BI-RADS Category Research Articles

Invited Commentary: BI-RADS Category 3: Guidelines, Challenges, and the Path Forward.

Invited Commentary: BI-RADS Category 3: Guidelines, Challenges, and the Path Forward.

Role of International Academy of Cytology Yokohama reporting system in breast lesions at tertiary care centre in Central India

BackgroundThe International Academy of Cytology (I.A.C.) Yokohama System to report breast cytopathology can effectively categorize breast diseases into different cytological groups. Fine needle aspiration (FNAC) from the lesions in the breast has been regarded as a major method of diagnosing breast cancer, particularly in rural settings. The major purpose of this study was to validate the diagnostic accuracy of breast FNA utilizing the IAC Yokohama system in future endurances. Histopathological examination is considered the gold standard for diagnosing benign as well as malignant breast lesions and is compared with FNA results.Material and methodsResearch on patients getting a core-needle, incisional, or excisional biopsy of breast lesions between January 1st, 2021, and December 31st, 2021, was conducted at a tertiary care center in central India. 216 breast FNAs were recorded utilizing the IAC Yokohama system, and the most appropriate category was assigned for every case and correlated with histopathology to evaluate the effectiveness of IAC system.ResultsThe new "International Academy of Cytology (IAC) Yokohama system" was used to categorize 216 patients into five categories based on the cytologic diagnosis.Those were C1: insufficient material (8.7%), C2: benign (65.7%), C3: atypical (1.8%), C4: suspicious of malignancy (2.7%), and C5: malignant (20.8%). FNACs were associated with ancillary testing and histological diagnosis to examine diagnostic accuracy. The overall Specificity, sensitivity, negative predictive value, positive predictive value, and accuracy were calculated with the risk of malignancy.ConclusionWith high specificity and sensitivity for each type of situation, for all tumors, and for each analyzed BI-RADS category, the IAC Yokohama system provides excellent accuracy for breast FNA .

Diagnostic value of digital breast tomosynthesis in suspicious lesions detected in screening mammogram

BackgroundDigital mammography (DM) serves as the primary breast imaging technique for early cancer detection and diagnosis. However, it faces certain limitations, particularly in imaging dense breasts. DM exhibits reduced sensitivity and specificity in women with radiographically dense breast tissue due to diminished contrast between potential tumors and surrounding tissue, as well as tissue summation potentially obscuring lesions. The aim of this study was to assess the diagnostic efficacy of digital breast tomosynthesis compared to digital mammography in evaluating suspicious breast lesions. The study included 60 female patients eligible for mammography. All participants underwent full-field digital mammography and 3d tomosynthesis. Written informed consent was obtained from all subjects after explaining the research’s purpose and benefits. The Ethics Committee of the Faculty of Medicine, Menoufia University approved the study under code no. 10/2022RADI24.ResultsRegarding BIRADS classification: All 60 patients were categorized using the BIRADS lexicon for both mammography and digital breast tomosynthesis. Mammography results showed BIRADS 3 in 10% (6/60), BIRADS 4a in 33.3% (20/60), 4b in 10% (6/60), BIRADS 4c in 26.7% (16/60), and BIRADS 5 in 20% (12/60) of cases. In comparison, tomosynthesis classified cases as BIRADS 3 in 13.3% (8/60), 4b in 16.7% (10/60), BIRADS 4c in 23.3% (14/60), and BIRADS 5 in 46.7% (28/60) of cases.ConclusionsDigital breast tomosynthesis (DBT) has established itself as a significant advancement in three-dimensional breast imaging for both screening and diagnostic purposes. It exhibits enhanced performance in identifying breast abnormalities and generates images of superior diagnostic quality with improved precision compared to conventional digital mammography. This improvement is particularly notable when examining dense breast tissue, which has traditionally been one of the most challenging aspects of breast imaging.

Association between mammographic breast density and outcome in patients with unilateral invasive breast cancer receiving neoadjuvant chemotherapy.

To analyze the relationship between mammographic breast density and tumor response and outcome at follow-up, in terms of overall survival (OS) and disease-free survival (DFS), in patients with unilateral invasive breast cancer receiving neoadjuvant chemotherapy (NACT). A total of 228 women (mean age, 47.6years ± 10 [SD]; range: 24-74years) with invasive breast cancer who underwent NACT were included in this observational retrospective study. Clinical, radiological and histopatological data were retrieved. Categorization of breast density was performed by two radiologists in consensus on mammography acquired at the time of diagnosis according to BI-RADS categories. Association between density categories and tumor response was analyzed in the overall population and in subgroups defined by menopausal status, tumor phenotype and stage at diagnosis. Kaplan-Meier (KM) curves were used to estimate the OS and DFS probabilities. Subgroup analyses based on menopausal status and tumor phenotype were performed. A total of 30 patients (13.2%) achieved pathological complete response (pCR). No association between density categories and pCR was found (P = 0.973), even at subgroups analysis. The median follow-up time was 92months. Patients with dense breast showed the longest DFS (P = 0.0094), results confirmed in premenopausal patients (P = 0.0024) and in triple negative breast cancers (P = 0.0292). Density category did not show a statistically significant association with OS. Breast cancer patients receiving NACT with extremely dense breasts showed better DFS. No evidence of breast density as a predictive marker for complete pathological response or as a prognostic factor in terms of OS was found.

Radiomic and clinical model for predicting atypical ductal hyperplasia upgrades and potentially reduce unnecessary surgical treatments

ObjectiveTo identify patients with atypical ductal hyperplasia (ADH) at low risk of upgrading to carcinoma. This study aims to assess the performance of radiomics combined with clinical factors to predict occult breast cancer among women diagnosed with ADH. MethodsThis study retrospectively included microcalcification clusters of patients who underwent Mx and VABB with a diagnosis of ADH at a tertiary center from January 2015 to May 2023. Clinical and radiological data (age, cluster size, BI-RADS classification, mammographic density, breast cancer history, residual microcalcifications) were collected. Surgical outcomes were used to determine upgrade. Four logistic regression models were developed to predict the risk of upgrade. The performance was evaluated using the area under the receiver operating characteristic curve (AUC) and performance scores. ResultsA total of 143 patients with 153 clusters were included. Twelve radiomic features and six clinical factors were selected for model development. The sample was split into 107 training and 46 test cases. Clinical features achieved an AUC of 0.72 (0.60–0.84), radiomic features an AUC of 0.73 (0.61–0.85). Radiomic features with “cluster size” and “age” improved the AUC to 0.79 (0.67–0.91). The best model, incorporating all data, achieved an AUC of 0.82 (0.71–0.92), a specificity of 0.89 (0.75, 0.97), and NPV of 0.92 (0.78–0.98). ConclusionThis study demonstrates the potential of radiomic as a valuable tool for reducing unnecessary treatments for patient classified as “low risk of ADH upgrade”. Combining radiomic information with clinical data improved the accuracy of risk prediction.

Imaging manifestations and treatment efficacy of Granulomatous Lobular Mastitis: An analysis of 29 cases with internal and external traditional Chinese medicine approaches.

Using magnetic resonance imaging (MRI), we analysed the clinical manifestations of granulomatous lobular mastitis (GLM) before and after treatment with traditional Chinese medicine (TCM). This was a retrospective study. Clinical manifestations and imaging features of patients with biopsy-proven GLM before and after treatment were retrospectively analysed from April 2021 to April 2023 at Xiyuan Hospital, China Academy of Chinese Medical Sciences. Among 29 women of childbearing age (mean age, 34.3±3.6 years), Compared to pre-therapy, the number of patients with lumps, ruptures, pain, and menstrual irregularities was significantly reduced (P < 0.05). The Chinese medicine staging demonstrated a transition from bulk to ulcerated (P=0.041). Pre- and post-treatment MRI changes included lesion number, distribution, maximal diameter, time-signal intensity curves (TIC), apparent diffusion coefficients (ADC), and BI-RADS categories 3 and 4a (all P<0.05). Furthermore, substantial changes were seen in chest wall invasion, nipple discharge, increased feeding arteries, and skin edema (all P<0.05). Combining internal and external Traditional Chinese Medicine (TCM) therapy proved successful for GLM. A reliable assessment of therapy efficacy is provided by MRI examination of lesion changes before and after treatment.

Positive predictive value of malignancy for additional calcifications found during evaluation of a synchronous breast cancer

PurposeTo evaluate the positive predictive value and factors predictive of malignancy of additional calcifications in the pre-therapeutic work-up of a synchronous breast cancer. Materials and methodsInstitutional review board approval was obtained for this retrospective study and informed consent was waved. Consecutive patients referred to our center between January 1st 2018 and December 31st 2022 for a breast cancer and who presented additional calcifications detected during the pretreatment work-up were eligible for inclusion in this study. Morphology, distribution and BI-RADS category of the calcifications were assessed in consensus by 3 radiologists specialized in breast imaging. Side and distance from the cancer were collected. The predictive value of malignancy of the calcifications was calculated for each BI-RADS category. Factors associated with malignancy were evaluated by logistic non-conditional regression on univariate and multivariate analysis. ResultsOne hundred and thirteen clusters of calcifications in 103 patients were included. Among the groups of calcifications 41 % were malignant, 31 % benign and 28 % were atypia on biopsy. After exclusion of the non-operated atypia, 50.5 % of additional calcifications were ultimately malignant and 49.5 % were benign. The predictive value of malignancy was 20.7 %; 40.7 %; 63 %; 85.7 % and 100 % for category BI-RADS 3, 4a, 4B, 4c and 5 respectively. On multivariate analysis, multifocality or centricity of the index tumour (P = 0.01), BI-RADS classifications (P = 0.0001) and location ipsilateral less than 35 mm to the index cancer (P = 0.008) of the additional calcifications were found to be independent predictors of malignancy. Sixty percent of calcifications were not described on the initial out-center diagnostic work-up. ConclusionAdditional calcifications detected during the pretreatment work-up of a breast cancer are associated with a higher probability of malignancy than in a screening population and require biopsy even when demonstrating probably benign (BI-RADS 3) features.

Abbreviated Breast MRI as a Supplement to Mammography in Family Risk History of Breast Cancer within the Croatian National Breast Screening Program.

To evaluate the diagnostic performance of abbreviated breast MRI compared with mammography in women with a family history of breast cancer included in the Croatian National Breast Screening Program. 178 women with a family history of breast cancer aged 50 to 69 underwent abbreviated breast MRI and mammography. Radiological findings for each method were categorized according to the BI-RADS classification. The gold standard for assessing the diagnostic accuracy of breast MRI and mammography, in terms of suspicious BI-RADS 4 and BI-RADS 5 findings, was the histopathological diagnosis. Performance measures, including cancer detection rates, specificity, sensitivity, and positive and negative predictive values, were calculated for both imaging methods. Twelve new cases of breast cancer were detected, with seven (58.3%) identified only by abbreviated breast MRI, four (33.3%) detected by both mammography and breast MRI, and one (8.3%) diagnosed only by mammography. Diagnostic accuracy parameters for abbreviated breast MRI were 91.67% sensitivity, 94.58% specificity, 55.0% positive predictive value (PPV), and 99.37% negative predictive value (NPV), while for mammography, the corresponding values were 41.67%, 96.39%, 45.46%, and 95.81%, respectively. Abbreviated breast MRI is a useful supplement to screening mammography in women with a family history of breast cancer. Considering the results of the conducted research, it is recommended to assess whether women with a family history of breast cancer have an increased risk and subsequently provide annual abbreviated breast MRI in addition to mammography for early detection of breast cancer.

Diagnosis of Benign and Malignant Breast Nodules by Conventional Ultrasound in Combination with S-Detect Technology and Elastic Imaging.

To determine the diagnostic value of conventional ultrasound combined with S-Detect and elastic imaging technology in differentiating between benign and malignant breast nodules. Observational study. Place and Duration of the Study: Department of Ultrasound Imaging, Yichang Central People's Hospital, Yichang, China, from October 2019 to October 2022. The study included all breast nodules diagnosed using ultrasound, with patients undergoing conventional ultrasound for BI-RADS classification, elasticity score, and S-Detect examination. Benign and malignant breast nodules were classified according to the three tests and their combinations. The diagnostic sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under curve (AUV) of those alone and combinations were calculated and compared. Of the three methods, BI-RADS, elasticity score, and S-Detect, BI-RADS had the highest accuracy (89.29%), elasticity score had the highest specificity (96.20%), and S-Detect had the highest sensitivity (93.92%). The accuracy of combined groups were higher than that of the single group. When combined with elasticity score, the AUC of the new BI-RADS increased from 0.882 to 0.917 (p <0.001); and combined with S-Detect, the AUC of the new BI-RADS increased from 0.882 to 0.927 (p <0.001). The combination of conventional ultrasound BI-RADS classification with elasticity score or S-Detect technology has a higher diagnostic efficacy for breast nodules, which can improve breast cancer detection and provide valuable diagnostic evidence for clinical practice. S-Detect technology, Ultrasound elastic imaging, Elasticity scoring, Elasticity strain ratio value, Breast tumour.

Integrating the incident angle of main vessel of breast nodule with BI-RADS can improve the efficacy of breast malignancy evaluation

The aim of this study was to investigate the measurement of the incident angle of the main blood vessel, and the benefits of its integral with ultrasound malignant features of breast nodules for the assessment of breast malignancy based on BI-RADS. The incident angles of main blood vessels of 185 breast nodules in 185 patients who underwent breast nodule surgical excision or biopsy were quantitatively measured using color Doppler ultrasound from October 2022 to October 2023 in a tertiary hospital, and related data were collected and analyzed. Based on histopathology as the gold standard, the breast nodules were classified into benign and malignant groups. The incident angle values of both groups were compared, Receiver Operating Characteristic (ROC) curves were plotted, and the optimal cutoff value for distinguishing between benign and malignant breast nodules was determined. The malignancy risk of the breast nodules was assessed using the incident angle of the breast main vessel, BI-RADS classification, and a combination of ultrasound malignant features with the incident angle. The areas under the ROC curves (AUC) for each method were calculated and compared. The average incident angle of the main vessel of the breast nodule for the benign and malignant breast nodule groups was (41.47 ± 14.27)° and (22.65 ± 11.09)°, respectively, with a statistically significant difference (t = 10.027, P < 0.001). There was a significant negative correlation between the breast nodule vessel incident angle and histopathological malignancy (r = – 0.593, P < 0.001). The ROC curve and Youden index suggested that the optimal cutoff value for distinguishing between benign and malignant breast nodules using the vascular incident angle was 26.9°, with a sensitivity of 76.34%, specificity of 84.78%, positive predictive value of 83.53%, negative predictive value of 78.00%, and AUC of 0.853. The diagnostic performance of BI-RADS classification based on ultrasound malignant features of the breast nodules alone in assessing the malignancy risk of breast nodules showed a sensitivity of 78.50%, specificity of 92.39%, positive predictive value of 91.25%, negative predictive value of 79.95%, and AUC of 0.905. The integral of ultrasound malignant features and vascular incident angle for BI-RADS based assessment for breast nodule malignancy risk demonstrated a sensitivity of 90.32%, specificity of 89.13%, positive predictive value of 89.36%, negative predictive value of 90.11%, and AUC of 0.940. The differences in negative predictive value and AUC between ultrasound malignant features BI-RADS classification alone and the combination of ultrasound malignant features BI-RADS classification with the incident angle of the main vessel of the breast nodule were all statistically significant (x2 = 3.243, P = 0.042; Z = 2.955, P = 0.003). Measuring the incident angle of the main blood vessel of breast nodules and combining this measurement with ultrasound malignant features for BI-RADS classification can enhance the effectiveness of malignancy risk assessment of breast nodules, increase the negative predictive value, and potentially reduce unnecessary biopsies.

Evaluating diagnostic significance: The utilization of elastography and contrast-enhanced ultrasound for differential diagnosis in breast lesions.

The primary aim of this study is to assess the diagnostic efficacy of elastography and contrast-enhanced ultrasound (CEUS) in the identification of breast lesions subsequent to the optimization and correction of the BI-RADS category 4 classification obtained through conventional ultrasound. The objective is to augment both the specificity and accuracy of breast lesion diagnosis, thereby establishing a reliable framework for reducing unnecessary biopsies in clinical settings. A cohort comprising 50 cases of breast lesions classified under BI-RADS category 4 was collected during the period from November 2022 and November 2023. These cases were examined utilizing strain elastography (SE), shear wave elastography (SWE), and CEUS. Novel scoring methodologies for ultrasonic elastography (UE) and CEUS were formulated for this investigation. Subsequently, the developed UE and CEUS scoring systems were used to refine and optimize the conventional BI-RADS classification, either in isolation or in conjunction. Based on the revised classification, the benign group was classified as category 3 and the suspected malignant group was classified as category 4a and above, with pathological results serving as the definitive reference standard. The diagnostic efficacy of the optimized UE and CEUS, both independently and in combination, was meticulously scrutinized and compared using receiver operating characteristic (ROC) curve analysis, with pathological findings as the reference standard. Within the study group, malignancy manifested in 11 cases. Prior to the implementation of the optimization criteria, 78% (39 out of 50) of patients underwent biopsies deemed unnecessary. Following the application of optimization criteria, specifically a threshold of≥8.5 points for the UE scoring method and≥6.5 points for the CEUS scoring method, the incidence of unnecessary biopsies diminished significantly. Reduction rates were observed at 53.8% (21 out of 39) with the UE protocol, 56.4% (22 out of 39) with the CEUS protocol, and 89.7% (35 out of 39) with the combined UE and CEUS optimization protocols. The diagnostic efficacy of conventional ultrasound BI-RADS category 4 classification for breast lesions is enhanced following optimized correction using UE and CEUS, either independently or in conjunction. The application of the combined protocol demonstrates a notable reduction in the incidence of unnecessary biopsies.

Percentage mammographic density or absolute breast density for risk stratification in breast screening: Possible implications for socioeconomic health disparity.

Obesity levels and mortality from breast cancer are higher in more deprived areas of the UK, despite lower breast cancer incidence. Supplemental imaging for women with dense breasts has been proposed as a potential improvement to screening, but it is not clear how stratification by percentage mammographic density (%MD) would be reflected across socioeconomic groups. This study aims to clarify the associations between breast composition (dense and fatty tissue) and socioeconomic status in a multi-ethnic screening population. Demographic characteristics were collected for 62,913 participants in a UK breast screening programme (age, ethnicity, Index of Multiple Deprivation (IMD)). Automated mammographic measurements were derived: dense volume (DV), non-dense volume (NDV) and percent density (%MD). Correlations between deprivation and mammographic composition were examined before and after adjustment for age, ethnicity and NDV, using non-dense breast volume as a proxy for body mass index (BMI). There was negligible correlation between deprivation and DV (r = 0.017; P < 0.001 in all cases), but NDV increased with increasing deprivation (Pearson r = 0.101). Correlations were weaker in the Asian and Chinese ethnic groups. %MD decreased with deprivation (r = -0.094) and adjustment for ethnicity did not alter the association between %MD and IMD (relative change, most to least deprived quintile IMD: 1.18; 95% confidence interval: 1.16, 1.21). Deprivation-related differences in %MD in the screening population are largely explained by differences in breast fat volume (NDV) which reflects BMI. Women in more deprived areas, where obesity and breast cancer mortality rates are higher, have increased breast adiposity and may miss out on risk-adapted screening if stratification is based solely on %MD or BIRADS classification.

Development and Validation of a Nomogram for Predicting Breast Malignancy in Male Patients Based on Clinical and Ultrasound Features.

This study aimed to construct a nomogram based on clinical and ultrasound (US) features to predict breast malignancy in males. The medical records between August, 2021 and February, 2023 were retrospectively collected from the database. Patients included in this study were randomly divided into training and validation sets in a 7:3 ratio. The models for predicting the risk of malignancy in male patients with breast lesions were virtualized by the nomograms. Among the 71 enrolled patients, 50 were grouped into the training set, while 21 were grouped into the validation set. After the multivariate analysis was done, pain, BI-RADS category, and elastography score were identified as the predictors for malignancy risk and were selected to generate the nomogram. The C-index was 0.931 for the model. Concordance between predictions and observations was detected by calibration curves and was found to be good in this study. The model achieved a net benefit across all threshold probabilities, which was shown by the decision curve analysis (DCA) curve. We successfully constructed a nomogram to evaluate the risk of breast malignancy in males using clinical and US features, including pain, BI-RADS category, and elastography score, which yielded good predictive performance.

Diagnostic Accuracy of Mammography and Ultrasonography Screening for Breast Cancer in Pregnant and Lactating Women

Breast cancer was of significant health concern affecting women worldwide. Objective: To assess diagnostic accuracy of mammography and ultrasonography in differentiating malignant and benign breast lesions in pregnant and lactating women. Methods: A cross sectional retrospective study was conducted at Radiology department of Shahida Islam Medical Complex, Lodhran from May 2023 to April 2024. A sample size of 242 females was calculated. Electronic medical records were reviewed for radiological examination including screening ultrasound and mammography. All those pregnant and lactating females on which ultrasound and mammograms were performed were included. SPSS version 23.0 was used for data analysis. Diagnostic accuracy of both ultrasound and mammography were calculated in terms of malignant or benign and sensitivity and specificity. Mann-Whitney U test was applied between mammography, ultrasonography and BI-RADS categories. Results: Of 242 females, 110 underwent mammography and 132 underwent ultrasound. Negative mammography was observed in 71 females in which at biopsy, 24 were benign. Negative ultrasound with only benign lesion was seen in 68 females and 10 of which were confirmed at biopsy. Specificity of ultrasonography was 100 %, sensitivity 85.7 %, positive predictive value of 100 % while negative predictive value of 25 %. Specificity of mammography was 100 %, sensitivity 92.3 %, positive predictive value of 100 % while negative predictive value of 42.8 % (p&lt;0.001). Conclusions: Although both ultrasound and mammography were found to be specific, use of mammography was considered better in terms of sensitivity and diagnostic accuracy.

Role of ultrasound-guided vacuum-assisted breast biopsy in the management of radiologic-pathologic discordance: a retrospective single-centre study.

To evaluate the efficacy of US-guided vacuum-assisted biopsy (US-VAB) in radiologic-pathologic (rad-path) discordance in women with suspicious breast lesions. Two thousand three hundred and sixty patients with 2385 BI-RADS category 4 and 5 lesions underwent percutaneous US-guided CNB. Thirty-six lesions were classified as discordant benign and underwent second-line US-VAB. A 14-gauge needle was utilized for CNB and 10-gauge for US-VAB. Final pathology was the reference standard for women who underwent surgery, imaging follow-up in other cases. Rates of malignancy for US-VAB and subsequent surgery were evaluated. Lesions with upgrade and no upgrade to second-line VAB were compared in terms of patient's age, lesion type and characteristics, size and BI-RADS category. Positive predictive value (PPV), negative predictive value (NPV) for BI-RADS categories and diagnostic performance for second-line US-VAB were calculated. p value < 0.05 was considered statistically significant (t-test, Mann-Whitney, χ2). US-VAB identified 10 B2, 9 B3 and 17 B5 lesions with upgrade to malignancy of 47.2% (17/36). There were 8 invasive no special type, 7 ductal in situ, 1 invasive lobular carcinoma and 1 angiosarcoma, and their distribution among BI-RADS categories was: 2/2 in BI-RADS 5 (100%), 12/18 in BI-RADS 4C (67%) and 3/16 in BI-RADS 4B lesions (19%) (p = 0.006). Of the remaining 19 lesions, 6 underwent surgery and 2 were upgraded to ductal carcinoma in situ; 13 underwent radiological follow-up and one resulted malignant. False-negative rate for US-VAB was 15.8% (3/19) with final upgrade to malignancy of 55% (20/36). The univariate analysis revealed mass shape (p = 0.008) and BI-RADS categories (p = 0.006) to be associated with upgrade to malignancy. Sensitivity, specificity, PPV, NPV and accuracy for US-VAB were 85, 100, 100, 84 and 92%, respectively. US-VAB identified almost 50% of cancers missed by CNB, avoiding surgical biopsies and validating as an effective mini-invasive approach in rad-path discordance.

Breast multiparametric ultrasound: a single-center experience.

To evaluate the role of multiparametric ultrasound (mpUS) in the characterization of focal breast lesions (FBLs). This prospective study enrolled patients undergoing multiparametric breast ultrasound for FBLs. An experienced breast radiologist evaluated the following ultrasound features: US BI-RADS category, vascularization pattern (internal, vessels in rim and combined) and presence of penetrating vessels with each Doppler method (Color-Doppler, Power-Doppler, Microvascular imaging), strain ratio (SR) and Tsukuba score (TS) with Strain Elastography (SE), Emax, Emean, Emin and Eratio with 2D-shear wave elastography (2D-SWE). Core biopsy for all BI-RADS 4-5 FBLs and 24-month follow-up for all BI-RADS 2-3 FBLs were considered for standard of reference. The diagnostic performance was assessed with the area under curve (AUCs) and cut-off values were determined according to the Youden's index. A total of 139 FBLs were included with 75/139 (53.9%) benign and 64/139 (46.1%) malignant FBLs. Internal vascularization patterns (p < 0.001), penetrating vessels (p < 0.001), TS 4-5 (p < 0.001) and all 2D-SWE parameters (p < 0.001) were significantly different between benign and malignant FBLs. The BI-RADS score provided an AUC of 0.876 (95% CI 0.810-0.926) for the diagnosis of malignant FBLs. Among the 2D-SWE measurements, an excellent diagnostic performance was observed for Emax with an AUC of 0.915 (95% CI 0.856-0.956) and Emean of 0.908 (95% CI 0.847-0.951). Optimal cutoff for the diagnosis of malignant FBLs were US BI-RADS > 3, Strain Ratio > 2.52, Tsukuba Score > 3, Emax > 82.6kPa, Emean > 66.0kPa, Emin > 54.4kPa and Eratio > 330.8. Multiparametric ultrasound, particularly SWE, can improve specificity in the characterization of FBLs.

Comparative Analysis of the Diagnostic Value of S-Detect Technology in Different Planes Versus the BI-RADS Classification for Breast Lesions

Rationale and ObjectivesS-Detect, a deep learning-based Computer-Aided Detection system, is recognized as an important tool for diagnosing breast lesions using ultrasound imaging.However,it may exhibit inconsistent findings across multiple imaging planes. This study aims to evaluate the diagnostic performance of S-Detect in different planes and identify factors contributing to these inconsistencies. Materials and MethodsA retrospective cohort study was conducted on 711 patients with 756 breast lesions between January 2019 and January 2022. S-Detect was utilized to assess lesions in radial and anti-radial planes. BI-RADS classifications were employed for comparative analysis.The diagnostic performance was compared within each group, and p-values were computed for intergroup comparisons. Univariable and multivariable analyses were conducted to identify factors contributing to diagnostic inconsistency in S-Detect across planes. ResultsAmong 756 breast lesions, 668 (88.4%) exhibited consistent S-Detect outcomes across planes while 88 (11.6%) were inconsistent. In the consistent group, the diagnostic accuracy and area under the curve (AUC) of S-Detect were significantly higher than those of BI-RADS (accuracy: 91.2% vs. 84.9%, p = 0.045; AUC: 0.916 vs. 0.859, p = 0.036). In the inconsistent group, the diagnostic accuracy and AUC of S-Detect in radial and anti-radial planes were lower than those of BI-RADS (accuracy: 47.7% for radial, 52.2% for anti-radial vs. 69.3% for BI-RADS, p = 0.014, p-anti = 0.039; AUC: 0.503 for radial, 0.497 for anti-radial vs. 0.739 for BI-RADS, p = 0.042, p-anti < 0.001). Diagnostic inconsistency in S-Detect across planes was significantly associated with lesion size, indistinct or angular margins, and enhancement posterior acoustic features(p< 0.05). ConclusionS-Detect has outperformed BI-RADS in diagnostic precision under conditions of inter-planar concordance. However, its diagnostic efficacy is compromised in scenarios of inter-planar discordance. Under these circumstances, the results of S-Detect should be carefully referenced.

Abbreviated Breast MRI for Supplemental Screening in Patients With Dense Breasts: Comparison of Baseline Versus Subsequent-Round Examinations.

BACKGROUND. Abbreviated breast MRI (AB-MRI) achieves a higher cancer detection rate (CDR) than digital breast tomosynthesis when applied for baseline (i.e., first-round) supplemental screening of individuals with dense breasts. Limited literature has evaluated subsequent (i.e., sequential) AB-MRI screening rounds. OBJECTIVE. This study aimed to compare outcomes between baseline and subsequent rounds of screening AB-MRI in individuals with dense breasts who otherwise had an average risk for breast cancer. METHODS. This retrospective study included patients with dense breasts who otherwise had an average risk for breast cancer and underwent AB-MRI for supplemental screening between December 20, 2016, and May 10, 2023. The clinical interpretations and results of recommended biopsies for AB-MRI examinations were extracted from the EMR. Baseline and subsequent-round AB-MRI examinations were compared. RESULTS. The final sample included 2585 AB-MRI examinations (2007 baseline and 578 subsequent-round examinations) performed for supplemental screening of 2007 women (mean age, 57.1 years old) with dense breasts. Of 2007 baseline examinations, 1658 (82.6%) were assessed as BI-RADS category 1 or 2, 171 (8.5%) as BI-RADS category 3, and 178 (8.9%) as BI-RADS category 4 or 5. Of 578 subsequent-round examinations, 533 (92.2%) were assessed as BI-RADS category 1 or 2, 20 (3.5%) as BI-RADS category 3, and 25 (4.3%) as BI-RADS category 4 or 5 (p < .001). The abnormal interpretation rate (AIR) was 17.4% (349/2007) for baseline examinations versus 7.8% (45/578) for subsequent-round examinations (p < .001). For baseline examinations, PPV2 was 21.3% (38/178), PPV3 was 26.6% (38/143), and the CDR was 18.9 cancers per 1000 examinations (38/2007). For subsequent-round examinations, PPV2 was 28.0% (7/25) (p = .45), PPV3 was 29.2% (7/24) (p = .81), and the CDR was 12.1 cancers per 1000 examinations (7/578) (p = .37). All 45 cancers diagnosed by baseline or subsequent-round AB-MRI were stage 0 or 1. Seven cancers diagnosed by subsequent-round AB-MRI had a mean interval of 872 ± 373 (SD) days since prior AB-MRI and node-negative status at surgical axillary evaluation; six had an invasive component, all measuring 1.2 cm or less. CONCLUSION. Subsequent rounds of AB-MRI screening of individuals with dense breasts had lower AIR than baseline examinations while maintaining a high CDR. All cancers detected by subsequent-round examinations were early-stage node-negative cancers. CLINICAL IMPACT. The findings support sequential AB-MRI for supplemental screening in individuals with dense breasts. Further investigations are warranted to optimize the screening interval.

Comparison of diagnostic efficacy of 2D and 3D ultrasound in women under the age of mammography screening

Breast cancer is the most common cancer among women worldwide. Younger women are more likely than older women to have aggressive molecular subtypes and late-stage disease. Mammography has less sensitivity in detecting breast cancer in women with a dense breast, and 2D ultrasound (2D US) has limitations, such as the specialists high level of skill and experience and the time it takes to perform the examination. Nowadays, there is a new technique – automated volumetric ultrasound scanning of the breast (3D US), which allows you to obtain high-resolution images.Aim. To perform a comparative analysis of the diagnostic efficacy of 2D US and 3D US among women under 40 years of age with high breast tissue density.Methods. A retro-prospective clinical single-center study. From February 2019 to May 2023, 1511 patients under the age of 40 were examined. The patients were divided into two groups. Patients in group A underwent 2D ultrasound, the results of the study were evaluated according to the BI-RADS classification. In addition to 2D ultrasound, the patients who were placed in group B underwent 3D US also with the BI-RADS category. Based on the results of the study, the positive and negative predictive value, sensitivity, specificity and accuracy, as well as the compilation of a predictive model of the method were determined.Results. The 2D US in group A showed sensitivity of 0.8, specificity 1, balanced accuracy of 0.9, and area under the predictive model curve of 0.947, US in group B 0.89, 0.98, 0.94, and 0.903, respectively, and US of the entire sample of 0.87, 0.99, 0.93, and 0.916, respectively. The 3D US in group B showed a sensitivity of 0.95, specificity of 0.99 and a balanced accuracy of 0.97 and an area under the predictive model curve of 0.968.Conclusion. The diagnostic efficiency of 3D US of the mammary glands in patients under 40 years of age is comparable in terms of specificity and is better in terms of accuracy, sensitivity and a better prognostic model of the method compared to US examination in 2D mode. The 3D US method has advantages in comparison with 2D US examination, namely reproducibility, operator independence of the method, reduced examination time, obtaining visualization of the entire organ, improved visualization in multicentric and multifocal processes, the possibility of operational planning, the possibility of “double reading” of the results.

Breast Cancer Screening With Automated Breast US and Mammography vs Handheld US and Mammography in Women With Dense Breasts in a Real-World Clinical Setting.

We compared the performance of 2 breast cancer screening approaches, automated breast US (ABUS) with same-day mammography (ABUS/MG) and handheld US (HHUS) with same-day mammography (HHUS/MG), in women with dense breasts to better understand the relative usefulness of ABUS and HHUS in a real-world clinical setting. In this institutional review board-approved, retrospective observational study, we evaluated all ABUS/MG and HHUS/MG screening examinations performed at our institution from May 2013 to September 2021. BI-RADS categories, biopsy pathology results, and diagnostic test characteristics (eg, sensitivity, specificity) were compared between the 2 screening approaches using Fisher's exact test. A total of 1120 women with dense breasts were included in this study, with 852 undergoing ABUS/MG and 268 undergoing HHUS/MG. The sensitivities of ABUS/MG and HHUS/MG were 100% (5/5) and 75.0% (3/4), respectively, which was not a statistically significant difference (P = .444). The ABUS/MG approach demonstrated a slightly higher specificity (97.4% [825/847] vs 94.3% [249/264]; P = .028), higher accuracy (97.4% [830/852] vs 94.0% [252/268]; P = .011), and lower biopsy recommendation rate (3.2% [27/852] vs 6.7% [18/268]; P = .019) than the HHUS/MG approach in our patient population. Our findings suggest that ABUS/MG performs comparably with HHUS/MG as a breast cancer screening approach in women with dense breasts in a real-world clinical setting, with the ABUS/MG approach demonstrating a similar sensitivity and slightly higher specificity than the HHUS/MG approach. Additional variables, such as patient experience and physician time, may help determine which imaging approach to employ in specific clinical settings.