Mammography In Patients Research Articles

Reliability of Magseed® marking before neoadjuvant systemic therapy with subsequent contrast-enhanced mammography in patients with non-palpable breast cancer lesions after treatment: the MAGMA study

PurposeTo assess the reliability of excising residual breast cancer lesions after neoadjuvant systemic therapy (NAST) using a previously localized paramagnetic seed (Magseed®) and the subsequent use of contrast-enhanced spectral mammography (CESM) to evaluate response.MethodsObservational, prospective, multicenter study including adult women (> 18 years) with invasive breast carcinoma undergoing NAST between January 2022 and February 2023 with non-palpable tumor lesions at surgery. Radiologists marked tumors with Magseed® during biopsy before NAST, and surgeons excised tumors guided by the Sentimag® magnetometer. CESMs were performed before and after NAST to evaluate tumor response (Response Evaluation Criteria for Solid Tumors [RECIST]). We considered intraoperative, surgical, and CESM-related variables and histological response.ResultsWe analyzed 109 patients (median [IQR] age of 55.0 [46.0, 65.0] years). Magseed® was retrieved from breast tumors in all surgeries (100%; 95% CI 95.47–100.0%) with no displacement and was identified by radiology in 106 patients (97.24%), a median (IQR) of 176.5 (150.0, 216.3) days after marking. Most surgeries (94.49%) were conservative; they lasted a median (IQR) of 22.5 (14.75, 40.0) min (95% CI 23.59–30.11 min). Most dissected tumor margins (93.57%) were negative, and few patients (5.51%) needed reintervention. Magseed® was identified using CESM in all patients (100%); RECIST responses correlated with histopathological evaluations of dissected tumors using the Miller–Payne response grade (p < 0.0001) and residual lesion diameter (p < 0.0001). Also 69 patients (63.3%) answered a patient’s satisfaction survey and 98.8% of them felt very satisfied with the entire procedure.ConclusionLong-term marking of breast cancer lesions with Magseed® is a reliable and feasible method in patients undergoing NAST and may be used with subsequent CESM.

The Impact of Mammographic, Radiologist, and Patient Factors on the Likelihood of Probably Benign (BI-RADS 3) Assessment at Diagnostic Mammography.

To evaluate the association of mammographic, radiologist, and patient factors on BI-RADS 3 assessment at diagnostic mammography in patients recalled from screening mammography. This Institutional Review Board-approved retrospective study of consecutive unique diagnostic mammography examinations in asymptomatic patients recalled from screening mammography March 5, 2014, to December 31, 2019, was conducted in a single large United States health care institution. Mammographic features (mass, calcification, distortion, asymmetry), breast density, prior examination, and BI-RADS assessment were extracted from reports by natural language processing. Patient age, race, and ethnicity were extracted from the electronic health record. Radiologist years in practice, recall rate, and number of interpreted diagnostic mammograms were calculated. A mixed effect logistic regression model evaluated factors associated with likelihood of BI-RADS 3 compared with other BI-RADS assessments. A total of 12 080 diagnostic mammography examinations were performed during the study period, yielding 2010 (16.6%) BI-RADS 3 and 10 070 (83.4%) other BI-RADS assessments. Asymmetry (odds ratio [OR] = 6.49, P <.001) and calcification (OR = 5.59, P <.001) were associated with increased likelihood of BI-RADS 3 assessment; distortion (OR = 0.20, P <.001), dense breast parenchyma (OR = 0.82, P <.001), prior examination (OR = 0.63, P = .01), and increasing patient age (OR = 0.99, P <.001) were associated with decreased likelihood. Mass, patient race or ethnicity, and radiologist factors were not significantly associated with BI-RADS 3 assessment. Malignancy rate for BI-RADS 3 lesions was 1.6%. Asymmetry and calcifications had an increased likelihood of BI-RADS 3 assessment at diagnostic evaluation with low likelihood of malignancy, while radiologist features had no association.

Clinical impact of semi-annual mammography in patients undergoing breast conserving surgery following neoadjuvant therapy

IntroductionGuidelines recommend annual mammography for most patients following breast conserving surgery (BCS) for invasive breast cancer (IBC). However, for patients treated with BCS following neoadjuvant therapy (NAT), the optimal frequency for surveillance has not been established. The study objective is to assess the efficacy of semi-annual mammography after BCS in patients treated with NAT. MethodsAn institutional database of patients with IBC (cT1-T4, N0-N3, M0) who received BCS following NAT from 2007–2020 was analyzed. Clinicopathologic features, surveillance imaging, and outcomes were analyzed. Direct costs associated with surveillance were estimated based on Medicare Physician Fees. Results139 patients received BCS following NAT, of which 59 (42.4%) had a pathologic complete response. Most patients received semi-annual mammography for 24 months post-operatively (84.2%, 82.0%, 80.0%, and 78.0% of patients received a mammogram at 6, 12, 18, and 24 months, respectively). Biopsies were performed due to abnormal imaging findings in 9 (6.5%), 7 (5.3%), 2 (1.5%), and 8 (6.3%) patients at 6, 12, 18, and 24 months, respectively. Overall, 77.8% of biopsies performed were benign. At median follow up of 65 months (IQR 37–86), 22 (15.8%) patients developed recurrences, of which 14 (63.6%) were distant and 8 (36.4%) were locoregional. Only 2 (1.4%) patients had a recurrence detected by mammographic surveillance. The additional direct costs associated with semi-annual imaging was $373.68 per patient. ConclusionsThere is insufficient evidence to support semi-annual mammography in the early post-operative period following BCS in patients treated with NAT, and annual mammography with clinical exam is likely sufficient. SynopsisTo date, there is no consensus on the optimal frequency of mammographic surveillance in breast cancer patients receiving breast conserving surgery following neoadjuvant therapy given their higher risk for recurrent disease. Our data demonstrates overall low-yield and high costs associated with semi-annual mammography and suggests that annual mammography with clinical breast exam is sufficient for detecting locoregional recurrences.

Recommendations on screening mammography in patients with ventriculoperitoneal shunts and deep brain stimulation

Insertion of ventriculoperitoneal (VP) shunt and deep brain stimulation (DBS) are common neurosurgical procedures. Concerns have been raised regarding the safety of mammography in this patient cohort due to the risk of damaging the VP shunt tubing or DBS implantable pulse generator, and the degradation in mammography image quality secondary to the implanted devices. Based on a review of the current literature, the authors propose that mammography is safe in patients with VP shunts and DBS, and should be performed routinely as a part of population screening.

Role of Contrast-Enhanced Spectral Mammography in the detection of breast cancer

Objective: to assess the benefits of using contrast-enhancer spectral mammography in patients with an established category of BI-RADS 4a, 4b according to the results of a standard examination (digital mammography and ultrasound). Materials and methods. The date of 425 patients with a suspicious category of BI-RADS in the period from 2018 to 2021 were analyzed. As part of the additional examination, all patients underwent contrast-enhanced spectral mammography follow by histological verification of the identified changes. The sensitivity and specificity of the methods were evaluated. Results. The final diagnosis of breast cancer was established in 247 (58.1%) patients out of 425 women. Multicenter and multifocal growth was diagnosed in 17 (6.8%) patients out of 247, and primary multiple synchronous cancer was detected in 6 (2.4%) patients out of 247. False-positive cases when assessing CESM mainly consisted of: typical and atypical ductal hyperplasia, fibroadenoma, intraductal papilloma. Conclusion. Contrast-enhancer spectral mammography is a highly sensitive and highly specific method in the detection of malignant tumors of the breast. The method also allows minimizing the number of unwanted interventions in suspicious BI-RADS categories.

Uptake of MRI in patients without a personal history of breast cancer (PHBC) classified as “high risk”.

e18754 Background: The American Cancer Society (ACS) recommends annual screening MRI in addition to mammography in patients without a personal history of breast cancer (PHBC) who are ages 25-75 with a Tyrer-Cuzick (TC) score ≥ 20%. Here, we evaluate the uptake of supplemental MRI in these high-risk patients. Methods: Data was extracted from the EMR of an academic medical center for patients (ages 25-75) with a mammogram between 07/20/2020 and 07/19/2021 and a TC ≥ 20%. We assessed uptake differences in demographics, access to healthcare, and breast density in the patient populations that opted for supplemental MRI. A chi-squared analysis was used to compare the groups: 1) No supplemental screening, 2) Patients who underwent MRI supplemental screening, and 3) Patients who did not receive MRI supplemental screening. Results: Of the 1144 patients with a TC ≥ 20%, 27% (n = 307) underwent supplemental MRI screening, while 73% (n = 837) did not. Out of 635 patients with an MRI order, those who were recommended by a high-risk breast cancer (HRBC) provider (n = 227, 36%) were more likely to undergo the MRI (88%, n = 200) compared to those without a HRBC provider (33%, n = 135) (p-value &lt; 0.001). However, the other 509 patients that were recommended MRI never followed up for further imaging or health care visits. Of the patients who were notified that they had dense breasts (n = 842, 74%), 28% (n = 237) underwent MRI, compared to those without dense breasts (18%, n = 55) (p-value &lt; 0.001). Conclusions: 27% (n = 307 out of 1144) of women without a PHBC who are at high-risk for breast cancer underwent MRI as a supplemental breast cancer screening. Our study shows that access to a HRBC is a contributing factor to follow through with the recommended MRI as a supplemental screening. More than 80% of the patients who underwent MRI had a HRBC. Patients may still be faced with challenges, including having access to a HRBC.

Appropriate screening mammography method for patients with breast implants

In this study, we aimed to evaluate the benefits and losses of mammography with and without implant displacement (ID) and propose an appropriate imaging protocol for the screening of breasts with implants. We evaluated mammograms of 162 breasts in 96 patients including 71 breasts with biopsy-proven cancers. Mammography of each breast included standard MLO and ID MLO images. We reviewed the mammograms using clinical image quality criteria, which consist of parameters that evaluate the proper positioning of the breast and the image resolution. Standard MLO images showed significantly higher scores for proper positioning but showed significantly lower scores for image resolution than the ID MLO images. Moreover, standard MLO images showed significantly higher kVp, mAs, and compressed breast thickness than the ID MLO images. The organ dose was also higher in the standard MLO images than in the ID MLO images, but the difference was not statistically significant. In mammography with proven cancer, ID MLO images showed significantly higher degree of cancer visibility than standard MLO images. For screening mammography in patients with breast implants, ID MLO view alone is sufficient for MLO projection with reducing the patient’s radiation dose without compromising the breast cancer detection capability, especially in dense breasts with subpectoral implants.

Performance of abbreviated protocols versus unenhanced MRI in detecting occult breast lesions of mammography in patients with dense breasts

To assess the diagnostic ability of abbreviated protocols of MRI (AP-MRI) compared with unenhanced MRI (UE-MRI) in mammographically occult cancers in patients with dense breast tissue. The retrospective analysis consisted of 102 patients without positive findings on mammography who received preoperative MRI full diagnostic protocols (FDP) between January 2015 and December 2018. Two breast radiologists read the UE, AP, and FDP. The interpretation times were recorded. The comparisons of the sensitivity, specificity and area under the curve of each MRI protocol, and the sensitivity of these protocols in each subgroup of different size tumors used the Chi-square test. The paired sample t-test was used for evaluating the difference of reading time of the three protocols. Among 102 women, there were 68 cancers and two benign lesions in 64 patients and 38 patients had benign or negative findings. Both readers found the sensitivity and specificity of AP and UE-MRI were similar (p > 0.05), whereas compared with FDP, UE had lower sensitivity (Reader 1/Reader 2: p = 0.023, 0.004). For different lesion size groups, one of the readers found that AP and FDP had higher sensitivities than UE-MRI for detecting the lesions ≤ 10 mm in diameter (p = 0.041, p = 0.023). Compared with FDP, the average reading time of UE-MRI and AP was remarkably reduced (p < 0.001). AP-MRI had more advantages than UE-MRI to detect mammographically occult cancers, especially for breast tumors ≤ 10 mm in diameter.

Evaluation of high-risk patients with dense breast on high-resolution ultrasound for screening and detection of breast cancer where mammography is of low significance

Abstract Background: Early diagnosis of breast cancer is a challenging problem in high-risk patients with dense breast. The risk of breast cancer is many fold higher in dense breast as compared to nondense on one side with limited screening or diagnostic role of mammography on the other side. The aim of our study is to elaborate the role of high-resolution ultrasonography (HR-USG) as adjunct modality to overcome this limitation. Materials and Methods: This is a prospective observational study conducted in the breast care clinic of a tertiary care cancer hospital. Totally, 2720 patients were enrolled for mammography. Out of these, 339 patients were reported according to Breast Imaging Reporting and Data System (BIRADS) as 0 (inconclusive) and were suggested for further evaluation by other modalities. All patients reported for mammography as BIRADS 0, were included in this study for HR-USG. Results: On HR-USG, 33.4% of patients with dense breast were shown to have suspicious (BIRADS 5) lesions. 21.7% had simple cysts. Fibro adenomas and abscess were seen in 18% and in 15% of patients, respectively. Other findings were duct ectasia (4.3%) and galactocele (3.4%). 1.4% of patients were normal on HR-USG. Conclusion: Our study showed HR-USG as a modality of choice that supersedes the diagnostic efficiency of mammography in patients with dense breasts thus enhances early detection and better treatment of breast cancer, decreasing mortality owning to delay in diagnosis.

MRI for Evaluation of Complications of Breast Augmentation.

Breast augmentation is one of the most common aesthetic procedures performed in the United States. Several techniques of breast augmentation have been developed, including the implantation of breast prostheses and the injection of autologous fat and other materials. The most common method of breast augmentation is to implant a prosthesis. There are different types of breast implants that vary in shape, composition, and the number of lumina. The rupture of breast implants is the leading cause of implant removal. The rupture rate increases substantially with the increasing age of the implant. Most implant ruptures are asymptomatic. Implant complications can be grouped into two categories: local complications in the breast and adjacent soft tissue, and systemic complications associated with rheumatologic or neurologic symptoms. The onset of local complications may be early (infection and periprosthetic collections including seromas, hematomas, or abscesses) or late (capsular contraction, implant rupture, gel bleed, or breast implant-associated anaplastic large cell lymphoma). Although mammography is the imaging modality for breast cancer screening, noncontrast breast MRI is the imaging modality of choice for evaluation of the integrity of breast implants and the complications of breast augmentation, for equivocal findings at conventional imaging, and as a supplement to mammography in patients with free injectable materials. The fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) provides a systematic outline for MRI evaluation of patients with breast implants. Silicone- and water-selective sequences provide useful supplemental information to confirm intracapsular and extracapsular rupture. Breast MRI for evaluation of implant integrity does not require intravenous contrast material. The use of MRI contrast material in patients with breast augmentation is indicated when infection or malignancy is suspected. Radiologists should have a thorough understanding of the different techniques for breast augmentation, normal imaging features, and complications specific to breast augmentation. An invited commentary by Ojeda-Fournier is available online. ©RSNA, 2022.

Prediction of Underestimation Using Contrast-Enhanced Spectral Mammography in Patients Diagnosed as Ductal Carcinoma In Situ on Preoperative Core Biopsy

BackgroundTo assess the performance of contrast-enhanced spectral mammography (CESM) for the prediction of DCIS underestimation in comparison with mammography, breast US, and breast MRI. Patients and MethodsWe prospectively enrolled patients diagnosed with DCIS on preoperative core biopsy. Visibility, lesion type, and extent on each imaging modality, CESM gray values (CGV) were evaluated. Pathologic features of core biopsy and surgery were recorded. Chi-square or Fisher's exact test were used for univariate analysis. Multivariate logistic regression analysis was used to find independent predictors for DCIS underestimation and receiver operating characteristic (ROC) curve analysis was performed. ResultsA total of 113 lesions in 108 patients were analyzed (50 pure DCIS; 63 underestimated DCIS). Visibility on mammography, breast US, CESM, and breast MRI were 44%, 76%, 58%, and 80% for pure DCIS, and 73%, 81%, 86%, and 92% for underestimated DCIS. Tumor extents on surgical pathology of pure and underestimated DCIS were 1.11 ± 1.35 cm and 2.61 ± 2.09 cm. On multivariate analysis, nuclear grade and suspected invasion on core biopsy, visibility on mammography, and extent on breast MRI were independent factors for the model 1, whereas nuclear grade on core biopsy, extent on CESM, and mean CGV on MLO-recombined image were independent factors for the model 2. Area under ROC curve (AUC) was 0.843 for model 1 including breast MRI, whereas AUC was 0.823 for model 2 including CESM, which didn't show a significant difference (P = .968). ConclusionFor detecting underestimated DCIS, CESM was superior to mammography and breast US, and comparable to breast MRI.

Abstract PS3-23: Experience of contrast-enhanced mammography in patients with breast augmentation surgery

Abstract Background: Contrast-enhanced mammography (CEM) is an emerging breast imaging technique utilizing iodinated contrast to highlight areas of neovascularity. The role of CEM in patients with breast implants has not yet been characterized. We report our clinical experience of CEM in patients with breast augmentation surgery to better understand the potential diagnostic utility and limitations of CEM in the setting of breast implants. Materials and Methods: A HIPPA compliant, IRB exempt single-institution review of prospective CEM cases who had “breast implants” in their report between 01/2015 and 03/2020. Medical records were reviewed to supplement database information. Results: Forty-six patients were included with a mean age of 52 years (range 33-72). Clinical indications included: high risk research screen 3 (6%), diagnostic evaluation for abnormal imaging 24 (52%), further evaluation of newly diagnosed breast cancer 12 (26%) or assessment of neoadjuvant treatment response 7 (15%). Thirty patients had malignant lesions. Histology was invasive ductal carcinoma (90%), invasive lobular carcinoma (7%), and ductal carcinoma in situ (3%). CEM identified the index cancer and extent of disease in 28/30 (93%) of malignant cases. In two patients (7%), the malignant lesion was not included in the field-of-view due to its location. One of these lesions was a far medial mass within the breast which was detected by ultrasound alone. The other false negative CEM was a palpable axillary mass negative on both mammogram (MG) and MRI but seen by ultrasound. Twenty-three (50%) underwent additional breast MRI of which 20 had an already diagnosed cancer. the findings on CEM were concordant with MR imaging for the index lesion in 19/20 (95%) cases (kappa=0.86; p &amp;lt;0.001). Six additional lesions were found by CEM and confirmed by MRI. Of these lesions, 33% were found to be malignant and changed the surgical procedure. Four were only seen on CEM (no MRI comparison was available) and 75% were found to be malignant. One was only seen on MRI and was benign. One additional lesion was only seen as an asymmetry on MG without CEM or MRI correlate. This was benign on both the biopsy and surgical pathology. Conclusions: CEM appears to be a valuable breast imaging modality for diagnostic evaluations and surgical staging, including patients with breast implants. Due to technical artifacts and positioning limitations for posterior lesions, we recommend performing CEM with implant displaced views. Breast centers that use CEM, should be aware of field of view as a potential limitation when evaluating extent of disease in patients with breast augmentation. Citation Format: Molly Carnahan, Barbara Pockaj, Victor Pizzitola, Marina Giurescu, Roxanne Lorans, William Eversman, Richard Sharpe, Patricia Cronin, Donald Northfelt, Karen Anderson, Brenda Ernst, Bhavika Patel. Experience of contrast-enhanced mammography in patients with breast augmentation surgery [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS3-23.

Added value of contrast-enhanced spectral mammography in symptomatic patients with dense breasts

BackgroundBreast cancer is the most common malignancy in females around the world representing 25.1% of all cancers.The high prevalence and need for early treatment of breast malignancy highlight the importance of early and accurate diagnosis. In order to achieve this target, it is necessary to select the most appropriate modality for investigation.Early detection of breast cancer by conventional mammography tends to reduce mortality; however, it has a low sensitivity and specificity in young females with dense breasts owing to reduced contrast between a possible tumor and the surrounding breast tissue with superimposition of the glandular tissue obscuring underlying lesions.Our study included 25 patients with dense breasts presented with different breast symptoms, yet the breast lump was the most common complaint. The aim of our study is to evaluate the supplementary value of contrast-enhanced spectral mammography in the assessment of symptomatic patients with dense breasts.ResultsIn our study, the enrolled subjects underwent both contrast-enhanced spectral mammography (CESM) and conventional full-field digital mammography (FFDM). CESM was shown to be better than FFDM in terms of sensitivity, positive predictive value, negative predictive value, and accuracy, measuring 100%, 77.8%, 100%, and 84%, compared to 56%, 75%, 46%, and 60%, respectively, yet both modalities showed low specificity, measuring 63.6% and 66.6% for CESM and FFDM, respectively.The added value of CESM was assessed in terms of ability to detect and correctly characterize the lesions in correlation to histopathological results where CESM could detect 88% of the lesions included in our study and correctly characterized 84% of the lesions; on the other side, FFDM detected only 20% of the lesions and correctly characterized 60% of the lesions. CESM changed the treatment plan to a more extensive surgery +/− neoadjuvant chemotherapy in 57% out of fourteen cases diagnosed with breast cancer emphasizing the role of CESM in assessing the extent of the disease, multicentricity, and multifocality and consequently tailoring the most appropriate treatment plan suitable for each patient.ConclusionContrast-enhanced spectral mammography is superior to full-field digital mammography in patients with dense breasts with a significant supplementary value in detection, characterization of lesions, and tailoring the appropriate treatment plan.

К юбилею Адольфа Исааковича Бухмана

Adolf I. Bukhman, one of the founding fathers of Russian roentgenology, was celebrating his 90th anniversary on September 30, 2018. A.I. Bukhman has developed, modified, and launched into clinical practice 27 diagnostic and radiation therapy procedures (lymphography of the thyroid and parathyroid glands, electroroentgenography and thermography in patients with endocrine disorders, bone age assessment tables taking into account developmental acceleration, etc.). He was first to address the issue skeletal mineralization with respect to age, characterize the condition of soft tissues in patients with diabetes mellitus and acromegaly, and develop radiation therapy to manage angiopathies, arthropathies, and trophic ulcers. A.I. Bukhman has significantly contributed to the development of mammography. He was first to publish the first studies on using mammography in patients with endocrine disorders in the USSR. Adolf Isaakovich has also been the first roentgenologist worldwide who has described fluoromammography. Adolf Isaakovich has earned love and respect from his colleagues. On his anniversary, the staff of the National Medical Research Center for Endocrinology are wishing Adolf Isaakovich sound health, many fruitful years for the benefit of Russian roentgenology and endocrinology, success in future endeavors, wellbeing, vivacity and fortitude.

On the Occasion of the Anniversary of Adolf I. Bukhman

Adolf I. Bukhman, one of the founding fathers of Russian roentgenology, was celebrating his 90th anniversary on September 30, 2018.&#x0D; A.I. Bukhman has developed, modified, and launched into clinical practice 27 diagnostic and radiation therapy procedures (lymphography of the thyroid and parathyroid glands, electroroentgenography and thermography in patients with endocrine disorders, bone age assessment tables taking into account developmental acceleration, etc.). He was first to address the issue skeletal mineralization with respect to age, characterize the condition of soft tissues in patients with diabetes mellitus and acromegaly, and develop radiation therapy to manage angiopathies, arthropathies, and trophic ulcers. A.I. Bukhman has significantly contributed to the development of mammography. He was first to publish the first studies on using mammography in patients with endocrine disorders in the USSR. Adolf Isaakovich has also been the first roentgenologist worldwide who has described fluoromammography.&#x0D; Adolf Isaakovich has earned love and respect from his colleagues. On his anniversary, the staff of the National Medical Research Center for Endocrinology are wishing Adolf Isaakovich sound health, many fruitful years for the benefit of Russian roentgenology and endocrinology, success in future endeavors, wellbeing, vivacity and fortitude.

Missed Breast Cancer: What We Can Do!

Background: Breast cancer is a major health concern all over the world, and also in the Kingdom of Saudi Arabia. Despite availability of modern facilities in diagnosis and improvements in healthcare systems, still many of the breast cancers are missed. Careful understanding of situation may help to minimize and even stop such unfortunate outcomes. Aim: To highlight various aspects of missed breast cancers on mammography based on their cause and course of disease. Methods: We retrospectively reviewed clinical information, imaging data and outcomes of mammography in patients who presented for both screening and diagnostic mammography in our hospital. Although we found less number of patients having diagnosed or developed breast cancer (on follow-up mammography and biopsy results) with initial negative mammogram studies. Careful analysis of clinical and imaging findings were made and interviews with the patients conducted to sort out cause of such unfortunate outcome (of missed breast cancer). Results: We found important aspects of missed breast cancers because of patient factors (lack of awareness for importance of regular check-up, social factors, inertia for access to care and late check-up), imaging related (suboptimal acquisition of mammogram views), physician related (unfamiliarity with rad-reports and BIRADS classification, late referral) and natural causes (rapid course of disease). Conclusion: Causes of missed breast cancers may be simple to understand but sometimes overlooked by anyone in the chain of process (from technician, patient, radiologist and physician). Careful analysis, creating awareness and implementing standardized practice may help to overcome such unwanted events.

Value Added of Preoperative Contrast-Enhanced Digital Mammography in Patients With Invasive Lobular Carcinoma of the Breast

BackgroundInvasive lobular carcinoma (ILC) is the second most frequently diagnosed breast cancer, accounting for 5% to 15% of all invasive breast cancers, yet it remains radiologically elusive in many cases. The goal of this study was to compare the ability to accurately assess disease extent with contrast-enhanced digital mammography (CEDM) and full-field digital mammography (FFDM) in patients with biopsy-proven ILC. Patients and MethodsA single-institution retrospective review of patients diagnosed with ILC with preoperative CEDM was performed. One of 3 blinded radiologist readers rereviewed cases within 1 month of another. Final size diameter was based on the largest dimension on recombined CEDM or FFDM and compared to the reference standard histopathology. Bland-Altman plots were used to visualize the differences between tumor size on imaging and pathology. ResultsThirty women were included. Mean tumor diameter was 27.0 mm (range, 7.0-118 mm) on postoperative histology, 26.0 mm on CEDM, and 16.4 mm on standard mammogram. For CEDM versus FFDM, 5 (16.7%) of 30 versus 9 (30.0%) of 30 cases underestimated pathology by > 10 mm and 5 (16.7%) of 30 versus 3 (10.0%) of 30 overestimated histopathology by > 10 mm, respectively. Two (6.7%) of 30 cases required surgical reexcision. Both Lin (0.87 vs. 0.55) and Pearson (0.87 vs. 0.70) correlation coefficient measures were higher for CEDM versus FFDM. ConclusionCEDM outperforms standard digital mammography in ability to accurately assess disease extent in patients with biopsy-proven ILC, resulting in improved surgical outcomes. Future studies should compare surgical outcomes in patients with preoperative magnetic resonance imaging and CEDM in patients with ILC.

Abstract P3-10-08: Breast cancer in octogenarians: Presentation and treatment affect mortality

Abstract Background: Breast cancer incidence increases in age. Unfortunately, elderly patients are often under-treated and under-diagnosed affecting their overall survival with limited availability of clinical trial data. Patients and Methods: We used data from our cancer registry and our state cancer registry to evaluate cases of breast cancer diagnosed between the years 2005 and 2010 with follow up data available to date to examine the method of diagnosis (mammogram vs. palpable abnormality), age at diagnosis, stage at diagnosis, type of surgery, receptor status, treatment received, and survival. We then were able to use our state database which contained data regarding causality of death. Based on the data available we were able to evaluate the impact of the method of diagnosis and treatment on patient mortality. Results: A total of 495 octogenerian breast cancer patients were diagnosed between 2005 and 2010. The median age at diagnosis was 85 with a range of 81-102. Out of the 495 patients 55% were diagnosed with a mammogram and 41% by palpable abnormality. The patients who presented with a palpable mass were more likely to die of breast cancer (26%) than the patients who presented with a screening abnormality (9%). The patients with a screening abnormality also had a longer survival (30.0 month) among patients who died from breast cancer as opposed to those who presented with a palpable abnormality who died from breast cancer (16.7 months). While the number of patients dying from other causes was similar (65% screened vs. palpable) the patients with palpable findings had a shorter survival (30.5 months) compared to those detected by screening (48.9 months). Table 1: Comparison of outcomes between screen detected and physical exam detected breast cancer patientsOutcomeScreenedPalpableDied of Breast Cancer9% (30.0 months)26% (16.7 months)Died of Other Causes65% (48.9 months)60% (30.5 months)Still Alive25.6% (66.9 months)10% (51.0 months) There was an improvement in survival among patients who presented with a palpable mass and were treated with endocrine therapy (17.3 vs 11%). This improvement did not extend to the screened population (24.3% vs 29%), although the patients who died from breast cancer had an overall longer survival (35.4 months vs 27.3 months). There was also an improvement in survival among patients who received radiation therapy in both the screened (33% vs. 22%) and palpable (22.5% vs 11.1%) groups. Only 6% of patients in the entire study received chemotherapy. Effect of presentation and treatment on survivalModalityScreened/TreatedPalpable/TreatedScreened/ No TreatmentPalpable/No TreatmentRadiation33% (29.6 months)22.5% (10 months)22% (27 months)11.1% (20 months)Endocrine24.3% (35.4 months)17.3% (15.7 months)29% (27.3 months)11% (18.5 months) Conclusion: Our data support continued use of screening mammography in patients who are at good surgical risk into their 80's. The patients who were diagnosed with symptoms fared worse than the patients who had their cancer discovered on routine imaging. There was an improvement in patients who were treated with adjuvant endocrine and radiation therapy although the rationale behind providing or excluding treatment cannot be discerned from this retrospective registry study. Citation Format: Wilson JP, Gadiyaram V, Blumencranz PW. Breast cancer in octogenarians: Presentation and treatment affect mortality [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-10-08.

Abstract OT3-08-01: Interview data from women contemplating LORIS trial entry during the feasibility study

Abstract Background: LORIS is a multi-centre, randomised (1:1) controlled trial of Surgery v Active Monitoring with annual mammography in patients with low risk ductal carcinoma in situ (DCIS). During a 2 year Feasibility Study potential patients were invited to complete the Clinical Trials Questionnaire (CTQ)1 and participate in a semi structured telephone interview about the verbal, written and DVD based trial information. The DVD was produced to complement the patient information sheet (PIS) and incorporates simple graphics and a Q&amp;A session with women asking the Chief Investigator questions about the trial. Aims:To examine the reasons for trial participation/rejection and obtain feedback about the clarity, timing and usefulness of the PIS and DVD in order to identify potential communication drivers and barriers to trial recruitment. Methods: Participants completed the CTQ1 prior to randomisation and with their consent were contacted following randomisation for an interview. Women declining the trial were issued with an optional pack containing the CTQ1 and the researchers' contact details if they wanted an interview. The CTQ1 comprises16 reasons that might influence a decision to either accept or decline a trial. For each statement participants register their agreement or disagreement on a scale of 1 (strongly agree) to 5 (strongly disagree) and indicate the most important reason for their decision. Interviews explored factors such as, attitudes about randomisation, and usefulness of the trial information provided. Results: 41 patients were randomised during feasibility; 20 surgery, 21 active monitoring, 16 patients declined the trial. 40/41(98%) acceptors and 9/16 (56%) decliners completed the CTQ1. The main reason for joining LORIS was:- “I thought the trial offered the best treatment available” 13/40 (32%) and for decling the trial was “The idea of randomisation worried me” (4/9; 44%). 35 interviews were conducted (31/41 (76%) accepted and 4/16 (25%) declined LORIS). At interview acceptors commented that the PIS was very useful and clear (84%; 26/31 &amp; 90%; 28/31, respectively). 74% (23/31) of women who joined LORIS watched the DVD and the majority (19/23; 83%) found it “very useful” and 22 (22/23; 96%) “very easy to understand”. A third of women (10/31) said the PIS and the DVD helped them decide to participate in LORIS. Women who declined the trial had clear treatment preferences; 2/4 did not watch the DVD. Three quarters of women interviewed (19/25) watched the DVD with family members/friends and found it reassuring. One commented it was “Put in words you can understand and not be baffled by”. The most popular aspect was the Q&amp;A session (13/25; 52%). Conclusions:The LORIS DVD was a useful, easy to understand recruitment tool, complementing the PIS. Many women felt reassured that the content was consistent with, and added to that provided by healthcare professionals. Opinions of family and friends, worries about randomisation and personal preferences exert an influence of those declining these types of trial. Fallowfield LJ, Jenkins V, et al. (1998) Attitudes of patients to randomised clinical trials of cancer therapy. Eur J Cancer 34(10):1554–1559. Citation Format: Fallowfield LJ, Matthews L, Jenkins VA, May SF, Francis A, Rae D, Wallis M. Interview data from women contemplating LORIS trial entry during the feasibility study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-08-01.

Downstream Breast Imaging Following Screening Mammography in Medicare Patients with Advanced Cancer: A Population-Based Study.

Screening tests are generally not recommended in patients with advanced cancer and limited life expectancy. Nonetheless, screening mammography still occurs and may lead to follow-up testing. We assessed the frequency of downstream breast imaging following screening mammography in patients with advanced colorectal or lung cancer. Population-based study. The study included continuously enrolled female fee-for-service Medicare beneficiaries ≥65years of age with advanced colorectal (stage IV) or lung (stage IIIB-IV) cancer reported to a Surveillance, Epidemiology, and End Results (SEER) registry between 2000 and 2011. We assessed the utilization of diagnostic mammography, breast ultrasound, and breast MRI following screening mammography. Logistic regression models were used to explore independent predictors of utilization of downstream tests while controlling for cancer type and patient sociodemographic and regional characteristics. Among 34,127 women with advanced cancer (23% colorectal; 77% lung cancer; mean age at diagnosis 75years), 9% (n=3159) underwent a total of 5750 screening mammograms. Of these, 11% (n=639) resulted in at least one subsequent diagnostic breast imaging examination within 9months. Diagnostic mammography was most common (9%; n=532), followed by ultrasound (6%; n=334) and MRI (0.2%; n=14). Diagnostic mammography rates were higher in whites than African Americans (OR, 1.6; p<0.05). Higher ultrasound utilization was associated with more favorable economic status (OR, 1.8; p<0.05). Among women with advanced colorectal and lung cancer, 9% continued screening mammography, and 11% of these screening studies led to at least one additional downstream test, resulting in costs with little likelihood of meaningful benefit.