Breast Cancer ChoicesTM
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Mammogram / Ultrasound/ MRI Studies
See full article by Samuel Epstein, MD at Dr. Epstein on Mammograms
AJR Am J Roentgenol. 2005 Feb;184(2):439-44. Related Articles,Links
Impact of breast density on computer-aided detection for breast cancer.
Brem RF, Hoffmeister JW, Rapelyea JA, Zisman G, Mohtashemi K, Jindal G, Disimio
MP, Rogers SK.
Department of Radiology, The George Washington University, 2150 Pennsylvania
Ave. NW, Washington, DC 21117.
OBJECTIVE: Our aim was to determine whether breast density affects the
performance of a computer-aided detection (CAD) system for the detection of
breast cancer. MATERIALS AND METHODS: Nine hundred six sequential
mammographically detected breast cancers and 147 normal screening
mammograms from 18 facilities were classified by mammographic density. BI-RADS
1 and 2 density cases were classified as nondense breasts; BI-RADS 3 and 4
density cases were classified as dense breasts. Cancers were classified as either
masses or microcalcifications. All mammograms from the cancer and normal cases
were evaluated by the CAD system. The sensitivity and false-positive rates from
CAD in dense and nondense breasts were evaluated and compared. RESULTS:
Overall, 809 (89%) of 906 cancer cases were detected by CAD; 455/505 (90%)
cancers in nondense breasts and 354/401 (88%) cancers in dense breasts were
detected. CAD sensitivity was not affected by breast density (p = 0.38). Across both
breast density categories, 280/296 (95%) microcalcification cases and 529/610 (87%)
mass cases were detected. One hundred fourteen (93%) of the 122
microcalcifications in nondense breasts and 166 (95%) of 174 microcalcifications in
dense breasts were detected, showing that CAD sensitivity to microcalcifications
is not dependent on breast density (p = 0.46). Three hundred forty-one (89%) of 383
masses in nondense breasts, and 188 (83%) of 227 masses in dense breasts were
detected-that is, CAD sensitivity to masses is affected by breast density (p = 0.03).
There were more false-positive marks on dense versus nondense mammograms
(p = 0.04). CONCLUSION: Breast density does not impact overall CAD detection of
breast cancer. There is no statistically significant difference in breast cancer
detection in dense and nondense breasts. However, the detection of breast
cancer manifesting as masses is impacted by breast density. The false-positive
rate is lower in nondense versus dense breasts. CAD may be particularly
advantageous in patients with dense breasts, in which mammography is most
Ultraschall Med. 2004 Dec;25(6):411-7.
Re-evaluating the role of breast ultrasound in current diagnostics of malignant
[Article in German]
Hille H, Vetter M, Hackeloer BJ.
Praxis fur Gynakologie und Geburtshilfe, Hamburg.
AIM: New evaluation of breast ultrasound based upon review of new literature
comparing ultrasound and mammography. METHOD: Description and discussion of
the published trials regarding breast imaging methods. RESULTS: Breast
is the preferable method in the case of a symptomatic patient (after clinical
examination). In the case of a patient without symptoms (screening), breast
ultrasound is ascribed a higher sensitivity for detecting breast cancer in women
dense breast tissue, women under the age of 50 and high-risk women.
Mammographically occult cancers can be detected by sonography in 10 to 40 % of
the cases depending on the patient's breast density and age. The mean size of
cancers detected only by ultrasound is not significantly different to that only
by mammography. The prevalence of breast cancers detected by ultrasound is
approximately equal to the one detected by mammography, regarding the total
number of examined patients.
CONCLUSIONS: Breast ultrasound should be the
preferred imaging procedure in the case of a palpable lump, leading to a definitive
diagnosis itself or with an additional consecutive core needle biopsy. For women
without symptoms, breast sonography should be mandatory and complementary to
mammography in the case of breast density grade II (BI-RADS) or more. Application
of breast ultrasound as a primary method or an alternative to mammography has
yet been evaluated sufficiently. It seems advisable in the case of women with
breast tissue grade III and IV, women under the age of 50 and high-risk women. The
implementation of breast ultrasound in this manner has to be checked by future
Radiology. 2004 Dec;233(3):830-49.
Diagnostic accuracy of mammography, clinical examination,
US, and MR imaging in preoperative assessment of breast
Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan
M, Lewis RS, Ioffe OB.
American College of Radiology Imaging Network, 301 Merrie
Hunt Drive, Lutherville, MD 21093, USA.
PURPOSE: To prospectively assess accuracy of mammography,
clinical examination, ultrasonography (US), and magnetic
resonance (MR) imaging in preoperative assessment of local
extent of breast cancer.
MATERIALS AND METHODS:
Institutional review board approval and informed patient
consent were obtained. Results of bilateral mammography, US,
and contrast-enhanced MR imaging were analyzed from 111
consecutive women with known or suspected invasive breast
cancer. Results were correlated with histopathologic findings.
RESULTS: Analysis included 177 malignant foci in 121
cancerous breasts, of which 89 (50%) foci were palpable.
Median size of 139 invasive foci was 18 mm (range, 2-107
mm). Mammographic sensitivity decreased from 100% in fatty
breasts to 45% in extremely dense breasts. Mammographic
sensitivity was highest for invasive ductal carcinoma (IDC) in
89 of 110 (81%) cases versus 10 of 29 (34%) cases of invasive
lobular carcinoma (ILC) (P < .001) and 21 of 38 (55%) cases of
ductal carcinoma in situ (DCIS) (P < .01). US showed higher
sensitivity than did mammography for IDC, depicting 104 of
110 (94%) cases, and for ILC, depicting 25 of 29 (86%) cases (P
< .01 for each). US showed higher sensitivity for invasive
cancer than DCIS (18 of 38 [47%], P < .001). MR showed
higher sensitivity than did mammography for all tumor types (P
< .01) and higher sensitivity than did US for DCIS (P < .001),
depicting 105 of 110 (95%) cases of IDC, 28 of 29 (96%) cases
of ILC, and 34 of 38 (89%) cases of DCIS. In anticipation of
conservation or no surgery after mammography and clinical
examination in 96 breasts, additional tumor (which altered
surgical approach) was present in 30. Additional tumor was
depicted in 17 of 96 (18%) breasts at US and in 29 of 96 (30%)
at MR, though extent was now overestimated in 12 of 96 (12%)
at US and 20 of 96 (21%) at MR imaging. After combined
mammography, clinical examination, and US, MR depicted
additional tumor in another 12 of 96 (12%) breasts and led to
overestimation of extent in another six (6%); US showed no
detection benefit after MR imaging. Bilateral cancer was present
in 10 of 111 (9%) patients; contralateral tumor was depicted
mammographically in six and with both US and MR in an
additional three. One contralateral cancer was demonstrated
CONCLUSION: In nonfatty breasts, US and MR
imaging were more sensitive than mammography for invasive
cancer, but both MR imaging and US involved risk of
overestimation of tumor extent. Combined mammography,
clinical examination, and MR imaging were more sensitive than
any other individual test or combination of tests. (c) RSNA,
PMID: 15486214 [PubMed - indexed for MEDLINE]
Take home questions to
1. If other reliable imaging
procedures are available,
should do you want to
risk having a mammogram
if the compression during
the mammogram is
more than minimal?
2. If you've already had a
mammogram, can you
shorten the time
between the mammogram
and surgery date to
minimize the chance of
traumets before they can
become real "mets"