A cross-sectional study exploring the justification of opportunistic breast cancer screening in Thailand

Objective: Breast cancer is currently the most common malignant disease in Thailand. The present study aims to evaluate the most beneficial method of breast cancer screening in different breast densities by analyzing the benefits of screening mammography with additional breast ultrasonography classified by breast density. Method: 49 middle-aged and elderly Bangkokian women who had undergone both mammography and ultrasonography were picked at random for analysis. BI-RADS scores were assigned based on mammography results alone and based on combined mammography and ultrasonography results. Concordance/discordance rates between the 2 radiographic techniques were compared in women stratified based on their breast densities. Results: All of our participants were given a score between BIRADS 1 and 3, while over 40% of participants are in the BIRADS 2 category. 60% of subjects with extremely dense breasts benefit from screening mammography with additional breast ultrasonography, while only 50% of samples with heterogeneous density and 34.21% samples with heterogeneous fibroglandular breasts benefit from the extra intervention. Conclusion: Our study concludes that women with higher breast density are more likely to benefit from screening using ultrasonography in addition to mammography as opposed to mammography screening alone. We recommend both mammography and ultrasonography for initial breast cancer screening. For follow-up visits, we suggest the screening method in accordance with breast density, using ultrasonography alone for women with high breast densities and mammography for women with heterogeneously dense breasts.

Re-evaluation of high-risk breast mammography lesions by target ultrasound and ABUS of breast non-mass-like lesions

Objective The purpose of this study was to reevaluate the high-risk breast non-mass-like lesions (NMLs) in mammography (MG) by target ultrasound (US) and Automated breast ultrasonography (ABUS), and to analyze the correlation between different imaging findings and the factors influencing the classification of lesions. Methods A total of 161 patients with 166 breast lesions were recruited in this retrospectively study. All cases were diagnosed as BI-RADS 4 or 5 by MG and as NML on ultrasound. While all NMLs underwent mammography, target US and ABUS before breast surgery or biopsy in the consistent position of breast. The imaging and pathological features of all cases were collected. All lesions were classified according to the lexion of ACR BI-RADS®. Results There were significant differences between benign and malignant breast NML in all the features of target US and ABUS. US, especially ABUS, was superior to MG in determining the malignant breast NML. There was a significant difference in the detection rate of calcification between MG and Target US (P < 0.001), and there was a significant difference in the detection rate of structural distortion between ABUS and MG (P < 0.001). Conclusions Target US, especially ABUS, can significantly improve the sensitivity, specificity and accuracy of the diagnosis of high-risk NMLs in MG. The features of Target US and ABUS such as blood supply, hyperechogenicity, ductal changes, peripheral changes and coronal features could be employed to predict benign and malignant lesions. The coronal features of ABUS were more sensitive than those of Target HHUS in showing structural abnormalities. Target US was less effective than MG in local micro-calcification.

Role of Breast Ultrasonography in Adding Diagnostic Value in Case of Dense Breasts Detected by Mammography

Introduction: Mammography is a simple and effective tool in early detection of breast lesions. However its sensitivity is less in dense breast. The aim of the study is to see whether addition of ultrasonography adds on to the diagnostic value by finding more breast lesions in evaluation of mammographic dense breasts or not. Methods: The hospital data of all the patients who underwent mammography in the Department of Radiology of Shree Birendra Hospital, Kathmandu over a period of two and a half years from November 2017 to April 2020 were retrieved and retrospectively analyzed. The mammographic findings of patients with dense breast were compared with the corroborative ultrasonographic findings. Discrepancy in positive findings between the two imaging modalities was studied. Results: Out of 536 patients studied, 238 patients had mammographic dense breast. Comparative study showed 82 cases with positive findings on mammography alone, compared to 114 cases with positive findings on combined mammography and ultrasonography with p-value < 0.05 which is statistically significant. Conclusions: Ultrasonography is a useful additional imaging modality in evaluation of mammographic dense breast by finding more breast lesions compared to Mammography alone.

A difficult-to-diagnose fibromatosis-like metaplastic carcinoma of the breast: a case report

Background Fibromatosis-like metaplastic carcinoma (FLMCa), classified as a metaplastic carcinoma of the breast, is a very rare type of metaplastic carcinoma. We report a case of FLMCa that was difficult to diagnose. Case presentation The patient was a 56-year-old postmenopausal woman who presented with a left-sided breast mass. A 1.3-cm irregular mass was found in the lower outer quadrant of the left breast on breast ultrasonography. She underwent core needle biopsy and vacuum-assisted biopsy, but the pathological findings only revealed inflammatory cell infiltration and a high level of fibrosis, with no malignant findings. At 3 months follow-up, she underwent a repeat breast ultrasonography, which revealed an increase in the size of the mass to 1.8 cm, and a repeat core needle biopsy, which showed a few spindle cells and squamous cells positive for cytokeratin (CK)5/6 and AE1/AE3, leading to the suspicion of FLMCa. Since the amount of tissue was insufficient to establish a definitive diagnosis, she underwent a lumpectomy. We found low-grade and slightly atypical spindle cells and partly atypical spindle cell carcinoma and squamous cell carcinoma. CK5/6 and α-SMA were positive, thus confirming FLMCa. Because the margins on the edge of the nipple side and anterior side were “ink on tumor”, she underwent a mastectomy and sentinel lymph node biopsy. After the surgery, she received adjuvant chemotherapy. At 3 years and 8 months of follow-up, no recurrent or metastatic lesions were identified in her body. Conclusions FLMCa should be considered in the differential diagnosis when collagenous fibers are proliferating and malignancy is clinically suspected. Immunohistochemical analysis may be helpful in confirming this diagnosis.