Synopsis
Features of undiagnosed breast cancers on prior screening US and screening MRI of patients with breast cancers diagnosed on subsequent screening examinations will be presented. Screening mammography is the only imaging
modality to reduce breast cancer mortality through increased detection of early
cancers (1). However, diminished sensitivity in women with dense breast
composition remains a major limitation (2). Multicenter
prospective trials have consistently validated that supplemental screening
breast ultrasonography (US) can increase node-negative invasive cancer
detection rates in women at regular to elevated risk for breast cancer (3,4).
In addition, the American Cancer Society recommends breast MRI screening in
addition to mammography for women with BRCA-mutations or those with a lifetime
risk (20-25% or greater) of breast cancer (5), as the sensitivity of breast MRI
in cancer detection, which is the highest among the mainstream imaging
modalities such as mammography or ultrasonography, ranges from 77% to 94% (6-10).
Thus, to improve cancer detection through supplemental breast US or MRI in
addition to mammography, understanding features of undiagnosed breast cancers on prior
screening US and screening MRI examinations would be helpful.
First, we evaluated 230 prior screening breast US
images of patients in whom breast cancers were diagnosed in subsequent examinations and found 31.3% (72/230)
had visible findings. Of the 72 visible findings on prior screening breast US
images, 79.2% (57/72) were determined to be actionable and 20.8% (15/72) were
underthreshold. Misinterpretaion and multiple distracting lesions were the two
most common reasons for the actionable but undiagnosed findings on prior US
images. In addition, breast cancer patients who
had shown negative findings on prior US images were more frequently associated
with high nuclear grade or triple negative cancers than those who had shown visible
findings (11).
Second, we evaluated 72 prior screening breast MR
images of patients in whom breast cancers were diagnosed in subsequent examinations and found 50% (36/72) had
visible findings (mean size, 1.0 cm; range, 0.3-5.2
cm). Of the 36 visible findings
on prior screening breast MR images, 33.3% (12 of 36) were
determined to be actionable and 66.7% (24 of 36) were underthreshold. Mimicking
physiologic enhancements (27.8%, 10 of 36) and small lesion size (27.8%, 10 of
36) were the most common reasons for missed cancer. Actionable findings tended to show more washout or
plateau kinetic patterns on MR-computer aided evaluation program than the underthreshold findings (12).
Understanding these features through the lecture
will help radiologists to find early cancers in women with dense breast
composition.
Acknowledgements
No acknowledgement found.References
1. Humphrey LL, Helfand M, Chan
BK, Woolf SH. Breast cancer screening: a summary of the evidence for the U.S.
Preventive Services Task Force. Ann Intern Med 2002;137:347–360.
2. Kerlikowske K, Grady D, Barclay
J, Sickles EA, Ernster V. Effect of age, breast density, and family history on
the sensitivity of fi rst screening mammography. JAMA 1996; 276:33–38.
3. Ohuchi N,
Suzuki A, Sobue T, et al. Sensitivity and specificity of mammography and
adjunctive ultrasonography to screen for breast cancer in the Japan Strategic
Anti-cancer Randomized Trial (J-START): a randomised controlled trial. Lancet 2016;387(10016):341–348. .
4. Berg WA,
Zhang Z, Lehrer D, et al. Detection of breast cancer with addition of annual
screening ultrasound or a single screening MRI to mammography in women with
elevated breast cancer risk. JAMA 2012;307(13):1394–1404.
5. Saslow D, Boetes C, Burke W,
et al. American Cancer Society guidelines for
breast screening with MRI as an adjunct to mammography. CA Cancer J Clin
2007;57:75–89.
6. Kriege
M, Brekelmans CT, Boetes C, et al.
Efficacy of MRI and mammography for breast-cancer screening in women with a
familial or genetic predisposition. N
Engl J Med 2004;351:427-437.
7. Kuhl
CK, Schrading S, Leutner CC, et
al. Mammography, breast ultrasound, and magnetic resonance imaging for
surveillance of women at high familial risk for breast cancer. J Clin Oncol 2005;23:8469–8476.
8. Warner
E, Plewes DB, Hill KA, Causer PA, Zubovits JT, Jong RA, et al. Surveillance of
BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound,
mammography, and clinical breast examination. JAMA 2004;292:1317-1325.
9. Sardanelli
F, Podo F, D'Agnolo G, Verdecchia A, Santaquilani M, Musumeci R, et al.
Multicenter comparative multimodality surveillance of women at genetic-familial
high risk for breast cancer (HIBCRIT study): interim results. Radiology 2007;242:698–715.
10. Leach MO, Boggis CR, Dixon AK, et al. Screening with magnetic resonance imaging and mammography
of a UK population at high familial risk of breast cancer: a prospective
multicentre cohort study (MARIBS). Lancet
2005;365:1769–1778.
11. Undiagnosed
breast cancer: features at supplemental screening US. Song SE, Cho N, Chu A, et
al. Radiology 2015;277(2):372–380.
12. Features
of undiagnosed breast cancers at screening breast MR imaging and potential utility of computer-aided evaluation. Seo M, Cho N, Bae MS, et al. Korean J
Radiol 2016;17(1):59–68.