Do automated breast ultrasound and tomosynthesis have an effective role in dense breast evaluation?

Background Mammography plays a great role in reducing breast cancer mortality as it is the standard method of breast imaging and screening. But the accuracy of mammography performance reduces in cancer detection in women with dense breast due to the summation of images and overlapping of breast tissue. ABUS and tomosynthesis both recently help to detect breast cancer in dense breasted women. This prospective study was done in the female imaging unit and approved by its research and ethical committee; all the patients did an informed consent during the period from October 2018 to March 2019. The study was conducted on 38 patients with 38 lesions subjected to digital mammography, tomosynthesis and automated breast ultrasound (ABUS), who all had dense breast in mammography. Results Automated breast ultrasound (ABUS) showed 100% in all sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) as well as accuracy, while the digital mammography tomosynthesis showed 100% in specificity, 87.5% in sensitivity, 100% in PPV, 82.4% in NPV and 92.1% accuracy. Conclusion Automated breast ultrasound (ABUS) together with tomosynthesis makes a revolution in breast screening and detecting cancer in women with dense breasts.

Which Modality Should Be Integrated to Increase the Diagnostic Efficiency of BI-RADS 0, 3, and 4 Lesions? Ultrasonography or Digital Breast Tomosynthesis?

Background: Digital mammography (DM) is one of the most common and effective radiological methods for breast cancer screening and detection. A dense fibroglandular breast tissue can lead to false negative results by superimposing on the lesion margins. Therefore, adjunctive imaging methods, such as digital breast tomosynthesis (DBT) and ultrasonography (US), are needed to increase mammographic sensitivity. Objectives: This study aimed to examine the contribution of US and DBT to DM in different patient groups (patients group of BI-RADS 0 and 3-4 lesions, patients with dense breast parenchyma, patients with non-dense breast parenchyma).. Whether US and DBT can upgrade or downgrade the BI-RADS category of uncertain lesions detected on DM was also investigated. Patients and Methods: Forty-six patients, who were classified as BI-RADS categories 0, 3, and 4 in DM, according to DBT and US findings, were included in the study. DM followed by DBT was performed for the patients, and the BI-RADS classification system was applied. Subsequently, the patients were evaluated sonographically, and the BI-RADS system was applied according to the US results. Each BI-RADS category was compared with the histopathological and multimodality follow-up results. The diagnostic performance of all modalities was also examined alone and in combination. Results: The sensitivity and specificity of DM alone was 42% and 87%, respectively. DBT detected the lesions with 92% sensitivity and 68% specificity. The modality with the highest sensitivity for the detection of malignant lesions was US (100%). Besides, the specificity of DBT was significantly high for dense breasts (P < 0.001). There was no significant difference in terms of the diagnostic accuracy of US measurements between dense and non-dense breasts. For indeterminate lesions, the integration of DBT and US to DM increased the diagnostic accuracy. Conclusion: The contribution of DBT is more valuable than US in patients with dense breast parenchyma.

ACR BI-RADS Breast Density and its correlation with breast cancer screening program

Background Breast cancer remains one of the leading causes of death in women over the age of 40 years. Breast cancer screening is used to identify women with asymptomatic cancer with the goal of enabling women to undergo less invasive treatments that lead to better outcomes, ideally at earlier stages and before the cancer progresses. Mammography is the best-studied breast cancer screening modality and the only recommended imaging tool for screening the general population of women. Objective to correlate the relation between ACR density of breast and breast cancer in screening program. Patients and Methods Our study included 40 women of breast cancer were depicted radiologically and histo-pathologically diagnosed after outreaching for screening by Digital Mammography by the Egyptian National Breast Cancer Screening Program in Ain Shams University Hospitals at period from January 2018 to October 2019.Their data were collected from the medical records of the program. Their age ranged between 40 and 65 years. Results According to the BI-RADS 5th edition 2013, cases were classified into four classes as follows: 6 were ACR-A (15.0%), 21 were ACR-B (52.5%), 12 were ACR-C (30.0%) and 1 were ACR-D (2.5%), So according to our study results dense breast shouldn’t be considered as a risk factor for breast cancer as we observed that the percentage of breast cancer in our study increases the most with average breast density ACR class B then increases with ACR class C and A respectively. Conclusion dense breast is not a risk factor for breast cancer, so further researches are needed to study the relationship between breast density and breast cancer in Egyptian population, to elucidate the role of breast density estimation in prediction of breast cancer considering the genotypical and phenotypical differences of the Egyptian population.

Contrast-enhanced spectral mammography: successful initial clinical institute experience

Background Contrast-enhanced spectral mammography (CESM) is a relatively newly developed advanced application with modification of digital mammography by the use of a contrast agent, but still has little known efficacy among Egyptian patients. Our aim in this study is to share our initial experience in evaluating symptomatic patients with different ACR breast parenchyma especially in dense breast parenchyma as it is always challenging in diagnosis. Results CESM in this study gave a sensitivity of 92% and specificity of 85% in characterization of benign and malignant lesions. For postoperative cases, sensitivity was 85% and specificity was 60%. For chemotherapy cases, sensitivity was 85% and specificity was 76%. Contrast uptake was noted in 68% of masses. Cavitary benign lesions were noted in 22.1% of cases. Multifocal and multicentric carcinomas were detected in 39.7% of pathologically proved malignant masses. Statistical analysis revealed sensitivity, specificity, and accuracy of 82.9%, 76.5%, and 81.0% for conventional mammograms as compared to 92.7%, 82.4%, and 89.7% for CESM respectively. Conclusion CESM is a promising technique that can enhance the specificity of conventional mammograms. It is an easy, simple, and rapid contrast-based procedure, especially for characterization of lesions in dense breast parenchyma. It performs proper diagnosis for high-risk patients and follow-up response to different lines of management.

Breast Density and Risk of Interval Cancers: The Effect of Annual Versus Biennial Screening Mammography Policies in Canada

Regular screening mammography reduces breast cancer mortality. However, in women with dense breasts, the performance of screening mammography is reduced, which is reflected in higher interval cancer rates (ICR). In Canada, population-based screening mammography programs generally screen women biennially; however, some provinces and territories offer annual mammography for women with dense breast tissue routinely and/or on recommendation of the radiologist. This study compared the ICRs in those breast screening programs with a policy of annual vs. those with biennial screening for women with dense breasts. Among 148,575 women with dense breasts screened between 2008 to 2010, there were 288 invasive interval breast cancers; screening programs with policies offering annual screening for women with dense breasts had fewer interval cancers 63/70,814 (ICR 0.89/1000, 95% CI: 0.67-1.11) compared with those with policies of usual biennial screening 225/77,761 (ICR 1.45 /1000 (annualized), 95% CI: 1.19-1.72) i.e. 63% higher (p = 0.0016). In screening programs where radiologists’ screening recommendations were able to be analyzed, a total of 76,103 women were screened, with 87 interval cancers; the ICR was lower for recommended annual (65/69,650, ICR 0.93/1000, 95% CI: 0.71, 1.16) versus recommended biennial screening (22/6,453, ICR 1.70/1000 (annualized), 95%CI: 0.70, 2.71)(p = 0.0605). Screening program policies of annual as compared with biennial screening in women with dense breasts had the greatest impact on reducing interval cancer rates. We review our results in the context of current dense breast notification in Canada.