The Association of Breast Pain with Malignancy

Abstract Objective Breast pain is a common reason for imaging evaluation; however, the limited literature available suggests a low incidence of malignancy with isolated pain. The goal of this study is to calculate the risk of cancer in patients with breast pain, and to compare to the screening mammography cancer detection rates. Methods This retrospective, institutional review board–approved study included all patients for whom a breast pain history sheet was filled out between November 3, 2013, and July 28, 2016. Those without at least two years of follow-up were excluded. From the medical record, any malignancy found at the site of pain at presentation or within two years was noted. Screening cancer detection rate was calculated from the mammography tracking software, and the Chi-square test was used to evaluate the significance of the difference between the cancer detection rates in patients with pain versus that detected by screening. Results Of 421 patients who met the inclusion criteria, 4 (1.0%) had cancer at the site of pain, with a rate of malignancy of 9.5/1000 (95% CI: 3.5/1000 to 25.2/1000). The screening cancer detection rate was 7.3/1000 (P = 0.403), which was not significantly different. All cancers occurred in patients with coexisting palpable abnormalities; none was found when pain was the only symptom. Conclusion The rate of malignancy in patients with breast pain did not differ significantly from that detected by screening mammography. In patients with isolated breast pain without a palpable abnormality, there were no cases of malignancy. Imaging patients for the sole purpose of evaluating breast pain may not be necessary.

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3D versus 2D Systematic Transrectal Ultrasound-Guided Prostate Biopsy: Higher Cancer Detection Rate in Clinical Practice

Prostate Cancer ◽

10.1155/2013/783243 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

Alexandre Peltier ◽

Fouad Aoun ◽

Fouad El-Khoury ◽

Eric Hawaux ◽

Ksenija Limani ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rate ◽

Transrectal Ultrasound ◽

Daily Practice ◽

Cancer Detection Rate ◽

Prior History ◽

Detection Rates ◽

Significant Difference

Objectives. To compare prostate cancer detection rates of extended 2D versus 3D biopsies and to further assess the clinical impact of this method in day-to-day practice.Methods. We analyzed the data of a cohort of 220 consecutive patients with no prior history of prostate cancer who underwent an initial prostate biopsy in daily practice due to an abnormal PSA and/or DRE using, respectively, the classical 2D and the new 3D systems. All the biopsies were done by a single experienced operator using the same standardized protocol.Results. There was no significant difference in terms of age, total PSA, or prostate volume between the two groups. However, cancer detection rate was significantly higher using the 3D versus the 2D system, 50% versus 34% (P<0.05). There was no statistically significant difference while comparing the 2 groups in term of nonsignificant cancer detection.Conclusion. There is reasonable evidence demonstrating the superiority of the 3D-guided biopsies in detecting prostate cancers that would have been missed using the 2D extended protocol.

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Digital mammography in a screening programme and its implications for pathology: a comparative study

Journal of Clinical Pathology ◽

10.1136/jcp.2010.085860 ◽

2010 ◽

Vol 64 (3) ◽

pp. 215-219 ◽

Cited By ~ 15

Author(s):

Linda Feeley ◽

Donal Kiernan ◽

Therese Mooney ◽

Fidelma Flanagan ◽

Gormlaith Hargaden ◽

...

Keyword(s):

Cancer Detection ◽

Digital Mammography ◽

Detection Rate ◽

Screening Programme ◽

Ductal Carcinoma ◽

Recall Rate ◽

Primary Objective ◽

Cancer Detection Rate ◽

Detection Rates ◽

Predictive Values

AimsMost studies comparing full-field digital mammography (FFDM) with conventional screen-film mammography (SFM) have been radiology-based. The pathological implications of FFDM have received little attention in the literature, especially in the context of screening programmes. The primary objective of this retrospective study is to compare FFDM with SFM in a population-based screening programme with regard to a number of pathological parameters.MethodsDuring the study period, 107 818 women underwent screening mammograms with almost equal numbers obtained with each technique (49.9% with SFM vs 50.1% with FFDM). We compared SFM with FFDM using the following parameters: recall rate, diagnostic core biopsy rate, cancer detection rates, B3 rate, B4 rate, preoperative diagnostic rate for malignancy, positive predictive values and tumour characteristics.ResultsThe recall rate was significantly higher with FFDM (4.21% vs 3.52%, p<0.0001). The overall cancer detection rate of 7.2 per 1000 women screened with FFDM was also significantly higher than the rate of 6.2 per 1000 women screened with SFM (p=0.04). The B3 rate in the SFM group was 1.3 per 1000 women screened versus 2.5 per 1000 women screened in the FFDM group (p<0.001). The recall rate and cancer detection rates (overall, invasive and pure ductal carcinoma in situ) were all significantly higher with FFDM for lesions presenting as microcalcifications.ConclusionsThe higher cancer detection rate with FFDM in this study was due to improved detection of microcalcifications. However, this was achieved at the cost of a higher recall rate and a higher B3 rate, indicating that overtreatment may be problematic with digital mammography.

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Magnetic resonance/ultrasound fusion targeted biopsy of the prostate can be improved by adding systematic biopsy

Medical Ultrasonography ◽

10.11152/mu-2932 ◽

2021 ◽

Author(s):

Victor Mihail Cauni ◽

Dan Stanescu ◽

Florin Tanase ◽

Bogdan Mihai ◽

Cristian Persu

Keyword(s):

Prostate Cancer ◽

Magnetic Resonance ◽

Cancer Detection ◽

Detection Rate ◽

Specific Antigen ◽

Cancer Detection Rate ◽

Targeted Biopsy ◽

Detection Rates ◽

Clinically Significant ◽

Systematic Biopsy

Aim: Magnetic resonance/ ultrasound fusion targeted biopsy (Tbs) is widely used for diagnosing prostate cancer (PCa). The aim of our study was to compare the cancer detection rate (CDR) and the clinically significant prostate cancer detection rate (csPCa) of the magnetic resonance/ultrasound fusion targeted biopsy with those of the standard systematic biopsy (Sbs) and of the combination of both techniques.Material and methods: A total of 182 patients underwent magnetic resonance/ultrasound fusion Tbs on the prostate for PCa suspicion based on multiparametric magnetic resonance imaging (mMRI) detection of lesions with PI-RADSv2 score ≥3. A total of 78 patients had prior negative biopsies. Tb was performed by taking 2-4 cores from each suspected lesion, followed by Sb with 12 cores. We evaluated the overall detection rate of PCa and clinically significant prostate cancer, defined as any PCa with Gleason score ≥3+4.Results: Median prostate specific antigen (PSA) level pre-biopsy was 7.4 ng/ml and median free-PSA/PSA ratio was 10.2%. Patient median age was 62 years old. PIRADSv2 score was 3 in 54 cases, 4 in 96 cases and 5 in 32 cases. PI-RADS-dependent detection rate of Tbs for scores 3, 4 and 5 was 25.9%, 65.6% and 84.4%, respectively, with csPCa detection rates of 24.1%, 54.2%, and 71.9%. Overall detection rate was 57.1% for Tbs, which increased to 60.4% by adding Sbs results. Detection rate for clinically significant prostate cancer (csPCa) was 48.4% and increased to 51.1% by adding Sbs. Overall detection rate for repeated biopsy was 50% and 68.3% for biopsy in naïve patients. Sbs detection rate was 55.5%, 8 patients having a negative biopsy on Tbs.Conclusions: When Tbs is considered due to a PI-RADS ≥3 lesion on mMRI, combined Tbs + Sbs increases the overall CDR and csPCa detection rates.

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Results from the NHS Breast Screening Programme 1990–1993

Journal of Medical Screening ◽

10.1177/096914139500200403 ◽

1995 ◽

Vol 2 (4) ◽

pp. 186-190 ◽

Cited By ~ 34

Author(s):

S M Moss ◽

M Michel ◽

J Patnick ◽

L Johns ◽

R Blanks ◽

...

Keyword(s):

Cancer Detection ◽

Breast Screening ◽

Detection Rate ◽

Screening Programme ◽

Interval Cancer ◽

Cancer Detection Rate ◽

Quality Assurance Programme ◽

Detection Rates ◽

Breast Screening Programme ◽

Single View

Objective –To present results from the NHS breast screening programme (NHSBSP) for the three year period 1990 to 1993, and to examine the extent to which interim targets are being met. Methods –Data have been collated from all screening programmes in the United Kingdom on standard “Korner” returns, supplemented for the year 1991/92 by data from the radiology quality assurance programme. Most of the data refer to the prevalent screening round, but some data on rescreening are also available. Results –The total cancer detection rate at prevalent screens was 6·0/1000, 18% being in situ cancers; the detection rate of invasive cancers ⩽ 10 mm in diameter was 1·3/1000, but data on size were missing for 12% of cancers. Referral rates were significantly lower for programmes using' two view mammography at the prevalent screen than for those using single view, and cancer detection rates were significantly higher. For prevalent screens over the three year period, 70% of programmes had a referral rate of ≤ 7%, 87% had a benign biopsy rate of ≤ 5/1000, and 79% had a cancer detection rate of ≥ 5/1000. By contrast, only 30% of programmes appeared to meet the target detection rate of > ⩽5/1000 for invasive cancers ≤ 10 mm in diameter. Conclusions – While the majority of interim targets are being met by the NHSBSP, the rate of detection of small invasive cancers requires careful monitoring. Collection of more accurate data on size of cancers and interval cancer rates will give a better indication of progress towards the target mortality reduction.

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Outcomes of an organized breast cancer screening program over the past 15 years.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.14 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 14-14

Author(s):

Rasika Rajapakshe ◽

Brent Parker ◽

Cynthia Araujo ◽

Christina Chu ◽

Christine Wilson ◽

...

Keyword(s):

Breast Cancer ◽

British Columbia ◽

Cancer Detection ◽

Detection Rate ◽

Screening Program ◽

Participation Rate ◽

Screening Mammography ◽

Cancer Detection Rate ◽

Stable Range ◽

The Past

14 Background: Founded in 1988, The Screening Mammography Program of British Columbia (SMPBC) is a large, and stable screening program and a formal review of its effectiveness provides suggestions for further improvements. The purpose of this study is to quantify and report trends of the SMPBC and to assess if there have been any major changes in outcomes over the past fifteen years as this program has matured. Methods: A retrospective review of the SMPBC was performed by extracting data from the past 15 years from the SMPBC Annual Reports. The changes and trends in percentage of eligible population screened/participation rate, number of screening exams and number of first screens performed, overall cancer detection rate, and DCIS detection rate was extracted and reported. Furthermore, cost analysis data was extracted, and adjusted to compensate for inflation using The Bank of Canada Inflation Calculator, which bases its calculations from the Canadian Consumer Price Index (CPI) from Statistics Canada. Results: Over the past 15 years, the total number of exams provided per year has almost doubled from 166,746 in 1996 to 303,157 in 2010, and this increase accommodates the overall and aging growth of the BC population. An increasing participation rate is seen from 1999-2009 for women from rural sites and traditionally underserved areas of British Columbia, while the overall participation rate over this time period remains stable (range 48%-51%). The cancer detection rate also remains stable (range: 3.4-4.5 cases per 1000 screens). After adjusting for inflation, a 12.6% increase in the cost per screen from 1995-2009 is observed. This increase is multifactorial and includes an increase in operating costs central services and physician reading fees. Conclusions: The province of British Columbia has consistently had the lowest rates of breast cancer related mortality in Canada, and this may be, in part, because of the long term stability of the BC Screening Mammography Program. Our report suggests that the SMPBC has been effective in accommodating the growing aging population, although there is still room for improvement, as a target participation of 70% is considered the standard to effectively reduce mortality through screening.

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Transrectal versus transperineal 14-core prostate biopsy in detection of prostate cancer: A comparative evaluation at the same Institution

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2014.4.284 ◽

2014 ◽

Vol 86 (4) ◽

pp. 284 ◽

Cited By ~ 6

Author(s):

Maria Angela Cerruto ◽

Fabio Vianello ◽

Carolina D’Elia ◽

Walter Artibani ◽

Giovanni Novella

Keyword(s):

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rate ◽

Cancer Detection Rate ◽

Controlled Study ◽

Pain Level ◽

Prostatic Biopsy ◽

Detection Rates ◽

The Mean ◽

Prospective Controlled Study

Background: The ideal bioptic strategy for CaP detection is still to be completely defined. The aim of our study is to compare transperineal (TP) and transrectal (TR) approaches, in a 14-core initial prostate biopsy for CaP detection. Material and methods: A prospective controlled study was conducted enrolling 108 consecutive patients with a PSA level greater than 4 ng/mL and/or an abnormal DRE. TR versus TP 14-core initial prostatic biopsies were performed on 54 and 54 patients, respectively, with a randomisation ratio of 1:1. Results: The cancer detection rates were 46.29 (25 out of 54 patients), and 44.44% (24 out of 54 patients), respectively, using the TR or the TP approach (p = 0.846). The overall cancer core rate was significantly higher when the TP approach was used: 21.43% (162 out of 756 cores) and 16.79% (127 out of 756 cores), with the TP and the TR approach, respectively (p = 0.022). The cores were significantly longer performing TP approach: at the site “1” (14.92 versus 12.97 mm, p = 0.02); at “5” (15.53 versus 13.69 mm, p = 0.037); at “7” (15.06 versus 12.86 mm, p = 0.001); at “9” (14.92 versus 13.38 mm, p = 0.038); at “11” (16.32 versus 12.31 mm, p = 0.0001); at “12” (15.14 versus 12.19 mm, p = 0.0001); at “13” (17.49 versus 13.98 mm, p = 0.0001); at “14” (16.77 versus 13.36 mm, p = 0.0001). As to the biopsy related pain, the mean pain level perceived by patients during the TR approach was 1.56 ± 1.73 versus 1.42 ± 1.37 registered during TP approach (p = 0.591). Conclusions: No significant differences were found in cancer detection rate, cancer core rate between TP and TR approaches for prostatic biopsy. Even in terms of complication rate or pain level, it cannot be concluded that one procedure is superior to the other one. Apparently, strictly following our protocol, TP approach seems to offer a better sampling at the level of the apex and the TZ, however without adding any significant advantage in terms of overall cancer detection rate.

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Magnetic Resonance Imaging in Hematospermia: Does It Increase Unnecessary Prostate Biopsy?

Current Urology ◽

10.1159/000447151 ◽

2016 ◽

Vol 10 (1) ◽

pp. 50-54

Author(s):

Luke A. McGuinness ◽

Samer Obeidat ◽

Christopher Powell

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rate ◽

Digital Rectal Examination ◽

Cancer Detection Rate ◽

Detection Rates ◽

Uncommon Presentation ◽

Imaging Results ◽

Second Year

Introduction: Hematospermia is an uncommon presentation of prostate cancer. Following the introduction of MRI for patients with hematospermia we evaluated its use and effect on prostate biopsy and cancer detection rates. Materials and Methods: Analysis of patients attending our outpatient department over 2 years was undertaken. Diagnostic workup included digital rectal examination and PSA. Those with abnormal findings or persisting symptoms were offered prostate biopsy. In the second year MRI became available for patients with hematospermia. Abnormal MRI or persisting symptoms were offered biopsy. We compared the frequency of prostate biopsy and cancer detection in patients undergoing MRI and those not having imaging. Results: Forty-seven patients were referred with hematospermia. Nineteen patients did not undergo MRI; four received prostate biopsy with one adenocarcinoma found. Twenty-four patients had an MRI with 17 biopsies undertaken. Three biopsies revealed adenocarcinoma. In the MRI group 71% of patients underwent prostate biopsy but only 21% from the non-MRI group (p < 0.05). Prostate cancer detection rate in the MRI group was 18% whilst in the non-MRI group was 25% (p = 0.7). Conclusions: Our findings indicate that caution should be used with MRI as it can lead to an increase in prostate biopsy with no change in cancer detection rate.

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Complications and Prostate Cancer Diagnosis Rate of TRUS Prostate Biopsies Using 16 and 18G Needles by Clavien Scoring

Urologia Journal ◽

10.5301/uj.5000238 ◽

2017 ◽

Vol 84 (4) ◽

pp. 236-239 ◽

Cited By ~ 1

Author(s):

Serkan Ozcan ◽

Mehmet Akif Diri ◽

Murat Bagcioglu ◽

Tolga Karakan ◽

Arif Aydın

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rate ◽

Daily Basis ◽

Cancer Detection Rate ◽

Detection Rates ◽

Prostate Biopsies ◽

Group 2 ◽

Group 1

Aim We aimed to compare the 18 and 16-Gauge (G) needles used in transrectal ultrasonography (TRUS)-guided needle biopsy for cancer detection rates and complications using the Clavien Scoring System. Materials and Methods The 80 patients who were included in the study were randomized and divided into two groups. Group 1 (n = 36) had a TRUS-guided prostate biopsy with an 18G needle and Group 2 had a 16G needle (n = 44). The hematuria, bleeding assessment, and infection events were evaluated on a daily basis. These complications were graded according to the Clavien Scoring. Results In Group 1, only five (13%) patients were diagnosed with prostate cancer, and three patients were reported to have atypical small acinar proliferation (ASAP). In Group 2, 16 (36%) patients were diagnosed with prostate cancer and one patient was reported to have ASAP. The difference in the prostate cancer detection rate between the groups was statistically significant. According to the Clavien grading system, the complications were at the Grade 1 level in 25 people in Group 1 in 29 people in Group 2. Grade 2 level complications were not observed in either group. While one person was Grade 3 in Group 1, two people in Group 2 had this rate. There were no significant differences between the groups. Conclusions We found that cancer detection rate increased by increasing the thickness of the needle used in TRUS-guided prostate biopsy without any increase in the complications.

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Comparisons of cancer detection rate and complications between transrectal and transperineal prostate biopsy approaches - a single center preliminary study

BMC Urology ◽

10.1186/s12894-019-0539-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 6

Author(s):

Guan-Lin Huang ◽

Chih-Hsiung Kang ◽

Wei-Ching Lee ◽

Po-Hui Chiang

Keyword(s):

Prostate Cancer ◽

Local Anesthesia ◽

Visual Analog Scale ◽

Cancer Detection ◽

Local Anesthetic ◽

Prostate Biopsy ◽

Detection Rate ◽

Cancer Detection Rate ◽

Analog Scale ◽

Detection Rates

Abstract Background Prostate biopsy remains the gold standard approach to verify prostate cancer diagnosis. Transrectal (TR) biopsy is a regular modality, while transperineal (TP) biopsy is an alternative for the patients who display persistently high levels of prostate-specific antigen (PSA) and thus have to undergo repeat biopsy. This study aimed to compare the cancer detection rates between TR and TP approaches and assess the post-bioptic complications of the two procedures. Besides, the feasibility of performing TP biopsies under local anesthesia was also evaluated. Methods A total of 238 outpatient visits meeting the criteria for prostate cancer biopsy were enrolled for this study. They were divided into two groups: the TP group (n = 130) consists of patients destined to undergo local anesthetic TP biopsy; and the TR group (n = 108) contained those who received TR biopsy as comparison. Age, PSA level, digital rectal exam (DRE) finding, prostate volume, and biopsy core number were used as the parameters of the multivariable analyses. The comparable items included cancer detection rate, complication rate, admission rate and visual analog scale (VAS) score. Results The cancer detection rates between TP and TR groups were quite comparable (45% v.s. 49%) (p = 0.492). However, the TP group, as compared to the TR group, had significantly lower incidence of infection-related complications (except epididymitis and prostatitis) that commonly occur after biopsies. None of the patients in the TP group were hospitalized due to the post-bioptic complications, whereas there was still a minor portion of those in the TR group (7.4%) requiring hospitalization after biopsy. Medians (25–75% quartiles) of visual analog scale (VAS) were 3 [3, 4] and 4 [3–5] respectively for the TP and TR procedures under local anesthesia, but no statistical significance existed between them (p = 0.085). Conclusions Patients receiving TP biopsy are less likely to manifest infection-related complications. Therefore, TP biopsy is a more feasible local anesthetic approach for prostate cancer detection if there are concerns for infectious complications and/or the risk of general anesthesia.

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