Breast cancer detection using sonography in women with mammographically dense breasts

BMC Medical Imaging

Moses Galukande²  Sam Bugeza¹  Harriet Kisembo¹  Jimmy Okello¹ 

[1] Department of Radiology and Radiotherapy, Mulago National Referral and University Teaching Hospital, Kampala, Uganda;Department of Surgery, College of Health Sciences, Makerere University, Kampala, Uganda

关键词: Dense breasts;    BIRADS;    Breast cancer;    Sonography;   

Others  :  1125923
DOI  :  10.1186/s12880-014-0041-0

 received in 2014-07-21, accepted in 2014-12-11,  发布年份 2014

【 摘 要 】

Background

Mammography, the gold standard for breast cancer screening misses some cancers, especially in women with dense breasts. Breast ultrasonography as a supplementary imaging tool for further evaluation of symptomatic women with mammographically dense breasts may improve the detection of mass lesions otherwise missed at mammography.

The purpose of this study was to determine the incremental breast cancer detection rate using US scanning in symptomatic women with mammographically dense breasts in a resource poor environment.

Methods

A cross sectional descriptive study. Women referred for mammography underwent bilateral breast ultrasound, and mammography for symptom evaluation. The lesions seen by both modalities were described using sonographic BI-RADS lexicon and categorized. Ultrasound guided core biopsies were performed. IRB approval was obtained and all participants provided informed written consent.

Results

In total 148 women with mammographically dense breasts were recruited over six months. The prevalence of breast cancer in symptomatic women with mammographically dense breasts was 22/148 (15%). Mammography detected 16/22 (73%) of these cases and missed 6/22 (27%). The six breast cancer cases missed were correctly diagnosed on breast ultrasonography. Sonographic features typical of breast malignancy were irregular shape, non-parallel orientation, non circumscribed margin, echogenic halo, and increased lesion vascularity (p values < 0.005). Typical sonofeatures of benign mass lesions were: oval shape, parallel orientation and circumscribed margin (p values <0.005).

Conclusion

Breast ultrasound scan as a supplementary imaging tool detected 27% more malignant mass lesions otherwise missed by mammography among these symptomatic women with mammographically dense breasts. We recommend that ultra sound scanning in routine evaluation of symptomatic women with mammographically dense breasts.

【 授权许可】

   
2014 Okello et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Kelly KM, Dean J, Comulada WS, Lee SJ: Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts. Eur Radiol 2010, 20:734-742.
• [2]Boyd N, Guo H, Martin LJ, Sun L, Stone J, Fishell E, et al.: Mammographic density and the risk and detection of breast cancer. N Engl J Med 2007, 356:227-236.
• [3]Galukande M, Kiguli-Malwadde E: Rethinking breast cancer screening strategies in resource-limited Settings. Afr Health Sci 2010, 10(1):89-92.
• [4]Stomper PC, D’Souza DJ, Di Nitto PA, Arredondo MA: Analysis of parenchymal density on mammograms in 1353 women 25–79 years old. AJR Am J Roentgenol 1996, 167:1261-1265.
• [5]Kelemen LE, Pankratz VS, Sellers TA: Age-specific trends in mammographic density: the Minnesota breast cancer family study. Am J Epidemiol 2008, 167:1027-1036.
• [6]Hersh MR: Imaging the dense breast. Appl Radiol 2004, 33:22.
• [7]Buist DSM, Porter PL, Lehman C, Taplin SH, White E: Factors contributing to mammography failure in women aged 40–49 years. J Natl Cancer Inst 2004, 96:1432-1440.
• [8]Bevers TB, Anderson BO, Bonaccio E, Buys S, Daly MB, et al.: National Comprehensive Cancer Network: Breast cancer screening and diagnosis. J Natl Compr Canc Netw 2009, 7:1060-1096.
• [9]Berg WA, Blume JD, Cormack JB, Mendelson EB, Lehrer D, Böhm-Vélez M, Pisano ED, et al.: Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA 2008, 299:2151-2163.
• [10]Mandelson MT, Oestreicher N, Porter PL, White D, Finder CA, Taplin SH, et al.: Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst 2000, 92:1081-1087.
• [11]American College of Radiology. BI-RADS: Mammography Atlas. 4th edition. American College of Radiology, Reston, VA; 2003.
• [12]American College of Radiology BI-RADS: Ultrasound, 1st Ed In Breast imaging reporting and data system: BI-RADS atlas 4th ed. American College of Rad, Reston, VA; 2003.
• [13]Zanello PA, Felipe A, Robim C, Mendes T, Oliveira G, et al. Breast ultrasound diagnostic performance and outcomes for mass lesions using Breast Imaging Reporting and Data System category 0 mammogram, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072469/.
• [14]Hong AS, Rosen EL, Soo M, Jay A, et al.: BI-RADS for Sonography: Positive and Negative Predictive Values of Sonographic Features. AJR 2005, 184:1260-1265.
• [15]Sseggwanyi J, Galukande M, Fualal J, Jombwe J: Prevalence of HIV/AIDS among Breast Cancer Patients and the associated Clinico-pathological features.Annals of African Surgery 2011, 8:22-27
• [16]Zanello P A, Andre Felipe Cica Robim, Tatiane Mendes Gonçalves Oliveira et al. Breast ultrasound diagnostic performance and outcomes for mass lesions using Breast Imaging Reporting and Data System category 0 mammogram.http://www.ncbi.nlm.nih.gov/pubmed/21552670 Accessed on line June 2014
• [17]Gakwaya A, Kigula-Mugambe JB, Kavuma A, Luwaga A, Fualal J, Jombwe J, Galukande M, Kanyike D: Cancer of the breast: 5-year survival in a tertiary hospital in Uganda. Br J Cancer 2008, 99:63-67.
• [18]IAEA; Quality assurance programme for screen film mammography. Volume 2. Viena; ISSN 2075–3772; 2009.