Evidence of the effect of adjunct ultrasound screening in women with mammography-negative dense breasts: interval breast cancers at 1 year follow-up.

Surveillance of interval cancers (IC) provides a measure of breast screening efficacy. Increased breast density is a predictor of breast cancer risk and of the risk of IC in screening. Improving screening sensitivity in women with dense breasts, through adjunct ultrasound (US), may potentially reduce IC; however this has not been proven. We report on first-year IC in a retrospective cohort of 8865 women who had 19,728 screening examinations (2001-2006): women with non-dense (D1-D2) breasts received mammography (M) screening, and women with dense (D3-D4) breasts also received ultrasound. Data linkage with both hospital discharge records and cancer registry databases was used to identify IC. Underlying cancer rates (cancers observed within 1-year from screening) were 6.3/1000 screens in the D1-D2 group and 8.3/1000 screens in the D3-D4 group. Cancer detection rate (CDR) was 5.98/1000 in all screening examinations; in D3-D4 breasts ultrasound had an additional CDR of 4.4/1000 screens. There were 21 first-year IC, an overall interval cancer rate (ICR) of 1.07/1000 negative screens: 0.95/1000 in women < 50 years and 1.16/1000 screens in women ≥ 50 years. ICR by breast density were 1.0/1000 negative screens in D1-D2, and 1.1/1000 negative screens in D3-D4. Interval cancers were early stage (in situ or small invasive) cancers, almost all were node-negative. Screening sensitivity was 83.5% for mammography alone in D1-D2 breasts relative to 86.7% for mammography with ultrasound in D3-D4 breasts. Our study shows that including ultrasound as adjunct screening in women with D3-D4 breasts brings the IC rate to similar levels as IC in non-dense breasts--this suggests that additional cancer detection by ultrasound is likely to improve screening benefit in dense breasts, and supports the implementation of a randomised trial of adjunct ultrasound in women with increased breast tissue density.

Breast screening with ultrasound in women with mammography-negative dense breasts: evidence on incremental cancer detection and false positives, and associated cost.

BACKGROUND: We evaluated the contribution of ultrasound (US) in detecting breast cancer in women with dense breasts and negative mammograms. METHODS: 9157 (35.8%) of 25,572 self-referring women during 2000-2007 had BI-RADS D3-4 negative mammograms - all were screened with bilateral US. RESULTS: US detected 37 cancers - incremental cancer detection rate (ICDR) was 0.40% (95% CI: 0.39-0.41%); ICDR was 0.33% in women <50 and 0.51% in those 50 years and older. US detected a larger proportion of cancers below age 50 compared to older women. US-only detected cancers had a more favourable stage (pTis-pT1a-pT1b: 64.8% versus 35.5%, p=0.001; pN1: 13.5% versus 31.3%, p=0.047) than cancers detected on mammography. US caused additional investigations in 4.9% of women and benign surgical biopsies in 0.9%. Cost per US-screened woman, and per US-detected cancer ranged between euro59-62 and euro14,618-15,234, respectively. CONCLUSION: US detects early-stage cancers in women with mammography-negative dense breasts, with higher contribution in women younger than 50 years.

Primary pulmonary high grade non-Hodgkin's lymphoma in an elderly patient. A case report.

An 82-year-old non-smoker female was admitted with cough, fever and poor general health. Radiological examination revealed a right parahilar mass and a transbronchial biopsy confirmed the presence of a tumor. Immunohistochemical analysis established the diagnosis of high-grade primary pulmonary lymphoma. The rare nature of this disease, its non-specific clinical presentation and particular prognosis, also in elderly patients, are discussed in this article.