Developing Asymmetry at Mammography: Correlation with US and MR Imaging and Histopathologic Findings

Chesebro, Allyson L.; Winkler, Nicole; Birdwell, Robyn L.; Giess, Catherine S.

doi:10.1148/radiol.2015151131

Cited by 18 publications

(17 citation statements)

References 20 publications

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“…This might be because we only included women who had clinical signs and symptoms of breast lesions, or an abnormality detected at a screening examination. Even though DBT alone performed similarly to the combined modality in our study, current evidence favors using DBT as an adjunct to 2D mammography rather than as a stand-alone modality [22]. Two-dimensional images are essential for comparison with prior mammograms to evaluate developing asymmetry.…”

Section: Discussionmentioning

confidence: 85%

Addition of Digital Breast Tomosynthesis to Full-Field Digital Mammography in the Diagnostic Setting: Additional Value and Cancer Detectability

Seo

Chang

Kim³

et al. 2016

J Breast Cancer

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PurposeThe purpose of this study was to assess the value of adding digital breast tomosynthesis (DBT) to full-field digital mammography (FFDM) in the diagnostic workup of breast cancer and to determine which lesion variables affect cancer detectability in the combined modality.MethodsBetween March and May 2012, paired FFDM and DBT images were obtained from 203 women as part of a diagnostic workup for breast cancer. Images from FFDM alone, DBT alone, and DBT combined with FFDM were reviewed in separate sessions by six blinded readers. Jackknife alternative free-response receiver operating characteristic (JAFROC) figure of merit (FOM), sensitivity, and specificity were compared between the modalities. Lesion characteristics affecting the cancer detection rate when using the combined modality were also analyzed.ResultsAmong the 203 women, 126 women had a total of 129 malignancies and 77 women had total of 77 benign lesions. The overall JAFROC FOM of the combined modality was higher than that of FFDM alone (0.827 vs. 0.775, p<0.001) and that of DBT alone was higher than that of FFDM alone (0.807 vs. 0.775, p=0.027). The overall sensitivity of the combined modality was higher than that of FFDM alone (80.0% vs. 73.2%, p<0.001) and that of DBT alone was higher than that of FFDM alone (78.3% vs. 73.2%, p=0.007). Compared to FFDM alone, the combined modality detected an additional 48 cancers. Using the combined modality, the presence of masses or microcalcifications was significantly associated with the cancer detection rate (p<0.001).ConclusionThe combination of DBT with FFDM results in a higher diagnostic yield than FFDM alone. Additionally, DBT alone performs better than FFDM alone. However, even when DBT is combined with FFDM, breast cancers with no discernible masses and those lacking calcifications are difficult to detect.

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Section: Discussionmentioning

confidence: 85%

Addition of Digital Breast Tomosynthesis to Full-Field Digital Mammography in the Diagnostic Setting: Additional Value and Cancer Detectability

Seo

Chang

Kim³

et al. 2016

J Breast Cancer

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“…Developing asymmetry has a moderate likelihood of malignancy, seen on 12.8% of screening and 26.7% of diagnostic mammograms (5). In a study from our institution, the overall malignancy rate of developing asymmetries in the screening and diagnostic populations was 15.4% (6). In a review of 300 nonpalpable breast cancers, Sickles (7) found that 6% of malignancies manifested as developing asymmetries.…”

Section: Diagnostic Mammographymentioning

confidence: 94%

“…Breast MR imaging has long been known to be highly sensitive for detection of malignancy (25,26), but the role of MR imaging has not yet been established in evaluation of developing asymmetries. In a study from our institution, 66 of 201 patients (33%) with developing asymmetries underwent breast MR imaging, with an MR imaging correlate found in 26 (39%), of which 10 (38%) were malignant (6). No malignancies were found in the 40 cases without an MR imaging correlate during a 1-5-year follow-up period (6).…”

Section: Diagnostic Breast Mr Imagingmentioning

confidence: 99%

“…In a study from our institution, 66 of 201 patients (33%) with developing asymmetries underwent breast MR imaging, with an MR imaging correlate found in 26 (39%), of which 10 (38%) were malignant (6). No malignancies were found in the 40 cases without an MR imaging correlate during a 1-5-year follow-up period (6). A positive MR imaging correlate may increase clinical suspicion and potentially guide biopsy.…”

Section: Diagnostic Breast Mr Imagingmentioning

confidence: 99%

“…Some of the more common benign causes include cyst, fibrocystic change, PASH, scar, focal infections, weight loss or gain, trauma, fat necrosis, and hormone replacement therapy (5,8,9,(28)(29)(30). Malignant developing asymmetries may represent IDC, ILC, mixed IDC and ILC, invasive mucinous carcinoma, and ductal carcinoma in situ (5,6,9,30). In a study from our institution, the most common benign causes at biopsy were benign breast tissue, fibrocystic change, fibroadenomatoid change, and PASH; malignant causes included both invasive carcinoma and ductal carcinoma in situ (6).…”

Section: Causes Of Developing Asymmetrymentioning

confidence: 99%

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Developing Asymmetries at Mammography: A Multimodality Approach to Assessment and Management

Chesebro¹,

Winkler²,

Birdwell³

et al. 2016

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A developing asymmetry is a focal asymmetry that is new or increased in conspicuity compared with the previous mammogram. It is challenging to evaluate, as it often looks similar to fibroglandular tissue at mammography. A developing asymmetry should be viewed with suspicion because it is an uncommon manifestation of breast cancer. Diagnostic mammography forms the foundation of diagnostic evaluation of a developing asymmetry and begins with additional spot compression, lateral, and/or rolled views to evaluate and localize it in three-dimensional space. Digital breast tomosynthesis can aid in evaluation by improving radiologists' sensitivity and specificity, as well as allowing localization of the lesion. Once the developing asymmetry has been fully characterized and localized with diagnostic mammography, targeted ultrasonography (US) should be performed to identify potentially benign causes of the developing asymmetry or identify a target for biopsy. However, lack of a US correlate should not preclude biopsy of a developing asymmetry. Diagnostic breast magnetic resonance imaging can be used in a minority of cases for problem solving or biopsy planning if no US correlate is identified and stereotactic biopsy is not feasible. The purpose of this article is to review the definition of developing asymmetry, describe the multimodality diagnostic tools available to the radiologist for evaluation of this challenging entity, and review the various causes, both benign and malignant.

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Evolving Medical-Legal Issues in Breast Imaging

Brenner

2018

Curr Radiol Rep

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Developing Asymmetry at Mammography: Correlation with US and MR Imaging and Histopathologic Findings

Abstract: Developing asymmetries were malignant in 15% (95% CI: 11%, 21.1%) of patients. Presence of a US or MR imaging correlate was predictive of malignancy.

Cited by 18 publications

References 20 publications

Addition of Digital Breast Tomosynthesis to Full-Field Digital Mammography in the Diagnostic Setting: Additional Value and Cancer Detectability

Addition of Digital Breast Tomosynthesis to Full-Field Digital Mammography in the Diagnostic Setting: Additional Value and Cancer Detectability

Developing Asymmetries at Mammography: A Multimodality Approach to Assessment and Management

Evolving Medical-Legal Issues in Breast Imaging

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