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

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

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

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

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

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

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

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.