The Connecticut Experiment; The Third Installment: 4 Years of Screening Women with Dense Breasts with Bilateral Ultrasound.

To determine if the addition of breast ultrasound in women with dense breasts finds cancers that otherwise would have been obscured. Retrospective chart review from five sites from October 2009 through December 2013. Data included: number of screening mammograms; number of screening ultrasounds; Breast Imaging Reporting Data System code results; biopsy results including type of lesion, size, nuclear grade, receptor and node status, and patient demographic data. Year 1, 2,706 ultrasound with 151 biopsies yielded 11 cancers, positive predictive value (PPV) 7.3%. Detection rate of 4.0/1,000. Year 2, 3,351 ultrasounds with 180 biopsies yielded 11 cancers and high risk lesions (HRL), PPV 6.1%. Detection rate 3.3/1,000. Year 3, 4,128 ultrasounds with 148 biopsies yielded 13 cancers and HRL, PPV 8.8%. Detection rate 3.1/1,000. Year 4, 3,331 ultrasounds with 53 biopsies yielded 11 cancers and HRL, PPV of 20.1%. Detection rate of 3.3/1,000. Lesion size ranged 0.3-8.0 cm. Patient age 45-77 years. Three tumors nuclear grade 3 and 1 nuclear grade 2 had positive sentinel nodes. 8 patents had risk factors other than dense breasts. Cancers in patients with prior negative screening ultrasound measured 0.4-1.2 cm and were node negative. Breast ultrasound in women with dense breasts detects mammographically occult malignancy. Over 4 years, the PPV doubled indicating increased accuracy of lesions biopsied while rate of detection remained stable. Lesions were of all cancer types, grade and hormonal status. Only high grade cancers were sentinel node positive and women returning for yearly ultrasound had small lesions with no positive sentinel nodes.

Results of a multicenter patient registry to determine the clinical impact of breast-specific gamma imaging, a molecular breast imaging technique.

OBJECTIVE: Molecular breast imaging techniques, such as breast-specific gamma imaging, are increasingly being used as adjunctive diagnostic technologies to mammography and ultrasound. This multicenter clinical patient registry was designed to quantify the impact of this modality on the management of the breast patient population in clinical practice and to identify the subgroups of patients benefiting from its use. MATERIALS AND METHODS: There were 1042 patients included in this analysis, and breast-specific gamma imaging typically was recommended when the patient had at least two of the following indications: equivocal or negative mammogram or sonogram and an unresolved clinical concern; personal history of breast cancer or current cancer diagnosis; palpable masses negative on mammographic and sonographic examination; radiodense breast tissue; or high risk for breast cancer. Pathologic analysis or follow-up imaging, if biopsy was not conducted, was used as the reference standard, and lesions were classified as positive (i.e., malignant or high risk) in 250 cases and as negative (i.e., benign) in 792 cases. RESULTS: Breast-specific gamma imaging was positive in 408 patients (227 malignant or high-risk lesions requiring additional intervention), negative in 634 patients (23 with malignant or high-risk lesions), and indeterminate in 69 patients (all benign lesions). Breast-specific gamma imaging had an overall sensitivity of 91% and specificity of 77%. CONCLUSION: Breast-specific gamma imaging significantly contributed to the detection of malignant or high-risk lesions in patients with negative or indeterminate mammographic findings, and it provided improved management when compared with ultrasound.

Invasive lobular carcinoma: detection with mammography, sonography, MRI, and breast-specific gamma imaging.

OBJECTIVE: The objective of our study was to compare the sensitivity of mammography, sonography, MRI, and breast-specific gamma imaging (BSGI) in the detection of invasive lobular carcinoma. MATERIALS AND METHODS: This is a retrospective multicenter study of women with biopsy-proven invasive lobular carcinoma. All patients had undergone mammography and BSGI, and the imaging findings were classified as positive or negative for invasive lobular carcinoma by experienced breast imagers. The results of MRI and sonography, if either was performed, were included. Final surgical pathology results were used as the reference standard and the lesion sensitivities of BSGI, mammography, sonography, and MRI were then statistically compared using CIs. RESULTS: Twenty-six women ranging in age from 46 to 82 years (mean age, 62.8 years) with a total of 28 biopsy-proven invasive lobular carcinomas were included in the study group. Mammograms were negative in six of 28 (21%), yielding a sensitivity of 79%. In the 25 patients who underwent sonography, 17 had focal hypoechoic areas, yielding a sensitivity of 68%. In the 12 patients who underwent MRI, the sensitivity was 83%. BSGI had a sensitivity of 93%. There was no statistically significant difference in the sensitivity of BSGI, MRI, sonography, or mammography, although there was a nonsignificant trend toward improved detection with BSGI. CONCLUSION: BSGI has the highest sensitivity for the detection of invasive lobular carcinoma with a sensitivity of 93%, whereas mammography, sonography, and MRI showed sensitivities of 79%, 68%, and 83%, respectively. BSGI is an effective technique that should be used to evaluate patients with suspected cancer and has a promising role in the diagnosis of invasive lobular carcinoma.