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Nonmass lesions (NMLs) on breast US are defined as discrete areas of altered echotexture compared to surrounding breast tissue and lack the 3-dimensionality of a mass. They are not a component of American College of Radiology BI-RADS, but they are a finding type included in the Japan Association of Breast and Thyroid Sonology lexicon. Use of the NML finding is routine in many Asian practices, including the Samsung Medical Center and Seoul National University Hospital, and their features and outcomes have been investigated in multiple studies. Nonmass lesions are most often observed when US is used to evaluate mammographic asymmetries, suspicious calcifications, and nonmass enhancement on MRI and contrast-enhanced mammography. Nonmass lesions can be described by their echogenicity, distribution, presence or absence of associated calcifications, abnormal duct changes, architectural distortion, posterior shadowing, small cysts, and hypervascularity. Malignant lesions, especially ductal carcinoma in situ, can manifest as NMLs on US. There is considerable overlap between the US features of benign and malignant NMLs, and they also must be distinguished from normal variants. The literature indicates that NMLs with linear or segmental distribution, associated calcifications, abnormal duct changes, posterior shadowing, and hypervascularity are suggestive of malignancy, whereas NMLs with only interspersed small cysts are usually benign fibrocystic changes. In this article, we introduce the concepts of NMLs, illustrate US features suggestive of benign and malignant etiologies, and discuss our institutional approach for evaluating NMLs and an algorithm that we use to guide interpretation in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Sentinel lymph node biopsy (SLNB) has been accepted as the standard treatment for axillary evaluation for invasive breast cancer with a clinically negative axilla and the low rate of recurrence after SLNB was reported. Purpose: To evaluate the performance of screening ultrasound (US) for breast and axillary recurrence detection in breast cancer patients who underwent SLNB. Material and Methods: We identified 2807 examinations of 562 breast cancer patients who underwent SLNB and received annual screening US combined with mammography (MG) for five years. The cancer detection rate, recall rate, and positive predictive value (PPV3) of biopsies in breasts and breast plus axillae were calculated separately. Results: During the five-year follow-up period, 21 patients had recurrences of breast cancer (9.8 per 1000 person-year; 95% confidence interval [CI] = 6.0–14.9), including three axillary recurrences (1.4 per 1000 person-year; 95% CI = 0.3–4.1). Screening breast US detected 12 breast cancers. The axillary scanning detected none of the axillary recurrences, but yielded 11.8 recalls per 1000 US screenings; the PPV3 for the breast and breast plus axillae were 18.3% and 15.1%, respectively. Conclusion: Axillary recurrence was very rare in patient who underwent SLNB; additional axillary scanning did not provide axillary recurrence detection, but only increased the number of false-positive recalls and biopsies. [ABSTRACT FROM AUTHOR]

Background Supplemental breast ultrasonography (US) has been used as a surveillance imaging method in women with personal history of breast cancer (PHBC). However, there have been limited data regarding diagnostic performances. Purpose To evaluate diagnostic performances of supplemental breast US screening for women with PHBC and to compare with those for women without PHBC. Material and Methods Between 2011 and 2012, 12,230 supplemental US exams were performed in 12,230 women with negative mammograms: 6584 women with PHBC and 5646 women without PHBC. Cancer detection rate, interval cancer rate, abnormal interpretation rate, positive predictive values (PPVs), sensitivity, and specificity were calculated and compared. Results Overall cancer detection rate and first-year interval cancer rate were 1.80/1000 exams and 0.91/1000 negative exams, both of which were higher in women with PHBC than in women without PHBC (2.88 vs. 0.53 per 1000, P = 0.003; 1.50 vs. 0.20 per 1000, P = 0.027). Abnormal interpretation rate was lower in the women with PHBC than in women without PHBC (9.1% vs. 12.1%, P < 0.001). Sensitivity was not different (67.9% vs. 75.0%, P = 1.000), whereas specificity and PPV3 were higher in women with PHBC than in women without PHBC (91.2% vs. 88.0%, P < 0.001; 22.6% vs. 3.1%, P < 0.001). The majority of detected cancers in women with PHBC (78.9%, 15/19) were stage 0 or 1. Conclusion Supplemental breast US screening increases early stage second breast cancers with high specificity and PPV3 in women with PHBC, however, high interval cancer rate in younger women with PHBC should be noted. [ABSTRACT FROM AUTHOR]

Background Locoregional recurrence (LRR) following breast conservation therapy (BCT) is associated with an increased risk of distant metastasis and death in patients with breast cancer. Purpose To investigate whether preoperative breast magnetic resonance imaging (MRI) features are associated with the risk of LRR in patients undergoing BCT. Material and Methods A total of 3781 women with primary invasive breast cancer underwent preoperative MRI and BCT between 2003 and 2013. Forty-eight patients who developed LRR comprised the LRR cohort and one-to-one matching (age, tumor stage, grade, and axillary nodal status) of each patient to a control participant was performed in patients who did not develop recurrence. Three readers independently reviewed MR images of the index cancer and the presence of multifocal disease was assessed. Χ2 analysis was used to compare imaging and clinical features between LRR and control cohorts, with multivariate logistic regression analysis used to identify independent features. Results Significant differences were found in the proportion of multifocal disease ( P = 0.001), background parenchymal enhancement level ( P = 0.007), and breast cancer molecular subtype ( P = 0.01) between LRR and control cohorts. Multivariate analysis showed that multifocal disease (odds ratio [OR] = 11.9; 95% confidence interval [CI] = 1.4-102.5; P = 0.02) and human epidermal growth factor receptor 2-positive subtype (OR = 12.7; 95% CI = 1.3-127.6; P = 0.03) were both independently associated with LRR. Conclusion Multifocal disease on preoperative breast MRI may indicate an increased risk of LRR in patients treated with BCT. [ABSTRACT FROM AUTHOR]

Background According to the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS), background echotexture in breast ultrasound (US) can be categorized as homogeneous or heterogeneous. Purpose To prospectively evaluate the inter-observer agreement of a four-category classification in background echotexture assessments of breast US and to determine whether background echotexture is related to breast cancer risk factors, including mammography density. Material and Methods Thirty-eight healthy women (age range, 25-72) were recruited. Eleven radiologists performed breast US on all participants and classified each background echotexture into four categories (homogeneous, mild, moderate, and marked heterogeneous). The inter-observer agreement in the assessments was measured using kappa statistics (к). The association between background echotexture and breast cancer risk factors, including mammographic density, menopausal status, and parity, were evaluated using Spearman's correlation coefficient (ρ) and multiple linear regression analysis. Results There was moderate inter-observer agreement between the radiologists for the four categories of background echotexture (average к = 0.45). Heterogeneity of the background echotexture was positively correlated with mammographic density in both pre- and postmenopausal women (premenopausal, ρ = 0.42, P < 0.0001; postmenopausal, ρ = 0.56, P < 0.0001). Multiple linear regression analysis revealed that mammographic density and parity were significantly associated with background echotexture. Conclusion Background echotexture assessment of breast US using a four-category classification showed moderate inter-observer agreement, and more heterogeneous background echotexture was associated with denser breasts and lower parity. [ABSTRACT FROM AUTHOR]

Background Human epidermal growth factor receptor 2-positive (HER2+) breast cancer has two distinct subtypes according to hormone receptor (HR) status. Survival, pattern of recurrence, and treatment response differ between HR-/HER2+ and HR+/HER2+ cancers. Purpose To investigate imaging and clinicopathologic features of HER2+ cancers and their correlation with HR expression. Material and Methods Between 2011 and 2013, 252 consecutive patients with 252 surgically confirmed HER2+ cancers (125 HR- and 127 HR+) were included. Two experienced breast radiologists blinded to the clinicopathologic findings reviewed the mammograms and magnetic resonance (MR) images using the BI-RADS lexicon. Tumor kinetic features were acquired by computer-aided detection (CAD). The imaging and clinicopathologic features of 125 HR-/HER2+ cancers were compared with those of 127 HR+/HER2+ cancers. Association between the HR status and each feature was assessed. Results Multiple logistic regression analysis showed that circumscribed mass margin (odds ratio [OR], 4.73; P < 0.001), associated non-mass enhancement (NME) on MR images (OR, 3.29; P = 0.001), high histologic grade (OR, 3.89; P = 0.002), high Ki-67 index (OR, 3.06; P = 0.003), and older age (OR, 2.43; P = 0.006) remained independent indicators associated with HR-/HER2+ cancers. Between the two HER2+ subtypes, there were no differences in mammographic imaging presentations and calcification features and MR kinetic features by a CAD. Conclusion HER2+ breast cancers have different MR imaging (MRI) phenotypes and clinicopathologic feature according to HR status. MRI features related to HR and HER2 status have the potential to be used for the diagnosis and treatment decisions in HER2+ breast cancer patients. [ABSTRACT FROM AUTHOR]

Purpose: To compare the outcomes of ultrasound-guided core biopsy for non-mass breast lesions by the novel 13-gauge cable-free vacuum-assisted biopsy (VAB) and by the conventional 14-gauge semi-automated core needle biopsy (CCNB). Materials and methods: Our institutional review board approved this prospective study, and all patients provided written informed consent. Among 1840 ultrasound-guided percutaneous biopsies performed from August 2013 to December 2014, 145 non-mass breast lesions with suspicious microcalcifications on mammography or corresponding magnetic resonance imaging finding were subjected to 13-gauge VAB or 14-gauge CCNB. We evaluated the technical success rates, average specimen numbers, and tissue sampling time. We also compared the results of percutaneous biopsy and final surgical pathologic diagnosis to analyze the rates of diagnostic upgrade or downgrade. Results: Ultrasound-guided VAB successfully targeted and sampled all lesions, whereas CCNB failed to demonstrate calcification in four (10.3%) breast lesions with microcalcification on specimen mammography. The mean sampling time were 238.6 and 170.6 seconds for VAB and CCNB, respectively. No major complications were observed with either method. Ductal carcinoma in situ (DCIS) and atypical ductal hyperplasia (ADH) lesions were more frequently upgraded after CCNB (8/23 and 3/5, respectively) than after VAB (2/26 and 0/4, respectively P = 0.028). Conclusion: Non-mass breast lesions were successfully and accurately biopsied using cable-free VAB. The underestimation rate of ultrasound-detected non-mass lesion was significantly lower with VAB than with CCNB. Trial registration: CRiS . [ABSTRACT FROM AUTHOR]

Screening ultrasound (US) is increasingly used as a supplement to mammography in women with dense breasts, and more than 80% of cancers detected by US alone are 1 cm or smaller. An adaptive computer-aided diagnosis (CAD) system based on tumor size was proposed to classify breast tumors detected at screening US images using quantitative morphological and textural features. In the present study, a database containing 156 tumors (78 benign and 78 malignant) was separated into two subsets of different tumor sizes ( < 1 cm and ⩾ 1 cm) to explore the improvement in the performance of the CAD system. After adaptation, the accuracies, sensitivities, specificities and Az values of the CAD for the entire database increased from 73.1% (114/156), 73.1% (57/78), 73.1% (57/78), and 0.790 to 81.4% (127/156), 83.3% (65/78), 79.5% (62/78), and 0.852, respectively. In the data subset of tumors larger than 1 cm, the performance improved from 66.2% (51/77), 68.3% (28/41), 63.9% (23/36), and 0.703 to 81.8% (63/77), 85.4% (35/41), 77.8% (28/36), and 0.855, respectively. The proposed CAD system can be helpful to classify breast tumors detected at screening US. [ABSTRACT FROM AUTHOR]

Objectives: To compare the diagnostic performance of digital breast tomosynthesis (DBT) and magnetic resonance imaging (MRI) added to mammography in women with known breast cancers.Methods: Three radiologists independently reviewed image sets of 172 patients with 184 cancers; mammography alone, DBT plus mammography and MRI plus mammography, and scored for cancer probability using the Breast Imaging Reporting and Data System (BI-RADS). Jack-knife alternative free-response receiver-operating characteristic (JAFROC), which allows diagnostic performance estimation using single lesion as a statistical unit in a cancer-only population, was used. Sensitivity and positive predictive value (PPV) were compared using the McNemar and Fisher-exact tests.Results: The JAFROC figures of merit (FOMs) was lower in DBT plus mammography (0.937) than MRI plus mammography (0.978, P = 0.0006) but higher than mammography alone (0.900, P = 0 .0013). The sensitivity was lower in DBT plus mammography (88.2 %) than MRI plus mammography (97.8 %) but higher than mammography alone (78.3 %, both P < 0 .0001). The PPV was significantly higher in DBT plus mammography (93.3 %) than MRI plus mammography (89.6 %, P = 0 .0282).Conclusions: DBT provided lower diagnostic performance than MRI as an adjunctive imaging to mammography. However, DBT had higher diagnostic performance than mammography and higher PPV than MRI.Key Points: • Digital breast tomosynthesis (DBT) plus mammography was compared with MRI plus mammography. • DBT had lower sensitivity and higher PPV than MRI. • DBT had higher diagnostic performance than mammography. [ABSTRACT FROM AUTHOR]

Background: Ultrasound (US) screening is not currently recommended as a routine screening modality in the general population of average risk. The cancer detection yield and positive predictive value in an average risk general population who undergo breast screening by experienced radiologists is unclear. Purpose: To determine the performance of screening breast US in women at an average risk for breast cancer undergoing breast screening by experienced radiologists. Material and Methods: This study received institutional review board approval, and informed consent was waived. A retrospective review of our database revealed 1526 women who underwent prevalence screening US at a single health screening center and had negative findings on digital mammography (MG). The Breast Imaging and Reporting Data System (BI-RADS) final assessments of the breast US were analyzed retrospectively, with the reference standard defined as a combination of pathology and a 12-month follow-up. The cancer detection rate and positive predictive value (PPV2) of the biopsies were calculated according to breast density. Results: The average time to perform a screening US examination was 15-20 min. Of 1526 women, 1095 (71.8%) were classified as BI-RADS category 1 or 2; 340 (22.3%) were classified as category 3; and 91 (6.0%) were classified as category 4. Five malignant lesions were found in women with dense breasts. The overall cancer detection rate was 3.3, and the cancer detection rate for dense breasts was 5.1 per 1000 screens (4.1 per 1000 screens [heterogeneously dense breast], 7.7 per 1000 screens [extremely dense breast]). The PPV2 for biopsies was 5.3%. Conclusion: The radiologist-performed screening US offered to women with an average risk and dense breasts can detect additional mammographically occult breast cancers. In screening US, a relatively high rate of BI-RADS category 3 and 4 lesions was observed. [ABSTRACT FROM AUTHOR]

Abstract: We aimed to determine whether background 18F-FDG uptake in positron emission mammography (PEM) was related to mammographic density or background parenchymal enhancement in breast MRI. Methods: We studied a total of 52 patients (mean age, 50.9 years, 26 premenopausal, 26 postmenopausal) with newly diagnosed breast cancer who underwent 18F-FDG PEM (positron emission mammography), conventional mammography and breast MRI. The background mean 18F-FDG uptake value on PEM was obtained by drawing a user-defined region of interest (ROI) in a normal area of the contralateral breast. We reviewed the mammography retrospectively for overall breast density of contralateral breast according to the four-point scale (grade 1&#x2013;4) of the Breast Imaging Reporting and Data System (BI-RADS) classification. The background parenchymal enhancement of breast MRI was classified as minimal, mild, moderate, or marked. All imaging findings were interpreted by two readers in consensus without knowledge of image findings of other modalities. Results: Multiple linear regression analysis revealed a significant correlation between background 18F-FDG uptake on PEM and mammographic density after adjustment for age and menopausal status (P &lt;0.01), but not between background 18F-FDG uptake on PEM and background parenchymal enhancement on MRI. Conclusion: Background 18F-FDG uptake on PEM significantly increases as mammographic density increases. Background parenchymal enhancement in breast MRI was not an independent predictor of the background 18F-FDG uptake on PEM unlike mammographic density. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the variability of breast density assessments in short-term reimaging with digital mammography. Materials and methods: In 186 women, short term (mean interval, 27.6 days) serial digital mammograms including CC and MLO views were obtained without any treatment. Mammographic density assessments were performed by three blinded radiologists for Breast Imaging Report and Data System (BI-RADS, grades 1&#x2013;4) and visual percentage density (PD) estimation, and by one radiologist for computer-aided PD estimation. The variability of assessments was analyzed according to the age, breast density, and mammography types by multivariate logistic regression. Results: In BI-RADS assessments, 29% (161 of 558) of breast density categories were assessed differently after short-term reimaging and the mean absolute difference in PD for CC and MLO view was 7.6% and 8.1% for visual assessments, and 7.4% and 6.4% for computer-aided assessments, respectively. Among all computer-aided assessments, 29% (54 of 186) of CC view and 22% (41 of 186) of MLO view assessments had discrepancy over 10% in PD. Younger age (&lt;50), greater breast density (grades 3 and 4), and different mammography types were significantly associated with the variability. Conclusion: Considerable variability in breast density assessments occurred in short-term reimaging with digital mammography, particularly in women with younger age and greater breast density and when examined using different types of mammography. [ABSTRACT FROM AUTHOR]

Background: The computer-aided detection (CAD) system is widely used for screening mammography. The performance of the CAD system for contralateral breast cancer has not been reported for women with a history of breast cancer. Purpose: To retrospectively evaluate the performance of a CAD system on current and previous mammograms in patients with contralateral metachronous breast cancer. Material and Methods: During a 3-year period, 4945 postoperative patients had follow-up examinations, from whom we selected 55 women with contralateral breast cancers. Among them, 38 had visible malignant signs on the current mammograms. We analyzed the sensitivity and false-positive marks of the system on the current and previous mammograms according to lesion type and breast density. Results: The total visible lesion components on the current mammograms included 27 masses and 14 calcifications in 38 patients. The case-based sensitivity for all lesion types was 63.2% (24/38) with false-positive marks of 0.71 per patient. The lesion-based sensitivity for masses and calcifications was 59.3% (16/27) and 71.4% (10/14), respectively. The lesion-based sensitivity for masses in fatty and dense breasts was 68.8% (11/16) and 45.5% (5/11), respectively. The lesion-based sensitivity for calcifications in fatty and dense breasts was 100.0% (3/3) and 63.6% (7/11), respectively. The total visible lesion components on the previous mammograms included 13 masses and three calcifications in 16 patients, and the sensitivity for all lesion types was 31.3% (5/16) with false-positive marks of 0.81 per patient. On these mammograms, the sensitivity for masses and calcifications was 30.8% (4/13) and 33.3% (1/3), respectively. The sensitivity in fatty and dense breasts was 28.6% (2/7) and 33.3% (3/9), respectively. Conclusion: In the women with a history of breast cancer, the sensitivity of the CAD system in visible contralateral breast cancer was lower than in most previous reports using the same CAD system probably due to the relatively small size, subtlety of the lesion findings, and dense parenchymal pattern. [ABSTRACT FROM AUTHOR]

Background: Unexpected focal 18F-FDG breast uptakes are occasionally identified on PET/CT due to its increased use for cancer staging and follow-up. The need for their characterization has been suggested. Purpose: To retrospectively evaluate the diagnostic value of ultrasonography (US) in distinguishing benign from malignant lesions for unexpected focal 18F-FDG uptakes in breast on PET/CT scans. Material and Methods: Between April 2004 and January 2010, 27 focal 18F-FDG breast uptakes in 27 patients (age range 33-62 years; mean age 46 years) among 5214 patients who had undergone PET/CT scans were retrospectively analyzed. The American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) final assessment categories of the US and the maximum standardized uptake values (SUVs) of the lesions were compared between the benign and malignant lesions. Results: Of the 27 lesions, 15 (56%) lesions were malignant. The rate of malignancy, according to the final assessment category on the US, was 0% (0 of 6) for category 3, 60% for category 4 (9 of 15), and 100% (6 of 6) for category 5 (P = 0.001). The US evaluation revealed a sensitivity of 100% (15 of 15) and a specificity of 50% (6 of 12). The average maximum SUV of the malignant lesions was greater than that of the benign lesions (4.12 ± 1.94 vs. 1.94 ± 0.82; P = 0.001). Conclusion: US evaluation of unexpected focal 18F-FDG uptakes on PET/CT scans can accurately distinguish benign lesions from malignant lesions. [ABSTRACT FROM AUTHOR]

Objectives: To retrospectively evaluate whether sonoelastographic evaluation could help predict the presence of an invasive focus in nonpalpable DCIS diagnosed at US-guided needle biopsy.Methods: One hundred and three consecutive nonpalpable DCIS lesions diagnosed at US-guided needle biopsy were analyzed. To identify the preoperative factors associated with upgrade to invasive cancers on surgical histology, lesion size, B-mode US findings, elasticity score, biopsy variables, and histological variables were analyzed using univariate and multivariate logistic regression. Interobserver agreement for the elasticity score was evaluated using the multi-rater κ statistics.Results: The overall upgrade rate was 23% (24 of 103). Elasticity score was found to be the only independent predictor of invasion. The upgrade rates according to the median elasticity score was 6.7% (1 of 15) for a score of 1, 20.6% (13 of 63) for a score of 2, and 40.0% (10 of 25) for a score of 3 (Odds ratio [OR] = 1; OR = 4.19, P = 0.207; OR = 12.32, P = 0.039, respectively). No association was found between other factors and the upgrade rate. The overall interobserver agreement for the elasticity score was moderate (κ = 0.587; P < .001).Conclusions: Sonoelastographic lesion stiffness is an independent preoperative predictor of invasion in some patients with nonpalpable DCIS at US-guided needle biopsy. [ABSTRACT FROM AUTHOR]

Background: It has been reported that ultrasound (US)-elastography is helpful in differentiation of benign and malignant solid masses and in reducing benign biopsy procedures for the supplemental breast US in addition to screening mammography. Furthermore, potential application of US-elastography in distinguishing cystic lesions which is known to be a major source of benign biopsy results has been suggested. Purpose: To describe the aliasing artifact on US-elastography for breast cystic lesions that mimic solid masses. Material and Methods: We retrospectively reviewed 13 lesions which showed a blue-green-red pattern artifact on US-elastography in 13 women (mean age 50 years; age range 3-66 years). They disappeared immediately after a needle biopsy. Breast composition, mammography and US findings, histology and follow-up imaging findings were analyzed. Results: All 13 patients showed heterogeneously dense (n=5) or extremely dense breast parenchyma (n=8). The most common US findings were an irregular shape (n=7, 54%) and a circumscribed margin (n=7, 54%). All 13 lesions had internal echogenicity and were initially considered as solid masses; 62% (n=8) showed hypoechogenicity and 38% (n=5) had echogenic and anechoic components. Posterior shadowing was seen in 31% (n=4) of the lesions. All 13 lesions have been proven to be fibrocystic changes on biopsy histology. Follow-up US performed for 10 of 13 lesions showed no residual lesion (n=9) or decreased its size (n=1). Conclusion: An aliasing artifact that appears as a blue-green-red pattern in a breast mass as depicted on US-elastography is suggestive of a possible cystic breast lesion. [ABSTRACT FROM AUTHOR]

Background: Ultrasonography (US) has been used as an important adjunct to mammography (MG), and automated breast US (ABUS) scanners were originally designed to effectively examine the breast in its entirety. Purpose: To retrospectively assess the performance of radiologists in the detection of breast cancers, initially detected by hand-held ultrasound (HHUS), using 3D breast volume data obtained from a commercial ABUS system. Material and Methods: Bilateral whole breast US was performed using ABUS in 61 consecutive women who were scheduled to undergo US-guided needle biopsy due to suspicious breast masses detected during screening HHUS. Fourteen cancers in 13 women and 48 normal breasts of 48 women with benign disease in the contralateral breast were selected. Three radiologists who had not performed the HHUS examinations independently reviewed the 3D ABUS data for any lesions that required recall for further evaluation. Sensitivities and false-positive rates were calculated. Results: The sensitivities of the three readers for cancer detection were 78.6% (11/14), 78.6%, and 57.1% (8/14), respectively, with false-positive rates of 20.8% (10/48), 12.5% (6/48) and 8.3% (4/48). Seven cancers were detected by all three readers, four cancers by two readers, and one cancer by one reader. Two invasive cancers were not detected by any reader. Conclusion: Of HHUS-detected cancers, only 57.1-78.6% were identified with ABUS. A substantial level of experience and training is necessary to improve cancer detection by ABUS. [ABSTRACT FROM AUTHOR]

Background: Supplemental screening ultrasonography (US) in addition to mammography can help detect early breast cancers in women with dense breasts and other risk factors. It is crucial to understand the imaging features of US-detected cancer to identify them in screening population. Purpose: To retrospectively evaluate the US features and final assessments of breast cancers detected by supplemental screening US in comparison with cancers seen on screening mammography. Material and Methods: The study included 80 women (mean age 46 years, range 31–65 years) with 80 breast cancers detected by supplemental screening US. Another 80 women (mean age 52 years, range 33–77 years) with 80 breast cancers seen on screening mammography were included for a control group. US features and final assessments were classified according to the Breast Imaging Reporting and Data System (BI-RADS) without knowledge of the method of detection, or mammographic or histologic findings. Results of the two groups were compared. Results: Breast cancers detected by supplemental screening US were more frequently found to have the following features: an oval shape (21% [17/80] vs 10% [8/80], P = 0.013), a circumscribed margin (13% [10/80] vs 4% [3/80], P = 0.043), an abrupt interface (79% [63/80] vs 53% [42/80], P < 0.001), and no posterior acoustic (70% [56/80] vs 53% [42/80], P = 0.023) or surrounding tissue (79% [63/80] vs 28% [22/80], P < 0.001) changes. For the final assessment, 93% (74/80) of US-detected cancers and 60% (48/80) of cancers seen on mammography were classified as a category 4, while 3% (2/80) of US-detected cancers and 38% (30/80) of cancers seen on mammography were category 5. Conclusion: Compared with breast cancers seen on screening mammography, breast cancers detected by supplemental screening US tend to have less malignant US features, although most (95%) of them were classified as category 4 or 5. [ABSTRACT FROM AUTHOR]

Background: Microcalcifications found on mammography of asymptomatic women can be sampled by ultrasound (US)-guided percutaneous breast biopsy when stereotactic core biopsy is unavailable or unsuccessful. The role of specimen radiograph needs to be reevaluated after US-guided biopsy. Purpose: To compare retrospectively the histological diagnoses of calcified cores and non-calcified cores as depicted on specimen radiographs after a US-guided, 11-gauge, vacuum-assisted biopsy using surgical histology as the reference standard. Material and Methods: A total of 135 consecutive patients underwent a US-guided vacuum-assisted biopsy for calcifications with malignant histological results from 135 lesions. For each lesion, calcification was identified in at least one core on specimen radiographs. Calcified cores and non-calcified cores depicted on specimen radiographs were separately submitted to the pathology department. The pathological diagnoses of calcified cores and non-calcified cores were compared with final diagnoses at surgical excision. Results: Of a total of 2049 core specimens that were obtained (mean, 15 per lesion; range, 4-35 per lesion), 794 cores (mean, 5.9 per lesion; range, 1-17 per lesion) contained calcifications and 1255 cores (mean, 9.3 cores per lesion; range, 1-34 cores per lesion) did not contain calcifications. Calcified cores were more likely to enable an accurate diagnosis of cancer as compared to non-calcified cores (67%, 91 of 135 versus 52%, 70 of 135; P = 0.009). A diagnosis of cancer was more likely to be missed with non-calcified cores as compared to calcified cores (16%, 21 of 135 versus 4%, 5 of 135; P = 0.002). There was no difference in the underestimation of malignancy between calcified cores (29%, 39 of 135) and non-calcified cores (33%, 44 of 135) (P = 0.510). Conclusion: Calcified cores depicted on specimen radiographs are more accurate for a diagnosis of cancer as compared to non-calcified cores obtained during US-guided vacuum-assisted biopsy of microcalcifications. [ABSTRACT FROM AUTHOR]

To evaluate the tumour visibility and diagnostic performance of digital breast tomosynthesis (DBT) in patients with noncalcified T1 breast cancer. Medical records of 106 females with noncalcified T1 invasive breast cancer who underwent DBT and full-field digital mammography (FFDM) between January 2012 and December 2014 were retrospectively reviewed. To assess tumour visibility (score 1–3), all DBT and FFDM images were reviewed by two radiologists blinded to clinicopathological information. A reference standard was established by an unblinded consensus review of all images. Clinicopathological and imaging variables were analysed based on tumour visibility. After adding 159 negative controls, the diagnostic performance of DBT + FFDM was compared with that of FFDM. The tumour visibility was significantly higher through DBT + FFDM (2.5 vs 1.8; p = 0.002) than FFDM alone. Breast composition was the independent variable for tumour visibility through DBT + FFDM (extremely dense; odds ratio, 0.02; p < 0.001). Sensitivity (p = 0.642), specificity (p = 0.463), positive-predictive value (p = 0.078), and negative-predictive value (p = 0.072) of DBT + FFDM were not significantly superior to those of FFDM in 55 females with extremely dense breast composition, whereas specificity (p = 0.002) and positive-predictive value (p < 0.001) were significantly higher in 210 females with other breast compositions. Addition of DBT to FFDM showed no significant increase in the tumour visibility and diagnostic performance in patients with noncalcified T1 cancer in extremely dense breasts. Addition of DBT to FFDM did not further improve the detection of noncalcified early breast cancers in females with extremely dense breasts. [ABSTRACT FROM AUTHOR]

• Dense breasts have increased cancer risk, but low sensitivity of mammography necessitates supplemental screening modalities. • DW-MRI had sensitivity higher than mammography but lower than DCE-MRI in detecting clinically occult cancers in dense breasts. • DW-MRI is expected to be an effective supplemental screening tool for mammography in women with dense breasts. To compare the performance of mammography, high-resolution DW-MRI, DCE-MRI, and their combinations in detecting clinically occult breast cancer in women with dense breasts. 544 breasts from 281 consecutive asymptomatic women with dense breasts were retrospectively identified. They underwent breast MRI for preoperative evaluation of breast cancers (n = 214) or as supplemental screening (n = 67) including DCE-MRI and DW-MRI (b values, 0 and 1000 sec/mm2; in-plane resolution, 1.1 × 1.1 mm2 and 1.3 × 1.3 mm2; section thickness, 3 mm), in addition to mammography. Three readers independently reviewed each examination on a per-breast basis. Histopathology and at least two year of imaging follow-up served as the gold standard. The sensitivities and specificities of different imaging modalities were compared using McNemar test. 230 of 544 breasts (42 %) had malignant lesions. The sensitivity of DW-MRI was higher than that of mammography (77.0 % vs 57.9 %; adjusted p < 0.001), but lower than that of DCE-MRI (84.8 %; adjusted p = 0.014). The specificity of DW-MRI was comparable to those of mammography (98.1 % vs 99.1 %; adjusted p > 0.999) and DCE-MRI (97.1 %; adjusted p > 0.999). DW-MRI plus mammography had a comparable sensitivity and specificity to those of DCE-MRI plus mammography (88.6 % vs 90.9 % and 97.1 % vs 96.2 %; adjusted p > 0.999 for both). High-resolution DW-MRI had a sensitivity higher than mammography and lower than DCE-MRI. Nevertheless, DW-MRI plus mammography showed a comparable sensitivity and specificity to DCE-MRI plus mammography for detecting clinically occult cancers in women with dense breasts. [ABSTRACT FROM AUTHOR]

Objective To determine whether supplemental screening ultrasound (US) to mammography could improve cancer detection rate of the contralateral breast in patients with a personal history of breast cancer and dense breasts. Materials and methods During a one-year study period, 1314 screening patients with a personal history of breast cancer and dense breasts simultaneously underwent mammography and breast US. BI-RADS categories were given for mammography or US-detected lesions in the contralateral breast. The reference standard was histology and/or 1-year imaging follow-up, and the cancer rate according to BI-RADS categories and cancer detection rate and positive biopsy rate according to detection modality were analyzed. Results Of 1314 patients, 84 patients (6.4%) were categorized as category 3 with one interval cancer and one cancer which was upgraded to category 4A after 6-month follow-up US (2.5% cancer rate, 95% CIs 1.5–9.1%). Fifteen patients (1.1%) had category 4A or 4B lesions in the contralateral breast. Four lesions were detected on mammography (two lesions were also visible on US) and 11 lesions were detected on US and 5 cancers were confirmed (33.3%, 95% CIs 15.0–58.5%). Six patients (0.5%) had category 4C lesions, 2 detected on mammography and 4 on US and 4 cancers were confirmed (66.7%, 95% CIs 29.6–90.8%). No lesions were categorized as category 5 in the contralateral breast. Cancer detection rate by mammography was 3.3 per 1000 patients and that by US was 5.0 per 1000 patients, therefore overall cancer detection rate by mammography plus US was 8.3 per 1000 patients. Positive biopsy rate of mammography-detected lesions was 66.7% (4 of 6) and that of US-detected lesions was 40.0% (6 of 15). Conclusion US can be helpful to detect mammographically occult breast cancer in the contralateral breast with high positive biopsy rate and low category 3 rate in patients with a previous history of breast cancer and dense breasts. [ABSTRACT FROM AUTHOR]