográficas de sospecha y el 2,2% con hallazgos histopatológicos de malignidad. Conclusiones: Se demuestra la importancia del ultrasonido como método complementario de rastreo en pacientes con mama densa.

Objective: To determine the importance and usefulness of breast ultrasounds as supplementary imaging method in patients with dense breasts, ACR 3 and 4. Materials and methods: Prospective observational longitudinal type study. We evaluated 483 female patients in the Clínica de Mama (San Cristobal, Tachira Ste.) from February 2010 to February 2011 with dense breasts in mammography without clinical or radiological findings, with additional ultrasonographic evaluation and a histopathological study according to the degree of lesion suspicion by BIRADS categorization. Results: The average age of the patients was 45.15 years, The menarche age was 12.57 years and ACR 3 breasts. Most patients did not have a background of breast cancer, nor did they use hormone replacement therapy. 304 hidden lesions were diagnosed, 10.8% with suspicious ultrasonographic features and 2.2% with histopathological malignancy findings. Conclusions: The importance of the ultrasound as a complementary screening method is proven in patients with dense breasts.

Relationship between Mammographic Dense Breast and Other Risk Factors of Breast Cancer in Korean Women

BACKGROUND: Several studies have demonstrated that mammographic dense breast is related to the risk of breast cancer and is associated with decreased mammographic sensitivity and specificity. In contrast, studies concerning women with dense breast are virtually non-existent. This study was conducted to evaluate the relationship between mammographic dense breast and other risk factors of breast cancer, and to make a plan for individualized strategies in high risk populations. METHODS: The study subjects were 565 women, aged 20~70 years, who had a screening mammogram from April 2005 to August 2005 at a health promotion center. Data of demographic factors, breast caner risk factors and menstrual status were collected by the self-administered questionnaire. Mammographic breast density was classified according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) fours categories, as measured by the proportion of glandular tissues within the total breast tissue. RESULTS: By BI-RADS categories, 'entirely fat' were 46, 'scattered fibroglandular' were 96, 'heterogenous dense' were 332 and 'extremely dense' were 91 (16.1%). Univariate analysis showed that age, occupation, education level, body mass index, age at menarche, parity, breast feeding, menopausal status and triglyceride had significantly related to dense breast (P<0.05). In the multivariate logistic analysis, only low body mass index (P<0.001), low parity (P=0.009, 0.038) and premenopausal status (P=0.001) were significantly associated with dense breast. CONCLUSION: In Korean women, dense breast was significantly associated with low body mass index, low parity and premenopausal status. Therefore, if women with dense breast have these risk factors, they need to be managed more intensively with regular screening, breast sonogram, and lifestyle modification.

Interval Breast Cancer / 한국유방암학회지

PURPOSE: The aim of this research was to reduce the interval of breast cancer by reviewing and analyzing its occurrence METHODS: Of the 311 breast cancer patients observed at our clinic between 1998 and 2002, the 14 that had developed breast cancer within the 24 months of their previous screening examination were the subjects of this study. RESULTS: Ductal carcinoma in situ (DCIS) was found in 3 patients revealing changes of, or newly developed, microcalcification. 5 patients, believed to have benign lesion, where follow-up checking was recommended, were later found to have breast cancer. There were 3 failed cases from early diagnosis of cancer due to a dense breast. In 2 cases, the cancer was thought to have progressed due to the lack of an active recommendation for a biopsy, even after suspicious abnormal findings were observed. For all the other cases, the cancer was detected early during routine follow-ups. CONCLUSION: In case of dense breast, intense and thorough examinations including ultrasonography should be recommended because dense breast may prevent the detection of small masses. Especially, it is a fact in Korean women who carry dense breasts in many cases. Even if mass or microcalcification is thought to be benign, a biopsy should be encouraged. For a suspicious lesion, a biopsy should be recommended to a greater extent than the other follow-up measures. Routine screening examinations should be recommended once a year, but can be performed between 6 months and 2 years depending on the patients' age or degree of dense breast.