Focal Breast Lesions in Clinical CT Examinations of the Chest: A Retrospective Analysis

Abstract

ABSTR AC TPurpose Based on radiological reports, the percentage of breast cancers visualized as incidental findings in routine CT examinations is estimated at ≤ 2 %. In view of the rising number of CT examinations and the high prevalence of breast cancer, it was the goal of the present study to verify the frequency and image morphology of false-negative senological CT findings. Materials and MethodsAll first contrast-enhanced CT examinations of the chest in adult female patients carried out in 2012 were retrospectively included. A senior radiologist systematically assessed the presence of breast lesions on all CT images using the BI-RADS system. All BI-RADS ≥ 3 notations were evaluated by a second senior radiologist. A consensus was obtained in case of differing BI-RADS assessments.Reference diagnoses were elaborated based on all available clinical, radiological and pathological data. The findings of the CT reports were classified according to the BI-RADS system and were compared with the retrospective consensus findings as well as with the reference diagnoses. ResultsThe range of indications comprised a broad spectrum including staging and follow-up examinations of solid tumors/lymphoma (N = 701, 59.9 %) and vascular (190,16.2 %), inflammatory (48, 4.1 %) and pulmonologic (22, 1.9 %) issues. BI-RADS 1/2 classifications were present in 92.5 % and BI-RADS 6 classifications were assessed in 1.7 % of the 1170 included examinations. 68 patients (5.8 %) had at least one lesion retrospectively classified as BI-RADS 3 -5. The histological potential was known in 57 of these lesions as benign (46, 3.9 %) or malignant (11, 0.9 %). 13 BI-RADS 4/5 consensus assessments (1.1 %) were false-positive. 2 of the 10 lesions classified as being malignant based on the further clinical and radiological course were not mentioned in the written CT reports (0.2 %). Both false-negative CT reports were therapeutically and prognostically irrelevant. ConclusionThe relative frequency of BI-RADS 3 -5 findings was 5.8 %. It reflects the situation encountered in clinical imaging for primarily non-senologic questions and therefore differs from what would be expected in a dedicated screening program. The rates of known false-positive BI-RADS 4/5 findings in the retrospective evaluations (1.1 %) and of false-negative findings in the written CT reports (0.2 %) reflect the different diagnostic approaches of image-based senological screening and radiological examinations indicated in order to solve clinical problems not primarily concerning the breast region. Statements regarding the prevalence of clinically occult breast cancers can only be made with caution in the presented, highly selective group of patients due to the often incomplete visualization of breast tissue and the retrospective approach. Key points▪ Intramammary mass and non-mass lesions needing clarification may be present in up to 5.8 % of all contrast enhanced CT-examinations of the female chest. ▪ Irregular forms, unscharp/spiculated margins, inhomogeneous matrices and a pronounced c...

Tomografi ve Mamografinin Karşılaştırılması, Bilgisayarlı Tomografide Meme Kanserinin Tanısal Özellikleri

“…In our current literature review, only a few researchers identified the CT features of incidental breast lesions (7,8,11,14,15). Very limitted researchers investigate breast lesion's imaging features with CT and have attempted to compare other imaging modalities (3,16,17).…”

Differentiating between benign and malignant breast lesions using dual-energy CT-based model: development and validation

“…Breast cancer is now the most common cancer and the leading cause of cancer-related deaths among women [ 1 ]. Despite not being a conventional method for assessing breast lesions, the growing prevalence and utilization of computed tomography have revealed that incidental breast lesions are detected in a range of 0.3% to 7.63% of cases [ 2 – 4 ]. Furthermore, 31.0% to 70.0% of these incidental breast lesions have been found to be malignant upon pathological findings [ 5 , 6 ].…”

Diagnosis of triple negative breast cancer based on radiomics signatures extracted from preoperative contrast-enhanced chest computed tomography

“…It is generally believed that CT is not as good as X-ray mammography to show microcalcification nor as accurate as ultrasound to diagnose breast cystic lesions, although it can incidentally detect breast cancer [17]. It is generally not capable to differentiate benign and malignant breast lesions [18]. However, with the development of radiomics [19][20][21], which can provide a comprehensive quantification of the tumor phenotype by analyzing robustly [10][11][12] a large set of quantitative data with characterization algorithms [22], it has been become possible to use imaging features for treatment monitoring and outcome prediction in various cancers [23,24].…”