B-mode ultrasound diagnostic flowchart for solid breast masses: JABTS BC-01 study

Abstract Purpose Breast ultrasound has been widely used as an essential examination for diagnosing breast cancer. However, standardized diagnostic criteria are as yet lacking. This study aimed to develop a simple diagnostic flowchart for beginners learning breast ultrasonography. The diagnostic flowchart was developed based on the recall criteria widely used in Japan. Methods We conducted a multicenter study to examine recall criteria usefulness in the diagnostic phase of breast disease. Women with ultrasound-visible breast masses who underwent B-mode breast ultrasound examination were recruited from 22 hospitals in Japan between September 2009 and January 2010. B-mode images were evaluated by members of the centralized image interpretation committee. We developed the new diagnostic flowchart based on the results. The usefulness of the diagnostic flowchart was assessed by employing datasets from the current study and another study which we conducted (BC-04 study). Results We evaluated 1045 solid masses (malignant: 495, benign: 550). Multivariate analysis showed that shape, margin, echogenic halo, interruption of the mammary gland interface, and depth width ratio were significant findings for distinguishing between benign and malignant masses. We modified the recall criteria and developed our novel diagnostic flowchart using these findings. The sensitivity and specificity of the new flowchart (current study: 0.97, 0.45; BC-04 study dataset: 0.95, 0.45) were similar to those of experts (current study: 0.96, 0.54; BC-04 study dataset: 0.98, 0.38). Conclusion We developed a simple diagnostic flowchart for breast ultrasound. This flowchart is anticipated to be applicable to educating beginners learning breast ultrasound.

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Early Clinical Impact of Diagnostic Breast Ultrasound Performed by General Practitioners and Nurses in Rwanda

Journal of Global Oncology ◽

10.1200/jgo.18.49400 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 38s-38s

Author(s):

L.E. Pace ◽

J.M.V. Dusengimana ◽

V. Rugema ◽

V. Hategekimana ◽

J.B. Bigirimana ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Detection ◽

Clinical Care ◽

Breast Ultrasound ◽

Clinical Role ◽

Detection Rates ◽

Breast Masses ◽

Management Plans ◽

The Impact

Background: Diagnostic breast ultrasound (US) could be an important tool for early detection of breast cancer in low-resource settings, where efficient strategies to refine the likelihood of malignancy among palpable breast masses are needed. However, the feasibility and clinical role of diagnostic ultrasound in such settings has not been described. We trained 4 general practitioner doctors (GPs) and 5 nurses in diagnostic breast US at a rural district hospital in Rwanda that serves as a cancer referral facility. Aim: Assess management plans, biopsy rates and patient diagnoses after nurse- and GP-performed breast ultrasounds to determine the impact of diagnostic US on clinical care. Methods: We reviewed outcomes from trainees' ultrasounds during 21 months of in-person and electronic training and mentorship by Boston-based radiologists. Trainees' US assessments and management plans were recorded on structured clinical forms. Patient diagnoses and follow-up were extracted from medical records using a standardized data collection form. Among patients who received breast US, we examined a) clinicians' management plans; b) biopsy rate; c) cancer detection rate; c) rate of benign diagnoses; d) cancers diagnosed among patients who were sent home after initial evaluation. Results: Between January 1, 2016 and September 30, 2017, 307 patients with breast concerns had a diagnostic breast US and a documented trainee US assessment. Of these, following their initial US, 158 (51%) were recommended to receive a biopsy, 30 (10%) were recommended to have aspiration/drainage, 49 (16%) were recommended for clinical or US surveillance, 1 (0.3%) was referred to another facility, 65 (21%) were discharged, and 4 (all with no abnormalities on US) had missing recommendations. Of those recommended for biopsy at initial presentation, 151 (96%) had a biopsy at that time. 56 (37%) were diagnosed with breast cancer, 37 (25%) with fibroadenoma, 7 (5%) with lactating adenoma, and 50 (33%) with other benign diagnoses. Among those with breast masses on US (n=255), 149 (58%) received a biopsy and 55 (22%) were diagnosed with cancer. As of November 23, 2017, all patients ultimately diagnosed with cancer had had a biopsy at their initial visit, and no patients who had been discharged or recommended for clinical or radiographic surveillance had been subsequently diagnosed with cancer. Conclusion: Diagnostic breast US by GPs and nurses has been a useful tool in the evaluation of breast lesions, including palpable masses, at a rural cancer facility in Rwanda. Early findings suggest that it has allowed avoidance of biopsy for 42% of patients with breast masses noted on US. Clinical follow-up and evaluation are ongoing to assess longer-term patient outcomes, cancer detection rates among patients who are not initially biopsied, and rates of follow-up among patients recommended to have clinical or radiographic surveillance.

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Precautions for breast ultrasound examination following COVID-19 vaccination

Journal of Korean Medical Association ◽

10.5124/jkma.2021.64.10.671 ◽

2021 ◽

Vol 64 (10) ◽

pp. 671-677

Author(s):

Su Min Ha ◽

Jung Min Chang

Keyword(s):

Breast Cancer ◽

Ultrasound Examination ◽

Breast Ultrasound ◽

Vaccination Status ◽

Patient Anxiety ◽

Axillary Ultrasound ◽

Short Term ◽

Diagnostic Dilemma ◽

Axillary Lymphadenopathy

Background: Coronavirus disease 2019 (COVID-19) vaccine-induced lymphadenopathy is a critical side effect that should be a concern to clinicians, patients, radiologists, and oncologists. Vaccine-induced lymphadenopathy causes a diagnostic dilemma, especially for breast radiologists who examine both axillary regions during breast ultrasound examinations. Appropriate imaging guidelines are needed to manage vaccine-induced lymphadenopathy for patients undergoing screening examinations or symptomatic patients, including cancer patients.Current Concepts: For patients with axillary lymphadenopathy in the setting of recent ipsilateral vaccination, clinical follow-up is recommended. In other scenarios, short-term follow-up axillary ultrasound examinations are recommended if the clinical concerns persist for more than 6 weeks after vaccination. To mitigate the diagnostic dilemma of vaccine-induced lymphadenopathy, patients should schedule screening imaging examinations before the first vaccination or at least six weeks following the second vaccination. For clinicians and radiologists, documenting the patients’ vaccination status is critical to decreasing unnecessary follow-up imaging, biopsies, and patient’s anxiety.Discussion and Conclusion: Our proposal can help reduce patient anxiety, provider burden, and costs of unnecessary evaluation of enlarged lymph nodes in the setting of recent COVID-19 vaccination. Further, it can avoid delays in vaccination and breast cancer screening during the COVID-19 pandemic.

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Clinical Impact of Diagnostic Breast Ultrasound Performed by Generalist Doctors and Nurses in Rwanda

Journal of Global Oncology ◽

10.1200/jgo.18.10390 ◽

2018 ◽

Vol 4 (Supplement 3) ◽

pp. 35s-35s

Author(s):

Lydia E. Pace ◽

J.M.V. Dusengimana ◽

Vestine Rugema ◽

Vedaste Hategekimana ◽

Jean Bosco Bigirimana ◽

...

Keyword(s):

Breast Cancer ◽

General Practitioners ◽

Cancer Detection ◽

Clinical Care ◽

Breast Ultrasound ◽

Medical Services ◽

Breast Masses ◽

Management Plans ◽

The Impact

Purpose Diagnostic breast ultrasound (US) can be an important tool for the early detection of breast cancer in low-resource settings where efficient strategies to refine the likelihood of malignancy among palpable breast masses are needed. However, the feasibility and clinical role of breast US in such settings has not been described. We trained four general practitioners and five nurses in diagnostic breast US at a rural Rwandan district hospital that serves as a cancer referral facility. We examined management plans, biopsy rates, and patient diagnoses after trainee breast US to determine the impact on clinical care. Methods We abstracted US assessment forms and medical records to determine outcomes from trainee US during 21 months of in-person and electronic training by Boston-based radiologists. We examined management plans, biopsy rate, cancer detection rate, rate of benign diagnoses, and cancers diagnosed among patients discharged after initial evaluation. Results Between January 2016 and September 2017, 307 patients had trainee-performed diagnostic breast US. After US, 158 (51%) were recommended to undergo biopsy, 30 (10%) were recommended to have aspiration/drainage, 49 (16%) were recommended for clinical/US surveillance, one (0.3%) was referred elsewhere, 65 (21%) were discharged, and four—all with no abnormalities on US—had missing recommendations. Of those recommended for initial biopsy, 151 patients (96%) underwent biopsy at that time. Fifty-six patients (37%) were diagnosed with breast cancer, 44 (30%) with fibroadenoma, and 50 (33%) with other benign diagnoses. Among those with breast masses on US (n = 255), 149 patients (58%) underwent biopsy and 55 (22%) were diagnosed with cancer. As of November 2017, all patients ultimately diagnosed with cancer had had a biopsy at their initial visit. No patients who had been discharged or were receiving surveillance had been subsequently diagnosed with cancer. Conclusion Diagnostic breast US by general practitioners and nurses has been a useful tool for the evaluation of breast lesions at a rural Rwandan facility and has helped avoid biopsy for 42% of patients with breast masses on US. Clinical follow-up is ongoing to assess longer-term outcomes and examine cancer detection rates and loss-to-follow-up rates among patients not initially biopsied. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Lydia E. Pace Stock or Other Ownership: Firefly Health Sughra Raza Honoraria: Fujifilm Medical Services Travel, Accommodations, Expenses: Fujifilm Medical Services

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Abstract PS3-12: Prediction of pathological complete response to neoadjuvant chemotherapy in early triple negative breast cancer patients by serial breast ultrasound examination

10.1158/1538-7445.sabcs20-ps3-12 ◽

2021 ◽

Author(s):

Bernardo Rapoport ◽

Teresa Smit ◽

Liezl Heyman ◽

Farhana Moosa ◽

Carol Ann Benn

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Triple Negative ◽

Ultrasound Examination ◽

Pathological Complete Response ◽

Complete Response ◽

Breast Ultrasound ◽

Breast Cancer Patients ◽

Response To Neoadjuvant Chemotherapy

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Application possibilities of biguanides for fibrocystic breast disease in women of reproductive age

Journal of obstetrics and women s diseases ◽

10.17816/jowd68335-40 ◽

2019 ◽

Vol 68 (3) ◽

pp. 35-40 ◽

Cited By ~ 1

Author(s):

Ekaterina V. Musina ◽

Igor Yu. Kogan

Keyword(s):

Breast Cancer ◽

Insulin Resistance ◽

Breast Disease ◽

Breast Ultrasound ◽

Reproductive Age ◽

Childbearing Age ◽

Actual Problem ◽

Female Population ◽

Fibrocystic Mastopathy ◽

Fibrocystic Breast Disease

Hypothesis/aims of study. The ongoing global problem of health care and medical science is an associated increase in the frequency of endocrine and metabolic diseases and cancer, including in women of childbearing age. Thus, the frequency of diabetes in the population has been growing rapidly for many years. Similar trends were observed in the dynamics of the frequency of cancer pathology, especially of breast cancer, which is one of the leading places in the structure of the cancer incidence in the female population. It is known that diabetes and related insulin resistance have a very negative effect on the female reproductive function, leading to hyperplastic processes of the mammary glands. The least studied problem so far is understanding the mechanisms of development, timely diagnosis, prevention, and treatment of fibrocystic mastopathy, the proliferative forms of which underlie malignant tumors, while its atypical variations are regarded as a precancerous condition. It is likely that the pathogenesis of hyperplastic processes in the mammary gland and the risk of neoplastic transformation in disorders of carbohydrate metabolism may have special factors. The actual problem is the development of a method for pathogenetically substantiated correction of fibrocystic breast disease. This is essential for the development of pharmacological strategies for secondary prevention of breast cancer and, in this regard, it is of great interest to study application possibilities of biguanides. The purpose of the present study was to conduct a comparative assessment of the effectiveness of metformin therapy in fibrocystic mastopathy patients with and without insulin resistance. Study design, materials, and methods. The study involved 120 women, aged 18 to 40 years inclusive, with clinical and / or ultrasound signs of fibrocystic breast disease. According to the results of calculating HOMA index, patients were divided into two groups: the first group comprised 66 patients with insulin resistance (HOMA > 2.5) and the second group consisted of 54 patients with no insulin resistance (HOMA < 2.5). Assessment of mastalgia was performed using the Visual Analogue Scale. Breast ultrasound examination was performed on days 5 to 7 of the menstrual cycle. For the purpose of quantitative image analysis of the breast parenchyma, the following parameters were evaluated: a) thickness of the parenchyma (fibroglandular zone); b) diameter of the milk ducts; c) echogenicity. All patients received metformin at a dose of 1500 mg per day. Dynamic control of the clinical picture of the disease, as well as of mammographic breast parenchymal pattern, was performed after 3 and 6 months from the start of therapy. Results and conclusion. After 6 months of therapy, there was a decrease in the frequency of mastalgia, and significant changes in breast ultrasound picture were observed. The data obtained on the positive effect of metformin on clinical mastitis and structural changes in the mammary parenchyma in patients with mastopathy allow considering such an approach as a promising therapeutic strategy in this pathological association.

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Multiple Myeloma Breast Involvement: A Case Report

Case Reports in Radiology ◽

10.1155/2019/2079439 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Heba O. E. Ali ◽

Zafar Nasir ◽

Ahmed M. S. M. Marzouk

Keyword(s):

Breast Cancer ◽

Multiple Myeloma ◽

Case Report ◽

Primary Breast Cancer ◽

Breast Disease ◽

Breast Masses ◽

Radiological Features ◽

Spinal Lesions

Multiple Myeloma involving the breast is very rare and the diagnosis is challenging because the clinical and radiological features of breast multiple myeloma are indistinguishable to other forms of breast disease whether primary or metastatic. In this article the authors report a case presented with breast masses, which were found to be extra osseous Multiple Myeloma. The patient was managed for multiple spinal lesions that were primarily thought to be metastasis from primary breast cancer.

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