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Screening Ultrasound in Women with Negative Mammography: Outcome Analysis.

Hwang JY, Han BK, Ko EY, Shin JH, Hahn SY, Nam MY - Yonsei Med. J. (2015)

Bottom Line: We analyzed the distribution of Breast Imaging Reporting and Data System (BI-RADS) category and the performance outcome through follow up.The recall rate (=BI-RADS category 3, 4, 5) was 5.8%.The sensitivity, specificity, and positive predictive value (PPV1, PPV2) were 88.9%, 94.6%, 8.0%, and 28.0%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To show the results of an audit of screening breast ultrasound (US) in women with negative mammography in a single institution and to analyze US-detected cancers within a year and interval cancers.

Materials and methods: During the year of 2006, 1974 women with negative mammography were screened with US in our screening center, and 1727 among them had pathologic results or any follow up breast examinations more than a year. We analyzed the distribution of Breast Imaging Reporting and Data System (BI-RADS) category and the performance outcome through follow up.

Results: Among 1727 women (age, 30-76 years, median 49.5 years), 1349 women (78.1%) showed dense breasts on mammography, 762 (44.1%) had previous breast US, and 25 women (1.4%) had a personal history of breast cancers. Test negatives were 94.2% (1.627/1727) [BI-RADS category 1 in 885 (51.2%), 2 in 742 (43.0%)]. The recall rate (=BI-RADS category 3, 4, 5) was 5.8%. Eight cancers were additionally detected with US (yield, 4.6 per 1000). The sensitivity, specificity, and positive predictive value (PPV1, PPV2) were 88.9%, 94.6%, 8.0%, and 28.0%, respectively. Eight of nine true positive cancers were stage I or in-situ cancers. One interval cancer was stage I cancer from BI-RADS category 2.

Conclusion: Screening US detected 4.6 additional cancers among 1000. The recall rate was 5.8%, which is in lower bound of acceptable range of mammography (5-12%), according to American College of Radiology standard.

No MeSH data available.


Related in: MedlinePlus

A supplementary screening US detected cancer case in a 40-year-old woman that was initially assessed as BI-RADS category 3 (case 8 in Table 2). Initial supplementary screening US was assessed as BI-RADS 3 due to multiple small oval isoechoic nodules in both breasts. Diagnostic US after 6 months revealed that the mass in right breast increased in size up to 1.1 cm, and it was still not palpable. Both initial and follow-up mammograms were negative (not shown here). The pathologic diagnosis was invasive ductal cancer. US, ultrasound; BI-RADS, Breast Imaging Reporting and Data System.
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Figure 5: A supplementary screening US detected cancer case in a 40-year-old woman that was initially assessed as BI-RADS category 3 (case 8 in Table 2). Initial supplementary screening US was assessed as BI-RADS 3 due to multiple small oval isoechoic nodules in both breasts. Diagnostic US after 6 months revealed that the mass in right breast increased in size up to 1.1 cm, and it was still not palpable. Both initial and follow-up mammograms were negative (not shown here). The pathologic diagnosis was invasive ductal cancer. US, ultrasound; BI-RADS, Breast Imaging Reporting and Data System.

Mentions: The size of malignant lesions on US ranged from 0.5 cm to 2.4 cm (median, 0.9 cm). All the US-detected carcinomas were accompanied by multiple (more than 3) nodules; six cases in bilateral and two in ipsilateral breasts. All the cancers were different from the accompanying benign-appearing nodules; 5 were different in both size and shape, two were different in size only, and one was different in shape only. The size difference between suspicious and the largest non-suspicious nodule was 0.1-1.8 cm (median; 0.45 cm) and a difference 0.2 cm or greater was regarded as being significant when a nodule was less than 1 cm. Five had previous US; 3 carcinomas newly appeared and 2 carcinomas (initial category 3 and 4a) increased since the previous screening US. One carcinoma initially assessed as BI-RADS category 3 has changed in its shape and size (from 0.8 cm to 1.2 cm) at the follow-up US 182 days after the initial US date (Fig. 5, case 8 in Table 3). Four had suspicious BI-RADS descriptors on the original report; microlobulated margin (n=1), irregular shape (n=2), and non-parallel orientation (n=1). Four had an oval shape on the report, but they showed an interval change in three and a complex cyst in one later.


Screening Ultrasound in Women with Negative Mammography: Outcome Analysis.

Hwang JY, Han BK, Ko EY, Shin JH, Hahn SY, Nam MY - Yonsei Med. J. (2015)

A supplementary screening US detected cancer case in a 40-year-old woman that was initially assessed as BI-RADS category 3 (case 8 in Table 2). Initial supplementary screening US was assessed as BI-RADS 3 due to multiple small oval isoechoic nodules in both breasts. Diagnostic US after 6 months revealed that the mass in right breast increased in size up to 1.1 cm, and it was still not palpable. Both initial and follow-up mammograms were negative (not shown here). The pathologic diagnosis was invasive ductal cancer. US, ultrasound; BI-RADS, Breast Imaging Reporting and Data System.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541666&req=5

Figure 5: A supplementary screening US detected cancer case in a 40-year-old woman that was initially assessed as BI-RADS category 3 (case 8 in Table 2). Initial supplementary screening US was assessed as BI-RADS 3 due to multiple small oval isoechoic nodules in both breasts. Diagnostic US after 6 months revealed that the mass in right breast increased in size up to 1.1 cm, and it was still not palpable. Both initial and follow-up mammograms were negative (not shown here). The pathologic diagnosis was invasive ductal cancer. US, ultrasound; BI-RADS, Breast Imaging Reporting and Data System.
Mentions: The size of malignant lesions on US ranged from 0.5 cm to 2.4 cm (median, 0.9 cm). All the US-detected carcinomas were accompanied by multiple (more than 3) nodules; six cases in bilateral and two in ipsilateral breasts. All the cancers were different from the accompanying benign-appearing nodules; 5 were different in both size and shape, two were different in size only, and one was different in shape only. The size difference between suspicious and the largest non-suspicious nodule was 0.1-1.8 cm (median; 0.45 cm) and a difference 0.2 cm or greater was regarded as being significant when a nodule was less than 1 cm. Five had previous US; 3 carcinomas newly appeared and 2 carcinomas (initial category 3 and 4a) increased since the previous screening US. One carcinoma initially assessed as BI-RADS category 3 has changed in its shape and size (from 0.8 cm to 1.2 cm) at the follow-up US 182 days after the initial US date (Fig. 5, case 8 in Table 3). Four had suspicious BI-RADS descriptors on the original report; microlobulated margin (n=1), irregular shape (n=2), and non-parallel orientation (n=1). Four had an oval shape on the report, but they showed an interval change in three and a complex cyst in one later.

Bottom Line: We analyzed the distribution of Breast Imaging Reporting and Data System (BI-RADS) category and the performance outcome through follow up.The recall rate (=BI-RADS category 3, 4, 5) was 5.8%.The sensitivity, specificity, and positive predictive value (PPV1, PPV2) were 88.9%, 94.6%, 8.0%, and 28.0%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To show the results of an audit of screening breast ultrasound (US) in women with negative mammography in a single institution and to analyze US-detected cancers within a year and interval cancers.

Materials and methods: During the year of 2006, 1974 women with negative mammography were screened with US in our screening center, and 1727 among them had pathologic results or any follow up breast examinations more than a year. We analyzed the distribution of Breast Imaging Reporting and Data System (BI-RADS) category and the performance outcome through follow up.

Results: Among 1727 women (age, 30-76 years, median 49.5 years), 1349 women (78.1%) showed dense breasts on mammography, 762 (44.1%) had previous breast US, and 25 women (1.4%) had a personal history of breast cancers. Test negatives were 94.2% (1.627/1727) [BI-RADS category 1 in 885 (51.2%), 2 in 742 (43.0%)]. The recall rate (=BI-RADS category 3, 4, 5) was 5.8%. Eight cancers were additionally detected with US (yield, 4.6 per 1000). The sensitivity, specificity, and positive predictive value (PPV1, PPV2) were 88.9%, 94.6%, 8.0%, and 28.0%, respectively. Eight of nine true positive cancers were stage I or in-situ cancers. One interval cancer was stage I cancer from BI-RADS category 2.

Conclusion: Screening US detected 4.6 additional cancers among 1000. The recall rate was 5.8%, which is in lower bound of acceptable range of mammography (5-12%), according to American College of Radiology standard.

No MeSH data available.


Related in: MedlinePlus