Accuracy and Value of Breast Ultrasound for Primary Imaging Evaluation of Symptomatic Women 30-39 Years of Age

Jang

et al. 2017

J Korean Soc Radiol

Purpose:To evaluate the clinicopathological and imaging features of mammography, ultrasonography, and magnetic resonance imaging (MRI) for breast cancer in Korean women under 40 years of age according to molecular subtypes. Materials and Methods:We included 183 breast cancers in 176 consecutive women under 40 years old who had been diagnosed with breast cancer between January 2012 and November 2014. The patients' clinical and pathologic records were available as electronic medical records. A retrospective review of the pre-operative imaging studies was performed with 177 mammographies, 183 ultrasonographies, and 178 MRIs. Results: Eighty-six percent (158/183) of lesions were symptomatic, with masses (147/183) as the most common presentation. Eighty percent (22/25) of the asymptomatic lesions were diagnosed via screening ultrasonography. The luminal A subtype was the most common (n = 79, 43%), human epidermal growth factor receptor 2-enriched subtype showed indistinct margins on mammography (p = 0.006), the triple negative subtype depicted a posterior enhancement on ultrasonography (p < 0.001) and rim enhancement on MRI (p < 0.001). Conclusion: Breast cancers in Korean women under 40 years of age are commonly presented with a palpable mass, and luminal A is the most common molecular subtype. In our study, the imaging and pathologic characteristics of breast cancer in younger women were similar to those previously reported for older patients.

Section: Discussionsupporting

confidence: 90%

Clinicopathological and Imaging Features of Breast Cancer in Korean Women under 40 Years of Age

Jang

et al. 2017

J Korean Soc Radiol

“…We attribute the higher CDR observed in our study to the higher incidence of breast cancer in Uganda (32.3 per 100,000) compared to India (20 per 100,000) and the inclusion of only symptomatic women in our study (23,24). We further demonstrate interpretive performance for PPV2 and 3 that are within the performance ranges published previously (2-96%) (25)(26)(27)(28). Our specificity was lower than in these studies (49-97%), which reflects the high proportion of women presenting with masses assessed as BI-RADS 3 (46%), and also the high proportion of young women presenting for evaluation.…”

Section: Performance Of Front-line Sonographers At Nawanyago Hciiisupporting

confidence: 86%

Pilot Study of a Resource-Appropriate Strategy for Downstaging Breast Cancer in Rural Uganda

Matovu¹,

Shadrack²,

Ssembatya³

et al. 2016

JGR

Breast cancer incidence and mortality are rapidly increasing in low-and middle-income countries like Uganda. Shifting the proportion of women presenting with late-stage breast cancer to earlystage breast cancer (downstaging) at the time of diagnosis would substantially improve survival and efficient use of available resources. Imaging The World (ITW) conducted a pilot study in Uganda where trained village health teams (VHTs) promoted breast cancer awareness in the Kamuli District (Uganda). As a result, 212 women with self-detected lumps presented to the community health center level III (Nawanyago HCIII) for a clinical breast examination (CBE). Patients with masses on CBE were examined with breast ultrasound by a certified sonographer trained in breast imaging. Women with ultrasound-detected masses were referred to a regional health center for further evaluation. Of the 212 women, 44 (21%) had a palpable mass by CBE, 11 (28%) examined by ultrasound were recommended for biopsy, and four breast cancers were diagnosed. Providing ultrasound scanning at Nawanyago HCIII reduced the number of women travelling to the referral hospital by 75%. As a result of breast cancer awareness and ultrasound studies, we were able to diagnose breast cancer at an earlier stage than would be otherwise possible. This pilot project supports locally available breast ultrasound as a resource-appropriate strategy to downstage breast cancer in a low-income country. I S S N 2 3 7 2 -8 4 1 8 in large numbers of patients. Therefore, given the resources, the most resource-appropriate strategy seems to be downstaging through health awareness leading to increased rates of BSE and CBE.According to the Breast Health Global Initiative (BHGI) guidelines, resource-appropriate strategies to downstage breast cancer in Uganda should include increased breast health awareness, so women begin to practice BSE and present early to their providers after self-detecting a lump (9, 10). It is also important to train the providers in breast health to obtain appropriate history and physical examination including a proper CBE. Both BSE and CBE have the potential for a high false-positive rate and are, therefore, no longer recommended in countries where screening mammography is available (11-13). But, with one publically available mammography unit in the country, screening mammography is not a feasible option for most Ugandan women, particularly rural women. Ultrasound is more widely available, even in rural areas, and has the ability to characterize palpable masses detected by CBE as those requiring biopsy versus those that can safely be managed by imaging or clinical follow-up (14).In accordance with the World Health Organization's recommendations to reduce the global burden of breast cancer (15), Imaging The World (ITW) developed a resource-appropriate strategy to downstage breast cancer. ITW is a non-profit organization with a global team of volunteers who provide ultrasound training, equipment and technology in LMICs to improve and sustain health outcomes...

Asian Pacific Journal of Cancer Prevention

“…Age is an independent factor to influence the sensitivity of imaging examinations. Ultrasonography has been previously found to be more sensitive than mammography in detecting breast cancer in patients under 40 in a U.S. population (Lehman et al, 2012). Our data showed that ultrasonography was markedly more effective than mammography in diagnosis for most Chinese patients who are under 55 years of age.…”

Section: Discussionmentioning

confidence: 46%

“…It has been widely reported that ultrasonography is more sensitive than mammography in breast cancer diagnosis (Kang et al, 2007;Huang et al, 2012;Lehman et al, 2012;Ya-Jie et al, 2012). Although the specificity of mammography is higher than that of ultrasonography (Birdwell, 2009), in the view of breast cancer screening, the higher sensitivity is more beneficial for early diagnosis of breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Effects of Age, Breast Density and Volume on Breast Cancer Diagnosis: A Retrospective Comparison of Sensitivity of Mammography and Ultrasonography in China's Rural Areas

Wang¹,

Chen²,

Yin³

et al. 2013

Purpose: Mammography has been confirmed as the only effective mode to improve the prognosis of patients with breast cancer in Western developed countries, but might not be a good choice in other areas of the world. One of the major challenges in China is to determine an optimal imaging modality for breast cancer screening. This study was designed to clarify the sensitivity of ultrasonography compared with that of mammography in rural China. Methods: We retrospectively studied the sensitivity of mammography and ultrasonography based on 306 breast cancer patients detected by the program of "screening for cervical cancer and breast cancer" performed in Chinese rural areas between January 2009 and December 2011, and analyzed the effects of age, breast density and volume on the sensitivity. Results: Stratified analysis showed that the sensitivity of breast ultrasonography was significantly higher than that of mammography in premenopausal patients (81.4% vs. 61.1%, p=0.02), in women ≤ 55 years of age (82.2% vs. 63.4%, p<0.01), in the high breast density group (American College of Radiology [ACR] levels 3-4) (85.9% vs. 60.6%, p<0.01) and in the small breast volume group (≤400 ml) (87.1% vs. 66.7%, p<0.01). Age had a significant effect on sensitivity of mammography (breast density and volume-adjusted odds ratio, 6.39; 95% confidence interval, 2.8-14.4 in age group > 55 compared to age group ≤ 45), but not that of ultrasonography. Neither breast density nor volume had significant effect on sensitivity of mammography or ultrasonography. Conclusions: Ultrasonography is more sensitive than mammography in detecting breast cancer in women under 55 year-old Chinese, especially in those with high-density and relatively small breasts.