Supplemental Screening Breast US in Women with Negative Mammographic Findings: Effect of Routine Axillary Scanning

Abstract

Purpose To evaluate the effect of routine axillary scanning when supplemental screening breast ultrasonography (US) is performed in women with negative mammographic findings. Materials and Methods This retrospective review included 12 844 screening breast US examinations performed in 8664 asymptomatic women aged 40 years or older with dense breasts and negative results for cancer at mammography performed between January 2012 and December 2014. Bilateral whole-breast US was performed with a handheld device by one of 10 experienced radiologists. The bilateral axillae were routinely scanned, and representative images were documented in all examinations. The abnormal interpretation rate (AIR), cancer detection rate (CDR), and positive predictive value (PPV) of screening breast US with and without axillary scanning were calculated. The 95% confidence intervals (CIs) were calculated for cancer detection after an abnormal finding at screening US. Results The frequency of positive axillary findings was 3.5 per 1000 (14 of 4009) baseline screening US examinations and 2.2 per 1000 (19 of 8835) subsequent screening US examinations. Of the 33 women with 33 positive axillary findings, 11 had positive breast findings; none were diagnosed with breast cancer. The remaining 22 women showed positive findings only in the axilla. The axillary findings revealed no malignancy at biopsy (n = 12) or during 22-54-month follow-up (n = 21) (95% CI: 0%, 10.6%). Without routine axillary scanning, the AIR of screening US decreased from 15.2% (610 of 4009 examinations) to 15.0% (602 of 4009 examinations) at baseline US and from 8.1% (714 of 8835 examinations) to 7.9% (700 of 8835 examinations) at subsequent US examinations, and the PPV for biopsy performed increased from 6.0% (five of 83 examinations) to 6.4% (five of 78 examinations) at baseline US and from 7.6% (13 of 170 examinations) to 7.9% (13 of 164 examinations) at subsequent US examinations, without a change in the CDR. Conclusion Routine axillary scanning during screening breast US had no effect on additional cancer detection, but rather increased the number of false-positive results. However, the conclusions based on these findings must be tempered by the low rate of positive findings. RSNA, 2017.

Dedicated Breast Computed Tomography With a Photon-Counting Detector

“…A comprehensive evaluation of the breast glandular tissue needs to be guaranteed also in women with glandular extension in the axillary tail area by integrating B-CT images with a sonographic evaluation. 27,28 Moreover, additional sonography remains crucial in all women with dense breasts. 13 Indeed, among our records, additional cystic lesions up to 10 mm, completely surrounded by glandular tissue, were not visible in B-CT images an only depicted in sonography due to a lack of a "mass-effect."…”

Analysis of breast cancer subtypes and their correlations with receptors and ultrasound

“…US is considered a tool that can be used regardless of age, especially on women less than 40, both as a screening method and as a complementary investigation when a woman presents a palpable tumor [ 36 , 37 ]. It is recommended to be performed as a routine for breast control, as it helps to evaluate false positive results [ 38 , 39 , 40 ].…”

Detection of axillary lymph node recurrence in patients with personal history of breast cancer treated with sentinel lymph node biopsy (SLNB): results of postoperative combined ultrasound and mammography screening over five consecutive years

“…In addition, Lee et al. reported that axillary scanning during breast US had no effect on additional cancer detection, but rather increased the number of false-positive results in dense breast women without mammographic abnormality (30). In our study, there was no additional cancer detection when the axillary scan was added and no evidence of axillary recurrence in screening US examinations even in retrospect.…”

“…§ Five false-negative cases were added to 21 recurrence cases as five additional negative or benign screening US examinations were performed within 12 months before the pathologically confirmation which included high-risk women, axillary screening US detected only one malignancy among 2498 examinations (33.43% of the 7473 examinations; 0.4 per 1000) (29). In addition, Lee et al reported that axillary scanning during breast US had no effect on additional cancer detection, but rather increased the number of false-positive results in dense breast women without mammographic abnormality (30). In our study, there was no additional cancer detection when the axillary scan was added and no evidence of axillary recurrence in screening US examinations even in retrospect.…”