The use of ultrasonography and digital mammography in women under 40 years with symptomatic breast cancer: a 7-year Irish experience

Redmond, Ciaran E.; Healy, Gerard M.; Murphy, C F; O’Doherty, Ann; Foster, A.

doi:10.1007/s11845-016-1472-0

Cited by 13 publications

(14 citation statements)

References 20 publications

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“…found that patients with a false negative mammogram were much more likely to have dense breasts (49) and in a study from 2016 on the predictors of ultrasound-only visible cancers, higher PMD was the strongest predictor for the failure of mammography (50).…”

Section: Reduced Mammographic Sensitivitymentioning

confidence: 98%

Breast density: why all the fuss?

Vinnicombe

2018

Clinical Radiology

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The term "breast density" or mammographic density (MD) denotes those components of breast parenchyma visualised at mammography that are denser than adipose tissue. MD is composed of a mixture of epithelial and stromal components, notably collagen, in variable proportions. MD is most commonly assessed in clinical practice with the time-honoured method of visual estimation of area-based percent density (PMD) on a mammogram, with categorisation into quartiles. The computerised semi-automated thresholding method, Cumulus, also yielding area-based percent density, is widely used for research purposes; however, the advent of fully automated volumetric methods developed as a consequence of the widespread use of digital mammography (DM) and yielding both absolute and percent dense volumes, has resulted in an explosion of interest in MD recently. Broadly, the importance of MD is twofold: firstly, the presence of marked MD significantly reduces mammographic sensitivity for breast cancer, even with state-of-the-art DM. Recognition of this led to the formation of a powerful lobby group ('Are You Dense') in the US, as a consequence of which 32 states have legislated for mandatory disclosure of MD to women undergoing mammography. Secondly, it is now widely accepted that MD is in itself a risk factor for breast cancer, with a four-to sixfold increased relative risk in women with PMD in the highest quintile compared to those with PMD in the lowest quintile. Consequently, major research efforts are underway to assess whether use of MD could provide a major step forward towards risk-adapted, personalised breast cancer prevention, imaging, and treatment.

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Section: Reduced Mammographic Sensitivitymentioning

confidence: 98%

Breast density: why all the fuss?

Vinnicombe

2018

Clinical Radiology

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“…Digital mammography (DM) is the standard imaging modality for breast cancer diagnostics [1]. Lower sensitivity of DM is related to, for example, high breast density [2][3][4], low patient age [2,5] and lobular type of cancer [4]. The use of ultrasound (US) in the clinical setting is particularly helpful in characterizing palpable and non-palpable masses, guiding biopsies of non-palpable lesions and staging of nodal status in the axilla [6].…”

Section: Introductionmentioning

confidence: 99%

“…The use of ultrasound (US) in the clinical setting is particularly helpful in characterizing palpable and non-palpable masses, guiding biopsies of non-palpable lesions and staging of nodal status in the axilla [6]. In addition, US has been shown to better estimate tumour size in comparison with DM [7,8], but is inferior to DM regarding detection of DCIS [5]. Both DM and US have been found to underestimate the size of the lesion in comparison with histopathological examination [8].…”

Section: Introductionmentioning

confidence: 99%

Added value of contrast-enhanced mammography (CEM) in staging of malignant breast lesions—a feasibility study

Åhsberg

Gardfjell²,

Niméus

et al. 2020

World J Surg Onc

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Objectives: The aim of this feasibility study was to evaluate the added value of contrast-enhanced mammography (CEM) in preoperative staging of malignant breast lesions, beyond standard assessment with digital mammography and ultrasound, as a base for a future prospective randomized trial. Materials and methods: Forty-seven patients, with confirmed or strongly suspected malignant breast lesions after standard assessment (digital mammography (DM) and ultrasound (US)), scheduled for primary surgery, were invited to undergo CEM as an additional preoperative procedure. The primary endpoint was change in treatment due to CEM findings, defined as mastectomy instead of partial mastectomy or contrariwise, bilateral surgery instead of unilateral or neoadjuvant treatment instead of primary surgery. Accuracy in tumour extent estimation compared to histopathology was evaluated by Bland-Altman statistics. Number of extra biopsies and adverse events were recorded. Results: In 10/47 patients (21%), findings from CEM affected the primary treatment. Agreement with histopathology regarding extent estimation was better for CEM (mean difference − 1.36, SD ± 18.45) in comparison with DM (− 4.18, SD ± 26.20) and US (− 8.36, SD ± 24.30). Additional biopsies were taken from 19 lesions in 13 patients. Nine biopsies showed malignant outcome. No major adverse events occurred. Conclusion: The feasibility of preoperative additional CEM was found to be satisfactory without any serious negative effects. Results imply an added value of CEM in preoperative staging of breast cancer. Further evaluation in larger prospective randomized trials is needed.

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“…Routine screening of women in this age group in the absence of significant BC risk factors is not recommended. Some authors showed the superior sensitivity of ultrasound screening for BC in women under the age of 40 years; however, they noted that mammography and/or MRI remain essential adjuncts, particularly in the identification of multifocal disease [41]. The large body of analysis comparing ultrasound and mammography to evaluate women aged 30-39 with symptoms of possible BC has demonstrated that ultrasound screening is a superior diagnostic tool [42], which may impact on the consideration of current clinical practice guidelines that nowadays recommend mammography as the first evaluation in these women.…”

Section: Breast Cancer Screening By Mammography: An Evolutionmentioning

confidence: 99%

Why the Gold Standard Approach by Mammography Demands Extension by Multiomics? Application of Liquid Biopsy miRNA Profiles to Breast Cancer Disease Management

Žúbor

Kubatka

Kajo

et al. 2019

IJMS

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In the global context, the epidemic of breast cancer (BC) is evident for the early 21st century. Evidence shows that national mammography screening programs have sufficiently reduced BC related mortality. Therefore, the great utility of the mammography-based screening is not an issue. However, both false positive and false negative BC diagnosis, excessive biopsies, and irradiation linked to mammography application, as well as sub-optimal mammography-based screening, such as in the case of high-dense breast tissue in young females, altogether increase awareness among the experts regarding the limitations of mammography-based screening. Severe concerns regarding the mammography as the “golden standard” approach demanding complementary tools to cover the evident deficits led the authors to present innovative strategies, which would sufficiently improve the quality of the BC management and services to the patient. Contextually, this article provides insights into mammography deficits and current clinical data demonstrating the great potential of non-invasive diagnostic tools utilizing circulating miRNA profiles as an adjunct to conventional mammography for the population screening and personalization of BC management.

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The use of ultrasonography and digital mammography in women under 40 years with symptomatic breast cancer: a 7-year Irish experience

Cited by 13 publications

References 20 publications

Breast density: why all the fuss?

Breast density: why all the fuss?

Added value of contrast-enhanced mammography (CEM) in staging of malignant breast lesions—a feasibility study

Why the Gold Standard Approach by Mammography Demands Extension by Multiomics? Application of Liquid Biopsy miRNA Profiles to Breast Cancer Disease Management

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