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Imaging FAQ Articles




    Mammogram / Ultrasound/ MRI Studies

    See full article by Samuel Epstein, MD at Dr. Epstein on Mammograms

    Other documents:

    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
    challenging.

    Ultraschall Med. 2004 Dec;25(6):411-7.

    Re-evaluating the role of breast ultrasound in current diagnostics of malignant
    breast lesions

    [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
    ultrasound
    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
    with
    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
    detected
    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
    not
    yet been evaluated sufficiently. It seems advisable in the case of women with
    dense
    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
    trials.

    PMID: 15597233



    Radiology. 2004 Dec;233(3):830-49.

    Diagnostic accuracy of mammography, clinical examination,
    US, and MR imaging in preoperative assessment of breast
    cancer.

    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.
    wendieberg@hotmail.com

    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
    only clinically.

    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,
    2004.

    PMID: 15486214 [PubMed - indexed for MEDLINE]




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Take home questions to
ask yourself:
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"
(metastases)?
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