Mammographic Findings Research Articles

The impact of Digital Breast Tomosynthesis on BIRADS categorization of mammographic non-mass findings

ABSTRACT Introduction: Mammography is the most used breast screening tool and was proven to reduce breast-cancer-associated mortality. The estimated sensitivity of mammography varies between 77% and 95%; however, sensitivity could be 26% lower in dense breasts than in entirely fatty breasts. The ability to represent the complex 3D breast architecture and early changes in anatomical structures in a 2D view is the biggest challenge for mammography. In Digital Breast Tomosynthesis (DBT), tomographic images are reconstructed from multiple projections acquired from different angles. This technique allows the generation of 3D data, reduction of tissue overlap and allows better evaluation of masses, architectural distortion, and asymmetries compared with conventional two-dimensional mammographic images. Objective: To evaluate the impact of Digital Breast Tomosynthesis on BIRADS categorization of mammographic non-mass findings. Methods: Prospective cohort for 180 women with mammographic non-mass findings who presented to Alexandria University Radio diagnosis Department either for screening or diagnostic purposes between July 2019 and August 2020 with mean age 51.44 ± 10.67 . Digital breast tomosynthesis and ultrasound was done for all patients. Lesions were evaluated on DM; DBT alone then combined DBT & DM. Comparison of results according to changes in BIRADS, diagnostic performance using histopathology as gold standard. Results: 208 non-mass findings were detected by conventional mammography (104 asymmetry, 35 architectural distortion, 69 micro calcifications), Tomosynthesis reduced the BIRADS 3 count by 32%, upgraded the count of BIRADS 4 lesions by 11.4% while upgraded the BIRADS 2 by 18.9% with consequent improvement of sensitivity and specificity, PPV, NPV and accuracy to 96%, 95%, 94%,97%, and 95.6%. Conclusion: Combined FFDM and DBT improved the diagnostic performance in evaluation of non-mass findings and proper BIRADS categorization.

Hyperechoic Lesions on Breast Ultrasound: All Things Bright and Beautiful?

Ultrasound (US) lexicon of the Breast Imaging Reporting and Data System (BI-RADS) defines an echogenic breast mass as a lesion that is hyperechoic in comparison with subcutaneous adipose tissue. However, at sonography, only 0.6 to 5.6% of breast masses are echogenic and the majority of these lesions are benign. approximately, 0.5% of malignant breast lesions appear hyperechoic. The various benign pathologic entities that appear echogenic on US are lipoma, hematoma, seroma, fat necrosis, abscess, pseudoangiomatous stromal hyperplasia, galactocele, etc. The malignant diagnoses that may present as hyperechoic lesions on breast US are invasive ductal carcinoma, invasive lobular carcinoma, metastasis, lymphoma, and angiosarcoma. Echogenic breast masses need to be correlated with mammographic findings and clinical history. Lesions with worrisome features such as a spiculated margin, interval enlargement, interval vascularity, or association with suspicious microcalcifications on mammography require biopsy. In this article, we would like to present a pictorial review of patients who presented to our department with echogenic breast masses and were subsequently found to have various malignant as well as benign etiologies on histopathology.

Diagnostic mammography in Sokoto: A review of 123 cases

Background: Diagnostic mammography is a radiographic examination of the breast to detect the palpable and nonpalpable lesions. More than 1.15 million women are diagnosed of breast cancer yearly worldwide. Objective: This study is aimed at evaluating the mammographic outcomes among 123 Nigerian females who had the sign and symptoms of breast diseases. Materials and Methods: This is a cross-sectional study (retrospective in nature) of 123 adult females who came for diagnostic mammography between December 2010 and November 2012 at the mammographic suite of radiology department UDUTH. MLO and CC views were done for the breast examination though compression views were occasionally employed. Results: One hundred and twenty-three females had diagnostic mammography, with a minimum age of 30 years. The prevalence of diagnostic mammography within the stated period is 61.5%. The mammographic findings were normal in 62 (50.4%) and abnormal in 61 (49.6%) of the subjects. The abnormal mammographic findings were masses in either or both breasts in 45 participants (36.6%), architectural distortion in either or both breasts in 10 participants (8.1%), isolated calcification in either or both breasts in 4 participants (3.3%), left retracted nipple in 1 (0.8%) participant while another subject (0.8%) had a retracted right nipple. Conclusion: Diagnostic mammography can detect the various forms of breast pathologies which were mostly breast masses, calcifications, and architectural distortions. These findings affirmed the need of routine early screening so that breast diseases can be detected early.

COMPARISON OF PRE-OP 2D MAMMOGRAPHY AND 3D MAMMOGRAPHY (TOMOCYNTHESIS) FINDINGS IN PATIENTS DUE TO BREAST LESION

Ponte Academic JournalJul 2021, Volume 77, Issue 7 COMPARISON OF PRE-OP 2D MAMMOGRAPHY AND 3D MAMMOGRAPHY (TOMOCYNTHESIS) FINDINGS IN PATIENTS DUE TO BREAST LESIONAuthor(s): Vugar Samadli ,Sevinc Dagistanli, Mehmet Cingoz, Suleyman SonmezJ. Ponte - Jul 2021 - Volume 77 - Issue 7 doi: 10.21506/j.ponte.2021.7.1 Abstract:Aim: Conventional digital mammography (CDM) is a basic screening method especially used for women over 40 years of age. CDM enable multiple images from different angles and different depth levels. To avoid superposition of healthy and ill breast tissue the Digital Breast Tomosynthesis (DBT) reveals to be a certain method. Thus, we aimed to compare CDM and DBT (Digital Breast Tomosynthesis) images of preoperative lesions to detect their significance. Material and method: We retrospectively compared 646 patients divided into two groups with their CDM and DBT results at our Institution. Only patients with type C and D breast tissue paterns were included. In the first group (76 patients) lesions detected on CDM or DBT images were compared according to 6 parameters with 4 histopathological parameters correlation. In the second group 570 patients with lesions detected on CDM and/or DBT and without histopathological correlation were compared due to the parameters. Findings: There was a statistical significant result for detecting nodulary opacity and distortion with DBT compared to CDM (p<0.05). A parenchymal distorsion-area correlated with histopathology as a maligant lesion was significant better identified on DBT compared to CDM (p<0.05). Detection for nodulary opacity was significant better with DBT compared to CDM (p<0.05). Result: CDM is the gold Standard for detecting preoperative breast lesions and reveals to be the most commonly used method together with ultrasound. According to our study DBT is more successful at detecting findings like nodulary opacities and parenchymal distortion. Download full text:Check if you have access through your login credentials or your institution Username Password

Idiopathic granulomatous lobular mastitis: A rare entity with diagnostic dilemma on fine needle aspiration

Idiopathic granulomatous lobular mastitis (IGLM) is an uncommon and rare chronic inflammatory breast disease. The exact etiology is not known. Although various etiologies have been implicated, autoimmunity is favored and widely accepted. In countries with a high prevalence of tuberculosis, the diagnosis of IGLM is often challenging. Clinical presentation is quite variable. Ultrasonography and mammography findings lack specificity. Fine-needle aspiration (FNA) cytology features of idiopathic granulomatous mastitis (IGM) have been described in few reports, but they are still debatable. We report the case of a 36-year-old female with a hard lump in the left breast. Aspiration cytology smears showed many well-formed epithelioid granulomas and few scattered epithelioid cells. The background showed numerous polymorphonuclear leukocytes with few reactive lymphoid cells and foreign-body giant cells. There was no necrosis. Acid-fast bacilli (AFB) and fungal stains did not show AFB and fungal hyphae. A diagnosis of IGM was suspected on aspiration cytology. Histopathology examination confirmed the diagnosis. To conclude, though tuberculosis is highly prevalent in India, if breast FNA smears show epithelioid granulomas with numerous polymorphonuclear leukocytes with no necrosis or AFB, IGLM must be suspected.

Pattern of Presentation of Mammography in a Developing Country

Introduction: Breast cancer is the second commonest cancer (7.2%) in Nepal and almost 54%of patients present in the advanced stage. It is the leading cause of cancer death in females.The objective of the study was to determine the type of mammography, composition of breastdensity and BIRADS category.Methods: The study was conducted in a tertiary hospital from Jan 1st to Oct 30th of 2019according to non-probability convenience sampling. A total of 388 persons were included inthe study. The mammographic findings were assessed by categories based on the BIRADSsystem.Results: Mammography for screening was 38 percent and diagnostic was 68 percent. Commonbreast compositions were B and C. More frequent BIRADS categories were seen in 1 and 2.Conclusion: Dense breast is common in mammography. BIRADS categories 1 and 2 weremore common than other categories.

Glandular density distribution in digital mammography

Objectives&#x0D; The aim of this study was to evaluate the breast density distribution in digital mammography of patients.&#x0D; Materials and Methods&#x0D; This prospective study was performed in the Department of Radiology and Imaging of Tribhuvan University Teaching Hospital (TUTH). Data was collected over a period of 4 months from July to October 2019 and included one hundred and seventy patients who came for diagnostic or screening mammography, which was recorded as indication for the test. Appropriate statistical methods were used for analysis.&#x0D; Results&#x0D; The mean age of women included in this study was 48.09 ± 9.13 years. Nearly 43% of the patients had dense breasts. According to Breast Imaging, Reporting and Data System (BIRADS) classification of lesions, maximum mammograms i.e.,77.7% were normal or benign while 4.7% were BIRADS category 0 and 17.7% were of BIRADS category 3, 4 or 5. A negative correlation was observed between age and breast density category. The relationship between breast density and BIRADS category or indication for the test was insignificant while a weak correlation was observed between it and mammographic findings.&#x0D; Conclusion&#x0D; Our study showed an inverse linear relationship between age and mammographic density which is consistent with the fact that mammography has higher sensitivity in older age group usually with lesser density. No or weak correlation was present between breast density and BIRADS category, indication or findings on mammography. All patients in BIRADS 0 category had dense breasts.

Benefits of digital breast tomosynthesis: A lesion-level analysis.

To compare outcome metrics of digital breast tomosynthesis (DBT) breast cancer screening with full-field digital mammogram (FFDM); specifically, to compare recall rates by the type of recalled finding, and to assess if screening with DBT versus FFDM changes biopsy recommendations and if the likelihood of malignancy varied by lesion type, if detected on DBT or FFDM screening mammogram. The outcomes of 22,055 FFDM and DBT screening mammograms were retrospectively reviewed. The exams were performed at an academic institution between August 2015 and September 2016. Performance of screening with FFDM versus DBT was compared in terms of recall rate and percentage of recalled lesions resulting in a cancer diagnosis, with subset analyses performed for specific mammographic findings. The recall rate was 10.6% for FFDM and 8.0% for DBT (p < 0.001). Architectural distortion was more likely to be recalled on DBT screening than FFDM (p = 0.002), and was associated with an increased likelihood of malignancy (p = 0.008). Asymmetries were less likely to be recalled on DBT than FFDM (p < 0.001) screening mammogram, but more likely to be recommended for biopsy when detected on DBT. Calcifications more frequently required short-term follow-up or biopsy on both DBT and FFDM. DBT screening confers an advantage in detection of architectural distortion representing malignancy. Recall rate of asymmetries are reduced with screening DBT, probably due to reduction of tissue superimposition. Calcifications pose a particularly difficult diagnostic challenge for breast imagers, regardless of screening mammogram type.

Mammographic and Sonographic Features of Breast Cancer in Women Before 30 Years of Age.

Breast cancer uncommonly occurs in young women, but, tends to be diagnosed at a later stage and have a poorer prognosis than in older women. Standard screening guidelines for this age group are not established and the radiologic features of breast cancer in young women are not fully studied yet, because of the low incidence. To investigate the imaging findings for breast cancer in women aged 30 years or younger and to correlate them with clinicopathologic features and immunohistochemical subtypes. The study included 52 women with surgically confirmed breast cancer. The medical records of the patients were retrospectively reviewed and the mammographic and ultrasonographic findings were evaluated according to the fifth edition of the ACR BI-RADS lexicon. Most of the tumors in this study were presented as a self-detected mass (42/52, 80.8%) and were of histologic grade III (31/43 invasive carcinoma, 72.1%) and the estrogen receptorpositive subtype (32/52, 61.5%). The most common mammographic finding was an irregular (19/24, 79.2%), indistinct (16/24, 66.7%), and hyperdense (20/24, 83.3%) mass. The ultrasonographic findings were of an irregular (32/47, 68.1%), indistinct (19/47, 40.4%), and hypoechoic/ heterogeneous (40/47, 85.1%) mass with no posterior features (34/47, 72.3%). An oval/round-shaped mass on ultrasonography was also correlated with triple-negative cancer (p=0.011). On mammography and ultrasonography, breast cancer in young women usually presents as a mass with irregular shape and indistinct margin. Some radiologic findings could be used to predict the molecular phenotype of the tumor.

Correlation of FNAC with Histopathology of breast lesions

Breast cancer is a commonest maliganancy of women globally. A papable breast lump is common diagnostic dilemma to surgeons. Fine needle aspiration cytology (FNAC) is simple rapid, accurate diagnostic tool for evaluating palpable breast lumps. Mammography is other screening modality for a breast lump which is routinely used method with simple, low cost with high accuracy.To differentiate and categories the breast lesions, and to study the correlation of FNAC with histopathology of palpable breast lumps.one and half year retrospective study carried out from January 2019 to June 2020 in the department of pathology, KBNIMS, Gulbarga. FNAC and Histopathology slides were retrieved and reviewed. All the slides were observed and findings recorded. Mammography findings were retrieved and recorded.The present study includes 125 cases out of which 101 cases (80.8%) were benign and 24 cases (19.2%) were malignant. Most common benign breast lesion was fibroadenoma (52.4%) and malignant lesion was infiltrating ductal carcinoma (75%). Frequencies of left breast lesions were high compare to right breast lesions. Out of 125 cases FNAC, 123 cases (98.4%) correlated with histopathology with sensitivity of 91.66%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 98% and accuracy of 98.4%.Out of 125 cases, mammography of 25 cases were retrieved with sensitivity of 87.5% and specificity of 94.11% with diagnostic accuracy of 92%.FNAC is a valuable diagnostic tool; provide rapid and reliable diagnosis in breast lesions.

Clinicopathological features of breast cancer without mammographic findings suggesting malignancy

BackgroundMammography (MG) is widely used for screening examinations. Dense breast reduces MG screening sensitivity, possibly delaying diagnosis. However, little is known about the characteristics of breast cancers without MG findings indicative of malignancy. Hence, we investigated breast cancer patients with tumors not detected by MG. Patients and methodsIn total, 1758 Japanese patients with breast cancer, undergoing curative surgery between 2012 and 2018 without neo-adjuvant chemotherapy, were retrospectively investigated. Clinicopathological features were compared between patients without (MG-negative) and with (MG-positive) cancer-specific findings on MG. The current study included cases who came to our hospital after experiencing subjective symptoms, or whose tumors were detected by MG and/or US-screening. We reviewed results of both MG and US conducted at our institution. ResultsThere were 201 MG-negative cases (11.4%). In patients with invasive disease, multivariate analysis revealed MG-negative patients to have higher breast density on MG (p < 0.001). Tumors of MG-negative patients were smaller (p < 0.001), showed less lymph node involvement (p = 0.011), and were of lower grade (p = 0.027). The majority of MG-negative tumors were found by ultrasound screening, being smaller than tumors in patients with subjective symptoms. In the MG-negative group, tumor characteristics such as tumor grade did not differ between those detected by screening versus subjective symptoms. ConclusionMost tumors in MG-negative group patients were identified by US screening and the diseases were found at early stages with low malignancy. The usefulness of additional ultrasound with MG-screening might merit further investigations.

Clinical Indications for Mammography in Men and Correlation With Breast Cancer

PurposeThe purpose of this study is to examine the correlation between presenting clinical symptoms and imaging findings in men with breast cancer. Method and MaterialsFour hundred twenty-nine male patients who presented for mammography at one institution between January 2004 and December 2014 were retrospectively evaluated. Of the 429 patients, 291 presented with clinical symptoms for diagnostic mammography. The presenting clinical symptoms in 291 patients were recorded and correlated with imaging and histopathologic findings. ResultsTwo hundred ninety-one male patients were included. Some presented with multiple symptoms, for a total of 318 clinical symptoms. One hundred and ninety (65%) men presented with palpable abnormalities, 44 (15%) with nonfocal pain, 31 (11%) with breast swelling, 14 (5%) with breast enlargement, 13 (4%) with focal pain, 7 (2%) with skin changes, 6 (2%) with nipple discharge/changes and 13 (4%) with other symptoms (itching, throbbing and breast heaviness). A total of 290 patients underwent mammography and 176 underwent sonography. Forty-one malignancies were diagnosed, of which 24 (59%) were invasive ductal carcinoma. Nipple changes/discharge had a 100% positive predictive value for malignancy while breast pain showed a 0% positive predictive value. Fifty-two patients showed either a mass or a focal asymmetry on mammography, of which 38 (73%) were malignant. Three patients (1%) without a mass or focal asymmetry were diagnosed with malignancy. ConclusionCorrelating clinical symptoms and imaging findings can help with timely and accurate diagnosis of breast cancer in men. Nipple discharge/changes and skin changes with palpable abnormalities and mammographic findings of masses and focal asymmetries were associated with breast cancer. Pain, breast enlargement, and breast swelling were unlikely to be associated with malignancy

Breast cancer screening using digital breast tomosynthesis compared to digital mammography alone for Japanese women.

The purpose of this study is to confirm the position of DBT in breast cancer screening in Japan, to assess cancer detection rates, recall rates, positive predictive value (PPV), and to evaluate the type of mammographic findings of cancer with the use of digital mammography alone (2DDM) and combined with digital breast tomosynthesis (DBT). 11,894 examinations of the opportunistic breast cancer screening using only 2DDM and 2DDM plus DBT were performed from May 1, 2017 to March 31, 2019. The 11,894 women [3535 women who received DBT in addition to 2DDM (3D group) and 8359 who received 2DDM only (2D group)] participated in this study. The study was approved by the Institute's Ethics Committee and all participants provided written informed consent. The recall rate was 2.6% for the 3D group and 3.6% for the 2D group (p < 0.01). The cancer detection rate was 0.17% in both 3D and 2D groups (p = 0.978). The positive predictive value (PPV) was 6.5% for the 3D group and 4.7% for the 2D group (p = 0.484). The cause of the decrease in recall rate was due to a decrease in the finding of focal asymmetric density (FAD). The recall rate was improved by using DBT for breast cancer screening in Japanese women. Cancer detection rates were exactly the same in DBT and 2DDM groups, so only DBT non-inferiority could be verified. We have verified that breast cancer screening combined with DBT is useful even for Japanese women to reduce unnecessary further examination.

Impact of digital breast tomosynthesis (DBT) on finding types leading to true-positive and false-positive examinations

PurposeTo investigate the frequencies of finding types with combined digital breast tomosynthesis (DBT) and digital mammography (DM) leading to true-positive (TP) and false-positive (FP) examinations. Materials and methodsConsecutive screening mammograms at an academic medical center from March 2008 to February 2011 (DM group) and from January 2013 to December 2017 (DBT/DM group) were retrospectively reviewed. Multivariable logistic regression models were used to compare the proportions of mammographic finding types leading to TP and FP examinations between the two groups. ResultsThe DM group had 554 TP and 7278 FP examinations, and the DBT/DM group had 1271 TP and 14,544 FP examinations. The finding type of calcifications led to a lower proportion of TP examinations in the DBT/DM than DM group (34.3% versus 47.7%, p < 0.001) but also a lower proportion of FP examinations (18.7% versus 21.7%, p < 0.001). Mass led to a higher proportion of TP examinations in the DBT/DM than DM group (5.7% versus 1.3%, p < 0.001) but also a higher proportion of FP examinations (4.6% versus 0.3%, p < 0.001). Asymmetry led to a higher proportion of TP examinations in the DBT/DM than DM group (58.3% versus 50.4%, p = 0.03) and a lower proportion of FP examinations (75.9% versus 77.6%, p < 0.001). Architectural distortion led a similar proportion of TP examinations in the DBT/DM and DM groups (1.7% versus 0.7%, p = 0.12) but a higher proportion of FP examinations (0.8% versus 0.4%, p = 0.007). ConclusionsMammographic findings leading to TP and FP examinations have shifted with the addition of DBT to DM.

Digital Breast Tomosynthesis Slab Thickness: Impact on Reader Performance and Interpretation Time.

Background Digital breast tomosynthesis (DBT) helps reduce recall rates and improve cancer detection compared with two-dimensional (2D) mammography but has a longer interpretation time. Purpose To evaluate the effect of DBT slab thickness and overlap on reader performance and interpretation time in the absence of 1-mm slices. Materials and Methods In this retrospective HIPAA-compliant multireader study of DBT examinations performed between August 2013 and July 2017, four fellowship-trained breast imaging radiologists blinded to final histologic findings interpreted DBT examinations by using a standard protocol (10-mm slabs with 5-mm overlap, 1-mm slices, synthetic 2D mammogram) and an experimental protocol (6-mm slabs with 3-mm overlap, synthetic 2D mammogram) with a crossover design. Among the 122 DBT examinations, 74 mammographic findings had final histologic findings, including 31 masses (26 malignant), 20 groups of calcifications (12 malignant), 18 architectural distortions (15 malignant), and five asymmetries (two malignant). Durations of reader interpretations were recorded. Comparisons were made by using receiver operating characteristic curves for diagnostic performance and paired t tests for continuous variables. Results Among 122 women, mean age was 58.6 years ± 10.1 (standard deviation). For detection of malignancy, areas under the receiver operating characteristic curves were similar between protocols (range, 0.83-0.94 vs 0.84-0.92; P ≥ .63). Mean DBT interpretation time was shorter with the experimental protocol for three of four readers (reader 1, 5.6 minutes ± 1.7 vs 4.7 minutes ± 1.4 [P < .001]; reader 2, 2.8 minutes ± 1.1 vs 2.3 minutes ± 1.0 [P = .001]; reader 3, 3.6 minutes ± 1.4 vs 3.3 minutes ± 1.3 [P = .17]; reader 4, 4.3 minutes ± 1.0 vs 3.8 minutes ± 1.1 [P ≤ .001]), with 72% reduction in both mean number of images and mean file size (P < .001 for both). Conclusion A digital breast tomosynthesis reconstruction protocol that uses 6-mm slabs with 3-mm overlap, without 1-mm slices, had similar diagnostic performance compared with the standard protocol and led to a reduced interpretation time for three of four readers. © RSNA, 2020 See also the editorial by Chang in this issue.

Radiological review of prior screening mammograms of screen-detected breast cancer

ObjectiveTo perform a radiological review of mammograms from prior screening and diagnosis of screen-detected breast cancer in BreastScreen Norway, a population-based screening program.MethodsWe performed a consensus-based informed review of mammograms from prior screening and diagnosis for screen-detected breast cancers. Mammographic density and findings on screening and diagnostic mammograms were classified according to the Breast Imaging-Reporting and Data System®. Cases were classified based on visible findings on prior screening mammograms as true (no findings), missed (obvious findings), minimal signs (minor/non-specific findings), or occult (no findings at diagnosis). Histopathologic tumor characteristics were extracted from the Cancer Registry of Norway. The Bonferroni correction was used to adjust for multiple testing; p < 0.001 was considered statistically significant.ResultsThe study included mammograms for 1225 women with screen-detected breast cancer. Mean age was 62 years ± 5 (SD); 46% (567/1225) were classified as true, 22% (266/1225) as missed, and 32% (392/1225) as minimal signs. No difference in mammographic density was observed between the classification categories. At diagnosis, 59% (336/567) of true and 70% (185/266) of missed cancers were classified as masses (p = 0.004). The percentage of histological grade 3 cancers was higher for true (30% (138/469)) than for missed (14% (33/234)) cancers (p < 0.001). Estrogen receptor positivity was observed in 86% (387/469) of true and 95% (215/234) of missed (p < 0.001) cancers.ConclusionsWe classified 22% of the screen-detected cancers as missed based on a review of prior screening mammograms with diagnostic images available. One main goal of the study was quality improvement of radiologists’ performance and the program. Visible findings on prior screening mammograms were not necessarily indicative of screening failure.Key Points• After a consensus-based informed review, 46% of screen-detected breast cancers were classified as true, 22% as missed, and 32% as minimal signs.• Less favorable prognostic and predictive tumor characteristics were observed in true screen-detected breast cancer compared with missed.• The most frequent mammographic finding for all classification categories at the time of diagnosis was mass, while the most frequent mammographic finding on prior screening mammograms was a mass for missed cancers and asymmetry for minimal signs.

Correlation of the BI-RADS assessment categories of Papua New Guinean women with mammographic parenchymal patterns, age and diagnosis.

IntroductionWomen with increased breast density are at increased risk of breast cancer. The aim of this research is to evidence for the first time the mammographic breast findings of Papua New Guinean (PNG) women and the relationship between Breast Imaging‐Reporting and Data System (BI‐RADS) assessment, mammographic parenchymal patterns (MPPs) and age.MethodsA retrospective analysis of 1357 mammograms of women imaged at the Pacific International Hospital (PIH) from August 2006 to July 2010 was undertaken. Mammographic findings were categorised using the BI‐RADS Atlas® 5th Edition. MPPs were recorded for each woman using the Tabár Pattern I‐V classification system. Age was recorded in years. Statistical analysis was by descriptive analysis and Kruskal–Wallis with Dunn’s post‐test and Spearman’s rho correlation for inferential analysis.ResultsTrue pathological findings (benign and malignant); BI‐RADS 2–5 were noted in 111 women (8.2%); 1242 (91.5%) were negative. BI‐RADS categories for malignancy were reported in 16 (88.9%) of women aged 30 to 60 years. The lower risk Tabár Type I, II and III MPPs were associated with 94.4% (n = 17) of malignancies. Linear correlations between variables were weak and not statistically significant: age and Tabár pattern r = 0.031, P = 0.0261; age and BI‐RADS r = 0.018, P = 0.517; Tabár pattern and BI‐RADS r = 0.020, P = 0.459 (n = 1357).ConclusionThere was no correlation demonstrated between BI‐RADS category, age and MPP. Importantly, there was no correlation demonstrated between BI‐RADS categories 4 and 5 for breast malignancy and high‐risk Tabár Type IV and V MPPs. The results of this study again reflect that the incidence of breast cancer in PNG cannot be explained by breast density and suggest that any formalised screening program in PNG has a target age group aimed at women younger than that of Western screening programs.

Concordance and Diagnostic Accuracy of Ultrasonography and Mammography Findings with Pathology Results in Breast Cancer

Concordance and Diagnostic Accuracy of Ultrasonography and Mammography Findings with Pathology Results in Breast Cancer

Concordance and Diagnostic Accuracy of Ultrasonography and Mammography Findings with Pathology Results in Breast Cancer

Background: Ultrasonography and mammography are two radiologic approaches for screening breast cancer; however, the pathology report is required for the ultimate diagnosis of malignancy. This study aimed to assess the concordance of ultrasonography (US) and mammography with the pathology in breast cancer.Methods: A cross-sectional study was conducted to assess the breast US and the mammography findings based on the BI-RADS model in comparison with the definitive pathology reports in a single medical center. The sensitivity, the specificity, positive (PPV) and negative predictive value (NPV) and also the concordance between the US and the mammography data were analyzed.Results: In this study, 126 patients were included. The sensitivity, specificity, PPV, and NPV for the US were 69.8, 71.9, 75.6 and 81.3 and for mammography were 91.9, 76.6, 80.8 and, 94.6 percent, respectively. The ROC-curve for either the US or the mammography showed that the BI-RADS 4 was accompanied with the highest sensitivity and specificity for the screening of the malignant breast lesions regarding the final diagnosis. Although an overall higher correlation between mammography report and presence of a malignant lesion was observed, the total relative concordance between the results of US and mammography as screening tools proved to be statistically significant (P&lt;0.01).Conclusion: Both the US and the mammography were sensitive and specific screening tools, particularly for the malignant breast lesions. Furthermore, when evidence of the BI-RADS?4 in either the mammography or the US was present, utilization of the other test could be ignored before biopsy.

Correlation of Mammographic &amp; Ultrasonographic Findings of Palpable Malignant Breast Masses

Ultrasound makes the difference between cystic and solid changes in breast tissue. But, it also makes the differential diagnosis in term of benign from malignant to correlate the BI-RADs 4,5,6 category with mammography findings.