The Breast

Mammographic screening for breast cancer: An invited review of the benefits and costs

2010-07-23T16:02:00.000-07:00

Mammographic screening for breast cancer: An invited review of the benefits and costs
Jon M. Greif
The Breast 2010. 19;4:260-267

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Mammographic screening is a proven method for reducing breast cancer mortality for women 40 years of age and older, but the best method for implementation of mammographic screening, particularly in the age group 40–49, remains controversial. The author, in an invited review, summarizes the data and offers guidance based on the best information available for women at risk for breast cancer, and their care providers, with particular emphasis on costs and benefits

Breast cancer is a global public health problem and the reader can decide for him or her self if the costs and benefits outweigh the risks associated with breast health screening programs. Many governments will continue to debate the costs and the pros and cons; however without population based screening, many women will continue to suffer needlessly throughout the world. Thus, I would like to offer the following conclusions based on one surgeon’s analysis of the literature regarding the benefits and costs of mammographic screening for breast cancer:

1. Women invited to participate in a regular program of mammographic screening, beginning at age 40 and continuing annually for as long as a woman is healthy can be expected to have a 19% reduction in breast cancer mortality compared with women not invited to participate in systematic mammographic breast cancer screening. In fact, 75% of all breast cancer deaths occur in the 20% of women not undergoing periodic screening mammography. Breast cancer screening saves lives, and, when considering the monetary costs to society of treating advanced breast cancer, may actually save money.

2. Screening mammography is less than 100% sensitive or 100% specific for detection of breast cancer, and so there will be false negatives and false positives. Following rigorous quality control guidelines will minimize the incidence of false negatives and false positives. Combining annual screening mammography with annual professional clinical breast exams and encouraging women to become familiar with their breasts through monthly breast self exam are likely also to reduce the impact of the falsely negative mammogram, and should be encouraged.

3. It may be desirable to examine alternatives to current screening strategies, but, hopefully, this does not translate into less effective breast cancer screening strategies that aim to simply reduce costs in the future. Improving efficiency in mammographic screening practices may be a successful cost saving strategy that does not sacrifice benefit.

4. The perfect breast cancer screening tool would be 100% sensitive and 100% specific, inexpensive and not harmful. Mammography is not that perfect tool, but, for now, is a very satisfactory and evidence-based procedure which can save lives, and should be made accessible to all women at risk for developing this dreaded disease.

Risk assessment, screening and prevention of breast cancer: A look at cost-effectiveness

2010-07-23T16:01:00.000-07:00

Risk assessment, screening and prevention of breast cancer: A look at cost-effectiveness
Gail S. Lebovic, Alan Hollingsworth, Stephen A. Feig
The Breast 2010. 19;4:260-267
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Following consideration of the above review, it is clear that the cost-effectiveness surrounding the many clinical areas as they relate to breast cancer are difficult, if not impossible to fully assess. However, within the literature we begin to see an important framework for the future. This includes the importance of risk assessment for stratification of women of various ages, preventive measures including lifestyle, chemoprevention and surgery, as well as the continued support for the essential component of mammographic screening according to present guidelines. It is these measures taken together as a whole that ultimately will save lives with the most effective, efficient and most cost-effective approach to breast cancer throughout the world

Role of magnetic resonance imaging in managing selected women with newly diagnosed breast cancer

2010-04-09T09:31:00.000-07:00

Role of magnetic resonance imaging in managing selected women with newly diagnosed breast cancer
S. Scomersi, M. Urbani, M. Tonutti, F. Zanconati, M. Bortul
The Breast 2010 19;2:115-119

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The purpose of this study is evaluation of therapeutic impact of magnetic resonance imaging (MRI) in breast cancer patients that cannot be imaged adequately with traditional radiology: dense breasts, microcalcifications suspicious for carcinoma in situ or discordance between mammography and ultrasound. A review was performed of 493 patients’ records: determination of breast MRI effect on clinical management was made for the selected 70 cases by analysing pre-MRI and post-MRI therapeutic plans. Analysis of final pathology was useful to determine if the change in surgical plan prompted by MRI was appropriate.

Breast MRI added clinical information in 52.9% of patients that resulted in 44.3% of management changes that were judged as appropriate in 83.9% of cases. Breast MRI provides additional useful information, but causes more extensive surgery (40%) with no proven prognostic benefit. MRI should be considered optional in the clinical staging of breast cancer and performed in selected cases.

Freehand versus ultrasound-guided core biopsies of the breast: reducing the burden of repeat biopsies in patients presenting to the breast clinic

2010-04-09T09:25:00.001-07:00

Freehand versus ultrasound-guided core biopsies of the breast: reducing the burden of repeat biopsies in patients presenting to the breast clinic
S.T. Ward, J.A. Shepherd, H. Khalil
The Breast 2010 19;2:105-108

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In our breast unit a significant proportion of core biopsies are performed freehand sometimes necessitating a repeat biopsy under image guidance. The aims of this study were to establish the proportion of patients undergoing freehand core biopsies who proceeded to a repeat procedure and to determine any factors associated with a missed freehand biopsy. Four hundred and ten core biopsies over 21 months were included in the analysis. Demographic details, position and size of the lump, breast volume and lesion depth were recorded.

Twenty-four percent freehand biopsies were repeated under ultrasound guidance. The histological classification of two-thirds of the repeat biopsies were upgraded, suggesting that the lesion had been previously missed. Multivariate analysis showed that missed freehand biopsies were strongly associated with deep lesions. If all lumps sited at a depth of 6 mm or more were selected for US-guided core biopsy, the workload for the ultrasound department would increase by just less than a half and would have the effect of reducing the freehand biopsy miss rate by almost two-thirds.

Core biopsies should be performed under ultrasound guidance. A freehand technique could be limited to superficial lesions. Depth is more predictive for a missed biopsy than lesion size or breast volume

Long-term follow-up-findings in mammography and ultrasound after intraoperative radiotherapy (IORT) for breast cancer

2010-01-21T11:42:00.000-08:00

Long-term follow-up-findings in mammography and ultrasound after intraoperative radiotherapy (IORT) for breast cancer
M. Ruch, J. Brade, C. Schoeber, U. Kraus-Tiefenbacher, A. Schnitzer, D. Engel, F. Wenz, M. Sütterlin, S.O. Schoenberg, K. Wasser
The Breast Volume 18, Issue 5, October 2009, Pages 327-334

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In early postoperative follow-up studies the radiologist is confronted with large and partially organized wound cavities in most cases after IORT. In further follow-ups, fat necroses arise from those cavities, and about 60% of patients show likewise large oil cysts on late follow-up mammograms. As a frequent phenomenon wound cavities appear sonographically as liquid lesions with pronounced polypoid inner wall thickening. Furthermore, a prolonged parenchymal scarring has to be expected after IORT. No specific factors were found, which might influence the incidence or the value of these structural alterations after IORT

Comparison of interval breast cancer rates for two-versus single-view screening mammography: A population-based study

2010-01-21T11:37:00.000-08:00

Comparison of interval breast cancer rates for two-versus single-view screening mammography: A population-based study
A. Seigneurin, C. Exbrayat, J. Labarère, M. Colonna
The Breast Volume 18, Issue 5, October 2009, Pages 284-288

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Two-view mammography for first and subsequent screens is associated with lower rates of interval breast cancer. This is at the expense of an increased number of women being recalled for further assessment after subsequent screens

Localization of impalpable breast lesions: What are we aiming at?

2009-09-13T16:47:00.000-07:00

Localization of impalpable breast lesions: What are we aiming at?
Brian Mucci, Robert Shaw, Jean Lauder, Russell Pickard
The Breast Volume 18, Issue 4, August 2009, Pages 267-269

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As a quality control target for wire placement in clinically occult breast lesions success in traversing the lesion in both planes in 90% of procedures is measurable and achievable with clinical relevance. We believe that this could be an improvement on the current European target of 95% of wires being within 10 mm of the lesion

Quality of mammography screening in the Milan programme: Evidence of improved sensitivity based on interval cancer proportional incidence and radiolog

2009-06-16T20:40:00.000-07:00

Quality of mammography screening in the Milan programme: Evidence of improved sensitivity based on interval cancer proportional incidence and radiological review
Pirola Maria Elena, Houssami Nehmat, Maltagliati Ermes, Ceresa Piera, Quattrocchi Maria, Marinoni Guia, Caimi Francesco, Villa Roberto, Falda Giovanni, Gaffuri Isabella, Ciatto Stefano
The Breast 18, (3), June 2009: 208-210

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Interval cancer (IC) incidence and review-based initial evaluation of Milan service screening (ASLMI1) suggested suboptimal performance. We report results in a subsequent screening round to further determine screening quality.

Programme sensitivity is now within recommended European standards. Performance indicators improved relative to initial evaluation. Both increasing experience and formal training of radiologists are likely to have contributed to this improvement

An evaluation of a 10-gauge vacuum-assisted system for ultrasound-guided excision of clinically benign breast lesions

2009-06-16T20:37:00.000-07:00

An evaluation of a 10-gauge vacuum-assisted system for ultrasound-guided excision of clinically benign breast lesions
Zhi Li Wang, Jun Lai Li, Li Su, Yong Feng Zhang, Jie Tang
The Breast 18, (3), June 2009: 192-196

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The aim of this study was to evaluate a 10-gauge vacuum-assisted system for the excision of clinically benign breast lesions.

The minimal excision of 245 lesions in 162 patients was performed with VACORA vacuum-assisted system under the guidance of ultrasound between July 2007 and April 2008. The lesions were category 3 lesions as determined by ultrasound imaging according to Breast Imaging Reporting and Data System (BI-RADS) (n = 208) or had been confirmed as benign by a previous core-needle biopsy (n = 37).

As many as 244 lesions were demonstrated to be benign and one case was demonstrated to be malignant by pathology after resection. In the 244 benign lesions, 220 lesions were excised completely as demonstrated by the follow-up ultrasound examination. The malignant lesion was managed with surgical excision.

The 10-gauge vacuum-assisted system is highly successful for the excision of benign breast lesions; it is an alternative tool for minimal treatment of benign breast lesions

Accuracy of stereotactic vacuum-assisted breast biopsy with a 10-gauge hand-held system

2009-06-16T20:31:00.000-07:00

Accuracy of stereotactic vacuum-assisted breast biopsy with a 10-gauge hand-held system
C. Salem, R. Sakr, J. Chopier, C. Marsault, S. Uzan, E. Daraï
The Breast 18, (3), June 2009: 178-182

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The mean number of core specimens obtained per procedure was 9 (range 4–24). Complete radiological excision of the target lesion was achieved in 31.6% (91 of 288) with 91% of these lesions smaller than 10 mm (mean size 7 mm; range 4–20 mm). Under-estimation of ADH and DCIS was 18.2% (2 of 11) and 19.2% (9 of 47), respectively. There was no false negative result within a 3-year follow-up (from 2005 till date). Complications were mild and consisted of immediate bleeding and delayed hematomas

High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer

2009-04-22T08:02:00.000-07:00

High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer
Yoon Jung Choi, Eun Young Ko, Boo-Kyung Han, Jung Hee Shin, Seok Seon Kang, Soo Yeon Hahn
The Breast 18 (2009) 119–122

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US features known to accurately predict metastasis in axillary lymph nodes could be used at the time of the preoperative breast US to determine the need for FNA, SLN or ALND. Results of the present study indicate that a cortical thickness greater than 3 mm is the most reliable US feature predicting a metastasis, with sensitivity, specificity, PPV and NPV around 70%. For the L/S ratio, those parameters were only 52–65% accurate

Recent advances in high-resolution US allow examination of more detailed features of lymph nodes, such as cortex shape and internal hilar echogenicity, which may prove to be useful indicators of metastasis. Our results showed that the absence of a hilum had high specificity, but low sensitivity. Previous studies found that a hyperechogenic hilum indicated a benign lymph node, and loss of normal echogenicity had moderate to high specificity for metastasis

Predicting the status of axillary lymph nodes in breast cancer: A multiparameter approach including axillary ultrasound scanning

2009-04-22T07:57:00.000-07:00

Predicting the status of axillary lymph nodes in breast cancer: A multiparameter approach including axillary ultrasound scanning
Tommaso Susini, Jacopo Nori, Simone Olivieri, Cecilia Molino, Giulia Marini, Simonetta Bianchi, Vania Vezzosi, Lorenzo Livi, Mario Mascalchi, Gianfranco Scarselli

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Axillary US along with tumor site within the breast and Ki-67 proliferation index allowed reliable prediction of axillary metastases risk. These findings still require prospective validation in a larger sample of women. If our preliminary results will be confirmed, this multiparameter evaluation may be used to optimize the selection of breast cancer patients candidate to sentinel lymph node biopsy or axillary lymph node dissection

Patient-led breast cancer follow up

2009-04-22T07:53:00.000-07:00

Patient-led breast cancer follow up
D. Chapman, E. Cox, P.D. Britton, G.C. Wishart
The Breast 2009 18 (2): 100-102

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The introduction of PLFU has been well received by patients at low risk of breast cancer recurrence or death without a marked increase in GP workload. The use of risk stratification allows low risk patients to undergo five-year mammographic surveillance without regular breast examination but with access to clinical input if necessary. It also allows time to be spent with those patients at higher risk of recurrence as well as an increasing flow of new referrals with symptomatic disease.

Introduction of this model will comply with NICE guidelines to reduce unnecessary breast cancer follow up and contribute to UK breast units achieving the government target to see all breast cancer referrals within two weeks in the near future. The introduction of PLFU should therefore be considered by all breast units in the UK

Ultrasound-guided vacuum assisted breast biopsy in the assessment of C3 breast lesions by ultrasound-guided fine needle aspiration cytology: Results a

2009-04-22T07:47:00.000-07:00

Ultrasound-guided vacuum assisted breast biopsy in the assessment of C3 breast lesions by ultrasound-guided fine needle aspiration cytology: Results and costs in comparison with surgery
Francesca Abbate, Lorenzo Bacigalupo, Antuono Latronico, Chiara Trentin, Silvia Penco, Simona Menna, Giuseppe Viale, Enrico Cassano, Massimo Bellomi
The Breast 2009, 18 (2):73-77

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In our experience, US-guided VABB appears to be an accurate and cost-effective modality compared to surgery for the evaluation of lesions which are found to be C3 (indeterminate) at US-guided FNAC. In particular, considering the low percentage of malignant cases in this series (18/138 = 13%), surgical biopsy may be avoided in most cases. This diagnostic approach would allow surgery to be restricted to the treatment to malignant lesions and, in a few selected patients, to confirm or further investigate VABB findings.

Still the choice of using VABB to assess US visible C3 lesions might be excessive as core biopsy might be used as an alternative, more studies comparing VABB and core biopsy to assess C3 cases are needed before VABB may be recommended as the ideal option

Mammographic density estimation: Comparison among BI-RADS categories, a semi-automated software and a fully automated one

2009-02-15T10:23:00.000-08:00

Mammographic density estimation: Comparison among BI-RADS categories, a semi-automated software and a fully automated one
Alberto Tagliafico, Giulio Tagliafico, Simona Tosto, Fabio Chiesa, Carlo Martinoli, Lorenzo E. Derchi, Massimo Calabrese
The Breast 18, 1, February 2009, Pages 35-40

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Part of the BIRADS report is an estimation of breast density in 4 grades from fatty to extremely dense (as an indicator of the sensitivity of mammography to pick up cancers). This study compared standard reading with that obtained from semi-automated and fully automated breast density reporting software. Fully automated was better than semi-automated, which was also better than conventional density estimation.

This technique has the potential to eliminate the reader variability in reading out density for a particular mammogram

Ultrasound guided percutaneous axillary lymph node core biopsy: How often is the sentinel lymph node being biopsied?

2009-02-15T10:22:00.000-08:00

Ultrasound guided percutaneous axillary lymph node core biopsy: How often is the sentinel lymph node being biopsied?
P.D. Britton, E. Provenzano, S. Barter, M. Gaskarth, A. Goud, P. Moyle, R. Sinnatamby, M. Wallis, J.R. Benson, P. Forouhi, G.C. Wishart
The Breast 18, 1, 2009, 13-16

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This study aimed to establish the frequency of successful targeting of the SLN by ultrasound guided biopsy. False negative rate for CB of 30%. Reasons for false -ves - failure to sample the sentinel lymph node in 10 (45%) and failure to sample the metastatic disease in the sentinel node in 11 (55%). Better methods of identifying the sentinel lymph node and more adequate sampling are required

Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

2008-12-19T15:02:00.000-08:00

Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening
M E El-Sayed, E A Rakha, J Reed, A H S Lee, A J Evans, I O Ellis
Histopathology 2008, 53, 650–657

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Approximately 20% of needle core biopsy of screen-detected breast lesions classiﬁed as B3 are malignant on excision, and the likelihood of malignancy varies substantially between different histological subtypes

2008-12-19T14:57:00.000-08:00

Lobular neoplasia: Core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features
Viviana Londero, Chiara Zuiani, Anna Linda, Elena Vianello, Alessandro Furlan, Massimo Bazzocchi
The Breast 17 (2008) 623 - 630

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Purpose: to assess the positive predictive value (PPV) for malignancy of core needle biopsy (CNB) demonstrating lobular neoplasia.
Underestimation of malignancy was more likely in cases of LCIS, US-guided CNB, and lesions that were large and suspicious on imaging.

The value of a combination of wire localization and ultrasound-guided vacuum-assisted breast biopsy for clustered microcalcifications

2008-12-19T14:52:00.000-08:00

The value of a combination of wire localization and ultrasound-guided vacuum-assisted breast biopsy for clustered microcalcifications
Ki Seok Choo, Hee Suk Kwak, Young Tae Bae, Jee-Yeon Lee, Seung Ju Lee, Hyoung Il Seo, Su Bong Nam
The Breast 17 (2008) 611 - 616

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Purpose: to introduce and evaluate the usefulness of the combination of wire localization and ultrasound (US)-guided, vacuum-assisted breast biopsy (VAB) to histologically diagnose mammographically detected clustered microcalciﬁcations in the absence of sonographic and clinically palpable masses. Appears to be an accurate and useful method for diagnosing mammographically detected, clustered microcalciﬁcations

Pain during vacuum-assisted breast biopsy: Are there any predictors?

2008-12-19T13:25:00.000-08:00

Pain during vacuum-assisted breast biopsy: Are there any predictors?
George C. Zografos, Flora Zagouri, Theodoros N. Sergentanis, Afrodite Nonni, Philip Domeyer, Dimitra Koulocheri, Ioannis Flessas, Effrosyni Panopoulou, Dimosthenis Chrysikos, John Bramis
The Breast 17 (2008) 592e595

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Pain can be reduced by increased experience of the operator (shorter procedure times) and the avoidance of the luteal phase - timing is everything!

Lower recurrence risk through mammographic screening reduces breast cancer treatment costs

2008-12-19T08:39:00.000-08:00

Lower recurrence risk through mammographic screening reduces breast cancer treatment costs
Lea Kauhava, Pirjo Immonen-Räihä, Ilmo Parvinen, Kaija Holli, Liisa Pylkkänen, Anne Kaljonen, Hans Helenius, Pauliina Kronqvist, Pekka J. Klemi
The Breast 17 (2008) 550–554

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The high risk and high costs of breast cancer recurrence are reasons why interventions should be developed that can prevent or delay disease recurrence and reduce the costs of breast cancer care. The present study showed that screening saves costs by early detection of breast cancer with reduced risk of recurrence

Management of lesions of uncertain malignant potential on breast core needle histology: an alternative to surgery in selected cases

2008-12-19T08:30:00.000-08:00

Management of lesions of uncertain malignant potential on breast core needle histology: an alternative to surgery in selected cases
S.L. Tennant, A. Evans, L.J. Hamilton, J. James, A.H.S. Lee, Z. Hodi, I.O. Ellis, E.A. Rakha, A.R.M. Wilson
The Breast 17 (2008) 546–549

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Something we all aspire to do - not overtreat borderline lesions which could possibly be followed, after adequate Vacuum Assisted Biopsy. This is a sensible way to go, with adequate multidiscipinary discussion of the case, and close follow up

Management of lesions of uncertain malignant potential on breast core needle histology: Vacuum-assisted excision as an alternative to surgical excisio

2008-12-19T08:25:00.000-08:00

Management of lesions of uncertain malignant potential on breast core needle histology: Vacuum-assisted excision as an alternative to surgical excision (EDITORIAL)
The Breast 17 (2008) 543–544

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Editorial comment on the Nottingham paper

Evaluation of breast lesions with contrast-enhanced ultrasound using the microvascular imaging technique: Initial observations

2008-10-09T08:10:00.000-07:00

Evaluation of breast lesions with contrast-enhanced ultrasound using the microvascular imaging technique: Initial observations
He Liu, Yu-Xin Jiang, Ji-Bin Liu, Qing-Li Zhu, Qiang Sun
The Breast 17 (2008) 532 - 539

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The aim of the paper was to evaluate the usefulness of contrast-enhanced ultrasound using the microvascular imaging technique in the diagnosis of breast lesions. Conventional and contrast-enhanced ultrasound using the microvascular imaging technique were performed after administration of SonoVue. The peripheral enhancement pattern was suggestive of malignancy, with a sensitivity of 39.5%, specificity of 98.3%, PPV of 94.4%, NPV of 69.4%, and accuracy of 73.8%. Homogeneous, regional, and heterogeneous enhancement patterns did not show meaningful diagnostic information

Breast screening: Axillary lymph node status of interval cancers by interval year

2008-10-09T08:04:00.000-07:00

Breast screening: Axillary lymph node status of interval cancers by interval year
Lauro Bucchi, Donella Puliti, Alessandra Ravaioli, Laura Cortesi, Vincenzo De Lisi, Fabio Falcini, Stefano Ferretti, Alfonso Frigerio, Lucia Mangone, Marco Petrella, Chiara Petrucci, Priscilla Sassoli de Bianchi, Adele Traina, Rosario Tumino, Roberto Zanetti, Manuel Zorzi, Eugenio Paci
The Breast 17 (2008) 477 - 483

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We can conﬁrm the hypothesis that there exists a relationship between the time since last negative screen and the biological aggressiveness of interval-surfacing cancers. The second interval year, but not the ﬁrst, was associated with an excess risk of lymph node metastases that was independent from tumour size and grade. The results of this study improve the understanding of the screening process, particularly the interplay between mammography sensitivity and the natural history of breast cancer.

Can mammographic findings help discriminate between atypical ductal hyperplasia and ductal carcinoma in situ after needle core biopsy?

2008-06-02T12:34:00.000-07:00

Jenny K. Hoang, Prue Hill and Jennifer N. Cawson
The Breast 17, Issue 3, June 2008, Pages 282-288

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In a screening population of women, the mammographic characteristics for 68 cases of atypical ductal hyperplasia (ADH) diagnosed by needle core biopsy (NCB) were reviewed to seek mammographic findings which differentiate between ductal carcinoma in situ (DCIS) and ADH. A blinded analysis by two radiologists was performed for 48 cases with microcalcification. The mammographic findings were correlated with the surgical histological results of benign non-atypical, ADH and carcinoma (DCIS or invasive) to identify features which were associated with a higher or lower odds ratio (OR) for malignancy. Underestimates for malignancy occurred in 14 of 29 cases with granular calcification form (OR 7.9, 95% confidence interval (CI) 1.5–41) and 6 of 8 cases with segmental/linear branching distribution (OR 9.0, 95%CI 1.6–52). No malignancy was found at surgical excision in 16 cases with fine, rounded calcification.

In conclusion, detailed assessment of calcification distribution and form gave helpful predictors for malignancy. Lesions with fine rounded calcification were always benign.

Is surgical excision necessary in benign papillary lesions initially diagnosed at core biopsy?

2008-06-02T12:30:00.000-07:00

Won-Ho Kil, Eun Yoon Cho, Jung Han Kim, Seok-Jin Nam and Jung-Hyun Yang
The Breast 17, Issue 3, June 2008, Pages 258-262

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Debate continues regarding the use of surgical excision in benign papillary lesions initially diagnosed at core biopsy. The objective of this study is to propose management guidelines for benign papillary breast lesions initially diagnosed at core biopsy. Between January 2003 and January 2006, 76 lesions were identified as benign papillary lesions at initial core needle biopsy (n=68) or vacuum biopsy (n=8). After surgical excision, six of the 68 benign papillary lesions initially diagnosed at core needle biopsy were confirmed as malignant papillary neoplasms, giving a false-negative rate of core needle biopsy of 8.8%. Three of the eight atypical papillomas initially diagnosed at core needle biopsy were confirmed as papillary cancer in final pathology, giving a false-negative rate of 37.5%. In the analysis of the difference between benign papillary lesions and atypia or malignant papillary lesions, malignant papillary lesions were located more peripherally (p=0.005) than benign lesions and were larger (>1.5 cm, p=0.017).

It is concluded that atypical papillomas at initial core biopsy or large, clinically peripherally located papillomas (>1.5 cm) need additional surgical excision.

Improving B mode ultrasound evaluation of breast lesions with real-time ultrasound elastography—A clinical approach

2008-06-02T12:27:00.000-07:00

S.M. Tan, H.S. Teh, J.F. Kent Mancer and W.T. Poh
The Breast 17, Issue 3, June 2008, Pages 252-257

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Ultrasound elastography using the extended combined auto-correlation method of tissue elasticity allows for real-time strain image visualisation using a free-hand probe with concurrent conventional B mode imaging. Four hundred and fifteen consecutive women with 550 breast lesions confirmed on B mode ultrasound were assessed with elastography using the elasticity score. There were 119 malignant and 431 benign lesions. The elastography sensitivity was 78.0%, specificity was 98.5% and overall accuracy was 93.8%. The median score for malignancy was 5 and that for benign lesions was 2.

There was good correlation with B mode BIRADS category. 98.6% of lesions with an elasticity score of 2 or below (95%CI=96.8–99.4) were benign. BIRADS 3 lesions with an elasticity score of 2 or below may be re-classified as BIRADS 2 lesions. We found that 15.3% of BIRADS 2 and 3 lesions with an elasticity score of 3 were malignant. Real-time ultrasound elastography is user-friendly with a high accuracy rate, thereby improving B mode ultrasound assessment.

Surveillance mammography after breast conservation therapy in Hong Kong: Effectiveness and feasibility of risk-adapted approach

2008-04-14T16:08:00.000-07:00

T.K. Yau, H. Sze, I.S. Soong, W. Wong, K. Chan, A. Chang, K.Y. Lau and A. Lee
The Breast 17, 2, April 2008, Pages 132-137

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Annual surveillance mammography is commonly recommended after breast conservation therapy (BCT). We retrospectively reviewed its effectiveness on 511 invasive and non-invasive breast cancers treated with BCT between 1994 and 2003. The median follow-up was 5.9 years. The 5-year actuarial ipsilateral breast tumour recurrence (IBTR) rate was 4.5% and contralateral breast cancer (CBC) rate was 2.0% (representing eight times increase in risk). IBTR of 43% and 62% CBC were first detected by surveillance mammography. The IBTR detection rates per 1000 mammograms were 5.2 for patients (n=349) with one or more IBTR risk factors (age 45, positive/close margins or histological grade 3) and 0.6 for patients (n=162) without. No survival difference was observed between different modes of IBTR detection (p=0.342).

In conclusion, a risk-adapted approach of limiting ipsilateral surveillance to patients with IBTR risk is possible but its implementation will be complicated by the continued need of contralateral surveillance.

Borderline breast lesions diagnosed at core needle biopsy: Can magnetic resonance mammography rule out associated malignancy? Preliminary results base

2008-04-14T13:30:00.000-07:00

Anna Linda, Chiara Zuiani, Massimo Bazzocchi, Alessandro Furlan and Viviana Londero
The Breast 17, 2, April 2008, Pages 125-131

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The purpose of this study is to assess whether magnetic resonance mammography (MRM) can exclude associated malignancy in case of diagnosis of borderline breast lesions (B3) at core needle biopsy (CNB). Retrospective analysis of MRM findings of 79 borderline breast lesions (26 benign papillomas, 29 radial sclerosing lesions, 6 atypical ductal hyperplasias, 18 lobular neoplasias) diagnosed at CNB was performed.

Lesions were classified as “non-suspicious” or “suspicious” according to Fischer score. These findings were compared to the results of histological analysis of the excisional specimens. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of MRM in predicting the presence of malignancy were calculated. Out of 24 (30.4%) lesions classified as “suspicious”, 8 (33.3%) proved to be malignant and 16 (66.7%) benign. Among the 55 (69.6%) “non-suspicious” lesions, only 1 (1.8%) was malignant (low-grade ductal carcinoma in situ), while the remaining 54 (98.2%) proved to be benign. MRM sensitivity, specificity, PPV, and NPV were 88.9%, 77.1%, 33.3%, and 98.2%, respectively.

When a borderline lesion is diagnosed on CNB, in case of mild or no enhancement at MRM, follow-up rather than excisional biopsy might be prompted.

Performance of radiographers in mammogram interpretation: A systematic review

2008-02-15T08:41:00.000-08:00

F.J.H.M. van den Biggelaar, P.J. Nelemans and K. Flobbe
The Breast Volume 17, Issue 1, February 2008, Pages 85-90
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This systematic literature review focuses on the performance of radiographers (also referring to technologists and physician assistants) compared with radiologists in the interpretation of mammograms; the effect of training; and the question whether there are any studies evaluating the effects of involving radiographers in the interpretation of diagnostic mammograms in daily clinical practice on the sensitivity and specificity of cancer detection in breast imaging.

Six studies met the inclusion criteria (primary aim of the study has to be the evaluation of the performance of radiographers, sensitivity and specificity have to be reported or calculable and there has to be a sufficient gold standard). The results showed that, in a screening setting, radiographers scored higher false positive rates with a similar sensitivity in the detection of malignancies, compared with radiologists. Furthermore, results suggested that training could improve their performance. No studies were reported assessing the performance of radiographers interpreting diagnostic mammograms in a consecutive patient population in a daily clinical setting.

This indicates a need for a well-designed diagnostic study using an adequate gold standard, in order to evaluate the feasibility of deploying radiographers in the interpretation of diagnostic mammograms in a clinical setting.

Pain in different methods of breast biopsy: Emphasis on vacuum-assisted breast biopsy

2008-02-15T08:37:00.001-08:00

Flora Zagouri, Theodoros N. Sergentanis, Antonia Gounaris, Dimitra Koulocheri, Afroditi Nonni, Philip Domeyer, Constantine Fotiadis, John Bramis and George C. Zografos
The Breast Volume 17, Issue 1, February 2008, Pages 71-75
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This study examines pain (visual analog scale 0–10) in women undergoing breast biopsy. Two hundred and twenty-seven patients with a palpable lesion underwent FNA (21 G, n=85), core biopsy (14 G, n=86) or open biopsy under local anesthesia (n=56). One hundred and twenty-six women presented with a non-palpable lesion, and underwent vacuum-assisted breast biopsy (VABB, 11 G) under mammographic guidance, prone position (n=72) or hook-wire localization followed by open surgery (n=54).

The techniques sampling non-palpable lesions were the most painful: hook-wire (9.15±0.74) and VABB (4.35±1.70). Larger needle diameter was associated with more intense pain. Concerning VABB, an S-shape curve of pain (third-order pattern) was documented. A second dose of lidocaine just before the rapid increase phase was then adopted (n=61), and reduced the total/maximum pain. In conclusion, although VABB is less painful than hook-wire, the pain experienced in VABB is significant; however, it can be attenuated by a second dose of lidocaine.

Outcome of initially only magnetic resonance mammography-detected findings with and without correlate at second-look sonography

2008-02-15T08:33:00.000-08:00

Outcome of initially only magnetic resonance mammography-detected findings with and without correlate at second-look sonography: Distribution according to patient history of breast cancer and lesion size
Anna Linda, Chiara Zuiani, Viviana Londero and Massimo Bazzocchi
The Breast Volume 17, Issue 1, February 2008, Pages 51-57

The purpose of the study was to evaluate the outcome of initially only magnetic resonance mammography (MRM)-detected breast lesions as a function of radiologic features, history of breast cancer and lesion size.
Radiologic features, history of breast cancer and large diameter are associated with high likelihood of malignancy in case of initially only MRM-detected lesions. Nevertheless, biopsy might be spared just for MRI BI-RADS 3 lesions in patients without history of breast carcinoma.

The acceptance and feasibility of breast cancer screening in the East

2008-02-15T08:29:00.000-08:00

Ava Kwong, Polly S.Y. Cheung, Ada Y.W. Wong, Gloria T.Y. Hung, Gladys Lo, Marion Tsao, Edith W.K. Chan, Ting Wong and Michael Ma
The Breast Volume 17, Issue 1, February 2008, Pages 42-50
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WC2-4PHJGMR-1&_user=4430&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000059594&_version=1&_urlVersion=0&_userid=4430&md5=6b73ef38c616738fb79e6473b687d629

An overall malignancy detection rate of 2.3 per 1000 screens and a recall rate of 9.2% were found. Despite culture differences and differences in breast characteristics (denser and smaller breasts), breast screening is feasible and acceptable in the East

Quantitative assessment of mammographic density and breast cancer risk for Japanese women

2008-02-15T08:20:00.000-08:00

Yasuyuki Kotsuma, Yasuhiro Tamaki, Toshihiro Nishimura, Masayoshi Tsubai, Satsuki Ueda, Kenzo Shimazu, Seung Jin Kim, Yasuo Miyoshi, Yoshio Tanji, Tetsuya Taguchi and Shinzaburo Noguchi
The Breast Volume 17, Issue 1, February 2008, Pages 27-35
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WC2-4PGH4B3-1&_user=4430&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000059594&_version=1&_urlVersion=0&_userid=4430&md5=778797e49bafc65100bb6b6aa186d2f7

We conducted a case-control study to examine the relationship between breast density (BD) on mammography and breast cancer risk for postmenopausal Japanese women. The mammograms (205 cases and 223 controls) were classified by two doctors employing Wolfe's classification and used to measure BD with original computer software. A weak relationship between breast cancer risk and the parenchymal pattern of Wolfe's classification was found. The BD measured with the computer software, however, showed a significant relationship with breast cancer risk.

Atypical ductal hyperplasia: A way to minimize underestimation in vacuum-assisted breast biopsy?

2008-02-15T08:15:00.000-08:00

Flora Zagouri, Theodoros N. Sergentanis, Dimitra Koulocheri, Aphrodite Nonni, John Bramis and George C. Zografos
The Breast Volume 17, Issue 1, February 2008, Page 6
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WC2-4RV5S14-1&_user=4430&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000059594&_version=1&_urlVersion=0&_userid=4430&md5=cbdb6cda71a63b774631bde5c69d6618

The underestimation rate of atypical ductal hyperplasia (ADH) diagnosed via vacuum-assisted breast biopsy (VABB) is a crucial issue in the common clinical practice. Bedei et al. examined the underestimation of ADH diagnosis by VABB.
Independently, our research team has evaluated putative ways of minimizing underestimation rate in pre-invasive breast lesions.

Ectopic breast cancer without breast parenchyma

2008-02-15T08:12:00.000-08:00

Letter -
N. Toman, A. Buschmann and T. Muehlberger
The Breast Volume 17, Issue 1, February 2008, Pages 3-4
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WC2-4PRHKS2-2&_user=4430&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000059594&_version=1&_urlVersion=0&_userid=4430&md5=50a6cdbd3ec67454f0fe1e0426839fdf

Primary breast cancer of aberrant breast tissue is virtually never diagnosed preoperatively. Once the diagnosis of breast tissue has been established through the detection of hormone receptors, its origin as a metastatic lesion from classical breast cancer has to be ruled out. There are no specific therapeutic guidelines for these rare tumors; however, the interdisciplinary adjustment of treatment to the recommendations for orthotopic breast cancer seems reasonable and effective

Interval breast cancers in screening: The effect of mammography review method on classification

2007-12-02T09:38:00.000-08:00

Interval breast cancers in screening: The effect of mammography review method on classification
Stefano Ciatto, Sandra Catarzi, Maria Perla Lamberini, Gabriella Risso, Gianni Saguatti, Teresa Abbattista, Francesca Martinelli and Nehmat Houssami
The Breast 16, Issue 6, December 2007, Pages 646-652

More ‘informed’ review is more likely to yield an IC classification as MS or SE. Due to expected variability, review methods need standardisation to improve screening quality. Our data support blinded review of IC in mammography screening.

Reassurance following breast screening recall for female survivors of Hodgkin's lymphoma

2007-12-02T09:34:00.000-08:00

Reassurance following breast screening recall for female survivors of Hodgkin's lymphoma
Kate Absolom, Diana Greenfield, Richard Ross, Helena Davies, Barry Hancock and Christine Eiser
The Breast , 16, Issue 6, December 2007, Pages 590-596

After the recall, 64% had learned more about late effects and 76% were reassured about their health. All but one woman intended to attend future screening. Women are keen to take advantage of screening and experience relatively little distress

Mammography: Interobserver variability in breast density assessment

2007-12-02T09:31:00.000-08:00

Mammography: Inter-observer variability in breast density assessment
E.A. Ooms, H.M. Zonderland, M.J.C. Eijkemans, M. Kriege, B. Mahdavian Delavary, C.W. Burger and A.C. Ansink
The Breast 16, Issue 6, December 2007, Pages 568-576

In conclusion, overall interobserver agreement in mammographic interpretation of breast density is substantial and therefore, the BI-RADS classification for breast density is useful for standardization in a multicentre study

Management of lobular neoplasia diagnosed by core needle biopsy: Study of 52 biopsies with follow-up surgical excision

2007-11-18T10:18:00.000-08:00

Management of lobular neoplasia diagnosed by core needle biopsy: Study of 52 biopsies with follow-up surgical excision
Vincent Lavoué, Olivier Graesslin, Jean Marc Classe, Eric Fondrinier, Hélène H. Angibeau, Jean Levêque
TheBreast (2007) 16, 533 – 539
Abstract

Lobular neoplasia (LN) is a risk factor for bilateral breast cancer without consensus as to its appropriate management. The authors report on a retrospective multi-institutional study concerning 52 patients in whom a diagnosis of LN was made after core needle biopsy (CNB) and who subsequently underwent surgical excision. The excision specimens revealed seven cases of invasive carcinoma and three cases of ductal carcinoma in situ, indicating an underestimation of lesions at CNB in 19% of cases, and in particular in those patients with pleomorphic LN, and when clinical, radiological masses were detected. This lesion is increasingly being diagnosed by CNB due to widespread screening. Follow-up surgical excision should be performed in order to examine the whole lesion in the case of masses or when the histologic specimen reveals a pleomorphic subtype. In other cases, annual mammographic surveillance should be undertaken due to the persistent long-term risk of developing bilateral breast cancer

Pathological classification of ductal carcinoma in situ of the breast correlates with surgical treatment and may be predicted by mammography

2007-11-18T10:15:00.000-08:00

Pathological classification of ductal carcinoma in situ of the breast correlates with surgical treatment and may be predicted by mammography
Riccardo Ponzone, Annelis Dominguez, Vincenzo Marra, Alberto Pisacane, Furio Maggiorotto, Maria Elena Jacomuzzi, Alessandra Magistris, Nicoletta Biglia, Piero Sismondi
TheBreast (2007) 16, 495 – 502
Abstract

No significant differences in the distribution of clinical and pathological variables were detected among whole and limited series. The lesions were grouped into two (low versus high) pathological (PRG), radiological (RRG and CaRG) and needle biopsy (C/BRG) risk groups. PRG was associated with both RRG (p=0.002) and CaRG (p=0000), but not with C/BRG. Correlations with surgical outcome were also explored, with lesions of high PRG being more likely to undergo re-excision for inadequate first wide local excision [odds ratio (OR)=2.1], mastectomy (OR=2.6) and nodal staging procedures (OR=3.8) in the whole series. Conversely, no significant correlation was found between PRG, RRG, CaRG and C/BRG with surgical outcome in the limited series. We suggest that pathological features of DCIS are associated with surgical outcome and may be predicted by mammography

Role of pre-surgical breast MRI in the management of invasive breast carcinoma

2007-11-18T10:01:00.000-08:00

Role of pre-surgical breast MRI in the management of invasive breast carcinoma
Chiara Del Frate, Ludovica Borghese, Carla Cedolini, Alexia Bestagno, Fabio Puglisi, Miriam Isola, Franca Soldano, Massimo Bazzocchi
TheBreast (2007) 16, 469 - 481
Abstract

Breast MRI determined an overall change in management in 22 out of 121 breasts (18.2%), and in two out of 87 breasts (25.3%) in patients eligible for conservative surgery. In the evaluation of single breasts, MRI resulted in true-positive in 22 out of 29 breasts (75.9%), false-positive in 7 out of 29 breasts (24.1%), leading to over-treatment in women whose treatment was changed from conservative surgery to radical mastectomy. MRI sensitivity in the detection of additional foci not seen on conventional imaging was 57.4%, overall sensitivity 87.4%, sensitivity for invasive cancers 93.1%, while for ductal carcinoma in situ it was 58.8%. In conclusion, breast MRI determines a significant change in the management of patients affected by invasive breast carcinoma, particularly in patients eligible for conservative surgery after standard breast examination