Histologic work-up of non-palpable breast lesions classified as probably benign at initial mammography and/or ultrasound (BI-RADS category 3)

Gruber, Reinhard; Jaromi, Silvia; Rudas, Margaretha; Pfarl, Georg; Riedl, Christopher C.; Flöry, Daniel; Graf, Oswald; Sickles, Edward A.; Helbich, Thomas H.

doi:10.1016/j.ejrad.2012.02.004

Cited by 32 publications

(16 citation statements)

References 45 publications

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“…According to the BI-RADS, the management strategy of breast masses classified as BI-RADS category 3 is follow up rather than core needle or surgical biopsy since the likelihood of malignancy is very low (less than 2 %) [3][4][5]. The results of recent studies support this strategy [6][7][8][9]. Circumscribed margin and parallel orientation of the mass has been emphasized as benign US findings like fibroadenomas.…”

Section: Introductionsupporting

confidence: 58%

Quantitative Ultrasound Analysis for Classification of BI-RADS Category 3 Breast Masses

Moon

Chang

et al. 2013

J Digit Imaging

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The accuracy of an ultrasound (US) computeraided diagnosis (CAD) system was evaluated for the classification of BI-RADS category 3, probably benign masses. The US database used in this study contained 69 breast masses (21 malignant and 48 benign masses) that at blinded retrospective interpretation were assigned to BI-RADS category 3 by at least one of five radiologists. For computeraided analysis, multiple morphology (shape, orientation, margin, lesions boundary, and posterior acoustic features) and texture (echo patterns) features based on BI-RADS lexicon were implemented, and the binary logistic regression model was used for classification. The receiver operating characteristic curve analysis was used for statistical analysis. The area under the curve (Az) of morphology, texture, and combined features were 0.90, 0.75, and 0.95, respectively. The combined features achieved the best performance and were significantly better than using texture features only (0.95 vs. 0.75, p value=0.0163). The cut-off point at the sensitivity of 86 % (18/21), 95 % (20/21), and 100 % (21/21) achieved the specificity of 90 % (43/48), 73 % (35/48), and 33 % (16/48), respectively. In conclusion, the proposed CAD system has the potential to be used in upgrading malignant masses misclassified as BI-RADS category 3 on US by the radiologists.

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Section: Introductionsupporting

confidence: 58%

Quantitative Ultrasound Analysis for Classification of BI-RADS Category 3 Breast Masses

Moon

Chang

et al. 2013

J Digit Imaging

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“…The malignancy rate for probably benign (category 3) findings at adjunct MBI, after comparison with mammograms, was 5.1%, which is substantially higher than the less than 2% malignancy rate observed with probably benign assessments with mammography and ultrasound [18, 25, 26]. An analysis of probably benign (BI-RADS 3) findings at supplemental ultrasound showed a low malignancy rate of 0.8% [18, 27].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Workup and Costs of a Single Supplemental Molecular Breast Imaging Screen of Mammographically Dense Breasts

Hruska

Conners²,

Jones³

et al. 2015

American Journal of Roentgenology

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OBJECTIVE The purpose of this study was to examine additional diagnostic workup and costs generated by addition of a single molecular breast imaging (MBI) examination to screening mammography for women with dense breasts. SUBJECTS AND METHODS Women with mammographically dense breasts presenting for screening mammography underwent adjunct MBI performed with 300 MBq 99mTc-sestamibi and a direct-conversion cadmium-zinc-telluride dual-head gamma camera. All subsequent imaging tests and biopsies were tracked for a minimum of 1 year. The positive predictive value of biopsies performed (PPV3), benign biopsy rate, cost per patient screened, and cost per cancer detected were determined. RESULTS A total of 1651 women enrolled in the study. Among the 1585 participants with complete reference standard, screening mammography alone prompted diagnostic workup of 175 (11.0%) patients and biopsy of 20 (1.3%) and yielded five malignancies (PPV3, 25%). Results of combined screening mammography plus MBI prompted diagnostic workup of 279 patients (17.6%) and biopsy of 67 (4.2%) and yielded 19 malignancies (PPV3, 28.4%). The benign biopsy rates were 0.9% (15 of 1585) for screening mammography alone and 3.0% (48 of 1585) for the combination (p < 0.001). The addition of MBI increased the cost per patient screened from $176 for mammography alone to $571 for the combination. However, cost per cancer detected was lower for the combination ($47,597) than for mammography alone ($55,851). CONCLUSION The addition of MBI to screening mammography of women with dense breasts increased the overall costs and benign biopsy rate but also increased the cancer detection rate, which resulted in a lower cost per cancer detected than with screening mammography alone.

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“…In case of a probably benign finding (BI-RADS category 3), 6-month follow-up screens were ordered until the lesion was categorized as either benign or suspicious. 21 If one or more of the three imaging modalities resulted in a suspicious finding (ie, BI-RADS category 4 or 5), biopsy was performed. 22,23 …”

Section: Methodsmentioning

confidence: 99%

Triple-Modality Screening Trial for Familial Breast Cancer Underlines the Importance of Magnetic Resonance Imaging and Questions the Role of Mammography and Ultrasound Regardless of Patient Mutation Status, Age, and Breast Density

Riedl

Luft

Bernhart

et al. 2015

JCO

256

144

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Purpose To evaluate the breast cancer screening efficacy of mammography, ultrasound, and magnetic resonance imaging (MRI) in a high-risk population and in various population subgroups. Patients and Methods In a single-center, prospective, nonrandomized comparison study, BRCA mutation carriers and women with a high familial risk (>20% lifetime risk) for breast cancer were offered screening with mammography, ultrasound, and MRI every 12 months. Diagnostic performance was compared between individual modalities and their combinations. Further comparisons were based on subpopulations dichotomized by screening rounds, mutation status, age, and breast density. Results There were 559 women with 1,365 complete imaging rounds included in this study. The sensitivity of MRI (90.0%) was significantly higher (P<.001) than that of mammography (37.5%) and ultrasound (37.5%). Of 40 cancers, 18 (45.0%) were detected by MRI alone. Two cancers were found by mammography alone (a ductal carcinoma in situ [DCIS] with microinvasion and a DCIS with <10-mm invasive areas). This did not lead to a significant increase of sensitivity compared with using MRI alone (P =.15). No cancers were detected by ultrasound alone. Similarly, of 14 DCISs, all were detected by MRI, whereas mammography and ultrasound each detected five DCISs (35.7%). Age, mutation status, and breast density had no influence on the sensitivity of MRI and did not affect the superiority of MRI over mammography and ultrasound. Conclusion MRI allows early detection of familial breast cancer regardless of patient age, breast density, or risk status. The added value of mammography is limited, and there is no added value of ultrasound in women undergoing MRI for screening.

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Histologic work-up of non-palpable breast lesions classified as probably benign at initial mammography and/or ultrasound (BI-RADS category 3)

Cited by 32 publications

References 45 publications

Quantitative Ultrasound Analysis for Classification of BI-RADS Category 3 Breast Masses

Quantitative Ultrasound Analysis for Classification of BI-RADS Category 3 Breast Masses

Diagnostic Workup and Costs of a Single Supplemental Molecular Breast Imaging Screen of Mammographically Dense Breasts

Triple-Modality Screening Trial for Familial Breast Cancer Underlines the Importance of Magnetic Resonance Imaging and Questions the Role of Mammography and Ultrasound Regardless of Patient Mutation Status, Age, and Breast Density

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