Harmine M. Zonderland

Differences between first and subsequent rounds of the MRISC breast cancer screening program for women with a familial or genetic predisposition

Within the Dutch MRI Screening (MRISC) study, a Dutch multicenter screening study for hereditary breast cancer, the authors investigated whether previously reported increased diagnostic accuracy of magnetic resonance imaging (MRI) compared with mammography would be maintained during subsequent screening rounds.

The positive predictive value of the breast imaging reporting and data system (BI-RADS) as a method of quality assessment in breast imaging in a hospital population

Evaluation of the diagnostic performance of mammography and US in our hospital, based upon the positive predictive value (PPV) for breast cancer of the breast imaging reporting and data system (BI-RADS) final assessment categories, has been performed. A follow-up study of 2,762 mammograms was performed, along with 955 diagnostic exams and 1,807 screening exams. Additional US was performed in 655 patients (23.7%). The combined reports were assigned a BI-RADS category. Follow-up was obtained by pathologic examination, mammography at 12 months or from PALGA, a nationwide network and registry of histo- and cytopathology. Overall sensitivity was 85% (specificity 98.7%); sensitivity of the diagnostic examinations was 92.9% (specificity 97.7%) and of the screening examinations 69.2% (specificity 99.2%). The PPV of BI-RADS 1 was 5 of 1,542 (0.3%), and of BI-RADS 2, it was 6 of 935 (0.6%). BI-RADS 3 was 6 of 154 (3.9%), BI-RADS 4 was 39 of 74 (52.7%) and BI-RADS 5 was 57 of 57 (100%). The difference between BI-RADS 1 and 2 vs. BI-RADS 3 was statistically significant (P<0.01). Analysis of BI-RADS 3 cases revealed inconsistencies in its assignment. Evaluation of the BI-RADS final assessment categories enables a valid analysis of the diagnostic performance of mammography and US and reveals tools to improve future outcomes.

Ultrasound variables and their prognostic value in a population of 1103 patients with 272 breast cancers

Abstract. In a prospective two-centre study targeted US was performed as an adjunct to mammography in a population of 1103 patients with 272 breast cancers, 517 benign lesions and no abnormalities in 314 patients. The purpose of the study was to analyse the distribution of the different US variables among the breast lesions and to determine the prognostic value of these variables with respect to the diagnosis of malignancy. The following variables were analysed: border; contour; orientation; structure; echogenicity; sound transmission; and size. These variables were correlated with the definitive diagnosis and univariate analysis was performed. A statistically significant association with breast cancer (p < 0.001) was present for irregular border; ill-defined contour; indeterminate or vertical orientation; homogeneous, complex or heterogeneous structure; hypoechogenicity; and unchanged or decreased sound transmission. Multivariate analysis showed a high independent prognostic value for malignancy for irregular border, followed by ill-defined contour and unchanged or decreased sound transmission. However, their discriminative power was not absolute: in 38 cancers none of the malignant US variables were present, and in 11 benign lesions all variables were present. There were hardly any benign-looking lesions that proved to be malignant.

The role of ultrasound in the diagnosis of breast cancer

Ultrasonography (US) of the breast is not applied to its optimal capacity if it is restricted to the differentiation between cystic and solid lesions and evaluation of dense breasts. It can play a major role in the detection of breast cancer; not only because of detection of mammographically occult lesions but also because of more accurate identification of lesion characteristics suspicious of malignancy. Its yield is highest among women younger than 50 years. However, one should keep in mind that the profit obtained by US shows not only the diagnostic accuracy of US but also that of mammography. Further improvement can be achieved by refinement in US diagnosis, especially with respect to the US characteristics of diffusely growing cancers.

Additional value of US to mammography: profit and loss

To determine the additional value of US to mammograpln in benign and malignant breast pathology three observers scored on a five-point scale the mammograms retrospectively of 18 1 breast lesions consisting of 58 benion cystic lesions, 48 solid benign lesions and 75 malignant lesions. Subsequently, the sono,,rams were added and a second score followed. The scores were compared with the final diagnosis. Receiver-operating characteristics (ROCS) and x values for interobserrver variability were calculated, and with the differences between the mammogram scores and the sonogram scores a “profit-and-loss account” was designed. The ROCS showed the best performance after adding the sonograms, but the difference was not significant. On the basis of the profit-and-loss account the diagnostic performance could be analysed as profit in improved detection and loss in a downswing. In the category of benign cystic lesions the profit of US was 14.2 % and the loss was 1.1 %. In the category of benign solid lesions the profit was 1.3 % Because of an increase in false-positive malignant diagnoses US led to a loss of 10.1 % In the malignant lesions US led to a profit of 10.2% and a loss of 0.8 % In conclusion. US acids valuable additional information to the diagnosis of malignancies, but is a source of confusion in benign solid lesions. Its unreliability in the differentiation between solid benign and malignant lesions necessitates systematic application of fine-needle-aspiration cytology as a reliable diagnostic procedure in breast lesions.