Breast Imaging In Women Research Articles

Breast Imaging in Women Over Forty

Breast Imaging in Women Over Forty

Abstract PO4-19-02: Genetic risk estimation in breast cancer and assessing health disparities

Abstract Background: Breast Cancer (BC) incidence and the distribution of BC risk factors vary between racial and ethnic groups within the United States. It has been demonstrated that providing education on individualized breast cancer risk will improve patient uptake to recommended BC screening and prevention strategies. Most clinical risk assessment tools, including the validated IBIS model were derived from data using non-Hispanic white women. Consortia have also now identified over 300 common genetic susceptibility loci for BC, summarized by the polygenic risk score (PRS). When combined with clinical risk assessment tools, such as the IBIS or BCRAT models, the PRS can further refine risk estimation for patients. To date, most studies on the use of PRS have been done in non-Hispanic white women. While these PRS still perform well in racial minorities, there has been a recognized need to improve racial and ethnic diversity in genomic research cohorts. Herein, we aim to combine clinical risk assessment models that are already used in routine clinical practice with information derived from PRS testing in women of racial minorities to determine if this can improve risk estimation, patient understanding, and uptake to recommended breast cancer screening and prevention strategies. Design: This is a minimal risk prospective study with a single arm incorporating the PRS into a standard breast cancer risk reduction consultation, followed by annual surveys over 10 years to determine if and how the information provided by the PRS influenced patient decisions regarding recommended BC screening and prevention. Patients will have IBIS and BCRAT risks calculated at baseline visit. A survey of patient perceptions/understanding of risk, intention to undergo screening, and use of preventive medicine is completed after baseline visit prior to receiving the PRS results. Blood sample is obtained at baseline and DNA samples are analyzed for approximately 300 SNPs on a custom-designed, targeted SNP panel from ThermoFisher Scientific by the Mayo Clinic Genomics Laboratory. This PRS result is then combined with the clinical risk assessments (IBIS and BCRAT scores) using the R package Individualized Coherent Absolute Risk Estimators (iCare) tool to provide a new estimate of breast cancer risk for 5year, 10year, and lifetime risk. Patients are seen for follow-up to review results and then complete a second survey to assess their understanding of the results, BC risk, and how the PRS impacted their decision to undergo screening/prevention strategies. Eligibility Criteria: Women who self-identify as African American/Black or Hispanic/Latinx between 30-75 years old with any of the following: 1.)IBIS score of ≥5% for the 10 year risk OR BCRAT score of ≥ 3 % for the 5 year risk. 2.) History of biopsy proven atypical hyperplasia 3.) History of biopsy proven lobular carcinoma in situ. Specific Aims: Aim 1: The primary aim of this study is to explore if the addition of PRS to the BCRAT and IBIS score will improve intentions to undergo recommended breast cancer screening strategies such as mammography, MRI, or molecular breast imaging in women of underserved racial minorities Aim 2: To explore if the addition of the PRS to the BCRAT and IBIS risk score will aid women of racial minorities in deciding whether to take preventative endocrine therapy. Aim 3: To understand how individualized risk assessment and information on PRS may alter perceived risk of breast cancer. Statistical Methods Analysis will be mostly descriptive. Continuous variables will be summarized as mean (standard deviation) or median (range) and categorical variables will be reported as frequency (percentage). Kaplan-Meier method will be used to estimate the long-term cumulative risk of cancer. Current Accrual: 3. Target Accrual: 50 Citation Format: Lauren Cornell, Sandhya Pruthi, Linda Hasadsri, Sarah McLaughlin. Genetic risk estimation in breast cancer and assessing health disparities [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-19-02.

Breast Fluctuating Asymmetry in Women with Macromastia/Gigantomastia.

A number of studies have reported breasts have high fluctuating asymmetry (FA:|Right-Left|), suggesting that they contain evolutionary and clinical information (e.g., high FA correlates with breast cancer risk). Here we focus on breast FA in women with a wide range of breast sizes, including participants with macromastia and/or gigantomastia. The sample included 65 women (mean age 33.97 ± 12.1 years). Thirty were randomly selected students and/or patients who regarded their breast size as small, normal or average and who had not undergone or intended to have any breast surgery. The remainder (n = 35) were qualified for breast reduction due to macromastia and/or gigantomastia. In all participants we measured/calculated weight, height and BMI, as well as took chest photographs. Breast volumes and nipple areola complex FAs were evaluated in a specifically-designed software. Breast size significantly positively correlated with breast volume FA in all women (t = 5.17, p < 0.0001) and in women with macromastia/gigantomastia (t = 2.32, p = 0.027). All nipple location FAs correlated positively with breast size. In women with different breast sizes, breast size correlates with FA calculated from breast volume and nipple location FAs. In women with macromastia and/or gigantomastia, breasts present higher FA than "normal" breasts. This observation may give a rationale for earlier and more frequent prophylactic breast imaging in women with macromastia and/or gigantomastia.

Patterns of Breast Imaging Use Among Women with a Personal History of Breast Cancer.

National patterns of breast imaging in women with a personal history of breast cancer (PHBC) are unknown making evaluation of annual surveillance recommendations a challenge. To describe variation in use of mammography and breast magnetic resonance imaging (MRI) examinations beginning 6months after diagnosis among women with PHBC in US community practice. We report on the breast imaging indication, imaging intervals, and time since breast cancer diagnosis by examination type. Longitudinal study using cross-sectional data. Breast Cancer Surveillance Consortium breast imaging facilities. 19,955 women diagnosed between 2005 and 2012 with AJCC stage 0-III incident breast cancer who had 69,386 mammograms and 3,553 breast MRI examinations from January 2005 to September 2013; median follow-up of 37.6months (interquartile range, 22.1-60.7). Breast imaging indication, imaging intervals, and time since breast cancer diagnosis by examination type. Among women with a PHBC who received breast imaging, 89.4% underwent mammography alone, 0.8% MRI alone, and 10.3% had both mammography and MRI. About half of mammograms and MRIs were indicated for surveillance vs. diagnostic, with an increase in the proportion of surveillance exams as time from diagnosis increased (mammograms, 45.7% at 1year to 72.2% after 5years; MRIs, 54.8% at 1year to 78.6% after 5years). In the first post-diagnosis period, 32.8% of women had > 2 breast imaging examinations and of these, 65.8% were less than 6months apart. During the first 5-year post-diagnosis, the frequency of examinations per year decreased and the interval between examinations shifted towards annual examinations. In women with a PHBC who received post-diagnosis imaging, a third underwent multiple breast imaging examinations per year during the first 2-year post-diagnosis despite recommendations for annual exams. As time since diagnosis increases, imaging indication shifts from diagnostic to surveillance.

The clinical impact of molecular breast imaging in women with proven invasive breast cancer scheduled for breast-conserving surgery

PurposeTo investigate the clinical utility of molecular breast imaging (MBI) in patients with proven invasive breast cancer scheduled for breast-conserving surgery (BCS).MethodsFollowing approval by the institutional review board and written informed consent, records of patients with newly diagnosed breast cancer scheduled for BCS who had undergone MBI for local staging in the period from March 2012 till December 2014 were retrospectively reviewed.ResultsA total of 287 women (aged 30–88 years) were evaluated. MBI showed T stage migration in 26 patients (9%), with frequent detection of in situ carcinoma around the tumor. Surgical management was adjusted in 14 of these patients (54%). In 17 of 287 patients (6%), MBI revealed 21 proven additional lesions in the ipsilateral, contralateral breast or both. In 18 of these additional foci (86%), detected in 15 patients, malignancy was found. Thirteen of these 15 patients had ipsilateral cancer and 2 patients bilateral malignancy. In total, MBI revealed a larger tumor extent, additional tumor foci or both in 40 patients (14%), leading to treatment adjustment in 25 patients (9%).ConclusionMBI seems to be a useful imaging modality with a high predictive value in revealing ipsilateral and bilateral disease not visualized by mammography and ultrasound. It may play an important role in delineating the extent of the index lesion during preoperative planning. Incorporation of MBI in the clinical work-up as an adjunct modality to mammography and ultrasound may lead to better selection of patients who could benefit from BCS.

Abstract P4-01-11: Diagnostic performance of supplemental screening with molecular breast imaging in women with dense breast tissue

Abstract Purpose: The aim of this study was to retrospectively assess the diagnostic performance of molecular breast imaging (MBI) as a supplementary screening tool for women with dense breast tissue. We had previously reported excellent cancer detection rates and positive predictive values, whereas in this report we present 1-year follow up data and present sensitivity, specificity and negative predictive values. Methods: Molecular Breast Imaging (MBI) was implemented in routine clinical practice at a large, community-based breast imaging center. Women 25 to 90 years of age with dense breasts and negative mammogram results who underwent subsequent screening with 300 MBq (8 mCi) 99mTc-sestamibi MBI were retrospectively analyzed. Outcome measures included sensitivity, specificity, and positive and negative predictive values. Results: In 1,376 women with a complete reference standard, 17 (1.2%) were diagnosed with cancer. MBI detected cancer in 15 subjects such that 2 interval cancers occurred and were considered false negatives. Of those 17 cancers, 1 (5.9%) were ductal carcinoma in situ only, 13 were invasive tumors (76.5%); 1 (5.9%) patient was diagnosed with bilateral disease. Overall sensitivity of MBI in this sample was 88.2% (95% CI 63.6 – 98.5), while specificity was also high at 92.4% (95% CI 90.9 – 93.8). Positive predictive value for recall (PPV1) was 12.7% (95% CI 7.3 – 20.1), while negative predictive value for recall (NPV1) was calculated as 99.8% (95% CI 99.4 – 100.0). Conclusions: When incorporated into a community-based clinical practice environment, MBI demonstrated high sensitivity, specificity and negative predictive value. These results demonstrate the utility of MBI as a supplementary screening tool to mammography for women with dense breasts. Citation Format: Redfern RE, Shermis RB, Chen JT, Kudrolli H. Diagnostic performance of supplemental screening with molecular breast imaging in women with dense breast tissue [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-01-11.

Breast Imaging in Women Previously Irradiated for Hodgkin Lymphoma

Women treated with mantle irradiation for Hodgkin lymphoma (HL) are at an increased risk of developing breast cancer (BC). Current guidelines recommend screening breast magnetic resonance imaging (MRI) as an adjunct to mammography (M) in these patients. There are limited data, however, as to the impact of breast MRI on cancer detection rates. The aim of the current study is to evaluate the use of breast MRI in survivors of HL treated and followed at a single institution. We retrospectively reviewed 980 female patients treated with mantle irradiation for HL between 1961 and 2008. Records were reviewed to determine age at radiotherapy treatment, radiotherapy dose, breast imaging (including M and breast MRI), biopsy results if applicable, and incidence of BC. A total of 118 patients had breast imaging performed at our institution. Median age at HL diagnosis was 28 years (range, 10 to 69 y). Median radiotherapy dose was 36 Gy (range, 20 to 45 Gy). Seventy-nine patients (67%) underwent M screening only, 1 (1%) breast MRI only, and 38 (32%) both M and breast MRI. Of these 38, 19 (50%) underwent 54 screening MRI studies (range per patient=1 to 8), 13 (34%) underwent preoperative MRI for workup of BC, and 6 (16%) initiated screening MRI of the contralateral breast only after diagnosed with BC. Fifty-nine biopsies were performed: 47 were prompted by suspicious M findings only, 10 by palpable findings on physical examination (PE), and 2 by suspicious breast MRI findings. Of the 47 biopsies prompted by M, 24 revealed malignant disease, whereas 23 proved to be benign. All 10 biopsies performed by palpation were malignant. Both biopsies prompted by MRI findings were benign. With M, there were 34 true-positive findings in 32 patients, 23 false-positive findings, and 1 false-negative finding. With screening MRI, there were 2 false-positive findings, 1 false-negative finding, and no true-positive findings. The role of screening breast MRI in women previously irradiated for HL is evolving. Further education of patients and physicians is important to increase awareness of more sensitive BC screening modalities in this high-risk population. Future studies are necessary to determine the appropriate integration of screening breast MRI into the ongoing follow-up of these women.

Evaluation of Molecular Breast Imaging in Women Undergoing Myocardial Perfusion Imaging with Tc-99m Sestamibi

Our objective was to explore the potential benefits of molecular breast imaging (MBI) as a screening technique in women undergoing stress myocardial perfusion studies. MBI was offered to women receiving Tc-99m sestamibi injection for myocardial perfusion stress testing. During the required waiting period after stress isotope injection, MBI was performed using a dedicated breast imaging gamma camera system. MBI examinations were interpreted by breast radiologists, with review of a recent mammogram in cases with positive MBI. Of 322 women enrolled, 313 completed MBI, comprising 5 with known breast cancer, 2 with known high-risk benign breast lesions, and 306 who were asymptomatic for breast disease with a recent negative mammogram. Analysis was limited to the 306 patients with no known breast disease. MBI was positive in 22 of 306, giving a recall rate of 7.2% (95% confidence interval [CI] 4.8-10.6]. MBI detected 4 new cancers, resulting in a supplemental diagnostic yield of 13.1/1000 women screened (95% CI 5.1-33.2). The number of cancers diagnosed per abnormal MBI examinations (PPV(1)) was 18% (4 of 22) (95% CI 7.3-38.5), and the number diagnosed per MBI-prompted biopsies (PPV(3)) was 44% (4 of 9) (95% CI 18.9-73.3). The addition of MBI to clinically indicated stress myocardial perfusion imaging studies in women results in a high diagnostic yield of newly detected breast cancers while generating a low rate of additional unnecessary workup.

Predictive value of BI-RADS classification for breast imaging in women under age 50

In this study, we assessed the positive-predictive value (PPV) of mammography and/or ultrasonography in women age 50 based on recommendations for biopsies and final pathology results. We performed a retrospective analysis of all mammography and ultrasonography reports issued from 9/2005 to 1/2007 resulting in biopsy among women aged 18-50 at a large county hospital. Data included demographics, imaging modality, breast density, type of finding, BI-RADS, and final pathology. Results were compared to women aged >50 at the same institution. Four hundred and seventy-five biopsies in 395 patients were reviewed. The PPV of BI-RADS 3 (n = 11) was 9.1%, BI-RADS 4 (n = 440) 5.9%, and BI-RADS 5 (n = 24) 66.7%. Forty three (9%) were malignant, of which 31 (6.5%) were invasive carcinomas and 12 (2.5%) were noninvasive. None of the biopsies on patients aged <30 were malignant. Recommended biopsies based on mammography alone were malignant in 20.2% (20/99) compared to 3.4% (7/205) for ultrasonography alone, and 8.9% (15/168) for both mammography and ultrasonography. Suspicious calcifications were malignant in 25% compared to 6.8% for masses/nodules and 3.6% for cysts. Lesions larger than 2 cm are more likely to be malignant (11.8%) than lesions between 1 and 2 cm (3.6%) or below 1 cm (4.3%). The PPV of the current screening modalities diminishes markedly in women under the age of 50 and even more below the age of 40. Calcifications and masses larger than 2 cm should be biopsied, but the current BI-RADS criteria may benefit from revision for other findings in young patients.

Multifocal, multicentric and contralateral breast cancers: breast MR imaging in the preoperative evaluation of patients with newly diagnosed breast cancer

This study was done to verify the usefulness of preoperative breast magnetic resonance (MR) imaging in patients with newly diagnosed breast cancer. A retrospective analysis of 291 patients with invasive breast cancer newly diagnosed with conventional breast imaging (mammography and ultrasound) was performed. All patients underwent MR imaging prior to surgery. The MR imaging detection rate of additional malignant cancers occult to mammography and ultrasound was calculated. Data were analysed with Fisher's exact test (p<0.05) according to the following parameters: histopathological features of the index tumour (histological type and size) and mammographic density [according to the Breast Imaging Reporting and Data System (BI-RADS) classification from 1 fatty to 4 dense). The gold standard was the histological examination on the surgical specimen. MR imaging identified 40 mammographically and sonographically occult malignant lesions other than the index cancer in 27/291 patients (9%). These additional cancers were located in the same quadrant as the index cancer in 13 women (4%), in a different quadrant in 12 (4%) and in the contralateral breast in the remaining two (1%). The cancer detection rate in the subgroup of index cancers with lobular histological type was 25%, significantly higher (p=0.03) than the detection rate of 11% recorded in the subgroup of ductal cancers. The cancer detection rate in the subgroup of index cancers >2 cm was 27%, significantly higher (p=0.001) than the rate of 8% found in the subgroup of index cancers <2 cm. Mammographic density was not correlated (p=0.48) with MR detection of additional cancer, with 14% of additional malignancies being detected in both dense and fatty breasts. In patients with newly diagnosed invasive breast cancer, preoperative MR imaging is useful for detecting additional synchronous malignancies that are not detected on conventional breast imaging. The cancer detection rate is 9%. The use of preoperative MR imaging as an adjunct to conventional breast imaging in women with an infiltrating lobular index cancer and an index cancer >2 cm is especially beneficial.

Derby results and practical experience of breast imaging in women following supradiaphragmatic irradiation for Hodgkin's disease

The national recall programme for women who had supradiaphragmatic irradiation for Hodgkin's disease under the age of 30 years began in late 2003. In Derby, from an initial identified group of 56 women, 36 attended for a 1-hour consultation with a consultant oncologist. From these 36 women, 33 have attended for surveillance. In the group offered imaging surveillance, all 33 women took up the invitation. When magnetic resonance imaging (MRI) is indicated, it is done first; then the woman attends for mammography, MRI results and any focused ultrasound needed the following day. See Table ​Table11 for results. Five of the six MRI recalls were from a first screen, and the other from a second screen. One ductal carcinoma in situ was diagnosed in a lady with breast implants. Table 1 From the 56 eligible women, there were four with breast cancer: one woman diagnosed as above, two women from the National Health Service Breast Screening Programme and one woman symptomatically in 2007. The radiology and pathology of these cases will be presented. We commence family history screening with MRI soon and plan to apply this method, which works very well and within tight time limits.

Initial Clinical Experience with Microwave Breast Imaging in Women with Normal Mammography

We have developed a microwave tomography system for experimental breast imaging. In this article, we illustrate a strategy for optimizing the coupling liquid for the antenna array based on in vivo measurement data. We present representative phantom experiments to illustrate the imaging system's ability to recover accurate property distributions over the range of dielectric properties expected to be encountered clinically. To demonstrate clinical feasibility and assess the microwave properties of the normal breast in vivo, we summarize our initial experience with microwave breast exams of 43 women with negative mammography according to the Breast Imaging Reporting and Data System (BI-RADS 1). The clinical results show a high degree of bilateral symmetry in the whole breast average microwave properties. Focal assessments of microwave properties are associated with breast tissue composition evaluated through radiographic density categorization verified through magnetic resonance image correlation in selected cases. Specifically, both whole-breast average and local microwave properties increase with increasing radiographic density, in which the latter exhibits a more substantial rise. These findings support our hypothesis that water content variations in the breast play an influential role in dictating the overall dielectric property distributions and indicate that the microwave properties in the breast are more heterogeneous than previously believed based on ex vivo property measurements reported in the literature.

Value of breast imaging in women with painful breasts: observational follow up study

Objectives: To determine the value of breast imaging in patients with localised or diffuse pain in the breast in whom physical examination shows no abnormalities.Design: Observational follow up study.Setting: Radiology...

Breast imaging in women under 35 with symptomatic breast disease

With the increasing utilization of mammography, young women under the age of 35 are being referred for mammographic examination more frequently. A review of the mammograms of 159 consecutive patients aged under 35 was conducted to evaluate the clinical value of the examination in the age group for whom the probability of malignancy is low. 74% of patients referred had no discrete palpable mass and presented predominantly with lumpy or tender breasts, the remaining 24% had a discrete palpable mass. In neither group did radiographic examination beneficially influence clinical management. We propose protocol where no imaging is performed in women under 35 in the absence of a palpable mass unless there is a localized bloody discharge or a strong family history or previous personal history of breast cancer. In patients with a palpable mass, ultrasound should be performed initially to identify simple cysts and if negative only then progressing to mammography.

Indications for breast imaging in women under age 35 years.

To determine appropriate indications for breast imaging in young women, the authors correlated patient histories with mammographic and/or sonographic findings and biopsy or follow-up results for 625 patients aged 13-34 years. The only important indications were a palpable mass and suspicion of an abscess. Of the 335 studies performed for evaluation of a palpable mass, 184 (55%) were normal, 28 (8%) were compatible with benign disease, and 123 (37%) were suggestive of malignancy. Biopsies were performed in 73 patients; the findings were benign in 67 cases, and carcinoma was found in six. Imaging studies were considered helpful in four of the 15 cases of suspected abscess, in that the studies established the presence and extent of an abscess. Studies in 275 women were performed for a variety of other indications. The findings were normal in 239 (87%) studies, benign in 21 (8%), and suggestive of malignancy in 15 (5%); there were no known carcinomas in any of the patients. Women with the "low-yield" indications identified in this study should be followed up clinically rather than referred for imaging studies.