Targeted Ultrasound in Women Younger Than 30 Years With Focal Breast Signs or Symptoms: Outcomes Analyses and Management Implications

Loving, Vilert A.; DeMartini, Wendy B.; Eby, Peter R.; Gutierrez, Robert L.; Peacock, Sue; Lehman, Constance D.

doi:10.2214/ajr.10.4396

Cited by 51 publications

(43 citation statements)

References 25 publications

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“…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

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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...

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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

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“…In a large study of women aged <30 years, no malignancies were seen in 666 patients where the ultrasonography was reported as BI-RADS ® (Breast Imaging Reporting and Data System; American College of Radiology, Reston, VA, US) category 1, 2 or 3. 10 However, one should consider biopsy in a young woman who is known to have or at a high risk of carrying a mutation (owing to family history of such a mutation, or a strong family history of breast or ovarian carcinoma) that increases the risk of breast cancer such as BRCA1. Although the risk is very small (one recent study estimates the risk of breast cancer in BRCA1 mutation carriers aged 20-29 years at 8.7 per 1,000), 11 there are reports suggesting that cancers occurring in these women may exhibit benign ultrasonography features.…”

Section: Discussionmentioning

confidence: 99%

Triple assessment is not necessary in most young women referred with breast symptoms

Yue

Swinson

Ravichandran

2015

annals

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INTRODUCTION A palpable lesion in the breast is usually subjected to triple assessment (clinical examination [CE], imaging and core biopsy [CB] or fine needle aspiration [FNA]) to minimise the risk of missing breast cancer. However, breast cancer is rare in young women, and triple assessment (especially CB) is invasive and expensive. Our aim was to see whether CB/FNA could be avoided in young women with benign findings on CE and imaging. METHODS This study analysed data from a prospectively entered database on female patients aged under 25 years who attended a rapid diagnosis breast clinic over a 68-month period. RESULTS Among 10,301 patients seen, 955 females (9.3%) were aged <25 years. The most common presenting complaint was a lump, followed by pain and nipple discharge. CE was normal or revealed benign findings in all except 15 patients, in whom it was indeterminate. Ultrasonography was performed in 692 patients (72%) and was normal (n=289) or benign (n=382) in all except 21 patients, in whom it was indeterminate. In six patients, both were indeterminate. A total of 317 patients (35%) had triple assessment: FNA in 106, CB in 239 and both in 9 cases. No cancers were diagnosed. CONCLUSIONS It would appear safe to omit FNA/CB in patients aged under 25 years when clinical and ultrasonography findings are normal or benign. This approach would have avoided needle biopsies in all but 30 patients (3%) in the study.

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“…3 Ultrasound imaging has higher sensitivity than mammography in imaging dense breast but with low specificity in screening breast cancers. 4,5 Magnetic resonance imaging (MRI) was reported to have results correlated better with pathology findings than mammography and obtained promising results when dynamic contrast agents are applied. [6][7][8] However, MRI is expensive and exogenous agents are needed for better contrast.…”

Section: Introductionmentioning

confidence: 99%

Diffuse optical tomography for breast cancer imaging guided by computed tomography: A feasibility study

Baikejiang

Zhang

2017

XST

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Abstract. Diffuse optical tomography (DOT) has attracted attentions in the last two decades due to its intrinsic sensitivity in imaging chromophores of tissues such as hemoglobin, water, and lipid. However, DOT has not been clinically accepted yet due to its low spatial resolution caused by strong optical scattering in tissues. Structural guidance provided by an anatomical imaging modality enhances the DOT imaging substantially. Here, we propose a computed tomography (CT) guided multispectral DOT imaging system for breast cancer imaging. To validate its feasibility, we have built a prototype DOT imaging system which consists of a laser at the wavelength of 650 nm and an electron multiplying charge coupled device (EMCCD) camera. We have validated the CT guided DOT reconstruction algorithms with numerical simulations and phantom experiments, in which different imaging setup parameters, such as projection number of measurements and width of measurement patch, have been investigated. Our results indicate that an air-cooling EMCCD camera is good enough for the transmission mode DOT imaging. We have also found that measurements at six angular projections are sufficient for DOT to reconstruct the optical targets with 2 and 4 times absorption contrast when the CT guidance is applied. Finally, we have described our future research plan on integration of a multispectral DOT imaging system into a breast CT scanner.

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Targeted Ultrasound in Women Younger Than 30 Years With Focal Breast Signs or Symptoms: Outcomes Analyses and Management Implications

Cited by 51 publications

References 25 publications

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

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

Triple assessment is not necessary in most young women referred with breast symptoms

Diffuse optical tomography for breast cancer imaging guided by computed tomography: A feasibility study

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