Supplemental Screening for Women with Dense Breasts: What Do Practicing Radiologists Recommend?

2019 ◽  
Vol 1 (1) ◽  
pp. 32-36 ◽  
Author(s):  
Tisha Singer ◽  
Ana P Lourenco ◽  
Grayson L Baird ◽  
Martha B Mainiero
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Breast Imaging ◽  
Digital Breast Tomosynthesis ◽  
Risk Groups ◽  
High Rate ◽  
Breast Tomosynthesis ◽  
Dense Breasts ◽  
Additional Imaging ◽  
Magnetic Resonance Imaging Mri

Abstract Objective To evaluate radiologists’ supplemental screening recommendations for women with dense breasts, at average, intermediate, or high risk of breast cancer, and to determine if there are differences between their recommendations for their patients, their friends and family, and themselves. Methods This is an anonymous survey of Society of Breast Imaging (SBI) members. Demographics, knowledge of breast density as a risk factor, and recommendations for screening with digital breast tomosynthesis (DBT), ultrasound (US), and magnetic resonance imaging (MRI) in women with dense breasts, at average, intermediate, or high- risk of breast cancer were assessed. The likelihood of their recommending the screening test for their patients, their family and friends, and themselves was assessed on a Likert scale from 0 to 4 (0 = “not at all likely” to 4 = “extremely likely”). Results There were 295 responses: 67% were women, and breast imaging comprised 95% of their practice. Among participants, 53% correctly answered the question on relative risk of breast cancer when comparing extremely dense versus fatty breasts, and 57% when comparing heterogeneously dense versus scattered breasts. US is recommended at a relatively low rate (1.0–1.4 on the 0–4 scale), regardless of risk. DBT is recommended at a relatively high rate (2.5–3.0 on the 0–4 scale), regardless of risk status. MR is recommended mainly for those at high risk (3.6 on the 0–4 scale). Radiologists were more likely to recommend additional imaging for themselves than for their patients and their family and friends. Conclusion For women with dense breasts, radiologists are “somewhat likely” to recommend US and “likely” to “very likely” to recommend DBT regardless of risk group. They are “very likely” to recommend MRI for high-risk groups.

Global tissue stiffness on breast MR elastography: High-risk dense breast patients have higher stiffness compared to average-risk dense breast patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10541-10541
Author(s):  
Bhavika K. Patel ◽  
Kay Pepin ◽  
Kathy R Brandt ◽  
Gina L. Mazza ◽  
Barbara A. Pockaj ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Risk ◽  
Menopausal Status ◽  
Risk Groups ◽  
Average Risk ◽  
Tissue Stiffness ◽  
Tissue Properties ◽  
Dense Breasts ◽  
Risk Patients

10541 Background: Biomechanical tissue properties may vary in the breasts of patients at elevated risk for breast cancer. We aim to quantify in vivo biomechanical tissue properties in various breast densities and in both normal risk and high risk women using Magnetic Resonance Imaging (MRI)/MRE and examine the association of biomechanical properties of the breast with cancer risk. Methods: In this IRB–approved prospective single-institution study, we recruited two groups of women differing by breast cancer risk to undergo a 3.0 T dynamic contrast enhanced MRI/MRE of the breast. Low-average risk women were defined as having no personal or significant family history of breast cancer, no prior high risk breast biopsies and a negative mammography within 12 months. High-risk breast cancer patients were recruited from those patients who underwent standard of care breast MR. Within each breast density group (non-dense versus dense), two-sample t-tests were used to compare breast stiffness, elasticity, and viscosity across risk groups (low-average vs high). Results: There were 50 low-average risk and 86 high-risk patients recruited to the study. The risk groups were similar on age (mean age = 55.6 and 53.6 years), density (68% vs. 64% dense breasts) and menopausal status (66.0% vs. 69.8%). Among patients with dense breasts, mean stiffness, elasticity, and viscosity were significantly higher in high risk patients ( N = 55) compared to low-average risk patients ( N = 34; all p < 0.001). In the multivariate logistic regression model, breast stiffness remained a significant predictor of risk status (OR=4.26, 95% CI [1.96, 9.25]) even after controlling for breast density, MRI BPE, age, and menopausal status. Similar results were seen for breast elasticity (OR=4.88, 95% CI [2.08, 11.43]) and viscosity (OR=11.49, 95% CI [1.15, 114.89]). Conclusions: Structurally-based, quantitative biomarker of tissue stiffness obtained from global 3D breast MRE is associated with differences in breast cancer risk in dense breasts. As such, tissue stiffness could provide a novel prognostic marker to help identify the subset of high-risk women with dense breasts who would benefit from increased surveillance.[Table: see text]

scholarly journals Current and Future Directions of Breast MRI

2021 ◽  
Vol 10 (23) ◽  
pp. 5668
Author(s):  
Margaret Houser ◽  
David Barreto ◽  
Anita Mehta ◽  
Rachel F. Brem
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Digital Breast Tomosynthesis ◽  
Breast Mri ◽  
Preoperative Assessment ◽  
Average Risk ◽  
Dense Breast Tissue ◽  
Increased Risk ◽  
High Risk Populations ◽  
Magnetic Resonance Imaging Mri

Magnetic resonance imaging (MRI) is the most sensitive exam for detecting breast cancer. The American College of Radiology recommends women with 20% or greater lifetime risk of developing breast cancer be screened annually with MRI. However, other high-risk populations would also benefit. Hartmann et al. reported women with atypical hyperplasia have nearly a 30% incidence of breast cancer at 25-year follow-up. Women with dense breast tissue have up to a 4-fold increased risk of breast cancer when compared to average-risk women; their cancers are more likely to be mammographically occult. Because multiple cohorts of women are at high risk for developing breast cancer, there has been a movement to develop an abbreviated MRI (abMRI) protocol to expand the availability of MRI screening. Studies on abMRI effectiveness have been promising, with Weinstein et al. demonstrating a cancer detection rate of 27.4/1000 in women with dense breasts after a negative digital breast tomosynthesis. Breast MRI is also used to evaluate the extent of disease as part of preoperative assessment in women with newly diagnosed breast cancer, and to assess a patient’s response to neoadjuvant chemotherapy. This paper aims to explore the current uses of MRI and propose future indications and directions.

scholarly journals The value of mammography in women with focal breast complaints in addition to initial targeted ultrasound

2020 ◽  
Author(s):  
L. Appelman ◽  
P. T. M. Appelman ◽  
C. C. N. Siebers ◽  
P. Bult ◽  
H. L. S. Go ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Imaging ◽  
Digital Breast Tomosynthesis ◽  
Breast Disease ◽  
Added Value ◽  
Breast Tomosynthesis ◽  
Targeted Ultrasound ◽  
Symptomatic Breast Cancer ◽  
Symptomatic Breast

Abstract Purpose To determine the added value of mammography in women with focal breast complaints and the utility of initial targeted ultrasound in this setting. Methods Women with symptomatic breast disease who were evaluated by breast imaging (mammography/digital breast tomosynthesis and ultrasound) between January 2016 and December 2016 in the Radboud University Medical Centre were included. We retrospectively collected the following data: date of birth, indication of imaging, visibility on mammography/ultrasound, whether biopsy was taken, additional findings, BI-RADS-classification, pathology and follow-up results. Results A total of 494 women were included (mean age 46.5, range 30 to 93). In 49 women (9.9%), symptomatic breast cancer was diagnosed, all visible during targeted ultrasound. The negative predictive value of targeted ultrasound was very high (99.8%). Additional findings on mammography were significantly more often malignant when the symptomatic lesion was also malignant (3.8% vs 70%, P < 0.05). In only one patient with symptoms caused by a benign finding, an incidental malignancy was detected on mammography outside the area of complaint (detection rate 2.2/1000 examinations). Conclusions The contribution of mammography for cancer detection in women with focal breast complaints is very low when targeted ultrasound is performed. Additional findings are most common in patients with symptomatic breast cancer. Our results suggest that initial targeted ultrasound is a more appropriate initial tool for the evaluation of focal breast complaints. Mammography could be performed on indication only.

Advanced Imaging Techniques for the Detection of Breast Cancer

2012 ◽  
pp. 65-69 ◽  
Author(s):  
Maxine Jochelson
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Breast Imaging ◽  
Early Stage ◽  
Imaging Techniques ◽  
Breast Cancer Mortality ◽  
Digital Breast Tomosynthesis ◽  
Ct Scanning ◽  
High Risk Women ◽  
Contrast Enhanced

Overview: Mammography is the only breast imaging examination that has been shown to reduce breast cancer mortality. Population-based sensitivity is 75% to 80%, but sensitivity in high-risk women with dense breasts is only in the range of 50%. Breast ultrasound and contrast-enhanced breast magnetic resonance imaging (MRI) have become additional standard modalities used in the diagnosis of breast cancer. In high-risk women, ultrasound is known to detect approximately four additional cancers per 1,000 women. MRI is exquisitely sensitive for the detection of breast cancer. In high-risk women, it finds an additional four to five cancers per 100 women. However, both ultrasound and MRI are also known to lead to a large number of additional benign biopsies and short-term follow-up examinations. Many new breast imaging tools have improved and are being developed to improve on our current ability to diagnose early-stage breast cancer. These can be divided into two groups. The first group is those that are advances in current techniques, which include digital breast tomosynthesis and contrast-enhanced mammography and ultrasound with elastography or microbubbles. The other group includes new breast imaging platforms such as breast computed tomography (CT) scanning and radionuclide breast imaging. These are exciting advances. However, in this era of cost and radiation containment, it is imperative to look at all of them objectively to see which will provide clinically relevant additional information.

scholarly journals Digital breast tomosynthesis (DBT) value in breast mass detection

2021 ◽  
Vol 130 (1) ◽  
pp. 1-4
Author(s):  
Angelika Kuczyńska ◽  
Łukasz Kwietniewski ◽  
Wiktor Kupisz ◽  
Joanna Kruk-Bachonko ◽  
Witold Krupski
Keyword(s):  
Breast Cancer ◽  
Digital Breast Tomosynthesis ◽  
Screening Tests ◽  
Mass Detection ◽  
Middle Aged ◽  
Focal Lesions ◽  
Aged Patients ◽  
Breast Tomosynthesis ◽  
Conventional Mammography ◽  
Magnetic Resonance Imaging Mri

AbstractEpidemiologically, breast cancer is the most common cancer in middle-aged women and it is one of the leading causes of cancer-related deaths. Middle-aged patients are covered by screening tests – digital mammography, often supplemented with ultrasound (US) breast examination. Other radiological tests in the diagnosis of breast cancer include such techniques as tomosynthesis, spectral mammography and magnetic resonance imaging (MRI). Many research groups around the world have demonstrated superiority of tomosynthesis in detecting focal lesions in breasts when compared to conventional mammography. Tomosynthesis usage was proposed for screening studies as a test of choice and for radiologically-guided tissue biopsies of suspicious tissue lesions.

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