Improvements of the US BI-RADS Assessment – A Necessity for a Non-Invasive Positive and Differential Diagnosis of Breast Cancer. Application of the New Full Breast Ultrasonography Concept

Abstract

Objective: Despite the engineering progress, the diagnosis of breast cancer (BC) is unsatisfactory due to less specific descriptors and non-anatomical scanning and interpretation, proving that physicians lag behind technology. We aimed to improve the noninvasive positive and differential diagnosis of BC using modern technology applied to the new integrative concept of Full Breast Ultrasonography (FBU): anatomical radial scanning, color Doppler and Strain Sonoelastography (SE).
 Methods: We analyzed retrospectively 1841 consecutive FBUs in 1333 patients from screening, diagnosis, or follow-up, in two centers. We searched three descriptors: the ductal connection of the lesions, the incident angle of the plunging artery, and the SE (Ueno score). We compared the initial BI-RADS assessment with pathological reports or follow-up examinations of benign findings.
 Results: Radial scanning and ductal connection provided a standardized examination of the entire breast, with 100% sensitivity, early detection, precise location, and easy follow-up. We found no correlation BC-Density-Age, but a significant association BC - Benign pathology. The benign lesions, usually multiple, associated the proliferative and secretory types. The incident angle of the plunging artery was the best descriptor for the BC mass-type and associated with a score 4 or 5 Ueno led to PPV of 97.01%, specificity of 99.67%, and accuracy of 99.69%. Inflammatory BC illustrated high glandular strain and diffuse hyperemia.
 Conclusion: FBU had optimal accuracy, independent of the mammographic model, in screening and diagnosis. The vascular angle correlated with strain SE (adapted to the breast heterogeneity) raised the specificity and is recommended for inclusion in US BI-RADS.

The full breast ultrasonography usefulness in the diagnosis of a bicentric breast cancer – An anatomical imaging approach correlated with the pathological findings: A case report

“…The linear transducer ML 6-13 MHz had an intermediary length of 5 cm, but with a virtual convextrapezoid view useful for the radial scanning especially in large breasts. The Doppler sensitivity was improved by using in addition to the menu "Breast" the "Nearfield" menu that was more sensitive for detecting the vessels of lower velocities, and we completed the US BI-RADS descriptors with the incident angle of the plunging artery upon Kujiraoka et al [10], as the most specific descriptor for malignant masses [7]. The SSE results were classified upon the Ueno/Tsukuba scoring as a complementary technique [11].…”

“…Magnetic resonance imaging is considered the best technique of diagnosis of multiple BCs, which was detected in 14-30% cases [6]. However, multiple cancers were found in 40% cases diagnosed by full breast ultrasonography (FBU) of a series of 1841 examinations in 1333 patients, confirmed by other imaging techniques or after surgical treatment with histopathological examination [7]. This result is according with a pathological report of a series of 1000 cases, examined by the use of the large-pathological sections, which established by combining in situ and invasive breast tumors, three "aggregate growth patterns": unifocal (36%), multifocal (35%), and diffuse (28%) [8].…”

“…The value of the FBU is represented by the high resolution of the radial scanning examination of the whole breast volume, following the ductal-lobular tree of the mammary lobes that are disposed radially around the nipple; this technique offers a sensitivity close to 100%, and a specificity over 95-98% [7], as a result of combining 2D ultrasound data (that illustrates both the descriptors specified by the US BI-RADS system and the intralobar ductal connection), with Doppler analysis of the salient vasculature and strain sonoelastography (SSE) [9]. The normal galactophorous ducts may be detected using actual transducers from a thin diameter of 0.4 mm, representing the atrophied ducts, up to 3.0 mm in young women or at puberty; the normal lobules have a comparable size.…”