Characteristics of breast cancers detected by ultrasound screening in women with negative mammograms

Abstract

Screening ultrasound (US) can increase the detection of breast cancer. However, little is known about the clinicopathologic characteristics of breast cancers detected by screening US. A search of the database for patients with breast cancer yielded a dataset in 6837 women who underwent breast surgery at Seoul National University Hospital (Korea). Of 6837 women, 1047 were asymptomatic and had a non-palpable cancer. Two hundred fifty-four women with 256 cancers detected by US (US-detected cancer) and 793 women with 807 cancers detected by mammography (MGdetected cancer) were identified. The imaging, clinicopathologic, and molecular data were reviewed. Univariate and multivariate analyses were carried out. Women with US-detected cancer were younger and were more likely to undergo breast-conserving surgery and to have node-negative invasive cancer (P < 0.0001). By multivariate analysis, the significant independent characteristics were tumor size, mammographic density, final assessment category according to the American College of Radiology Breast Imaging Reporting and Data System, progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and molecular subtype. Compared to tumors that were >2 cm in size, tumors that were £1 cm in size were 2.2-fold more likely to be US-detected cancers (P = 0.02). Compared to the luminal A subtype tumors (estrogen receptor [ER]+, PR+, HER2)), luminal B subtype tumors (ER+, PR+, HER2+) were less likely to be in the US-detected cancer group (P < 0.01). Women with dense breasts were more likely to have US-detected cancer (P < 0.01) versus those with non-dense breasts. Screening US-detected cancers were less likely to be diagnosed as category 5 instead of category 4 (P < 0.01). In conclusion, women with US-detected breast cancer are more likely to have small-sized invasive cancer and more likely associated with the luminal A subtype. (Cancer Sci 2011; 102: 1862-1867 T he critical rationale for breast cancer screening is that early detection and resultant treatment improve the disease outcome.(1,2) Early detection often enables breast-conserving surgery and less harmful treatment. A large multicenter trial by the American College of Radiology Imaging Network (ACRIN) Protocol 6666 has shown that the addition of a single screening ultrasound (US) to mammography increased the detection of small and node-negative cancers from 7.6 to 11.9 per 1000 women with elevated risk for breast cancer.(3,4) A randomized controlled trial on effectiveness of US screening in women aged 40-49 years is underway in Japan.(5) Ultrasound has been proposed as a supplemental screening test in women with dense breast tissues and in high-risk women who cannot undergo MRI for any reason.(1) Although mammography remains the gold standard in breast imaging, high mammographic density may make breast cancer more difficult to detect and thus can increase the risk of cancer development in women screened by mammography alone. (3,(6)(7)(8)(9)(10)(11)(12)(13)(14) New individualized therapy approaches use spe...

Clinicopathological characteristics and long-term prognosis of screening detected non-palpable breast cancer by ultrasound in hospital-based Chinese population (2001-2014)

“…Currently the treatment strategy of NPBC is made according to palpable cancers of similar stage, subtype and grade [30]. Bae MS et al reported comparison study between 807 MG-detected NPBC vs 256 US-detected NPBC [31]. However, the 807 (MG+/US not done) NPBC would include some MG+/US- NPBC and majority of MG+/US+ NPBC patients, while the 256 US-detected NPBC patients were all MG-/US+.…”

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

“…Since the CAD could not be perfect (100 % sensitivity and 100 % specificity), the cut-off point with sensitivity of 95 % (20/21, one malignant case misclassified) can be chosen for the classification in a clinical setting. Recognizing the carcinomas among the BI- RADS category 3 lesions is important since circumscribed malignant lesions are often high-grade tumors [26][27][28]. The proposed CAD system can correctly upgrade most of malignant masses misclassified as BI-RADS category 3 on US by radiologists while downgrade majority of benign lesions classified as BI-RADS category 3.…”

Cancer Screening in Korea, 2012: Results from the Korean National Cancer Screening Survey

“…However, subjects who underwent ultrasonography for breast cancer screening during their lifetime made up nearly half of the population in Korea. There are reports that breast density appears to be greater in Asian women than in Western women (del Carmen et al, 2007), and ultrasound has been proposed as a supplemental screening test in women with dense breast tissues (Corsetti et al, 2006;Bae et al, 2011).…”