| 1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin 2022;72:7-33. |
Review/Other-Dx |
N/A |
Cancer statistics. |
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes. Incidence data (through 2018) were collected by the Surveillance, Epidemiology, and End Results program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2019) were collected by the National Center for Health Statistics. In 2022, 1,918,030 new cancer cases and 609,360 cancer deaths are projected to occur in the United States, including approximately 350 deaths per day from lung cancer, the leading cause of cancer death. Incidence during 2014 through 2018 continued a slow increase for female breast cancer (by 0.5% annually) and remained stable for prostate cancer, despite a 4% to 6% annual increase for advanced disease since 2011. Consequently, the proportion of prostate cancer diagnosed at a distant stage increased from 3.9% to 8.2% over the past decade. In contrast, lung cancer incidence continued to decline steeply for advanced disease while rates for localized-stage increased suddenly by 4.5% annually, contributing to gains both in the proportion of localized-stage diagnoses (from 17% in 2004 to 28% in 2018) and 3-year relative survival (from 21% to 31%). Mortality patterns reflect incidence trends, with declines accelerating for lung cancer, slowing for breast cancer, and stabilizing for prostate cancer. In summary, progress has stagnated for breast and prostate cancers but strengthened for lung cancer, coinciding with changes in medical practice related to cancer screening and/or treatment. More targeted cancer control interventions and investment in improved early detection and treatment would facilitate reductions in cancer mortality. |
4 |
| 2. Moossdorff M, van Roozendaal LM, Strobbe LJ, et al. Maastricht Delphi consensus on event definitions for classification of recurrence in breast cancer research. J Natl Cancer Inst 2014;106. |
Review/Other-Dx |
N/A |
To reach consensus on the definitions of local event, second primary breast cancer, regional and distant event for breast cancer studies. |
Twenty-four international breast cancer experts participated. Consensus was reached on 134 items in four categories. Local event is defined as any epithelial breast cancer or ductal carcinoma in situ (DCIS) in the ipsilateral breast, or skin and subcutaneous tissue on the ipsilateral thoracic wall. Second primary breast cancer is defined as epithelial breast cancer in the contralateral breast. Regional events are breast cancer in ipsilateral lymph nodes. A distant event is breast cancer in any other location. Therefore, this includes metastasis in contralateral lymph nodes and breast cancer involving the sternal bone. If feasible, tissue sampling of a first, solitary, lesion suspected for metastasis is highly recommended. |
4 |
| 3. Kalli S, Semine A, Cohen S, Naber SP, Makim SS, Bahl M. American Joint Committee on Cancer's Staging System for Breast Cancer, Eighth Edition: What the Radiologist Needs to Know. [Review]. Radiographics. 38(7):1921-1933, 2018 Nov-Dec. |
Review/Other-Dx |
N/A |
To review the major changes in the AJCC eighth edition for breast cancer staging, review anatomic TNM staging, familiarize the radiologist with prognostic biomarkers and prognostic staging, and identify key sites of disease that may alter clinical management. ©RSNA, 2018. |
No results in abstract |
4 |
| 4. Giuliano AE, Connolly JL, Edge SB, et al. Breast Cancer-Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA: a Cancer Journal for Clinicians. 67(4):290-303, 2017 07 08. |
Review/Other-Dx |
N/A |
To summarize major changes in the guidelines for the staging of breast cancer and describe clinical implications for treatment decision making based on the eighth edition of the American Joint Committee on Cancer guidelines. |
No results stated in abstract. |
4 |
| 5. Kim JY, Lim JE, Jung HH, et al. Validation of the new AJCC eighth edition of the TNM classification for breast cancer with a single-center breast cancer cohort. Breast Cancer Res Treat. 171(3):737-745, 2018 Oct. |
Observational-Dx |
2,790 breast cancer patients |
To evaluate the prognostic value of this new staging system compared to the previous AJCC 7th edition staging system. |
Of 3,208 BCs, this study was analyzed using the information of 2,790 BC patients. Hormone receptor-positive (HR+) and human epidermal growth factor 2 (HER2)- BCs were observed in 62.9% of BCs, HR+/ HER2+ in 9.3%, HR-/HER2- in 17.0%, and HR-/HER2+ in 10.8%. In survival analysis, we observed 245 distant recurrences and 198 deaths caused by BC progression. The median follow-up duration was 116.2 months. 10-year disease-specific survival (DSS) rates according to the AJCC 7th edition criteria were 97.2% of stage IA, 100% of IB, 94.9% of IIA, 87.9% of IIB, 86.4% of IIIA, 95.7% of IIIB, and 65.7% of IIIC (p < 0.001). After applying 8th edition criteria, the 10-year DSS rates were 98.1% of stage IA, 97.7% of IB, 93.8% of IIA, 92.7% of IIB, 88.2% of IIIA, 80.8% of IIIB, and 70.3% of IIIC (p < 0.001). |
4 |
| 6. Stringer-Reasor EM, Elkhanany A, Khoury K, Simon MA, Newman LA. Disparities in Breast Cancer Associated With African American Identity. Am Soc Clin Oncol Educ Book 2021;41:e29-e46. |
Review/Other-Dx |
N/A |
To discuss persistent disparities in the burden of breast cancer between African Americans and White Americans have been documented over many decades. |
No results provided |
4 |
| 7. Jatoi I, Sung H, Jemal A. The Emergence of the Racial Disparity in U.S. Breast-Cancer Mortality. N Engl J Med 2022;386:2349-52. |
Review/Other-Dx |
n/a |
No abstract available |
No abstract available |
4 |
| 8. Hahn EE, Tang T, Lee JS, et al. Use of imaging for staging of early-stage breast cancer in two integrated health care systems: adherence with a choosing wisely recommendation. J Oncol Pract. 11(3):e320-8, 2015 May. |
Review/Other-Dx |
10,010 patients with stages 0 to IIb breast cancer |
To evaluate and compare use of imaging for staging of breast cancer in two integrated health care systems, Kaiser Permanente (KP) and Intermountain Healthcare (IH).To distinguish whether imaging was routine or used for diagnostic purposes. |
For the sample of 10,010 patients, mean age at diagnosis was 60 years (range, 22 to 99 years); with 21% stage 0, 47% stage I, and 32% stage II. Overall, 15% of patients (n = 1,480) received at least one imaging test during the staging window, 15% at KP and 14% at IH (P = .5). Eight percent of patients received imaging before surgery, and 7% postsurgery. We found significant intraregional variation in imaging use. Chart abstraction (n = 129, 16% of patients who received presurgical imaging) revealed that 48% of presurgical imaging was diagnostic. |
4 |
| 9. Lupichuk S, Tilley D, Surgeoner B, King K, Joy AA. Unwarranted imaging for distant metastases in patients with newly diagnosed ductal carcinoma in situ and stage I and II breast cancer. Canadian Journal of Surgery. 63(2):E100-E109, 2020 02 28. |
Observational-Dx |
10,142 patients |
To report on the use of unwarranted bone scanning (BS), computed tomography (CT), nonbreast magnetic resonance imaging (MRI) and positron emission tomography (PET) among women diagnosed with stage 0–II breast cancer in Alberta in 2011–2015. |
Of 10,142 patients included, 2887 (28.5%) had at least 1 advanced imaging test completed for routine metastatic screening. Of these 2887 patients, 438 (15.2%) had a follow-up BS, CT, MRI or PET, and 28 patients (1.0%) had a nonbreast imageguided biopsy. Use of routine advanced imaging tests did not change clearly over time. |
4 |
| 10. Keating NL, Landrum MB, Guadagnoli E, Winer EP, Ayanian JZ. Surveillance testing among survivors of early-stage breast cancer. J Clin Oncol. 2007;25(9):1074-1081. |
Review/Other-Dx |
44,511 women |
To describe follow-up care for breast cancer survivors, examine how surveillance testing varies by the types of physicians seen, and assess changes in testing rates over time. |
Nearly half of breast cancer survivors saw a medical oncologist in surveillance year 1, but only 27% saw a medical oncologist annually for 3 years. In adjusted analyses, women seeing medical oncologists had more bone scans, tumor antigen testing, chest x-rays, and chest/abdominal imaging than other women (all P<.001). Nevertheless, rates of testing decreased over time (all P<.001). Rates of tumor antigen testing and chest x-rays decreased faster and chest/abdominal imaging increased slower among women seeing medical oncologists than among other women (all P<.05). |
4 |
| 11. Catalano OA, Daye D, Signore A, et al. Staging performance of whole-body DWI, PET/CT and PET/MRI in invasive ductal carcinoma of the breast. Int J Oncol. 51(1):281-288, 2017 Jul. |
Observational-Dx |
51 women with newly diagnosed invasive ductal carcinoma |
To evaluate the performance of whole-body diffusion-weighted imaging (WB-DWI), whole-body positron emission tomography with computed tomography (WB-PET/CT), and whole-body positron emission tomography with magnetic resonance imaging (WB-PET/MRI) in staging patients with untreated invasive ductal carcinoma of the breast. |
WB-DWI, WB-PET/CT and WB-PET/MRI correctly and concordantly staged 33/51 patients: stage IIA in 7 patients, stage IIB in 8 patients, stage IIIC in 4 patients and stage IV in 14 patients. WB-DWI, WB-PET/CT and WB-PET/MRI incorrectly and concordantly staged 1/51 patient as stage IV instead of IIIA. Discordant staging was reported in 17/51 patients. WB-PET/MRI resulted in improved staging when compared to WB-PET/CT (50 correctly staged on WB-PET/MRI vs. 38 correctly staged on WB-PET/CT; McNemar's test; p<0.01). Comparing the performance of WB-PET/MRI and WB-DWI (43 correct) did not reveal a statistically significant difference (McNemar test, p=0.14). WB-PET/MRI is more accurate in the initial staging of breast cancer than WB-DWI and WB-PET/CT, however, the discrepancies between WB-PET/MRI and WB-DWI were not statistically significant. |
2 |
| 12. de Mooij CM, Sunen I, Mitea C, et al. Diagnostic performance of PET/computed tomography versus PET/MRI and diffusion-weighted imaging in the N- and M-staging of breast cancer patients. Nucl Med Commun 2020;41:995-1004. |
Review/Other-Dx |
11 studies |
To provide a systematic review regarding the diagnostic performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) and diffusion-weighted imaging (DWI) compared to 18F-FDG PET/computed tomography (CT) focused on nodal and distant staging in breast cancer patients. |
Eleven eligible studies were selected from 561 publications identified by the search. In seven studies, PET/CT was compared with PET/MRI, and in five, PET/CT with DWI. Significantly higher sensitivity for PET/MRI compared to PET/CT in a lesion-based analysis was reported for all lesions together (77% versus 89%) in one study, osseous metastases (69-99% versus 92-98%) in two studies and hepatic metastases (70-75% versus 80-100%) in one study. Moreover, PET/MRI revealed a significantly higher amount of osseous metastases (90 versus 141) than PET/CT. PET/CT is associated with a statistically higher specificity than PET/MRI in the lesion detection of all lesions together (98% versus 96%) and of osseous metastases (100% versus 95%), both in one study. None of the reviewed studies reported significant differences between PET/CT and DWI for any of the evaluated sites. There is a trend toward higher specificity for PET/CT. |
4 |
| 13. Han S, Choi JY. Impact of 18F-FDG PET, PET/CT, and PET/MRI on Staging and Management as an Initial Staging Modality in Breast Cancer: A Systematic Review and Meta-analysis. Clin Nucl Med 2021;46:271-82. |
Meta-analysis |
29 studies (4276 patients) |
To perform a systematic review and meta-analysis to evaluate the impact of 18F-FDG PET, PET/CT, and PET/MRI on staging and management during the initial staging of breast cancer. |
We included 29 studies (4276 patients). The pooled proportions of changes in stage and management were 25% (95% confidence interval [CI], 21%-30%) and 18% (95% CI, 14%-23%), respectively. When stage changes were stratified according to initial stage, the pooled proportions were 11% (95% CI, 3%-22%) in stage I, 20% (95% CI, 16%-24%) in stage II, and 34% (95% CI, 27%-42%) in stage III. The relative proportions of intermodality and intention-to-treat changes were 74% and 70%, respectively. Using metaregression analyses, the mean age and the proportion of initial stage III to IV and histologic grade II to III were significant factors affecting the heterogeneity in changes in stage or management. |
Inadequate |
| 14. Lin CY, Lin CL, Kao CH. Staging/restaging performance of F18-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging in breast cancer: A review and meta-analysis. Eur J Radiol. 107:158-165, 2018 Oct. |
Meta-analysis |
8 studies |
To assess the staging/restaging performance of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance imaging (MRI) in breast cancer. |
The patient-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of F18-FDG PET/MRI for staging in breast cancer were 0.98 (95% CI, 0.95-0.99), 0.87 (95% CI, 0.76-0.95), 4.59 (95% CI, 1.91-11.05), 0.03 (95% CI, 0.01-0.09), 203.07 (95% CI, 50.33-819.38), and 0.99, respectively. The lesion-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of F18-FDG PET/MRI for staging in breast cancer were 0.91 (95% CI, 0.88-0.94), 0.95 (95% CI, 0.92-0.97), 11.28 (95% CI, 4.25-29.96), 0.07 (95% CI, 0.02-0.22), 286.46 (95% CI, 64.15-1279.17), and 0.99, respectively. The overall diagnostic accuracies (Q* index) of the staging performance of F18-FDG PET/MRI in breast cancer were 0.96 (patient-based analysis) and 0.95 (lesion-based analysis). |
Inadequate |
| 15. Lu XR, Qu MM, Zhai YN, Feng W, Gao Y, Lei JQ. Diagnostic role of 18F-FDG PET/MRI in the TNM staging of breast cancer: a systematic review and meta-analysis. Ann Palliat Med 2021;10:4328-37. |
Meta-analysis |
7 studies |
To investigate the value of 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) in diagnosing local tumor invasion (T stage), evaluating regional lymph node involvement (N stage), and detecting distant metastasis (M stage) in breast cancer patients. |
Based on seven studies, the pooled sensitivity, specificity and AUC for the diagnosis of T stage were 91% (95% CI: 84-96%), 91% (95% CI: 81-96%), and 0.96 (95% CI: 0.94-0.98), respectively. For N stage evaluation, four studies were included, with values of 94% (95% CI: 83-98%), 90% (95% CI: 81-95%), and 0.96 (95% CI: 0.94-0.97). For M stage detection, five studies were evaluated, with values of 98% (95% CI: 96-99%), 96% (95% CI: 83-99%), and 0.99 (95% CI: 0.98-1.00). |
Good |
| 16. Sumkin JH, Berg WA, Carter GJ, et al. Diagnostic Performance of MRI, Molecular Breast Imaging, and Contrast-enhanced Mammography in Women with Newly Diagnosed Breast Cancer. Radiology. 293(3):531-540, 2019 12. |
Observational-Dx |
99 women |
To compare extent-of-disease assessments by using MRI, CEM, and MBI versus pathology in women with breast cancer. |
A total of 102 women were enrolled and 99 completed the study protocol (mean age, 51 years ± 11 [standard deviation]; range, 32-77 years). Lumpectomy or mastectomy was performed in 71 women (79 index malignancies) without neoadjuvant chemotherapy and in 28 women (31 index malignancies) with neoadjuvant chemotherapy. Of the 110 index malignancies, MRI, CEM, and MBI depicted 102 (93%; 95% confidence interval [CI]: 86%, 97%), 100 (91%; 95% CI: 84%, 96%), and 101 (92%; 95% CI: 85%, 96%) malignancies, respectively. In patients without neoadjuvant chemotherapy, pathologic size of index malignancies was overestimated with all modalities (P = .02). MRI led to overestimation of 24% (17 of 72) of malignancies by more than 1.5 cm compared with 11% (eight of 70) with CEM and 15% (11 of 72) with MBI. MRI depicted more (P = .007) nonindex lesions, with sensitivity similar to that of CEM or MBI, resulting in lower positive predictive value of additional biopsies (13 of 46 [28%; 95% CI: 17%, 44%] for MRI; 14 of 27 [52%; 95% CI: 32%, 71%] for CEM; and 11 of 25 [44%; 95% CI: 24%, 65%] for MBI (overall P = .01). |
3 |
| 17. Kim BS.. Usefulness of breast-specific gamma imaging as an adjunct modality in breast cancer patients with dense breast: a comparative study with MRI. Ann Nucl Med. 26(2):131-7, 2012 Feb. |
Observational-Dx |
66 patients with dense breasts and biopsy-confirmed breast cancer |
To evaluate the adjunctive benefits of breast-specific gamma imaging (BSGI) versus magnetic resonance imaging (MRI) in breast cancer patients with dense breasts. |
Twenty-six of the 97 breast lesions proved to be malignant tumors (invasive ductal cancer, n = 16; ductal carcinoma in situ, n = 6; mixed or other malignancies, n = 4); the remaining 71 lesions were diagnosed as benign tumors. The sensitivity and specificity of BSGI were 88.8% (confidence interval (CI), 69.8-97.6%) and 90.1% (CI, 80.7-95.9%), respectively, while the sensitivity and specificity of MRI were 92.3% (CI, 74.9-99.1%) and 39.4% (CI, 28.0-51.7%), respectively (p < 0.0001). MRI detected 43 false-positive breast lesions, 37 (86.0%) of which were correctly diagnosed as benign lesions using BSGI. In 12 malignant lesions <1 cm, the sensitivities of BSGI and MR imaging were 83.3% (CI, 51.6-97.9%) and 91.7% (CI, 61.5-99.8%), respectively. |
3 |
| 18. Hunt KN, Conners AL, Goetz MP, et al. Comparison of 99mTc-Sestamibi Molecular Breast Imaging and Breast MRI in Patients With Invasive Breast Cancer Receiving Neoadjuvant Chemotherapy. AJR Am J Roentgenol. 213(4):932-943, 2019 10. |
Observational-Dx |
34 patients |
To prospectively compare the size of invasive breast cancer before and after neoadjuvant chemotherapy (NAC) at breast MRI and molecular breast imaging (MBI) and to assess the accuracy of post-NAC MBI and MRI relative to pathologic analysis. |
The longest dimension at MRI was within 1.0 cm of that at MBI in 72.3% of cases before NAC and 70.1% of cases after NAC. The difference between the longest dimension at imaging after NAC and pathologic tumor size was within 1 cm for 58.7% of breast MRI cases and 59.6% of MBI cases. Ninety patients underwent both MRI and MBI after NAC. In the 56 patients with invasive residual disease, 10 (17.9%) cases were negative at MRI and 23 (41.1%) cases were negative at MBI. In the 34 patients with breast pathologic complete response, there was enhancement in 10 cases (29.4%) at MRI and uptake in six cases (17.6%) at MBI. Sensitivity, specificity, positive predictive value, and negative predictive value after NAC were 82.8%, 69.4%, 81.4%, and 71.4%, respectively, for MRI and 58.9%, 82.4%, 84.6%, and 54.9%, respectively, for MBI. |
3 |
| 19. Kurland BF, Wiggins JR, Coche A, et al. Whole-Body Characterization of Estrogen Receptor Status in Metastatic Breast Cancer with 16alpha-18F-Fluoro-17beta-Estradiol Positron Emission Tomography: Meta-Analysis and Recommendations for Integration into Clinical Applications. Oncologist 2020;25:835-44. |
Meta-analysis |
113 nonbreast lesions (4 studies); 327 total lesions (11 studies) |
To conduct a meta-analysis of published results comparing 18 F-FES PET and tissue assays of ER status in patients with breast cancer. |
The primary analysis included 113 nonbreast lesions from 4 studies; an expanded analysis included 327 total lesions from 11 studies. Treating IHC results as the reference standard, sensitivity was 0.78 (95% confidence region 0.65-0.88) and specificity 0.98 (0.65-1.00) for the primary analysis of nonbreast lesions. In the expanded analysis including non-IHC tissue assays and all lesion sites, sensitivity was 0.81 (0.73-0.87) and specificity 0.86 (0.68-0.94). These results suggest that 18 F-FES PET is useful for characterization of ER status of metastatic breast cancer lesions. We also review current best practices for conducting 18 F-FES PET scans. This imaging assay has potential to improve clinically relevant outcomes for patients with (historically) ER-positive metastatic breast cancer, including those with brain metastases and/or lobular histology. IMPLICATIONS FOR PRACTICE: 16a-18F-fluoro-17ß-estradiol positron emission tomography (18 F-FES PET) imaging assesses estrogen receptor status in breast cancer in vivo. This work reviews the sensitivity and specificity of 18 F-FES PET in a meta-analysis with reference tissue assays and discusses best practices for use of the tracer as an imaging biomarker. 18 F-FES PET could enhance breast cancer diagnosis and staging as well as aid in therapy selection for patients with metastatic disease. Tissue sampling limitations, intrapatient heterogeneity, and temporal changes in molecular markers make it likely that 18 F-FES PET will complement existing assays when clinically available in the near future. |
Not Assessed |
| 20. Akashi-Tanaka S, Sato N, Ohsumi S, et al. Evaluation of the usefulness of breast CT imaging in delineating tumor extent and guiding surgical management: a prospective multi-institutional study. Ann Surg. 256(1):157-62, 2012 Jul. |
Review/Other-Dx |
297 patients |
To evaluate the usefulness of computed tomographic (CT) imaging in delineating tumor extent and guiding surgical management. |
A total of 297 patients were involved. The surgeons widened the extent of resection in 42 (14.1%, 95% confidence interval 10.1%-18.1%) patients on the basis of the CT findings. Among the 6 patients whose procedures were changed to mastectomy, 4 had pathologically multicentric tumors and 2 had widely spread intraductal components. The remaining 36 patients underwent quadrantectomy instead of wide excision on the basis of the CT images. There were 3 patients in whom conversion from wide excision to quadrantectomy resulted in overexcision. Preoperative breast CT may have reduced the positive margin rate and also correctly changed the extent of surgery in 13.1% of patients. |
4 |
| 21. American College of Radiology. ACR–SABI–SAR–SPR PRACTICE PARAMETER FOR THE PERFORMANCE OF COMPUTED TOMOGRAPHY (CT) OF THE ABDOMEN AND COMPUTED TOMOGRAPHY (CT) OF THE PELVIS. Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=168+&releaseId=2 |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 22. Berg WA, Gutierrez L, NessAiver MS, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 2004; 233(3):830-849. |
Observational-Dx |
111 consecutive women |
To prospectively assess the diagnostic accuracy of mammography, clinical examination, US, and MRI in the preoperative imaging of breast cancer. |
Mammographic sensitivity was highest for invasive ductal carcinoma (IDC) in 89 of 110 (81%) cases versus 10 of 29 (34%) cases of invasive lobular carcinoma (ILC) (P .001) and 21 of 38 (55%) cases of DCIS (P .01). US showed higher sensitivity than did mammography for IDC, depicting 104 of 110 (94%) cases, and for ILC, depicting 25 of 29 (86%) cases (P .01 for each). US showed higher sensitivity for invasive cancer than DCIS (18 of 38 [47%], P .001). MR showed higher sensitivity than did mammography for all tumor types (P .01) and higher sensitivity than did US for DCIS (P .001), depicting 105 of 110 (95%) cases of IDC, 28 of 29 (96%) cases of ILC, and 34 of 38 (89%) cases of DCIS. In anticipation of conservation or no surgery after mammography and clinical examination in 96 breasts, additional tumor (which altered surgical approach) was present in 30. Additional tumor was depicted in 17 of 96 (18%) breasts at US and in 29 of 96 (30%) at MR, though extent was now overestimated in 12 of 96 (12%) at US and 20 of 96 (21%) at MR imaging. After combined mammography, clinical examination, and US, MR depicted additional tumor in another 12 of 96 (12%) breasts and led to overestimation of extent in another six (6%); US showed no detection benefit after MR imaging. Bilateral cancer was present in 10 of 111 (9%) patients; contralateral tumor was depicted mammographically in six and with both US and MR in an additional three. One contralateral cancer was demonstrated only clinically. In non-fatty breasts, US and MRI were more sensitive than mammography for invasive cancer, but both overestimated tumor extent. US showed no detection benefit after MRI. Combined mammography, clinical examination, and MRI were more sensitive than any other individual test or combination of tests. |
3 |
| 23. Kim WH, Chang JM, Moon HG, et al. Comparison of the diagnostic performance of digital breast tomosynthesis and magnetic resonance imaging added to digital mammography in women with known breast cancers. Eur Radiol. 26(6):1556-64, 2016 Jun. |
Observational-Dx |
172 patients with 184 cancers |
To compare the diagnostic performance of digital breast tomosynthesis (DBT) and magnetic resonance imaging (MRI) added to mammography in women with known breast cancers. |
The JAFROC figures of merit (FOMs) was lower in DBT plus mammography (0.937) than MRI plus mammography (0.978, P = 0.0006) but higher than mammography alone (0.900, P = 0 .0013). The sensitivity was lower in DBT plus mammography (88.2 %) than MRI plus mammography (97.8 %) but higher than mammography alone (78.3 %, both P < 0 .0001). The PPV was significantly higher in DBT plus mammography (93.3 %) than MRI plus mammography (89.6 %, P = 0 .0282). |
2 |
| 24. Fontaine M, Tourasse C, Pages E, et al. Local Tumor Staging of Breast Cancer: Digital Mammography versus Digital Mammography Plus Tomosynthesis. Radiology. 291(3):594-603, 2019 06. |
Observational-Dx |
166 patients |
To compare the diagnostic accuracy of DM alone with that of DM plus DBT in the identification of additional ipsilateral and contralateral lesions in women with newly diagnosed breast cancer. |
Twenty-four women (14%) exhibited multifocal lesions; 20 (12%), multicentric lesions; 39 (23%), additional ipsilateral lesions; and 18 (11%), bilateral lesions. The sensitivities were higher for DM plus DBT than for DM in the diagnosis of multicentric (51% [41 of 80] vs 37% [30 of 80], P = .002) and additional ipsilateral (52% [81 of 156] vs 44% [69 of 156], P = .007) lesions. The AUC was larger for DM plus DBT than for DM (0.74 vs 0.67, P = .02) in the diagnosis of bilateral breast cancer. No significant differences in specificity were noted. The added diagnostic value of DBT was limited to the group of women with nondense breasts: For diagnosis of ipsilateral lesions, AUC of DM plus DBT versus DM was 0.74 versus 0.70 (P = .04). For diagnosis of contralateral lesions, AUC of DM plus DBT verus DM was 0.76 versus 0.68 (P = .02). |
3 |
| 25. Mercier J, Kwiatkowski F, Abrial C, et al. The role of tomosynthesis in breast cancer staging in 75 patients. Diagn Interv Imaging. 96(1):27-35, 2015 Jan. |
Observational-Dx |
75 patients |
To compare tomosynthesis to mammography, ultrasound, magnetic resonance imaging (MRI), and histology for the detection and staging of BI-RADS 4-5 anomalies, as a function of breast composition, lesion location, size, and histology. |
The sensitivities for detection were as follows: 92.5% with MRI, 79% for ultrasound, 75% for tomosynthesis, and 59.5% for mammography. Tomosynthesis improves the sensitivity of mammography (P=0.00013), but not the specificity. The detection of multifocality and multicentricity was improved, but not significantly. Tomosynthesis identified more lesions than mammography in 10% of cases and improved lesion staging irrespective of the density, but was still inferior to MRI. The detection of ductal neoplasia was superior with tomosynthesis than with mammography (P=0.016), but this was not the case with lobular cancer. The visualization of masses was improved with tomosynthesis (P=0.00012), but not microcalcifications. Tomosynthesis was capable of differentiating lesions of all sizes, but the smaller lesions were easier to see. Lesion sizes measured with tomosynthesis, excluding the spicules, concurred with histological dimensions. Spicules lead to an overestimation of the size. |
2 |
| 26. Gruber IV, Rueckert M, Kagan KO, et al. Measurement of tumour size with mammography, sonography and magnetic resonance imaging as compared to histological tumour size in primary breast cancer. BMC Cancer. 13:328, 2013 Jul 05. |
Observational-Dx |
121 patients with primary breast cancer |
To evaluate sizing of primary breast cancer using mammography, sonography and magnetic resonance imaging (MRI) and thereby establish which imaging method most accurately corresponds with the size of the histological result. |
Tumour size was found to be significantly underestimated with sonography, especially for the tumour groups IDC + DCIS, IDC and ILC. The greatest difference between sonographic sizing and actual histological tumour size was found with invasive lobular breast cancer. There was no significant difference between mammographic and histological sizing. MRI overestimated non-significantly the tumour size and is superior to the other imaging techniques in sizing of IDC + DCIS and ILC. |
3 |
| 27. Stein RG, Wollschlager D, Kreienberg R, et al. The impact of breast cancer biological subtyping on tumor size assessment by ultrasound and mammography - a retrospective multicenter cohort study of 6543 primary breast cancer patients. BMC Cancer. 16:459, 2016 07 13. |
Observational-Dx |
6543 patients |
To assess the accuracy of tumor size measurement by ultrasound and mammography in a multicentered health services research study. |
Overall, the correlation with histology was 0.61 for mammography and 0.60 for ultrasound. Both correlations were higher in pT2 cancers than in pT1 and pT3. Ultrasound as well as mammography revealed a significantly higher correlation with histology in invasive ductal compared to lobular cancers (p < 0.01). For invasive lobular cancers, the mammography showed better correlation with histology than ultrasound (p = 0.01), whereas there was no such advantage for invasive ductal cancers. Ultrasound was significantly superior for HR negative cancers (p < 0.001). HER2/neu positive cancers were also more precisely assessed by ultrasound (p < 0.001). The size of HER2/neu negative cancers could be more accurately predicted by mammography (p < 0.001). |
3 |
| 28. Helal MH, Mansour SM, Zaglol M, Salaleldin LA, Nada OM, Haggag MA. Staging of breast cancer and the advanced applications of digital mammogram: what the physician needs to know?. Br J Radiol. 90(1071):20160717, 2017 Mar. |
Observational-Dx |
98 proved malignant breast masses |
To study the role of advanced applications of digital mammogram, whether contrast-enhanced spectral mammography (CESM) or digital breast tomosynthesis (DBT), in the "T" staging of histologically proven breast cancer before planning for treatment management. |
Breast tomosynthesis showed the highest accuracy in size assessment (n = 69, 70.4%) than contrast-enhanced (n = 49, 50%) and regular mammography (n = 59, 60.2%). Contrast-enhanced mammography presented the least performance in assessing calcifications, yet it was most sensitive in the detection of multiplicity (92.3%), followed by tomosynthesis (77%) and regular mammography (53.8%). The combined analysis of the three modalities provided an accuracy of 74% in the "T" staging of breast cancer. |
2 |
| 29. Marinovich ML, Bernardi D, Macaskill P, Ventriglia A, Sabatino V, Houssami N. Agreement between digital breast tomosynthesis and pathologic tumour size for staging breast cancer, and comparison with standard mammography. BREAST. 43:59-66, 2019 Feb. |
Observational-Dx |
85 women |
To compare tomosynthesis and mammography in estimating the size of newly-diagnosed breast cancers. |
Where cancers were detected and hence measured by both tests, tomosynthesis overestimated pathologic size relative to mammography (Analysis 1: MD 5% versus 1%, Analysis 2: 7% versus 3%; P ¼ 0.10 both analyses). There was similar, large measurement variability for both tests (LOA range: 60% to þ166%). Overestimation by tomosynthesis was attributable to the subgroup with dense breasts (MDs ¼ 12e13% versus 4% for mammography). There was low average bias for both tests in the lowdensity subgroup (MDs ¼ 0e4%). LOA were larger in dense breasts for both tomosynthesis and mammography (P 0.02 all comparisons). Cancers detected only by tomosynthesis were more frequently in dense breasts (60e68%): for those tumours size was estimated with increased measurement variability (LOA ranging from 75% to þ293%). |
3 |
| 30. Kapoor NS, Eaton A, King TA, et al. Should breast density influence patient selection for breast-conserving surgery?. Ann Surg Oncol. 20(2):600-6, 2013 Feb. |
Observational-Dx |
1,056 invasive breast cancer patients |
To determine whether the increased mastectomy rate observed in women with dense breasts can be explained by clinical factors necessitating initial mastectomy, such as multicentricity and presence of extensive intraductal component (EIC), or whether the high mastectomy rate was due to failed attempted BCS with a higher rate of positive margins leading to conversion to mastectomy in patients with dense breasts.To determine whether magnetic resonance imaging (MRI) was beneficial in the subset of women with high breast density. |
Breast-conserving surgery (BCS) was attempted in 758 patients (72 %), 385 (51 %) of whom had preoperative magnetic resonance imaging (MRI). Initial BCS was less common among patients with the highest (BI-RADS 4) breast density compared to patients with less-dense breasts (52 vs. 74 %; p < 0.0001), but MRI use was more common (65 vs. 33 %; p < 0.0001). Adjusting for clinical and pathologic variables, patients with the highest breast density had 1.94-times (95 % confidence interval 1.44-2.62; p < 0.0001) the odds of initial mastectomy compared to patients with less-dense breasts. After initial BCS, 387 patients (51 %) had positive shaved margins, 96 (25 %) of whom converted to mastectomy. MRI did not correlate with the rate of positive margins overall or among those with dense breasts. Adjusting for clinical and pathologic variables, density did not predict margin status or conversion to mastectomy. In a multivariate model, age, histologic grade, extensive intraductal component, and multicentricity/multifocality were independently associated with conversion to mastectomy. |
3 |
| 31. Grubstein A, Rapson Y, Morgenstern S, et al. Invasive Lobular Carcinoma of the Breast: Appearance on Digital Breast Tomosynthesis. Breast Care (Basel) 2016;11:359-62. |
Review/Other-Dx |
23 women with pathologically proven invasive lobular carcinoma of the breast |
To characterize the signs of invasive lobular carcinoma of the breast on digital breast tomosynthesis (DBT) imaging. |
In 21 of the 23 patients, the combination of DM and DBT yielded pathologic findings (91%). Architectural distortions or spiculations were demonstrated in 87% of cases. The addition of DBT to DM improved lesion detection by more clearly depicting both the lesion margins and architectural distortions. Only 2 lesions were occult by both DM and DBT, including 1 lesion in a peripheral location that was not incorporated in the standard mediolateral oblique and craniocaudal views. |
4 |
| 32. Yun SJ, Ryu CW, Rhee SJ, Ryu JK, Oh JY. Benefit of adding digital breast tomosynthesis to digital mammography for breast cancer screening focused on cancer characteristics: a meta-analysis. [Review]. Breast Cancer Research & Treatment. 164(3):557-569, 2017 Aug. |
Meta-analysis |
11 studies |
To evaluate the benefit of adding digital breast tomosynthesis (DBT) to full-field digital mammography (FFDM) compared to FFDM alone for breast cancer detection, focusing on cancer characteristics. |
Eleven eligible studies were included. Pooled RRs showed a greater cancer detection for DBT plus FFDM than for FFDM alone for invasive cancer (1.327; 95% CI, 1.168-1.508), stage T1 (1.388; 95% CI, 1.137-1.695), nodal-negative (1.451; 95% CI, 1.209-1.742), all histologic grades (grade I, 1.812; grade II/III, 1.403), and histologic types of invasive cancer (ductal, 1.437; lobular, 1.901). However, adding DBT did not increase for detection of carcinoma in situ (1.198; 95% CI, 0.942-1.524), stage =T2 (1.391; 95% CI, 0.895-2.163), or nodal-positive cancer (1.336; 95% CI, 0.921-1.938). Heterogeneity among studies was not significant in any subset analysis. |
Good |
| 33. Marinovich ML, Macaskill P, Bernardi D, Houssami N. Systematic review of agreement between tomosynthesis and pathologic tumor size for newly diagnosed breast cancer and comparison with other imaging tests. Expert Rev Med Devices 2018;15:489-96. |
Review/Other-Dx |
8 studies (678 patients) |
To examine the accuracy of tomosynthesis in measuring tumor size relative to pathology and compared with other tests. |
A systematic literature search identified studies of tomosynthesis in estimating the size of newly diagnosed breast cancers. Descriptive analyses were performed due to heterogeneity in patients, technology, and methods between studies. Eight studies were eligible (678 patients). Mean differences (MDs) between measurements (tomosynthesis-pathology) were generally small; overestimation (MDs of 1-3 mm) and underestimation (-1 mm) were reported. Limits of agreement (LOA) ranged between ±10 mm and ±28 mm. MDs did not differ in high and low breast densities. Large underestimation (-11 mm) and wide LOA (±41 mm) were reported for invasive lobular carcinoma. MDs and LOA were lower for tomosynthesis than mammography, but differences between tests were small. |
4 |
| 34. Hadjiminas DJ, Zacharioudakis KE, Tasoulis MK, et al. Adequacy of diagnostic tests and surgical management of symptomatic invasive lobular carcinoma of the breast. Ann R Coll Surg Engl. 97(8):578-83, 2015 Nov. |
Observational-Dx |
904 consecutive cases |
To ascertain the diagnostic adequacy of modern mammography and ultrasonography in the context of a fast track symptomatic diagnostic clinic in the UK. It also sought to compare the mastectomy, re-excision and BCS rates for ILC with those for invasive ductal carcinoma (IDC).To compare the mastectomy, re-excision and BCS rates for ILC with those for invasive ductal carcinoma (IDC). |
Compared with IDC, ILC was significantly larger at presentation (46mm vs 25mm), needed re-excision after BCS more often (38.8% vs 22.3%) and required mastectomy more frequently (58.8% vs 40.8%). Although mammography performs poorly in diagnosing ILC compared with IDC, when combined with ultrasonography, sensitivity of the combined imaging was not significantly different between these two histological types. |
4 |
| 35. Liu Q, Xing P, Dong H, Zhao T, Jin F. Preoperative assessment of axillary lymph node status in breast cancer patients by ultrasonography combined with mammography: A STROBE compliant article. Medicine (Baltimore). 97(30):e11441, 2018 Jul. |
Observational-Dx |
3944 female patients with invasive breast cancer |
To determine the power of combined mammography and ultrasonography in differentiating N0-N1 from N2-N3 breast cancer. |
Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of mammography alone, ultrasonography alone, and combination of them for assessment of axillary lymph node (ALN) status were calculated, using definitive histological results as the baseline.The sensitivity, specificity, PPV, NPV, and accuracy was 90.4%, 68.2%, 36.5%, 97.2%, and 71.9% for ultrasonography; was 66.9%, 80.8%, 41.3%, 92.3%, and 78.4% for mammography; and was 94.9%, 62.4%, 33.8%, and 98.4% for combined mammography and ultrasonography. For combination, accuracy and the area under the receiver operating characteristic curve was 67.9% and 0.85, respectively. |
4 |
| 36. Pilewskie M, Jochelson M, Gooch JC, Patil S, Stempel M, Morrow M. Is Preoperative Axillary Imaging Beneficial in Identifying Clinically Node-Negative Patients Requiring Axillary Lymph Node Dissection?. J Am Coll Surg. 222(2):138-45, 2016 Feb. |
Observational-Dx |
425 patients |
To determine if abnormal axillary imaging is predictive of the need for axillary lymph node dissection (ALND) in this population. |
Between August 2010 and December 2013, 3,253 breast cancer patients were treated with BCS and SLN biopsy; 425 patients met Z0011 criteria (cT1-2N0) and had nodal metastasis on SLN biopsy. Clinicopathologic features were median patient age, 58 years; median tumor size, 1.8 cm; 85% ductal histology; and 89% estrogen receptor positive. All women had a mammogram, 242 had axillary US, 172 had MRI. Abnormal LNs were seen on 7%, 25%, and 30% of mammograms, US, and MRIs, respectively. Although abnormal LNs on mammogram or US were associated with a significant increase in ALND and a non-significant trend was seen with MRI, 68% to 73% of women with abnormal axillary imaging did not require ALND. |
1 |
| 37. Barrio AV, Mamtani A, Eaton A, Brennan S, Stempel M, Morrow M. Is Routine Axillary Imaging Necessary in Clinically Node-Negative Patients Undergoing Neoadjuvant Chemotherapy?. Ann Surg Oncol. 24(3):645-651, 2017 Mar. |
Observational-Dx |
402 patients |
To determine whether abnormal axillary imaging pre-NAC predicts nodal metastases post-NAC (ypN+) in cN0 patients. |
From May 2008 to March 2016, 402 eligible cN0 patients were identified. The median age of the patients was 49.5 years, and the median tumor size was 4 cm. Of these patients, 38% were estrogen receptor-positive (ER+) and human epidermal growth factor receptor 2-negative (HER2-), 30% were HER2+ , and 32% were triple negative. All had pre-NAC mammograms, 40% axillary ultrasound, 83% MRI, and 51% PET. Abnormal nodes on imaging were seen in 208 patients (52%); 128 had pre-NAC node biopsy, and 75 were positive. Overall, 28% of the patients (n = 111) were ypN+ post-NAC. Although the incidence of ypN+ was significantly higher in patients with abnormal nodes on pre-NAC imaging (p = 0.001), 54% did not require axillary lymph node dissection (ALND) post-NAC. Among the patients with normal nodes on pre-NAC imaging, 20% were ypN+ post-NAC. |
3 |
| 38. Botsikas D, Kalovidouri A, Becker M, et al. Clinical utility of 18F-FDG-PET/MR for preoperative breast cancer staging. Eur Radiol. 26(7):2297-307, 2016 Jul. |
Observational-Dx |
60 consecutive patients who underwent breast FDG-PET/MR |
To evaluate the performance of 18F-fluorodeoxyglucose (FDG) positron emission tomography magnetic resonance imaging (PET/MR) for preoperative breast cancer staging. |
The study included 101 breast lesions (83 malignant, 18 benign) and 198 lymph node groups, (34 malignant, 164 benign). Two patients had distant metastases. Areas under the curve (AUC) for breast cancer were 0.9558, 0.8347 and 0.8855 with MRI, and with qualitative and quantitative PET/MR, respectively (p = 0.066). Sensitivity for primary cancers with MRI and quantitative PET/MR was 100 % and 77 % (p = 0.004), and for lymph nodes 88 % and 79 % (p = 0.25), respectively. Specificity for MRI and PET/MR for primary cancers was 67 % and 100 % (p = 0.03) and for lymph nodes 98 % and 100 % (p = 0.25). |
2 |
| 39. Grueneisen J, Nagarajah J, Buchbender C, et al. Positron Emission Tomography/Magnetic Resonance Imaging for Local Tumor Staging in Patients With Primary Breast Cancer: A Comparison With Positron Emission Tomography/Computed Tomography and Magnetic Resonance Imaging. Invest Radiol. 50(8):505-13, 2015 Aug. |
Observational-Dx |
49 patients with biopsy-proven invasive breast cancer |
To assess the diagnostic performance of integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) of the breast for lesion detection and local tumor staging of patients with primary breast cancer in comparison to PET/computed tomography (CT) and MRI. |
Positron emission tomography/MRI and MRI correctly identified 47 (96%) of the 49 patients with primary breast cancer, whereas PET/CT enabled detection of 46 (94%) of 49 breast cancer patients and missed a synchronous carcinoma in the contralateral breast in 1 patient. In a lesion-by-lesion analysis, no significant differences could be obtained between the 3 imaging procedures for the identification of primary breast cancer lesions (P > 0.05). Positron emission tomography/MRI and MRI allowed for a correct identification of multifocal/multicentric disease in 3 additional patients if compared with PET/CT. For the definition of the correct T-stage, PET/MRI and MRI showed identical results and were correct in significantly more cases than PET/CT (PET/MRI and MRI, 82%; PET/CT, 68%; P < 0.05). Furthermore, the calculated sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the detection of nodal positive patients (n = 18) were 78%, 94%, 88%, 88%, and 88% for PET/CT; 67%, 87%, 75%, 82%, and 80% for MRI; and 78%, 90%, 82%, 88%, and 86% for PET/MRI, respectively. Differences between the imaging modalities were not statistically significant (P > 0.05). |
1 |
| 40. Teixeira SC, Rebolleda JF, Koolen BB, et al. Evaluation of a Hanging-Breast PET System for Primary Tumor Visualization in Patients With Stage I-III Breast Cancer: Comparison With Standard PET/CT. AJR Am J Roentgenol. 206(6):1307-14, 2016 Jun. |
Observational-Dx |
234 index lesions |
To evaluate the performance of a mammography with molecular imaging PET (MAMMI-PET) system for breast imaging in the hanging-breast position for the visualization of primary breast cancer lesions and to compare this method with whole-body PET/CT. |
For 234 index lesions (diameter, 5-170 mm), the overall sensitivity was 88.9% for MAMMI-PET and 91% for PET/CT (p = 0.61). Twenty-three (9.8%) index lesions located too close to the pectoral muscle were missed with MAMMI-PET, and 20 index lesions were missed with PET/CT. Lesion visibility on MAMMI-PET images was influenced by tumor grade (p = 0.034) but not by cancer subtype (p = 0.65). |
3 |
| 41. Koolen BB, Vrancken Peeters MJ, Aukema TS, et al. 18F-FDG PET/CT as a staging procedure in primary stage II and III breast cancer: comparison with conventional imaging techniques. Breast Cancer Res Treat. 131(1):117-26, 2012 Jan. |
Observational-Dx |
154 with stage II or III breast cancer |
To investigate if 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) outperforms conventional imaging techniques for excluding distant metastases prior to neoadjuvant chemotherapy (NAC) treatment in patients with stage II and III breast cancer. To assess the clinical importance of false positive findings. |
Forty-two additional distant lesions were seen in 25 patients with PET/CT and could be confirmed in 20 (13%) of 154 patients. PET/CT was false positive for 8 additional lesions (19%) and misclassified the presence of metastatic disease in 5 (3%) of 154 patients. In 16 (80%) of 20 patients, additional lesions were exclusively seen with PET/CT, leading to a change in treatment in 13 (8%) of 154 patients. In 129 patients with a negative staging PET/CT, no metastases developed during the follow-up of 9.0 months. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT in the detection of additional distant lesions in patients with stage II or III breast cancer are 100, 96, 80, 100, and 97%, respectively. |
4 |
| 42. Ecanow JS, Abe H, Newstead GM, Ecanow DB, Jeske JM. Axillary staging of breast cancer: what the radiologist should know. [Review]. Radiographics. 33(6):1589-612, 2013 Oct. |
Review/Other-Dx |
N/A |
To discuss considerations in determining prognosis and for deciding on appropriate treatment for patients with invasive breast cancer. |
No results in abstract |
4 |
| 43. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 1989;63:181-7. |
Observational-Dx |
24,740 patients |
To evaluate the breast cancer survival experience in a representative sample of women from the United States. |
Actuarial (life table) methods were used to investigate the 5-year relative survival rates in cases with known operative/pathologic axillary lymph node status and primary tumor diameter. Survival rates varied from 45.5% for tumor diameters equal to or greater than 5 cm with positive axillary nodes to 96.3% for tumors less than 2 cm and with no involved nodes. The relation between tumor size and lymph node status was investigated in detail. Tumor diameter and lymph node status were found to act as independent but additive prognostic indicators. As tumor size increased, survival decreased regardless of lymph node status; and as lymph node involvement increased, survival status also decreased regardless of tumor size. A linear relation was found between tumor diameter and the percent of cases with positive lymph node involvement. The results of our analyses suggest that disease progression to distant sites does not occur exclusively via the axillary lymph nodes, but rather that lymph node status serves as an indicator of the tumor's ability to spread. |
4 |
| 44. Sasada S, Masumoto N, Kimura Y, et al. Identification of Axillary Lymph Node Metastasis in Patients With Breast Cancer Using Dual-Phase FDG PET/CT. AJR Am J Roentgenol. 213(5):1129-1135, 2019 11. |
Observational-Dx |
826 patients with breast cancer |
To assess the diagnostic performance of dual-phase 18F-FDG PET/CT in detecting axillary lymph node metastasis in patients with breast cancer. |
Axillary lymph node metastasis was detected in 285 of 826 patients (34.5%). The median axillary SUVmax1, SUVmax2, and RI in patients with nodal metastasis were higher than those in patients without metastasis (1.5 vs 0.6, 1.6 vs 0.5, and 7.7 vs -3.7, respectively; all p < 0.001). The diagnostic accuracy of axillary SUVmax1 and SUVmax2 was equivalent, and the sensitivity and specificity of SUVmax1 were 74.7% and 83.4%, respectively. Although the performance of the axillary RI was inferior to that of SUVmax1 and SUVmax2, both the SUVmax and the RI were independent predictors of nodal metastasis, and a positive RI suggested axillary lymph node involvement when the SUVmax1 was significantly high. Of 533 patients with category T1-2 breast cancer without lymph node swelling, 101 (19.0%) had pathologic lymph node involvement; the negative predictive value of axillary SUVmax1 was 86.8%. |
4 |
| 45. Sohn YM, Hong IK, Han K. Role of [18F]fluorodeoxyglucose positron emission tomography-computed tomography, sonography, and sonographically guided fine-needle aspiration biopsy in the diagnosis of axillary lymph nodes in patients with breast cancer: comparison of diagnostic performance. J Ultrasound Med. 33(6):1013-21, 2014 Jun. |
Observational-Dx |
107 patients |
To compare the diagnostic performance of [(18)F]fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) with that of sonography and sonographically guided fine-needle aspiration (FNA) for determining the preoperative axillary lymph node (ALN) status.To evaluate the factors related to false-negative PET-CT, sonographic, and FNA results in ALN staging of invasive ductal carcinoma. |
Of the 107 patients, 45 (42.1%) had positive results on final pathologic analysis of ALNs. Sonographically guided FNA had a significantly higher specificity, positive predictive value, accuracy, and area under the receiver operating characteristic curve than sonography and PET-CT (P < .01). When sonography and PET-CT were combined, the sensitivity was significantly improved (P = .019) compared with sonography alone. When FNA and PET-CT were combined, the sensitivity and negative predictive value were significantly increased compared with each modality (P < .01). |
3 |
| 46. Cortadellas T, Argacha P, Acosta J, et al. Estimation of tumor size in breast cancer comparing clinical examination, mammography, ultrasound and MRI-correlation with the pathological analysis of the surgical specimen. Gland Surg 2017;6:330-35. |
Observational-Dx |
73 patients with infiltrating breast carcinoma |
To evaluate the best method in our center to measure preoperative tumor size in breast tumors, using as reference the tumor size in the postoperative surgical specimen.To compare physical examination vs. mammography vs. resonance vs. ultrasound. |
A total of 73 cases were collected from October 2015 to July 2016 with diagnosis of infiltrating breast carcinoma. Twelve cases of carcinoma in situ and seven cases of neoadjuvant carcinoma are excluded. Finally, a total of 56 cases were included in the analysis. The mean age of the patients is 57 years. The histology is of infiltrating ductal carcinoma in 46 patients (80.7%), lobular in 8 (14%) and other carcinomas in 3 cases (5.2%). We verified the relationship between preoperative tumor size by physical examination, mammography, ultrasound (US) and magnetic resonance imaging (MRI), and the final size of the surgical specimen by applying a Pearson correlation test. A strong correlation was found between the physical examination results 0.62 (0.43-0.76 at 95% CI), ultrasound 0.68 (0.51-0.8 at 95% CI), mammography 0.57 (0.36-0.72 at 95% CI) and RM 0.51 (0.29-0.68 at 95% CI) with respect to pathological anatomy. The mean tumor size of the surgical specimen was 16.1 mm. Mean of tumor size by physical examination was 12.1 mm (P<0.05), by 14 mm US (P<0.05), by mammography of 14.3 (P<0.05) and by MRI of 22.53 mm (P>0.05). |
3 |
| 47. Jochelson MS, Lobbes MBI. Contrast-enhanced Mammography: State of the Art. [Review]. Radiology. 299(1):36-48, 2021 04. |
Review/Other-Dx |
N/A |
To detail the CEM technique, diagnostic and screening uses, and future applications, including artificial intelligence and radiomics. |
No results provided. |
4 |
| 48. Fallenberg EM, Dromain C, Diekmann F, et al. Contrast-enhanced spectral mammography versus MRI: Initial results in the detection of breast cancer and assessment of tumour size. Eur Radiol. 24(1):256-64, 2014 Jan. |
Observational-Dx |
80 women with newly diagnosed breast cancer |
To compare mammography (MG), contrast-enhanced spectral mammography (CESM), and magnetic resonance imaging (MRI) in the detection and size estimation of histologically proven breast cancers using postoperative histology as the gold standard. |
reast cancer was visible in 66/80 MG, 80/80 CESM, and 77/79 MRI examinations. Average lesion largest dimension was 27.31 mm (SD 22.18) in MG, 31.62 mm (SD 24.41) in CESM, and 27.72 mm (SD 21.51) in MRI versus 32.51 mm (SD 29.03) in postoperative histology. No significant difference was found between lesion size measurement on MRI and CESM compared with histopathology. |
1 |
| 49. Jochelson MS, Dershaw DD, Sung JS, et al. Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma. Radiology. 266(3):743-51, 2013 Mar. |
Observational-Dx |
52 women. |
To determine feasibility of performing bilateral dual-energy (DE) contrast agent-enhanced (CE) digital mammography and to evaluate its performance compared with conventional digital mammography and breast magnetic resonance (MR) imaging in women with known breast cancer. |
Feasibility was confirmed with no adverse events. Visualization of tumor enhancement was independent of timing after contrast agent injection for up to 10 minutes. MR imaging and DE CE digital mammography both depicted 50 (96%) of 52 index tumors; conventional mammography depicted 42 (81%). Lesions depicted by using DE CE digital mammography ranged from 4 to 67 mm in size (median, 17 mm). DE CE digital mammography depicted 14 (56%) of 25 additional ipsilateral cancers compared with 22 (88%) of 25 for MR imaging. There were two false-positive findings with DE CE digital mammography and 13 false-positive findings with MR imaging. There was one contralateral cancer, which was not evident with either modality. |
1 |
| 50. Youn I, Choi S, Choi YJ, et al. Contrast enhanced digital mammography versus magnetic resonance imaging for accurate measurement of the size of breast cancer. Br J Radiol. 92(1098):20180929, 2019 Jun. |
Observational-Dx |
52 females with surgery due to breast cancer |
To compare the accuracy of contrast-enhanced digital mammography (CEDM) and MRI, including maximal intensity projection (MIP) images, for measuring the tumour size of breast cancer. |
Mean OPinvasive was 15.5 mm, and overestimation rate was similar or higher than underestimation rate on all images except CC view of mammography and axial MIP image of CEDM. Mean OPmax was 21.7 mm, and underestimation rate was higher than the overestimation rate. All parameters of CEDM and CEMRI showed good agreement ( k > 0.75) with OPinvasive, with the most favourable result being the CC view of CEDM and axial MIP image of CEMRI. |
1 |
| 51. Cheung YC, Juan YH, Lo YF, Lin YC, Yeh CH, Ueng SH. Preoperative assessment of contrast-enhanced spectral mammography of diagnosed breast cancers after sonographic biopsy: Correlation to contrast-enhanced magnetic resonance imaging and 5-year postoperative follow-up. Medicine (Baltimore). 99(5):e19024, 2020 Jan. |
Observational-Dx |
46 patients with 51 cancerous breasts |
To assess the feasibility of using contrast-enhanced spectral mammography (CESM) for operative planning of patients with breast cancers who were initially diagnosed by sonographic guided biopsy. |
Fifty-one cancerous breasts of 46 patients were included in the analysis. All the principal cancers could be detected by RSM or CE-MRI; however, only 45 were by LE-MG. The Pearson correlation coefficients for the size on microscopy were 0.44 for LE-MG, 0.77 for RSM, and 0.84 for CE-MRI (all P-values =.001). Regarding the microscopic reports, RSM or CE-MRI had sensitivities of 100% and a positive predictive value of 63.6% for multicentric cancers. One breast cancer with partial mastectomy recurred after 3 years of follow-up. |
3 |
| 52. Fallenberg EM, Dromain C, Diekmann F, et al. Contrast-enhanced spectral mammography: Does mammography provide additional clinical benefits or can some radiation exposure be avoided?. Breast Cancer Res Treat. 146(2):371-81, 2014 Jul. |
Observational-Dx |
118 patients |
To compare contrast-enhanced spectral mammography (CESM) with mammography (MG) and combined CESM + MG in terms of detection and size estimation of histologically proven breast cancers in order to assess the potential to reduce radiation exposure. |
A total of 107 imaging pairs were available for analysis. Densities were ACR1: 2, ACR2: 45, ACR3: 42, and ACR4: 18. Mean AGD was 1.89 mGy for CESM alone, 1.78 mGy for MG, and 3.67 mGy for the combination. In very dense breasts, AGD of CESM was significantly lower than MG. Sensitivity across readers was 77.9 % for MG alone, 94.7 % for CESM, and 95 % for CESM + MG. Average tumor size measurement error compared to postsurgical pathology was -0.6 mm for MG, +0.6 mm for CESM, and +4.5 mm for CESM + MG (p < 0.001 for CESM + MG vs. both modalities). CESM alone has the same sensitivity and better size assessment as CESM + MG and was significantly better than MG with only 6.2 % increase in AGD. The combination of CESM + MG led to systematic size overestimation. |
3 |
| 53. Lee-Felker SA, Tekchandani L, Thomas M, et al. Newly Diagnosed Breast Cancer: Comparison of Contrast-enhanced Spectral Mammography and Breast MR Imaging in the Evaluation of Extent of Disease. Radiology. 285(2):389-400, 2017 11. |
Observational-Dx |
52 women with newly diagnosed unilateral breast cancer |
To compare the diagnostic performances of contrast material-enhanced spectral mammography and breast magnetic resonance (MR) imaging in the detection of index and secondary cancers in women with newly diagnosed breast cancer by using histologic or imaging follow-up as the standard of reference. |
Fifty-two women with 120 breast lesions were included for analysis (mean age, 50 years; range, 29-73 years). Contrast-enhanced spectral mammography had similar sensitivity to MR imaging (94% [66 of 70 lesions] vs 99% [69 of 70 lesions]), a significantly higher PPV than MR imaging (93% [66 of 71 lesions] vs 60% [69 of 115 lesions]), and fewer false-positive findings than MR imaging (five vs 45) (P < .001 for all results). In addition, contrast-enhanced spectral mammography depicted 11 of the 11 secondary cancers (100%) and MR imaging depicted 10 (91%). |
2 |
| 54. van Nijnatten TJ, Jochelson MS, Pinker K, et al. Differences in degree of lesion enhancement on CEM between ILC and IDC. BJR Open 2019;1:20180046. |
Observational-Dx |
22 patients with ILC and 22 patients with IDC |
To investigate differences in the degree of enhancement on contrast-enhanced mammography (CEM) between patients with invasive lobular (ILC) and infiltrating ductal carcinoma (IDC) not otherwise specified. |
44 patients were included: 22 patients with ILC and 22 patients with IDC. There were no significant differences in age, mean tumor size, tumor grade or receptor status between the two subgroups. Degree of lesion enhancement on CEM was more often considered weak in case of ILC compared to IDC according to two out of three readers (31.8% vs 4.5 %, p = 0.045 and 22.7 vs 4.5 %, p = 0.185). All other lesions showed moderate or strong enhancement. Interobserver agreement between the three independent readers was good (? = 0.72). |
3 |
| 55. Miller BT, Abbott AM, Tuttle TM. The influence of preoperative MRI on breast cancer treatment. Ann Surg Oncol. 19(2):536-40, 2012 Feb. |
Observational-Dx |
414 patients (219 with MRI, 195 with no MRI) |
To evaluate rates of mastectomy and breast-conserving surgery (BCS) in patients who undergo preoperative MRI. |
Patients who underwent MRI were more likely to have mastectomy than those without MRI (43 vs. 28%; P = 0.002). Multivariate analysis revealed that younger age, larger tumor size, positive lymph node status, infiltrating lobular carcinoma, and preoperative MRI were independent predictors for mastectomy (P < 0.05). MRI detected occult contralateral breast cancer in 2.7% of patients. Among patients treated with BCS, preoperative MRI was not significantly associated with lower reexcision rates (MRI, 14%; no MRI, 18%; P = 0.34). |
4 |
| 56. Elmi A, Conant EF, Kozlov A, et al. Preoperative breast MR imaging in newly diagnosed breast cancer: Comparison of outcomes based on mammographic modality, breast density and breast parenchymal enhancement. Clinical Imaging. 70:18-24, 2021 Feb. |
Observational-Dx |
401 consecutive breast MR exams (201 diagnosed with DM and 187 diagnosed with DBT) |
To compare the role of MR for assessment of extent of disease in women newly diagnosed with breast cancer imaged with digital mammography (DM) alone versus digital breast tomosynthesis (DBT). |
50 additional malignancies were detected in 388 exams (12.9%), 37 ipsilateral and 13 contralateral. There was no difference in the MR detection of additional disease in women imaged by either DM versus DBT (p = 0.53). In patients with DM, there was no significant difference in the rate of MR additional cancer detection in dense versus non-dense breasts (p = 0.790). However, in patients with DBT, MR detected significantly more additional sites of malignancy in dense compared to non-dense breasts (p = 0.017). There was no difference in false-positive MR exams (p = 0.470) for DM versus DBT. For both DM and DBT cohorts, higher MR background parenchymal enhancement was associated with higher false-positive (p = 0.040) but no significant difference in true-positive exams. |
4 |
| 57. He H, Plaxco JS, Wei W, et al. Incremental cancer detection using breast ultrasonography versus breast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients. Br J Radiol. 89(1065):20160401, 2016 Sep. |
Observational-Dx |
259 patients with breast cancer |
To compare the incremental cancer detection rate (ICDR) using bilateral whole-breast ultrasonography (BWBUS) vs dynamic contrast-enhanced MRI in patients with primary breast cancer. |
A total of 266 additional lesions beyond 273 index malignancies were seen on at least 1 modality, of which 121 (45%) lesions were malignant and 145 (55%) lesions were benign. MRI was significantly more sensitive than BWBUS (p = 0.01), while BWBUS was significantly more accurate and specific than MRI (p < 0.0001). Compared with mammography, the ICDRs using BWBUS and MRI were significantly higher for oestrogen receptor-positive and triple-negative cancers, but not for human epidermal growth factor receptor 2-positive cancers. 22 additional malignant lesions in 18 patients were seen on MRI only. Surgical planning remained unchanged in 8 (44%) of those 18 patients. |
2 |
| 58. Brennan ME, Houssami N, Lord S, et al. Magnetic resonance imaging screening of the contralateral breast in women with newly diagnosed breast cancer: systematic review and meta-analysis of incremental cancer detection and impact on surgical management. J Clin Oncol 2009;27:5640-9. |
Meta-analysis |
22 studies (3,253 women) |
To report contralateral MRI in women with newly diagnosed invasive breast cancer. |
Twenty-two studies reported contralateral malignancies detected only by MRI in 131 of 3,253 women. Summary estimates were as follows: MRI-detected suspicious findings (TP plus FP), 9.3% (95% CI, 5.8% to 14.7%); ICDR, 4.1% (95% CI, 2.7% to 6.0%), PPV, 47.9% (95% CI, 31.8% to 64.6%); TP:FP ratio, 0.92 (95% CI, 0.47 to 1.82). PPV was associated with the number of test positives and baseline imaging. Few studies included consecutive women, and few ascertained outcomes in all subjects. Where reported, 35.1% of MRI-detected cancers were ductal carcinoma in situ (mean size = 6.9 mm), 64.9% were invasive cancers (mean size = 9.3 mm), and the majority were stage pTis or pT1 and node negative. Effect on treatment was inconsistently reported, but many women underwent contralateral mastectomy. |
Inadequate |
| 59. Choi WJ, Cha JH, Kim HH, Shin HJ, Chae EY. The Accuracy of Breast MR Imaging for Measuring the Size of a Breast Cancer: Analysis of the Histopathologic Factors. Clin Breast Cancer. 16(6):e145-e152, 2016 12. |
Observational-Dx |
800 women |
To compare the accuracy of different magnetic resonance (MR) sequences for measuring tumor size and to evaluate whether the imaging and histopathologic features affect the accuracy of the tumor size estimation on the MR sequence. |
Tumor measurement showed a good agreement with the pathology-determined size, and with the best results using MIP (k = 0.805) compared with the early-subtracted DCE T1W sequence (k = 0.802) and the T2W sequence (k = 0.779). On MIP, the tumors of patients with minimal or mild background parenchymal enhancement, a mass, invasive ductal carcinoma (IDC), pathology-determined size < 2 cm, positive estrogen receptor, negative HER2, luminal A type, nuclear and histologic grade 1, negative nodal status, negative lymphovascular invasion, and negative extensive intraductal component were significantly more accurately estimated. The independent factors associated with the accuracy of tumor measurement were a mass, IDC, and the pathology-determined size < 2 cm. |
4 |
| 60. Sanderink WBG, Caballo M, Strobbe LJA, et al. Reliability of MRI tumor size measurements for minimal invasive treatment selection in small breast cancers. European Journal of Surgical Oncology. 46(8):1463-1470, 2020 08. |
Observational-Dx |
192 female patients diagnosed with 2251 small (< or = 2 cm) invasive (cT1) or ductal in situ breast lesions |
To determine the reliability of MRI-based tumor size measurements with respect to clinical, histological and radiomics characteristics in small invasive or in situ carcinomas of the breast to select patients for minimal invasive therapy. |
Analysis included 343 cT1 breast carcinomas in 336 patients (mean age, 55 years; range, 25-81 years). Overall correlation of MRI measurements with pathology was moderately strong (? = 0.530, P < 0.001), in 42 cases (12.2%) MRI underestimated the size with more than 5 mm. Underestimation occurs more often in grade 2 and grade 3 disease than in low grade invasive cancers. In DCIS the frequency of underestimation is higher than in invasive breast cancer. Unfortunately, none of the patient, imaging or biopsy characteristics appeared predictive for underestimation. |
3 |
| 61. Shin HC, Han W, Moon HG, et al. Limited value and utility of breast MRI in patients undergoing breast-conserving cancer surgery. Ann Surg Oncol. 19(8):2572-9, 2012 Aug. |
Observational-Dx |
558 consecutive patients diagnosed with IBC and/or CIS |
To compare the accuracy of magnetic resonance imaging (MRI) and ultrasonography (US) in measuring the size of invasive breast cancer (IBC) and carcinoma in situ (CIS). To examine the utility of routinely performing MRI in addition to US before breast-conserving surgery (BCS). |
For CIS, IBC without CIS, and IBC with CIS, MRI was more accurate in estimating tumor size than US. When BCS was attempted (n = 794), the rate of tumor involvement in initial resection margins did not differ between non-MRI and MRI groups (23.0% and 23.4%, P = .926). Similarly, rates of re-excision (13.1% vs 17.5%, P = .130) and conversion to mastectomy (2.3% vs 2.1%, P = .893) were comparable, as were ipsilateral breast tumor recurrence, locoregional recurrence, and disease-free survival (log rank P = .284, .950, and .955, respectively). |
4 |
| 62. Carin AJ, Moliere S, Gabriele V, et al. Relevance of breast MRI in determining the size and focality of invasive breast cancer treated by mastectomy: a prospective study. World J Surg Oncol. 15(1):128, 2017 Jul 14. |
Observational-Dx |
101 mastectomies (98 patients) |
To evaluate breast MRI in determining the size and focality of invasive non-metastatic breast cancers. |
One hundred one mastectomies from 98 patients were extensively analysed. The rates of false-positive and false-negative MRI were 2 and 4% respectively. The sensitivity of breast MRI was 84.7% for the detection of all invasive foci, 69% for single foci and 65.7% for multiple foci. In the evaluation of tumour size, the Spearman rank correlation coefficient r between the sizes obtained by MRI and histology was 0.62. The MRI-based prediction of a complete response to neoadjuvant chemotherapy was 75%. |
3 |
| 63. Mann RM, Cho N, Moy L. Breast MRI: State of the Art. Radiology 2019;292:520-36. |
Review/Other-Dx |
N/A |
To describe the current state of the art in breast MRI,with a focus on the major indications and the potential indication-based adaptations to the imaging protocol to maximize its value. |
No results provided |
4 |
| 64. Gonzalez V, Sandelin K, Karlsson A, et al. Preoperative MRI of the breast (POMB) influences primary treatment in breast cancer: a prospective, randomized, multicenter study. World J Surg. 38(7):1685-93, 2014 Jul. |
Experimental-Dx |
440 breast cancer patients - with breast MRI (n = 220) or no breast MRI (n = 220) (control group) |
To determine whether preoperative breast MRI would affect primary surgical management, reduce reexcision/reoperation procedures, and influence the choice of neoadjuvant treatment in patients with newly diagnosed breast cancer. |
In patients randomized to the MRI group, who had an observed higher percentage of planned breast-conserving surgery (BCS) compared with the control group, a change from suggested breast conservation to mastectomy occurred in 23 of 153 (15 %) patients. Breast MRI provided additional information in 83 of 220 (38 %) patients, which caused a change in treatment plan in 40 (18 %). The breast reoperation rate was significantly lower in the MRI group: 11 of 220 (5 %) versus 33 of 220 (15 %) in the control group (p < 0.001). The number of mastectomies, axillary reoperations, and the number of patients receiving neoadjuvant chemotherapy after definitive treatment did not differ significantly between the groups. |
3 |
| 65. Kuhl CK, Strobel K, Bieling H, et al. Impact of Preoperative Breast MR Imaging and MR-guided Surgery on Diagnosis and Surgical Outcome of Women with Invasive Breast Cancer with and without DCIS Component. Radiology. 284(3):645-655, 2017 09. |
Observational-Dx |
593 consecutive patients with biopsy-proven invasive breast cancer |
To (a) compare the diagnostic accuracy of breast magnetic resonance (MR) imaging with that of conventional imaging (digital mammography and breast ultrasonography) in the identification of ductal carcinoma in situ (DCIS) components of biopsy-proven invasive breast cancer before surgery and(b) investigate the surgical outcome (positive margin rates and mastectomy rates) of women with breast cancer who underwent preoperative MR imaging combined with MR-guided needle biopsy and/or MR-guided lesion localization or bracketing where appropriate. |
Surgical-pathologic assessment demonstrated DCIS components in 139 of the 593 women (23.4%). The sensitivity of MR imaging for the diagnosis of DCIS components pre-operatively (84.9%; 118 of 139) was significantly higher than that of conventional imaging (36.7%; 51 of 139) (P < .0001); more than half of DCIS components (51.1%; 71 of 139) were detected only with MR imaging. The sensitivity advantage of MR imaging over conventional imaging increased with increasing relative size of DCIS components, as follows: The sensitivity of MR imaging versus conventional imaging for small, marginal DCIS components was 56.8% (21 of 37) versus 29.7% (11 of 37); the sensitivity for extensive DCIS components was 91.7% (55 of 60) versus 41.7% (25 of 60); the sensitivity for large, predominant DCIS components was 100.0% (42 of 42) versus 35.7% (15 of 42). Moreover, the sensitivity advantage of MR imaging over conventional imaging increased with increasing nuclear grade of DCIS components, as follows: The sensitivity of MR imaging versus conventional imaging for low-grade DCIS components was 74.0% (20 of 27) versus 40.7% (11 of 27); the sensitivity for intermediate-grade DCIS components was 84.1% (53 of 63) versus 34.9% (22 of 63); the sensitivity for high-grade DCIS components was 91.8% (45 of 49) versus 36.7% (18 of 49) (P < .05-.001 for all). Positive margin rates were low overall (3.7% [95% Clopper Pearson confidence interval [CI]: 2.3%, 5.6%]) and did not differ significantly between the 139 women with DCIS components (5.0% [95% CI: 2.0%, 10.1%]) compared with the 454 women without such components (3.3% [95% CI: 1.9%, 5.4%]). The same was true for mastectomy rates (10.8% [95% CI: 6.2%, 17.2%] vs 8.1% [95% CI: 5.8%, 11.1%]). |
1 |
| 66. Patel BK, Shah NA, Galgano SJ, et al. Does Preoperative MRI Workup Affect Mastectomy Rates and/or Re-excision Rates in Patients with Newly Diagnosed Breast Carcinoma? A Retrospective Review. Breast J. 21(6):604-9, 2015 Nov-Dec. |
Observational-Dx |
154 patients with no preoperative MRIs (control group) and 96 patients with preoperative breast MRIs |
To determine whether including breast magnetic resonance imaging (MRI) in the preoperative workup of patients with known breast cancer has an impact on mastectomy and/or re-excision rates. |
Patient race and age between the two populations were not statistically different. The difference in mastectomy rates between the two populations was 10.7%; although not statistically different, the p value of 0.10 suggests a trend toward significance. The re-excision rates between the two populations, however, were significantly different (p < 0.001), with women in the control group having a higher re-excision rate than those in the study group. The difference between involved and clear margins was significant as well (p = 0.002), with patients undergoing preoperative MRI more likely to have negative margins. |
3 |
| 67. Preibsch H, Blumenstock G, Oberlechner E, et al. Preoperative breast MR Imaging in patients with primary breast cancer has the potential to decrease the rate of repeated surgeries. Eur J Radiol. 94:148-153, 2017 Sep. |
Observational-Dx |
991 consecutive patients (1036 primary breast cancers) |
To evaluate the effect of preoperative breast MRI on the surgical procedure and rate of repeated surgeries. |
The result of preoperative MRI changed the surgical procedure in 25% (157/626) of the cases. In 81% (127/157), MRI was beneficial for the patients, as otherwise occult carcinomas were removed (n=122) or further biopsy could be prevented (n=5). Mastectomy rates did not differ between MR+ and MR- group (39% vs. 39%). On multiple regression analysis, the MR+ group had a lower chance for repeated surgery (p<0.05). |
4 |
| 68. Sung JS, Li J, Da Costa G, et al. Preoperative breast MRI for early-stage breast cancer: effect on surgical and long-term outcomes. AJR Am J Roentgenol. 202(6):1376-82, 2014 Jun. |
Observational-Dx |
174 women with stage 0, I, or II breast cancer who underwent preoperative MRI and 174 patients who did not undergo preoperative MRI (control group) |
To evaluate the effect of the use of preoperative breast MRI on surgical and long-term outcomes among women with early-stage breast cancer undergoing breast conservation therapy. |
Patients referred for preoperative breast MRI were more likely to have extremely dense breasts (28% vs 6%, p < 0.0001) and mammographically occult cancer (24% vs 9%, p = 0.0003). The two groups had identical rates of final negative margins, lymph node involvement, lymphovascular invasion, extensive intraductal component status, positive hormone receptor results, and systemic adjuvant therapy. Fewer patients in the preoperative MRI group needed reexcision (29% vs 45%, p = 0.02). The median follow-up period after treatment was 8 years. There was no significant difference in locoregional recurrence (p = 0.33) or disease-free survival (p = 0.73) rates between the two groups. |
4 |
| 69. Sardanelli F, Trimboli RM, Houssami N, et al. Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA). European Radiology. 32(3):1611-1623, 2022 Mar. |
Observational-Dx |
2763 patients (noMRI group); 3133 patients (MRI group) |
To conduct the Multicenter International Prospective Analysis (MIPA) study in order to provide new knowledge on this topic, building evidence on whether and to what extent MRI impacts surgical treatment in breast cancer practice. |
Of 5896 analyzed patients, 2763 (46.9%) had conventional imaging only (noMRI group), and 3133 (53.1%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1%), with preoperative intent in 2441/3133 women (77.9%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancers = 20 mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (p < 0.001 for all comparisons). Mastectomy was planned based on conventional imaging in 22.4% (MRI group) versus 14.4% (noMRI group) (p < 0.001). The additional planned mastectomy rate in the MRI group was 11.3%. The overall performed first- plus second-line mastectomy rate was 36.3% (MRI group) versus 18.0% (noMRI group) (p < 0.001). In women receiving conserving surgery, MRI group had a significantly lower reoperation rate (8.5% versus 11.7%, p < 0.001). |
3 |
| 70. Turnbull L, Brown S, Harvey I, et al. Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet. 375(9714):563-71, 2010 Feb 13. |
Experimental-Dx |
1623 women with biopsy-proven primary breast cancer |
To assess the clinical efficacy of contrast-enhanced MRI in women with primary breast cancer. |
816 patients were randomly assigned to MRI and 807 to no MRI. Addition of MRI to conventional triple assessment was not significantly associated with reduced a reoperation rate, with 153 (19%) needing reoperation in the MRI group versus 156 (19%) in the no MRI group, (odds ratio 0.96, 95% CI 0.75-1.24; p=0.77). |
1 |
| 71. Houssami N, Turner RM, Morrow M. Meta-analysis of pre-operative magnetic resonance imaging (MRI) and surgical treatment for breast cancer. [Review]. Breast Cancer Res Treat. 165(2):273-283, 2017 Sep. |
Meta-analysis |
19 studies |
To examine the association between pre-operative MRI and surgical outcomes in BC. |
Nineteen studies met eligibility criteria: 3 RCTs and 16 comparative studies that included newly diagnosed BC of any type except for three studies restricted to ILC. Primary analysis (85,975 subjects) showed that pre-operative MRI was associated with increased odds of receiving mastectomy [OR 1.39 (1.23, 1.57); p < 0.001]; similar findings were shown in analyses stratified by study-level median age. Secondary analyses did not find statistical evidence of an effect of MRI on the rates of re-excision, re-operation, or positive margins; however, MRI was significantly associated with increased odds of receiving contralateral prophylactic mastectomy [OR 1.91 (1.25, 2.91); p = 0.003]. Subgroup analysis for ILC did not find any association between MRI and the odds of receiving mastectomy [OR 1.00 (0.75, 1.33); p = 0.988] or the odds of re-excision [OR 0.65 (0.35, 1.24); p = 0.192]. |
Good |
| 72. Amin AL, Sack S, Larson KE, et al. Does the Addition of Breast MRI Add Value to the Diagnostic Workup of Invasive Lobular Carcinoma?. J Surg Res. 257:144-152, 2021 01. |
Review/Other-Dx |
166 breasts in 165 women |
To examine whether MRI adds value to the diagnostic workup in invasive lobular carcinoma (ILC) by better defining the extent of disease and identifying additional foci of malignancy, which can change the surgical plan. |
ILC was identified in 166 breasts in 165 women. Original surgical plan was for lumpectomy in 86 (52%), mastectomy in 49 (30%), and undecided in 31 (18%). MRI changed the plan in 25 (19%) with 24 (96%) changing from lumpectomy to mastectomy. Additional biopsy was performed in 28% after MRI, the majority (n = 41, 72%) were benign or high risk and 16 (28%) identified additional malignancy. MRI was not a better size estimate than mammogram/ultrasound. Re-excision rate after lumpectomy was 6.8% (5/73). MRI added value in 48 (28.9%) and was harmful in 48 (28.9%). |
4 |
| 73. Bansal GJ, Santosh D, Davies EL. Selective magnetic resonance imaging (MRI) in invasive lobular breast cancer based on mammographic density: does it lead to an appropriate change in surgical treatment?. Br J Radiol. 89(1060):20150679, 2016. |
Observational-Dx |
36 patients with pre-operative MRI and 61 patients with no MRI |
The purpose of this study was to evaluate whether high mammographic density can be used as one of the selection criteria for MRI in invasive lobular breast cancer (ILC). |
Between 2011 and 2015, there were a total of 1601 breast cancers with 97 lobular cancers, out of which 36 had pre-operative MRI and 61 had no MRI scan. 12 (33.3%) had mastectomy following MRI, out of which 9 (25%) had change in surgical plan from conservation to mastectomy following MRI. There were no unnecessary mastectomies in the MRI group. However, utilization of MRI in this cohort of patients did not reduce reoperation rate (19.3%). Lobular carcinoma in situ (LCIS) was identified in 60% of reoperations on post-surgical histology. Patients in the "No MRI" group had higher mastectomy rate 26 (42.6%), which was again appropriate. |
2 |
| 74. Brennan ME, McKessar M, Snook K, Burgess I, Spillane AJ. Impact of selective use of breast MRI on surgical decision-making in women with newly diagnosed operable breast cancer. BREAST. 32:135-143, 2017 Apr. |
Observational-Dx |
181 women (188 tumours/breasts) |
To evaluate the impact of breast MRI on surgical planning in selected cases of breast malignancy (invasive cancer or DCIS). |
MRI was performed in 181/1416 (12.8%) cases (invasive cancer 155/1219 (12.7%), DCIS 26/197 (13.2%)). Indications for MRI were: clinically dense breast tissue difficult to assess (n = 66; 36.5%), discordant clinical/conventional imaging assessment (n = 61; 33.7%), invasive lobular carcinoma in clinically dense breast tissue (n = 22; 12.2%), palpable/mass-forming DCIS (n = 11; 6.1%); other (n = 19; 10.5%). The recall rate for assessment of additional lesions was 35% (63/181). Additional biopsy-proven malignancy was found in 11/29 (37.9%) ipsilateral breast recalls and 8/34 (23.5%) contralateral breast recalls. MRI detected contralateral malignancy (unsuspected on conventional imaging) in 5/179 (2.8%). The additional information from MRI changed management in 69/181 (38.1%), with more unilateral surgery (wider excision or mastectomy) in 53/181 (29.3%), change to bilateral surgery in 12/181 (6.6%), less surgery in 4/181 (2.2%). Clinical examination estimated histological size within 20 mm in 57%, conventional imaging in 55% and MRI in 71%. |
3 |
| 75. El Sharouni MA, Postma EL, Menezes GL, et al. High Prevalence of MRI-Detected Contralateral and Ipsilateral Malignant Findings in Patients With Invasive Ductolobular Breast Cancer: Impact on Surgical Management. Clin Breast Cancer. 16(4):269-75, 2016 08. |
Review/Other-Dx |
109 patients with breast cancer containing a lobular component |
To evaluate to what extent preoperative magnetic resonance imaging (MRI) leads to the finding of additional malignancies and the effect on surgical management in the subcategory of women with invasive ductolobular disease. |
MRI revealed additional malignant foci in 28 of 109 patients (26%). More extensive disease was seen in 25 patients (23%). The preoperative MRI findings changed the TNM classification in 42% of the patients and altered the surgical policy in 37%. No correlation was found between the lobular component and the probability of detecting additional malignant foci, more extensive disease, or the frequency of a change in TNM classification or surgical policy. According to the final pathology report, the change in surgical policy was justified in 85% of the patients. |
4 |
| 76. Ha SM, Chae EY, Cha JH, Kim HH, Shin HJ, Choi WJ. Breast MR Imaging before Surgery: Outcomes in Patients with Invasive Lobular Carcinoma by Using Propensity Score Matching. Radiology. 287(3):771-777, 2018 Jun. |
Observational-Dx |
603 patients with ILC |
To investigate the association between preoperative breast magnetic resonance (MR) imaging and surgical outcomes in patients with invasive lobular carcinoma (ILC) by using propensity score matching to decide whether MR examination is beneficial in the ILC subtype of breast cancer. |
Of the 369 patients who underwent MR imaging, additional lesions were detected in 145 (39.3%); 95 of the 145 patients (65.5%) had malignant lesions. A change in surgical management occurred because of MR findings in 94 of the 369 patients (25.5%). According to pathologic findings, this change was appropriate for 84 of the 94 patients (89.4%). In the propensity score-matched analysis, breast MR imaging was associated with lower odds of repeat surgery (odds ratio, 0.140; P < .001) and similar likelihood of initial mastectomy (odds ratio, 0.876; P = .528) and final mastectomy (odds ratio, 0.744; P = .151) compared with patients without breast MR imaging. |
4 |
| 77. Heil J, Buehler A, Golatta M, et al. Do patients with invasive lobular breast cancer benefit in terms of adequate change in surgical therapy from a supplementary preoperative breast MRI?. Ann Oncol. 23(1):98-104, 2012 Jan. |
Observational-Dx |
92 patients with ILC |
To analyse if MRI leads to adequate changes in surgical management. |
A change in surgical therapy due to the MRI findings occurred in 23 of 92 patients (25%). According to the postoperative pathology findings, this change was adequate for 20 of these patients (22%; 95% confidence interval [CI] 14%-31%, P<0.0001). An overtreatment occurred for three patients (3%; 95% CI 0%-6%) who underwent a mastectomy following the results of breast MRI. Patients with larger tumours did likely benefit more from preoperative breast MRI. |
4 |
| 78. Muttalib M, Ibrahem R, Khashan AS, Hajaj M. Prospective MRI assessment for invasive lobular breast cancer. Correlation with tumour size at histopathology and influence on surgical management. Clin Radiol. 69(1):23-8, 2014 Jan. |
Review/Other-Dx |
51 consecutive women |
To evaluate the performance of breast magnetic resonance imaging (MRI) in determining the size of invasive lobular carcinoma (ILC) compared to histopathology, and its influence on breast surgical management. |
Of the 51 prospectively imaged consecutive women, seven were excluded as they had diffuse ILC. The remaining 44 patients had a mean histological tumour size of 34.9 mm (range 4-77 mm). MRI underestimated tumour size in 26 (59.1%) cases. In 21 (47.7%) patients, this discrepancy was small, ranging up to 16 mm. The largest underestimation occurred in five (11.4%) cases with a difference ranging between 31 and 48 mm. Fifteen (34.1%) tumours were overestimated by MRI where the discrepancy ranged up to 22 mm. In three (6.8%) patients MRI and histological size matched. The Bland-Altman agreement plot demonstrated that in 95% of cases the size at histopathology will be between 0.36 and 2.31 times the MRI size at extremes. MRI correlated better with histopathology in tumours up to T2 (<5 cm) size leading to a change in surgical management for nine of the 44 (20.5%) patients. |
4 |
| 79. Parvaiz MA, Yang P, Razia E, et al. Breast MRI in Invasive Lobular Carcinoma: A Useful Investigation in Surgical Planning?. Breast J. 22(2):143-50, 2016 Mar-Apr. |
Observational-Dx |
334 bilateral breast MRIs |
To find out the proportion of ILC patients where preoperative MRI caused a change in the surgical treatment. To find mastectomy rate (initial & final), re-operation rate, cancer size correlation with different imaging modalities and final histopathology, loco-regional recurrence and disease-free survival. |
A total of 334 bilateral breast MRI were performed including 72 (21.5%) MRI for ILC patients. All these MRI were carried out within 2 week of patients given the diagnosis (median 5.5 days). Age range was 24-83 (median 56.5) years. Nineteen of 72 ILC patients (26.4%) had a change in their planned operation from BCS to a different operation owing to MRI findings (seven patients with multifocal cancers, 10 with significantly larger size of the cancer and two with contralateral malignancy). Initial mastectomy rate was 31.9%, final mastectomy rate was 36.1% and re-operation rate in BCS group was 18.3%. MRI correlated better with ILC histopathology cancer size than mammogram and ultrasound scans. There was no statistically significant difference (p = 0.999) between the cancer size on histology (median 23 mm) and MRI (median 25 mm). However, mammogram (median 17 mm) and ultrasound (median 14.5 mm) scans showed cancer sizes significantly different to final histology cancer size (p = 0.0008 and p = 0.0021 respectively). Over a 44 months median follow-up (range 27-85), 95.8% disease-free survival and 98.6% overall survival have been observed. One out of every four patients (26.4%) with ILC had a change in their planned operation due to MRI findings. |
3 |
| 80. Selvi V, Nori J, Meattini I, et al. Role of Magnetic Resonance Imaging in the Preoperative Staging and Work-Up of Patients Affected by Invasive Lobular Carcinoma or Invasive Ductolobular Carcinoma. Biomed Res Int. 2018:1569060, 2018. |
Review/Other-Dx |
155 women diagnosed with ILC or IDLC |
To assess the importance of MRI in the preoperative management and staging of patients affected by invasive lobular carcinoma (ILC) or invasive ductolobular carcinoma (IDLC). |
Of the 155 women who met our inclusion criteria, 93 (60%) had additional cancer areas detected by MRI. In 61 women, 39,4% of the overall population, the additional cancer areas were confirmed by US/tomosynthesis second look and biopsy. Presurgical MRI staging changed surgical management in the 37,4% of the patients. Only six patients of the overall population needed a reoperation after the initial surgery. No statistically significant correlation was found between MRI overestimation and the presence of histological peritumoral vascular/linfatic invasion. No statistically significant correlation was found between additional cancer areas and histological cancer markers. |
4 |
| 81. Sinclair K, Sakellariou S, Dawson N, Litherland J. Does preoperative breast MRI significantly impact on initial surgical procedure and re-operation rates in patients with screen-detected invasive lobular carcinoma?. Clin Radiol. 71(6):543-50, 2016 Jun. |
Observational-Dx |
138 patients with ILC (59 with preoperative MRI and 79 without MRI) |
To investigate whether magnetic resonance imaging (MRI) changes the management of patients with screen-detected invasive lobular carcinoma (ILC). |
Forty-three percent of patients had preoperative MRI. MRI guided surgical management in 40.7% patients. Primary mastectomy rates were not significantly different between the MRI and non-MRI groups (32% and 30% respectively, p=0.71). The MRI group had a lower secondary surgery rate (6.8% versus 15.2%); however, the results did not reach statistical significance, and there were no unnecessary mastectomies. |
4 |
| 82. Moloney BM, McAnena PF, Ryan EJ, et al. The Impact of Preoperative Breast Magnetic Resonance Imaging on Surgical Management in Symptomatic Patients With Invasive Lobular Carcinoma. Breast Cancer (Auckl) 2020;14:1178223420948477. |
Observational-Dx |
218 patients with ILC (70 with preoperative MRI and 148 with no MRI) |
To determine the value of preoperative magnetic resonance imaging (MRI) for ILC and its impact on surgical outcomes. |
There were 218 cases of ILC, and 32.1% (n = 70) had preoperative MRI. Time from diagnosis to surgery was longer in the MR+ than the MR- group (32.5 vs 21.1 days, P < .001) even when adjusting for age and breast density. Initial BCS was performed on 71.4% (n = 50) of MR+ patients and 72.3% (n = 107) of the MR- group. While the rate of completion mastectomy following initial BCS was higher in the MR+ group (30.0%, n = 15 vs 14.0%, n = 15; ?2 = 5.63; P = .018), this association was not maintained in multivariable analysis. No difference was recorded in overall (initial and completion) mastectomy rate between the MR+ and MR- group (50.0%, n = 35 vs 37.8%, n = 56; ?2 = 2.89; P = .089). Margin re-excision following BCS was comparable between groups (8.0%, n =4, vs 9.3%, n = 10; ?2 = 0.076, P = .783) despite the selection bias for borderline conservable cases in the MR+ group. The rate of usage of MRI for ILC cases declined over the study period. |
4 |
| 83. Ha SM, Chae EY, Cha JH, Kim HH, Shin HJ, Choi WJ. Long-term survival outcomes in invasive lobular carcinoma patients with and without preoperative MR imaging: a matched cohort study. Eur Radiol. 29(5):2526-2534, 2019 May. |
Observational-Dx |
287 ILC patients (120 with MR and 167 with no MR) |
To investigate and compare the effect of preoperative breast magnetic resonance (MR) imaging on recurrence-free survival (RFS) and overall survival (OS) outcomes among patients with invasive lobular carcinoma (ILC). |
In the matched cohort, no statistically significant association was observed between MR imaging and total recurrence (hazard ratio [HR], 1.096; p = 0.821), loco-regional recurrence (HR, 1.204; p = 0.796), contralateral breast recurrence (HR, 0.945; p = 0.952), or distant recurrence (HR, 1.020; p = 0.973). MR imaging was associated with improved OS with 51% reduction, but not significantly (HR, 0.485; p = 0.231). Analysis with multivariable Cox regression model indicated that MR imaging was not significant independent factor for better RFS (HR, 0.823; p = 0.586) or improved OS (HR, 0.478; p = 0.168). |
4 |
| 84. Ryu J, Park HS, Kim S, Kim JY, Park S, Kim SI. Preoperative Magnetic Resonance Imaging and Survival Outcomes in T1-2 Breast Cancer Patients Who Receive Breast-Conserving Therapy. J. Breast Cancer. 19(4):423-428, 2016 Dec. |
Observational-Dx |
954 patients who had T1-2 breast cancer |
To evaluate the effect of preoperative magnetic resonance imaging (MRI) on survival outcomes for breast cancer. |
Preoperative MRI was performed in 743 of 954 patients. Clinicopathological features were not significantly different between patients with and without preoperative MRI. In the univariate analyses, larger tumors were marginally associated with poor LRRFS compared to smaller tumors (hazard ratio [HR], 3.22; p=0.053). Tumor size, histologic grade, estrogen receptor (ER), progesterone receptor (PR), hormonal therapy, and adjuvant chemotherapy status were associated with RFS. Larger tumor size, higher histologic grade, lack of ER and PR expression, and no hormonal therapy were associated with decreased OS. Tumor size was associated with LRRFS in the multivariate analyses (HR, 4.19; p=0.048). However, preoperative MRI was not significantly associated with LRRFS, RFS, or OS in either univariate or multivariate analyses. |
4 |
| 85. Houssami N, Turner R, Macaskill P, et al. An individual person data meta-analysis of preoperative magnetic resonance imaging and breast cancer recurrence. J Clin Oncol. 32(5):392-401, 2014 Feb 10. |
Review/Other-Tx |
4 studies |
To examine the association between preoperative MRI and LR as primary outcome, as well as distant recurrence, in patients with breast cancer. |
4 eligible studies contributed individual person data on 3,180 affected breasts in 3,169 subjects (median age, 56.2 years). 8-year LR-free survival did not differ between the MRI (97%) and no-MRI (95%) groups (P=.87), and the multivariable model showed no significant effect of MRI on LR-free survival: HR for MRI (vs no-MRI) was 0.88 (95% CI, 0.52 to 1.51; P=.65); age, margin status, and tumor grade were associated with LR-free survival (all P<.05). HR for MRI was 0.96 (95% CI, 0.52 to 1.77; P=.90) in sensitivity analysis. 8-year distant recurrence-free survival did not differ between the MRI (89%) and no-MRI (93%) groups (P=.37), and the multivariable model showed no significant effect of MRI on distant recurrence-free survival: HR for MRI (vs no-MRI) was 1.18 (95% CI, 0.76 to 2.27; P=.48) or 1.31 (95% CI, 0.76 to 2.27; P=.34) in sensitivity analysis. |
4 |
| 86. Gonzalez V, Arver B, Lofgren L, Bergkvist L, Sandelin K, Eriksson S. Impact of preoperative breast MRI on 10-year survival of patients included in the Swedish randomized multicentre POMB trial. BJS Open 2021;5. |
Observational-Dx |
440 patients with newly diagnosed breast cancer |
To report the 10-year follow-up of the POMB (preoperative MRI of the breast) study with a focus on the long-term outcomes disease-free survival (DFS) and overall survival (OS). |
A total of 440 patients, aged 56 years or less, with newly diagnosed breast cancer were randomized to either preoperative MRI (220) or conventional imaging (220; control). Median follow-up for each group was 10 years. DFS rates were 85.5 and 80.0 per cent for the MRI and control groups respectively (P = 0.099). The risk of relapse or death was 46 per cent higher in the control group (HR 1.46, 95 per cent c.i. 0.93 to 2.29). OS rates after 10 years were 90.9 and 88.6 per cent in the MRI and control groups respectively (P = 0.427). The risk of death was 27 per cent higher in the control group (HR 1.27, 0.71 to 2.29). Locoregional, distant, and contralateral recurrence outcomes combined were increased in the control group (P = 0.048). A subgroup analysis of patients with breast cancer stages I-III showed that preoperative MRI improved DFS compared with conventional imaging, but this did not reach statistical significance (P = 0.057). |
3 |
| 87. Freitas V, Li X, Amitai Y, et al. Contralateral Breast Screening with Preoperative MRI: Long-Term Outcomes for Newly Diagnosed Breast Cancer. Radiology. 304(2):297-307, 2022 08. |
Observational-Dx |
1,199 patients total (MRI Group, n = 842 and No-MRI Group, n = 357) |
To assess the impact of MRI for screening the contralateral breast on long-term outcomes in patients with newly diagnosed breast cancer and to determine whether subgroups with unfavorable prognoses would benefit from MRI in terms of survival. |
Of 1846 patients, 1199 fulfilled the inclusion criteria. Median follow-up time was 10 years (range, 0-14 years). The 2:1 matched sample comprised 705 patients (470 in the MRI group and 235 in the no-MRI group); median ages at surgery were 59 years (range, 31-87 years) and 64 years (range, 37-92 years), respectively. MRI depicted contralateral synchronous disease more frequently (27 of 470 patients [5.7%] vs five of 235 patients [2.1%]; P = .047) and was associated with a higher OS (hazard ratio [HR], 2.51; 95% CI: 1.25, 5.06; P = .01). No differences were observed between groups in metachronous disease rate (MRI group: 21 of 470 patients [4.5%]; no-MRI group: 10 of 235 patients [4.3%]; P > .99) or CSS (HR, 1.34; 95% CI: 0.56, 3.21; P = .51). MRI benefit was greater in patients with larger tumor sizes (>2 cm) (HR, 2.58; 95% CI: 1.11, 5.99; P = .03) and histologic grade III tumors (HR, 2.94; 95% CI: 1.18, 7.32; P = .02). |
3 |
| 88. Le-Petross HT, Slanetz PJ, Lewin AA, et al. ACR Appropriateness Criteria® Imaging of the Axilla. J Am Coll Radiol 2022;19:S87-S113. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for imaging of the axilla. |
No results stated in abstract. |
4 |
| 89. Giuliano AE, Ballman KV, McCall L, et al. Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA 2017;318:918-26. |
Experimental-Tx |
891 women |
To determine whether the 10-year overall survival of patients with sentinel lymph node metastases treated with breast-conserving therapy and sentinel lymph node dissection (SLND) alone without axillary lymph node dissection (ALND) is noninferior to that of women treated with axillary dissection. |
Among 891 women who were randomized (median age, 55 years), 856 (96%) completed the trial (446 in the SLND alone group and 445 in the ALND group). At a median follow-up of 9.3 years (interquartile range, 6.93-10.34 years), the 10-year overall survival was 86.3%in the SLND alone group and 83.6%in the ALND group (HR, 0.85 [1-sided 95%CI, 0-1.16]; noninferiority P = .02). The 10-year disease-free survival was 80.2%in the SLND alone group and 78.2%in the ALND group (HR, 0.85 [95%CI, 0.62-1.17]; P = .32). Between year 5 and year 10, 1 regional recurrence was seen in the SLND alone group vs none in the ALND group. Ten-year regional recurrence did not differ significantly between the 2 groups. |
1 |
| 90. Le-Petross HT, McCall LM, Hunt KK, et al. Axillary Ultrasound Identifies Residual Nodal Disease After Chemotherapy: Results From the American College of Surgeons Oncology Group Z1071 Trial (Alliance). AJR Am J Roentgenol. 210(3):669-676, 2018 Mar. |
Experimental-Dx |
611 patients |
To determine lymph node features on axillary ultrasound (US) images obtained after neoadjuvant chemotherapy that are associated with residual nodal disease in patients with initial biopsy-proven node-positive breast cancer. |
Axillary US images obtained after neoadjuvant chemotherapy and surgical pathologic findings were available for 611 patients. Residual nodal disease was present in 373 patients (61.0%), and 238 (39.0%) had a complete nodal pathologic response. Increased cortical thickness (mean, 3.5 mm for node-positive disease vs 2.5 mm for node-negative disease) was associated with residual nodal disease. Lymph node short-axis and long-axis diameters were significantly associated with pathologic findings. Patients with nodal morphologic type I or II had the lowest rate of residual nodal disease (51 of 91 patients [56.0%] and 138 of 246 patients (56.1%), respectively), whereas those with nodal morphologic type VI had the highest rate (44 of 55 patients [80.0%]) (p = 0.004). The presence of fatty hilum was significantly associated with node-negative disease (p = 0.0013). |
1 |
| 91. Ertan K, Linsler C, di Liberto A, Ong MF, Solomayer E, Endrikat J. Axillary ultrasound for breast cancer staging: an attempt to identify clinical/histopathological factors impacting diagnostic performance. Breast Cancer (Auckl). 7:35-40, 2013. |
Observational-Dx |
172 women |
To assess the diagnostic value of pre-surgery axillary ultrasound for nodal staging in patients with primary breast cancer and to identify clinical/histopathological factors impacting diagnostic performance. |
We enrolled a total of 172 women in the study. Sensitivity of clinical examination plus ultrasound was significantly higher than for clinical examination alone (58% vs. 31.6%). Specificity and positive predictive value were similar while the negative predictive value increased from 63.4% to 73% when additionally applying ultrasound. Sensitivity and specificity of axillary ultrasound were impacted by tumor size (P = 0.2/0.04), suspicious axillary palpation (P , 0.01/,0.01), number of affected lymph nodes (P , 0.01/-) and distant metastases (P = 0.04/,0.01). All other factors had no impact. |
3 |
| 92. Kaur N, Sharma P, Garg A, Tandon A. Accuracy of individual descriptors and grading of nodal involvement by axillary ultrasound in patients of breast cancer. Int J Breast Cancer 2013;2013:930596. |
Observational-Dx |
34 patients |
To assess the accuracy of different descriptors of axillary ultrasound and to formulate a model on grading of axillary involvement. |
Based on the presence of various descriptors, five grades of nodal involvement could be defined. The most accurate descriptors to indicate nodal involvement were loss of hilar fat and hypoechoic internal echoes with specificity of 83% and positive predictive value of 92% each. The combination of descriptors of round shape with loss of hilar fat and hypoechoic internal echos had 100% specificity and positive predictive value. |
3 |
| 93. Elmore LC, Appleton CM, Zhou G, Margenthaler JA. Axillary ultrasound in patients with clinically node-negative breast cancer: which features are predictive of disease?. J Surg Res. 184(1):234-40, 2013 Sep. |
Observational-Dx |
110 women with clinically node-negative breast cancer and suspicious axillary US |
To identify whether certain radiologic characteristics correlate with cytology and final pathology. |
Of the 110 patients, cytology was positive in 71 (68%) and final pathology was positive in 80 (73%). The most common indication for biopsy was lymph node cortex characterized by thickening or eccentric contour (N = 40). Loss of the fatty hilum was described in 17 patients, and 9 patients had lymph nodes with both abnormal cortical and hilar features. Of 43 patients with "suspicious" disease without specific criteria, the most common indication for biopsy was disparity in size of one or more lymph nodes compared with others. Maximum cortical thickness was greater in patients with positive cytology compared with those with negative cytology (7.6 versus 6.2 mm; P = 0.047). Ultrasound characteristics such as lymph node size, cortical morphology, contour, and hilar fat were not individually predictive of final cytology and pathology. |
3 |
| 94. Caudle AS, Kuerer HM, Le-Petross HT, et al. Predicting the extent of nodal disease in early-stage breast cancer. Ann Surg Oncol. 21(11):3440-7, 2014 Oct. |
Observational-Dx |
1108 patients |
To determine if imaging and clinicopathologic features could predict the extent of axillary nodal involvement in breast cancer. |
LND patients had fewer positive nodes (2.2 vs. 4.1; p < 0.0001), smaller metastases (5.3 vs. 13.8 mm; p < 0.0001), and a lower incidence of extranodal extension (24 vs. 53 %; p < 0.0001) than the US group. Even when US identified =2 abnormal nodes, patients were still more likely to have =3 positive nodes (45 %) than SLND patients (19 %; p < 0.001). After adjusting for tumor size, receptor status, and histology, multivariate analysis revealed that metastases identified by US [odds ratio (OR) 4.01; 95 % confidence interval (CI) 2.75-5.84] and lobular histology (OR 1.77; 95 % CI 1.06-2.95) predicted having =3 positive nodes. |
2 |
| 95. Abe H, Schmidt RA, Kulkarni K, Sennett CA, Mueller JS, Newstead GM. Axillary lymph nodes suspicious for breast cancer metastasis: sampling with US-guided 14-gauge core-needle biopsy--clinical experience in 100 patients. Radiology 2009;250:41-9. |
Observational-Dx |
100 patients |
To study the clinical usefulness of ultrasonography (US)-guided core-needle biopsy (CNB) of axillary lymph nodes and the US-depicted abnormalities that may be used to predict nodal metastases. |
Nodal metastases were documented at CNB in 64 (64%) of the 100 patients. All 36 patients with negative biopsy results underwent subsequent sentinel lymph node biopsy (SLNB), which yielded negative findings in 32 (89%) patients and revealed metastasis in four (11%). All 44 patients who did not undergo CNB because of negative US results subsequently underwent SLNB, which revealed lymph node metastasis in 12 (27%) patients. Cortical thickening was found in 63 (79%) of the total of 80 metastatic nodes, but only a minority (n = 26 [32%]) of the nodes had an absent fatty hilum. NHBF to the cortex was detected in 52 (65%) metastatic nodes. Both absence of a fatty hilum (metastasis detected in 26 [93%] of 28 nodes) and cortical thickening combined with NHBF (metastasis detected in 52 [81%] of 64 nodes) had a high positive predictive value. No clinically important complications were encountered with the biopsy procedures. |
3 |
| 96. Alvarez S, Anorbe E, Alcorta P, Lopez F, Alonso I, Cortes J. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. AJR Am J Roentgenol 2006;186:1342-8. |
Review/Other-Dx |
16 articles |
The purpose of our study was to evaluate the accuracy of sonography and sonographically guided biopsy in the preoperative diagnosis of metastatic invasion of the axilla in patients with breast carcinoma. |
Sixteen articles were selected. In sonography of axillae without palpable nodes, and using lymph node size as the criterion for positivity, sensitivity varied between 48.8% (95% confidence interval, 39.6-58%) and 87.1% (76.1-94.3%) and specificity, between 55.6% (44.7-66.3%) and 97.3% (86.1-99.9%). When lymph node morphology was used as the criterion for positivity, sensitivity ranged from 26.4% (15.3-40.3%) to 75.9% (56.4-89.7%) and specificity, from 88.4% (82.1-93.1%) to 98.1% (90.1-99.9%). The results are different if axillae with palpable nodes are included. The sonographically guided biopsy shows a sensitivity that varies between 30.6% (22.5-39.6%) and 62.9% (49.7-74.8%) and a specificity of 100% (94.8-100%). Many of the summary results obtained after meta-analysis show a heterogeneity that disappears, on occasion, on excluding the studies that use a double gold standard. |
4 |
| 97. Upadhyaya VS, Lim GH, Chan EYK, Fook-Chong SMC, Leong LCH. Evaluating the preoperative breast cancer characteristics affecting the accuracy of axillary ultrasound staging. Breast J. 26(2):162-167, 2020 02. |
Observational-Dx |
251 patients Positive for Nodal Metastases, 354 patients with No Nodal Metastases |
To evaluate the preoperative breast cancer (BC) characteristics that affect the diagnostic accuracy of axillary ultrasound (US) and determine the reliability of US in the different subgroups of BC patients. |
Of the 605 newly diagnosed invasive BC cases reviewed, 251 (41.5%) had nodal metastases. Axillary US sensitivity was 75.7%, specificity 92.9%, positive predictive value 88.4%, negative predictive value 84.4%, and false-negative rate 24.3%. Lower US sensitivity was seen with invasive lobular cancer (ILC) (P = .043), grade I/II, (P = .021), unifocal (P = .039), and smaller tumors (P < .001). US specificity was lower in grade III (P < .001), estrogen receptor (ER)-negative (P < .001), progesterone receptor (PR)-negative (P = .004), HER2-positive (P = .015), triple-negative (P = .001), and larger breast tumors (P < .001). US has moderate sensitivity and good specificity in detecting metastatic axillary lymph nodes. Based on preoperative cancer characteristics, US was less sensitive for nodal metastases from ILC, unifocal, lower grade, and smaller breast tumors. It was also less specific in grade III, ER-negative, PR-negative, HER2-positive, triple-negative, and larger breast tumors. Caution is suggested in interpreting the US axillary findings of patients with these preoperative tumor features. |
2 |
| 98. Lee B, Lim AK, Krell J, et al. The efficacy of axillary ultrasound in the detection of nodal metastasis in breast cancer. AJR Am J Roentgenol 2013;200:W314-20. |
Observational-Dx |
224 patients |
To assess the accuracy and effectiveness of ultrasound examination in detecting axillary nodal involvement in breast cancer patients with the aim of refining our current clinical pathways. |
Two hundred twenty-four cases were included in the analysis, 113 (50.4%) of which had evidence of metastatic nodal involvement at final histology. Of these 113 cases, ultrasound findings for 59 (52.2%) were positive. The overall positive predictive value of ultrasound for detecting metastatic nodal involvement measured 0.81. The negative predictive value was 0.60. The sensitivity was 53.7%; specificity, 85.1%; and accuracy, 67.9%. The ultrasound morphologic lymph node features with the greatest correlation with malignancy were the absence of a hyperechoic hilum (p = 0.003) and increased cortical thickness (p = 0.03). Patients with a metastatic nodal burden density of at least 20% were more likely to have abnormal findings on axillary ultrasound examination (p = 0.009). |
2 |
| 99. Cools-Lartigue J, Sinclair A, Trabulsi N, et al. Preoperative axillary ultrasound and fine-needle aspiration biopsy in the diagnosis of axillary metastases in patients with breast cancer: predictors of accuracy and future implications. Ann Surg Oncol. 20(3):819-27, 2013 Mar. |
Observational-Dx |
235 patients |
To determine the sensitivity, specificity, and accuracy of axillary ultrasound and fine-needle aspiration biopsy (FNAB) in the identification of axillary nodal metastasis in early breast cancer patients. |
Of 235 patients, none demonstrated more than 2 positive sentinel lymph nodes. Ductal carcinoma was present in 68%, estrogen and progesterone receptors were positive in 81 and 64%, respectively, Her-2/neu was positive in 10%, and 36% were axillary node positive. The sensitivity and specificity of ultrasound alone were 55 and 88%, respectively. Predictors of abnormal ultrasound included size of metastasis, estrogen receptor and Her-2 status, tumor grade, and presence of lymphovascular invasion. Addition of FNAB increased the sensitivity and specificity to 69 and 100%. In conjunction with FNAB, the positive and negative predictive values were 100 and 54%, respectively. Ten percent of patients with nodal metastases demonstrated a positive FNAB. Patients with a positive FNAB did not harbor more nodal metastases or a greater proportion of gross extranodal disease compared to patients not subjected to FNAB. |
2 |
| 100. Houssami N, Ciatto S, Turner RM, Cody HS 3rd, Macaskill P. Preoperative ultrasound-guided needle biopsy of axillary nodes in invasive breast cancer: meta-analysis of its accuracy and utility in staging the axilla. Ann Surg. 254(2):243-51, 2011 Aug. |
Meta-analysis |
31 studies (6166 subjects) |
To establish the effectiveness of UNB in staging the axilla by estimating in meta-analysis: (a) test-related measures, including accuracy and (b) patient-related outcomes, specifically test utility defined in terms of the proportion of women potentially triaged directly to AND, and in whom (unnecessary) SNB could be avoided through systematic use of preoperative UNB. |
Thirty-one studies provided 2874 UNB data from 6166 subjects (median proportion with metastatic nodes 47.2%; IQR 39.5%, 61.2%). Modeled estimates for UNB were: sensitivity 79.6% (95% confidence intervals [CI] 74.1-84.2), specificity 98.3% (95%CI 97.2-99.0), PPV 97.1% (95%CI 95.2-98.3); median UNB insufficiency was 4.1% (IQR0%-10.9%). UNB sensitivity increased with increasing ultrasound sensitivity, and was higher in studies performing UNB for "suspicious" than for "visible" nodes. Specificity was higher in studies of consecutive (vs. selected) subjects, in studies reporting ultrasound data, and in more recent studies. Median proportion of women triaged directly to AND (attributed to UNB) was 19.8% (IQR11.6%-28.1%) or 17.7% (IQR11.6%-27.1%) if restricted to clinically node-negative series. Median proportion of women with metastatic axillary nodes potentially triaged to AND was 55.2% (IQR41.8%-68.2%) and was higher (65.6%; IQR48.9%-69.7%) in the subgroup of studies with median tumor size =21 mm. |
Good |
| 101. Del Riego J, Diaz-Ruiz MJ, Teixido M, et al. The impact of axillary ultrasound with biopsy in overtreatment of early breast cancer. Eur J Radiol. 98:158-164, 2018 Jan. |
Observational-Dx |
355 pT1 breast cancers |
(a) To compare the axillary tumor burden detected by fine-needle aspiration cytology (FNAC) versus sentinel lymph node biopsy (SLNB). (b) To evaluate the relationship between axillary tumor burden and the number of suspicious lymph nodes detected by axillary ultrasonography (US). (c) To calculate the false-positive and false-negative rates for FNAC in patients fulfilling ACOSOG Z0011 criteria. |
High axillary burden: in entire series 38.5% FNAC+ vs. 5.7% SLNB+ (p<0.0001). In subgroup fulfilling ACOSOG Z0011 criteria: 45.5% vs 6.7%, respectively (p<0.001). 61 positive axillary US. With 1 suspicious node on axillary US: 95.6% had =2 involved nodes (including pN0); with 2 suspicious nodes: 60% had >2 involved nodes. In ACOSOG Z0011 patients, with 1 suspicious node, 93.7% had =2 involved nodes. Of the 37 FNAC in ACOSOG Z0011patients: 54.5% false-positives for high burden; 3.8% false-negatives. |
3 |
| 102. Balasubramanian I, Fleming CA, Corrigan MA, Redmond HP, Kerin MJ, Lowery AJ. Meta-analysis of the diagnostic accuracy of ultrasound-guided fine-needle aspiration and core needle biopsy in diagnosing axillary lymph node metastasis. Br J Surg. 105(10):1244-1253, 2018 09. |
Meta-analysis |
6 studies (1353 patients) |
To review comparative studies examining both preoperative US-FNA and US-CNB of axillary lymph nodes in breast cancer. |
Data on a total of 1353 patients from six studies met the inclusion criteria and were included in the final analysis. US-CNB was superior to US-FNA in diagnosing axillary nodal metastases: sensitivity 88 (95 per cent c.i. 84 to 91) versus 74 (70 to 78) per cent respectively. Both US-CNB and US-FNA had a high specificity of 100 per cent. Reported complication rates were significantly higher for US-CNB compared with US-FNA (7·1 versus 1·3 per cent; P < 0·001). Conversely, the requirement for repeat diagnostic procedures was significantly greater for US-FNA (4·0 versus 0·5 per cent; P < 0·001). |
Good |
| 103. Valente SA, Levine GM, Silverstein MJ, et al. Accuracy of predicting axillary lymph node positivity by physical examination, mammography, ultrasonography, and magnetic resonance imaging. Ann Surg Oncol. 19(6):1825-30, 2012 Jun. |
Observational-Dx |
244 women |
To accurately predict axillary nodal involvement by using physical examination and standard breast imaging studies in combination. |
A total of 62 (25%) of 244 women were found to have positive axillary lymph nodes on final histopathologic examination, 42% of whom were able to be identified preoperatively. The sensitivity for predicting axillary metastasis if any one or more examination modalities were suspicious was 56.5%. The specificity for predicting axillary metastasis if any three or more modalities were suspicious was 100%. Of the patients who had all four modalities negative, 14% were ultimately found to have histologically positive nodes at the time of surgery. |
3 |
| 104. Helal MH, Mansour SM, Salaleldin LA, Alkalaawy BM, Salem DS, Mokhtar NM. The impact of contrast-enhanced spectral mammogram (CESM) and three-dimensional breast ultrasound (3DUS) on the characterization of the disease extend in cancer patients. Br J Radiol. 91(1087):20170977, 2018 Jul. |
Observational-Dx |
300 breast masses |
To evaluate the role of contrast-enhanced spectral mammogram (CESM) in correlation with three-dimensional (3D) breast ultrasound in characterizing the extension of the intramammary cancer in view of the: (i) the size of the main tumor, (ii) the multiplicity of the breast cancer, and (iii) the peri-tumoral stromal involvement (i.e. free or intraductal extension of the cancer). |
There was no significant difference between the sizes of the included cancers as measured by CESM and 3D ultrasound and that measured at the pathological analysis. CESM showed higher accuracy (32.7%, n = 98) than 3D ultrasound (24.7%, n = 74) in the size agreement within 5% range. CESM was the most accurate modality (94%, n = 282) in detecting tumor multiplicity, followed by traditional sonomammogram (88%, n = 264), then 3D breast ultrasound (84%, n = 252). Intraductal extension of the breast cancer was best evaluated by the 3D ultrasound with an accuracy value of 98% (n = 294) compared to only 60% (n = 180) by CESM. |
3 |
| 105. Appleton DC, Hackney L, Narayanan S. Ultrasonography alone for diagnosis of breast cancer in women under 40. Ann R Coll Surg Engl. 96(3):202-6, 2014 Apr. |
Observational-Dx |
2,495 patients |
To assess the adequacy of ultrasonography and the utility of mammography in this patient group by reviewing the role these imaging techniques had in the diagnosis of breast cancer in our unit. |
A total of 2,495 patients were referred to the symptomatic breast clinic in this age group during the study period. Thirty women were identified with either invasive cancer (n=27) or ductal carcinoma in situ (n=3). Twenty-eight patients underwent mammography, graded as uncertain, suspicious or malignant in the majority. Malignancy was missed in one patient. All 30 patients underwent ultrasonography, reported as uncertain, suspicious or malignant, an indication for diagnostic core biopsy. Ultrasonography alone did not miss any cancers but did fail to detect multifocal disease in one patient. |
4 |
| 106. Mariscotti G, Houssami N, Durando M, et al. Accuracy of mammography, digital breast tomosynthesis, ultrasound and MR imaging in preoperative assessment of breast cancer. Anticancer Res. 34(3):1219-25, 2014 Mar. |
Observational-Dx |
200 consecutive women with breast cancer |
To define the accuracy of digital breast tomosynthesis (DBT) and magnetic resonance imaging (MRI) added to digital mammography (DM) and ultrasound (US) in the preoperative assessment of breast cancer. |
DBT had higher sensitivity than DM (90.7% vs. 85.2%). Combined DM and DBT with US yielded a 97.7% sensitivity; despite high sensitivity of MRI (98.8%), the addition of MRI to combined DM with DBT and US did not significantly improve sensitivity. Overall accuracy did not significantly differ between MRI and DM with DBT and US (92.3% vs. 93.7%). Breast density affected sensitivity of DM and DBT (statistically significant difference for DM), not MRI. |
2 |
| 107. Hungness ES, Safa M, Shaughnessy EA, et al. Bilateral synchronous breast cancer: mode of detection and comparison of histologic features between the 2 breasts. Surgery 2000;128:702-7. |
Observational-Dx |
51 patients |
To review our experience with patients with bilateral synchronous breast cancer, focusing on the mode of detection and histologic features in the 2 breasts. |
During the study period, 51 patients (all women) were treated at our institution for bilateral synchronous breast cancer. This comprised 2.1% of all patients (n = 2382 patients) treated for breast cancer during the same period of time. The first cancer was detected by palpation in 81% and by mammography in 14%. The corresponding figures for the contralateral cancer were 24% and 54%, respectively. The histologic type of cancer was identical in the 2 breasts in 29 patients (57%) and was different between the 2 breasts in 22 patients (43%). The overall 10-year survival rate was 63%. |
4 |
| 108. Broet P, de la Rochefordiere A, Scholl SM, et al. Contralateral breast cancer: annual incidence and risk parameters. J Clin Oncol 1995;13:1578-83. |
Observational-Dx |
282 metachronous CBCs |
To screen for factors that might predict the risk of developing metachronous contralateral breast cancer (CBC), taking into account the influence of local or distant recurrence, and to assess the annual incidence of CBC. |
The median follow-up time was 80 months (range, 1 to 158). The cumulative rate of CBC was 4.1% +/- 0.3% at 5 years, and the annual incidence rate of CBC increased slowly, while the risk of local recurrence and metastases decreased after the fourth year. Whichever model we chose, age less than 55 years (relative risk [RR] = 1.40) at the time of diagnosis of the first breast cancer, as well as the presence of lobular type carcinoma (RR = 1.50), was associated with an increased risk of developing a tumor in the contralateral breast. Adjuvant chemotherapy significantly decreased (RR = 0.54) the risk of CBC. |
4 |
| 109. Koh J, Kim EK, Kim MJ, Yoon JH, Moon HJ. Additional Magnetic Resonance Imaging-Detected Suspicious Lesions in Known Patients With Breast Cancer: Comparison of Second-Look Digital Tomosynthesis and Ultrasonography. ULTRASOUND Q.. 33(2):167-173, 2017 Jun. |
Observational-Dx |
55 patients with breast cancers |
To compare the performances of second-look digital breast tomosynthesis (DBT) and ultrasonography (US) for additional magnetic resonance imaging (MRI)-detected suspicious lesions in patients referred for breast cancer. |
Of 37 additional MRI-detected suspicious lesions, 27 were detected on DBT and/or US; 2 were detected on both DBT and US, 1 was detected only on DBT, and 24 were detected only on US. Ultrasonography detected more additional suspicious lesions than DBT (P < 0.0001). Twelve (44.4%) of the 27 lesions were malignant. The sensitivity and negative predictive value of US (100.0% and 100.0%) were significantly higher than those of DBT (16.7% and 83.6%, P < 0.001 and P = 0.001). The specificity of DBT was significantly higher (98.1%) than that of US (78.9%, P = 0.002). Positive predictive values of DBT and US were not significantly different (66.7% vs 52.2%, P = 0.598). The area under the receiver operating characteristic curve of US was significantly higher (0.894) than that of DBT (0.574, P < 0.001). |
4 |
| 110. Spick C, Baltzer PA. Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis. Radiology 2014;273:401-9. |
Meta-analysis |
17 studies |
To evaluate the diagnostic utility of second-look ultrasonography (US) in the assessment of lesions identified at breast magnetic resonance (MR) imaging. |
Seventeen studies that included benign and malignant lesions met the inclusion criteria. The general lesion detection rate at second-look US was very heterogeneous and ranged between 22.6% and 82.1% (pooled rate, 57.5% [1266 of 2201]; 95% confidence interval [ CI confidence interval ]: 50.0%, 64.1% [random-effects model]; I(2) = 90.9%; P < .0001). The highest second-look US detection rates were observed for mass lesions (as opposed to nonmass lesions) and malignant (vs benign) lesions (P < .001 for both). Pooled positive and negative predictive values (positive or negative second-look US correlates of MR imaging-detected malignant or benign lesions) were calculated as 30.7% (95% CI confidence interval : 25.3%, 36.4%; I(2) = 75.4%; P < .0001) and 87.8% (95% CI confidence interval : 82.0%, 92.7%; I(2) = 82.1%; P < .0001), respectively, by using random-effects models. |
Good |
| 111. Dillon MF, Hill AD, Fleming FJ, et al. Identifying patients at risk of compromised margins following breast conservation for lobular carcinoma. Am J Surg 2006;191:201-5. |
Observational-Dx |
991 patients with invasive ductal carcinoma and 150 patients with invasive lobular carcinoma |
To identify patients at risk of compromised margins following breast conservation surgery. |
A total of 991 patients with invasive ductal carcinoma and 150 patients with invasive lobular carcinoma were identified. Lobular carcinomas had a compromised margin rate of 49% (n = 38/77) in breast conservation compared to 24% (n = 143/588) of ductal carcinomas (P < .0001). Mammographic size (P = .017), pathological size (P = .01), age (P = .03), multifocality (P < .0001), and lymphovascular invasion (P = .015) were significantly associated with compromised margins. |
3 |
| 112. Mann RM, Veltman J, Barentsz JO, Wobbes T, Blickman JG, Boetes C. The value of MRI compared to mammography in the assessment of tumour extent in invasive lobular carcinoma of the breast. Eur J Surg Oncol 2008;34:135-42. |
Observational-Dx |
67 consecutive patients with ILC |
To evaluate its value, compare it to mammography and assess the possible causes of over- and underestimation of lesion size on MRI. |
MRI measurements correlated better to pathologic size (r=0.85) than mammographic measurements (r=0.27). Underestimation of tumour size was more common on mammography (p<0.001); overestimation occurred with equal frequency (p=0.69). Overestimation on MRI, caused by non-malignant findings, was attributed to enhancing lobular carcinoma in situ. |
3 |
| 113. Vijayaraghavan GR, Vedantham S, Santos-Nunez G, Hultman R. Unifocal Invasive Lobular Carcinoma: Tumor Size Concordance Between Preoperative Ultrasound Imaging and Postoperative Pathology. Clin Breast Cancer 2018;18:e1367-e72. |
Observational-Dx |
66 patients with ILC |
To systematically analyze the extent of disease in unifocal invasive lobular carcinoma (ILC) using ultrasonography, with the histopathologic findings as the reference standard. |
The median and quartiles (Q1, Q3) of tumor size from ultrasonography and pathology were 12.5 mm (Q1, 9 mm; Q3, 19 mm) and 17 mm (Q1, 12 mm; Q3, 25 mm), respectively. The corresponding data for tumor volume were 0.52 cm3 (Q1, 0.18 cm3; Q3, 1.92 cm3) and 1.04 cm3 (Q1, 0.45 cm3; Q3, 2.49 cm3). The ultrasound measurements correlated with the pathology-reported tumor size (Spearman ? = 0.678; P < .0001) and volume (Spearman ? = 0.699; P < .0001). The ultrasound-measured size and volume differed from the pathology-reported size and volume (P < .0001; Wilcoxon signed ranks test). Concordance between the clinical tumor size stage from ultrasound (cT) and pathology tumor size stage (pT) varied with the pT stage (P = .0003, Fisher's exact test), with the greatest concordance rate of 95.7% (95% confidence limit, 85.2%-99.5%) observed for pT1 tumors. |
3 |
| 114. Veltman J, Boetes C, van Die L, Bult P, Blickman JG, Barentsz JO. Mammographic detection and staging of invasive lobular carcinoma. Clin Imaging 2006;30:94-8. |
Review/Other-Dx |
42 patients with ILC |
To evaluate mammography in detecting and staging of invasive lobular carcinoma (ILC) in order to assess the performance and impact of observer variability. |
Forty-two cases of ILC were retrospectively evaluated twice by two breast radiologists. Mammographic performance as well as intra- and interobserver variations was evaluated. Thirty-five percent to 37% of the cases were understaged. The largest differences between radiologists were found in the breast imaging reporting and data system (BIRADS) classification and staging performance. These results can have serious influence on patient management. |
4 |
| 115. Coleman RE, Rubens RD. The clinical course of bone metastases from breast cancer. Br J Cancer 1987;55:61-6. |
Review/Other-Dx |
2240 patients with primary breast cancer |
To study the incidence, prognosis, morbidity and response to treatment of bone metastases.To compare biological characteristics of the primary tumour in patients relapsing first in bone or liver. |
Sixty-nine percent of patients dying with breast cancer had bone metastases and bone was the commonest site of first distant relapse. Bone relapse was more common in receptor positive or well differentiated (grade 1) tumours. The median survival was 24 months in those with disease apparently confined to the skeleton compared with 3 months after first relapse in liver. Ten percent of patients with breast cancer developed hypercalcaemia. All had metastatic disease and 85% had widespread skeletal involvement. Fifteen percent of patients with disease confined to the skeleton developed hypercalcaemia. |
4 |
| 116. Perou CM, Sorlie T, Eisen MB, et al. Molecular portraits of human breast tumours. Nature. 2000;406(6797):747-752. |
Review/Other-Tx |
65 surgical specimens |
The authors characterized variation in gene expression patterns in a set of 65 surgical specimens of human breast tumors from 42 different individuals, using complementary DNA microarrays representing 8,102 human genes. |
These patterns provided a distinctive molecular portrait of each tumor. 20 of the tumors were sampled twice, before and after a 16-week course of doxorubicin chemotherapy, and 2 tumors were paired with a lymph node metastasis from the same patient. Gene expression patterns in 2 tumor samples from the same individual were almost always more similar to each other than either was to any other sample. Sets of co-expressed genes were identified for which variation in messenger RNA levels could be related to specific features of physiological variation. |
4 |
| 117. Kennecke H, Yerushalmi R, Woods R, et al. Metastatic behavior of breast cancer subtypes. J Clin Oncol 2010;28:3271-7. |
Review/Other-Dx |
3,726 women |
To determine the association of breast tumor molecular subtypes on site of metastatic disease and to define the associated patient outcomes using a large validated tissue microarray (TMA) of primary invasive breast cancer specimens. |
Median follow-up time among 3,726 eligible patients was 14.8 years. Median durations of survival with distant metastasis were 2.2 (luminal A), 1.6 (luminal B), 1.3 (luminal/HER2), 0.7 (HER2 enriched), and 0.5 years (basal-like; P < .001). Bone was the most common metastatic site in all subtypes except basal-like tumors. In multivariate analysis, compared with luminal A tumors, luminal/HER2 and HER2-enriched tumors were associated with a significantly higher rate of brain, liver, and lung metastases. Basal-like tumors had a higher rate of brain, lung, and distant nodal metastases but a significantly lower rate of liver and bone metastases. TN nonbasal tumors demonstrated a similar pattern but were not associated with fewer liver metastases. |
4 |
| 118. Sorlie T, Perou CM, Tibshirani R, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A. 2001;98(19):10869-10874. |
Review/Other-Tx |
85 cDNA microarray experiments |
To classify breast carcinomas based on variations in gene expression patterns derived from cDNA microarrays and to correlate tumor characteristics to clinical outcome. |
A novel finding was that the previously characterized luminal epithelial/ER-positive group could be divided into at least 2 subgroups, each with a distinctive expression profile. These subtypes proved to be reasonably robust by clustering using 2 different gene sets: first, a set of 456 cDNA clones previously selected to reflect intrinsic properties of the tumors and, second, a gene set that highly correlated with patient outcome. |
4 |
| 119. Sihto H, Lundin J, Lundin M, et al. Breast cancer biological subtypes and protein expression predict for the preferential distant metastasis sites: a nationwide cohort study. Breast Cancer Res. 13(5):R87, 2011 Sep 13. |
Review/Other-Dx |
3,886 representative tumor tissue samples |
To investigate the associations between the primary tumor protein expression, as assessed by immunohistochemistry, and the first site of cancer distant recurrence. |
A total of 3,886 TMA cores were analyzed. Luminal A cancers had a propensity to give rise first to bone metastases, HER2-enriched cancers to liver and lung metastases, and basal type cancers to liver and brain metastases. Primary tumors that gave first rise to bone metastases expressed frequently estrogen receptor (ER) and SNAI1 (SNAIL) and rarely COX2 and HER2, tumors with first metastases in the liver expressed infrequently SNAI1, those with lung metastases expressed frequently the epidermal growth factor receptor (EGFR), cytokeratin-5 (CK5) and HER2, and infrequently progesterone receptor (PgR), tumors with early skin metastases expressed infrequently E-cadherin, and breast tumors with first metastases in the brain expressed nestin, prominin-1 and CK5 and infrequently ER and PgR. |
4 |
| 120. Smid M, Wang Y, Zhang Y, et al. Subtypes of breast cancer show preferential site of relapse. Cancer Res 2008;68:3108-14. |
Review/Other-Dx |
344 primary breast tumors of lymph node-negative patients. |
To explore whether the five previously reported molecular subtypes in breast cancer show a preference for organ-specific relapse and searched for molecular pathways involved. |
Fisher exact tests were used to determine the association between a tumor subtype and a particular site of distant relapse in these patients who only received local treatment. Modulated genes and pathways were identified in the various groups using Significance Analysis of Microarrays and Global Testing. Bone relapse patients were most abundant in the luminal subtypes but were found less than expected in the basal subtype. The reverse was true for lung and brain relapse patients with the remark that absence of lung relapse was luminal A specific. Finally, a pleura relapse, although rare, was found almost exclusively in both luminal subtypes. Many differentially expressed genes were identified, of which several were in common in a subtype and the site to which the subtype preferentially relapsed. WNT signaling was up-regulated in the basal subtype and in brain-specific relapse, and down-modulated in the luminal B subtype and in bone-specific relapse. Focal adhesion was found up-regulated in the luminal A subtype but down-regulated in lung relapse. |
4 |
| 121. Metzger-Filho O, Sun Z, Viale G, et al. Patterns of Recurrence and outcome according to breast cancer subtypes in lymph node-negative disease: results from international breast cancer study group trials VIII and IX. J Clin Oncol 2013;31:3083-90. |
Experimental-Dx |
1,951 patients with node-negative, early-stage BC |
To retrospectively evaluate the pattern of recurrence and outcome of node-negative breast cancer (BC) according to major subtypes. |
Median follow-up was 12.5 years. The 10-year BCFI was higher for patients with LA-like (86%) BC compared with LB-like (76%), HER2 (73%), and TN (71%; P < .001) BC. TN and HER2 cohorts had higher hazard of BCFI event in the first 4 years after diagnosis (pre-trastuzumab). LB-like cohorts had a continuously higher hazard of BCFI event over time compared with LA-like cohorts. Ten-year overall survival was higher for LA-like (89%) compared with LB-like (83%), HER2 (77%), and TN (75%; P < .001) BC. LB-like subtypes had higher rates of bone as first recurrence site than other subtypes (P = .005). Visceral recurrence as first site was lower for the LA-like subgroup, with similar incidence among the other subgroups when treated with chemotherapy (P = .003). |
3 |
| 122. Liede A, Jerzak KJ, Hernandez RK, Wade SW, Sun P, Narod SA. The incidence of bone metastasis after early-stage breast cancer in Canada. Breast Cancer Res Treat 2016;156:587-95. |
Observational-Dx |
2097 women with stage I, II, or III breast cancer |
To examine the occurrence and predictors of bone metastases, as well as post-metastasis survival in a prospective cohort of Canadian women with breast cancer. |
Among 2097 women studied, the 5-, 10-, and 15-year probability of bone metastasis was 6.5, 10.3, and 11.3 % for the first recurrence, and 8.4, 12.5, and 13.6 % for any bone recurrence. At median follow-up (12.5 years), 13.2 % of patients had bone metastases. Median survival was 1.6 years following bone metastasis, and shorter if both bone and visceral metastases occurred. Advanced age and adjuvant treatment with tamoxifen were protective against bone metastasis. |
4 |
| 123. Pulido C, Vendrell I, Ferreira AR, et al. Bone metastasis risk factors in breast cancer. Ecancermedicalscience 2017;11:715. |
Review/Other-Dx |
N/A |
To perform a literature review on risk factors for bone metastasis (BM) in breast cancer (BC) patients. |
No results provided |
4 |
| 124. Galasko CS. The significance of occult skeletal metastases, detected by skeletal scintigraphy, in patients with otherwise apparently 'early' mammary carcinoma. Br J Surg 1975;62:694-6. |
Review/Other-Dx |
50 patients with early breast carcinoma |
To examine whether there is a significance of occult lesions and whether they affect the survival of patients by following 50 consecutive patients that have 'early' mammary carcinoma who had had a skeletal scintigram. |
Fifty patients with apparently 'early' mammary carcinoma on clinical, radiological and biochemical grounds had a skeletal scintigram carried out when they first presented. Twelve (24 per cent) of the patients had a positive scintigram. All these patients have developed metastatic disease in the first 5 years following mastectomy, and at least 9 (75 per cent), and probably 10 (83 per cent), have died from mammary carcinoma during this period. This compares with 10 (26 per cent) of the patients with a negative scintigram who have developed recurrent or metastatic disease, of whom 8 (21 per cent) have died from their disease. Five years following mastectomy none of the patients with a positive scintigram was alive and free from disease, compared with 25 (66 per cent) of the patients with a negative scintigram. |
4 |
| 125. James J, Teo M, Ramachandran V, Law M, Ip E, Cheng M. Looking for Metastasis in Early Breast Cancer: Does Bone Scan Help? A Retrospective Review. Clin Breast Cancer 2021;21:e18-e21. |
Observational-Dx |
194 breast cancer patients (190 with BS and CTCAP, 4 with BS only, 12 with CTCAP only) |
To examine our experience with whole body bone scan (BS) as a staging investigation when selectively used in early breast cancer (EBC). |
Even with the selective use of BS, we could only achieve a yield of 1% (95% confidence interval, -0.6, 2.7) in EBC. When combined with CT scan ofchest, abdomen, and pelvis (CTCAP), only one additional metastasis was detected in 194 BSs. |
3 |
| 126. NCCN Clinical Practice Guidelines in Oncology. Breast Cancer. Version 4.2022. Available at: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. |
Review/Other-Dx |
N/A |
No abstract available |
No abstract available |
4 |
| 127. Gerber B, Seitz E, Muller H, et al. Perioperative screening for metastatic disease is not indicated in patients with primary breast cancer and no clinical signs of tumor spread. Breast Cancer Res Treat 2003;82:29-37. |
Observational-Dx |
1076 patients with an operable breast cancer and no clinical signs of metastases |
To examine the indications of a cost-intensive routine screening for distant disease in patients presenting with primary operable breast cancer and no signs of metastases. |
Staging examinations revealed 30 (2.8%) distant metastases, 130 (12.1%) suspect findings and excluded metastases in 916 (85.1%) patients. Further diagnostic procedures confirmed distant metastases in 7 (5.4%) and excluded them in 123 (94.6%) out of 130 patients with suspect findings. Distant metastases were detected more frequently with increasing pathological tumor size (pT < or = 2.0 cm: 1.6%, pT 2.1-5.0 cm: 3.0%, respectively pT > 5.0 cm: 15.1%; p < 0.001) and increasing number of involved axillary lymph nodes (pN0: 1.9%, pN1-3+: 1.8%, pN4-9+: 4.0%, pN > or = 10+: 18.7%; p < 0.001). Due to false positive findings 123 (11.4%) patients had to live for a significant period of time with the psychological distress of suspected metastatic disease. The abandonment of a perioperative screening in 1076 patients saves costs of at least Euros 259,367.68. |
4 |
| 128. ABIM/ASCO Choosing Wisely. Imaging and tumor marker tests for breast cancer. When you need them—and when you don’t. Available at: https://www.choosingwisely.org/wp-content/uploads/2018/03/Imaging-And-Tumor-Marker-Tests-ASCO.pdf. |
Review/Other-Dx |
N/A |
No abstract available |
No abstract available |
4 |
| 129. Ayala de la Pena F, Andres R, Garcia-Saenz JA, et al. SEOM clinical guidelines in early stage breast cancer (2018). Clin Transl Oncol 2019;21:18-30. |
Review/Other-Dx |
N/A |
To summarize current evidence and to give evidence-based recommendations for clinical practice. |
No results available |
4 |
| 130. Cardoso F, Kyriakides S, Ohno S, et al. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2019;30:1674. |
Review/Other-Dx |
N/A |
No abstract available |
No results provided |
4 |
| 131. Dull B, Linkugel A, Margenthaler JA, Cyr AE. Overuse of Chest CT in Patients With Stage I and II Breast Cancer: An Opportunity to Increase Guidelines Compliance at an NCCN Member Institution. J. Natl. Compr. Cancer Netw.. 15(6):783-789, 2017 06. |
Observational-Dx |
3,321 patients with early-stage breast cancer |
To assess the use and results of chest CT in these patients at an NCCN Member Institution. |
From 1998 to 2012, 3,321 patients were diagnosed with early-stage breast cancer. Of these, 2,062 (62.1%) had clinical stage I breast cancer at diagnosis and 1,259 (37.9%) had stage II; 227 patients (11%) with stage I and 456 (36.2%) with stage II breast cancer received staging chest CT. Of patients undergoing CT, 184 (26.9%) were found to have pulmonary nodules, which measured =5 mm for 128 patients (69.6%), 5 to 10 mm for 46 patients (25.0%), 11 to 20 mm for 6 patients (3.2%), and =20 mm for 4 patients (2.2%). Patients undergoing chest CT for staging subsequently underwent a mean of 2.34 (range, 0-16) additional CTs in follow-up. Of all patients undergoing chest CT for staging, only 9 (1.3%) were ultimately diagnosed with pulmonary metastases at an average of 25 months (range, 0-97) after initial staging chest CT. |
4 |
| 132. James J, Teo M, Ramachandran V, Law M, Stoney D, Cheng M. A critical review of the chest CT scans performed to detect asymptomatic synchronous metastasis in new and recurrent breast cancers. World J Surg Oncol. 17(1):40, 2019 Feb 23. |
Observational-Dx |
335 cases |
To report our experience with the use of chest CT (CTC). |
Fourteen asymptomatic synchronous distant metastasis (ASM) were detected from 335 CTCs giving an overall yield of 4% (95% CI 1.89–6.47). The overall false-positive rate was 10% due to 35 indeterminate findings that were found not to be metastases after further tests or observation. Even with selective use, CTCs have a low yield of 2% (95% CI -?0.19–4.19) in early breast cancers. Advanced breast cancers have a 9% incidence of ASMs. None of the clinically isolated locoregionally recurrent diseases were associated with detectable distant metastasis in CTC. |
3 |
| 133. Groheux D, Hindie E, Espie M, Ulaner GA. Letter to the Editor: PET/CT in Locally Advanced Breast Cancer: Time for a Guideline Change? J Natl Compr Canc Netw 2021;19:xxx. |
Review/Other-Dx |
N/A |
No abstract available |
No abstract available |
4 |
| 134. Ko H, Baghdadi Y, Love C, Sparano JA. Clinical Utility of 18F-FDG PET/CT in Staging Localized Breast Cancer Before Initiating Preoperative Systemic Therapy. J. Natl. Compr. Cancer Netw.. 18(9):1240-1246, 2020 09. |
Review/Other-Dx |
195 patients with 196 breast cancers |
To evaluate our experience with the use of PET/CT in this setting before beginning primary systemic therapy (PST) prior to planned surgery. |
A total of 195 patients with 196 breast cancers (bilateral disease in 1 patient) met the study inclusion criteria and had PET/CT as the first imaging study before PST. The overall upstaging rate for regional nodal metastasis and/or distant metastasis was 37% (73/196), including 24% for stage IIA (9/38), 39% for stage IIB (31/79), 54% for stage IIIA (22/41), 27% for stage IIIB (8/30), and 37% for stage IIIC (3/8). The overall upstaging rate for distant metastasis was 14% (27/196), including 0% for stage IIA, 13% for stage IIB (10/79), 22% for stage IIIA (9/41), 17% for stage IIIB (5/30), and 37% for stage IIIC (3/8). Medicare reimbursement rates were $1,604.37 for PET/CT and $1,679.94 for CTBS. The radiation dose for PET/CT was 14 mSv versus 21 mSv for CTBS. |
4 |
| 135. Srour MK, Amersi F. Response to Letter to the Editor: "18FDG-PET/CT Imaging in Breast Cancer Patients with Clinical Stage IIB or Higher". Ann Surg Oncol 2020;27:1710-11. |
Review/Other-Dx |
N/A |
No abstract available |
No abstract available |
4 |
| 136. Groheux D, Hindie E, Delord M, et al. Prognostic impact of (18)FDG-PET-CT findings in clinical stage III and IIB breast cancer. J Natl Cancer Inst. 104(24):1879-87, 2012 Dec 19. |
Observational-Dx |
254 patients with clinical stages II and III breast cancer |
To prospectively evaluated the yield of fluorodeoxyglucose positron emission tomography/computed tomography ((18)FDG-PET-CT) in patients with clinical stages II and III breast cancer and the impact of PET-CT results on prognosis. |
(18)FDG-PET-CT changed the clinical stage in 77 of 254 patients (30.3%; 95% confidence interval [CI] = 25.0% to 36.2%). It showed unsuspected N3 disease (infraclavicular, supraclavicular, or internal mammary nodes) in 40 patients and distant metastases in 53. PET-CT revealed distant metastases in 2.3% (1 of 44) of clinical stage IIA, 10.7% (6 of 56) of stage IIB, 17.5% (11 of 63) of stage IIIA, 36.5% (27 of 74) of stage IIIB, and 47.1% (8 of 17) of stage IIIC patients. Among 189 patients with clinical stage IIB or higher disease and adequate follow-up, disease-specific survival was statistically significantly shorter in the 47 patients scored M1 on (18)FDG-PET-CT in comparison with those scored M0, with a three-year disease-specific survival of 57% vs 88% (P < .001). In multivariable analysis, only distant disease on PET-CT and triple-negative phenotype were statistically significant prognostic factors. The relative risk of death was 26.60 (95% CI = 6.60 to 102.62) for M1 vs M0 patients. |
3 |
| 137. Ulaner GA. PET/CT for Patients With Breast Cancer: Where Is the Clinical Impact? AJR Am J Roentgenol 2019;213:254-65. |
Review/Other-Dx |
N/A |
To review the strengths and weaknesses of FDG PET/CT for the staging of the primary breast lesion, axillary and extraaxillary nodal metastases, and distant metastases. |
Although FDG PET/CT is currently the PET modality with the greatest effect on clinical management of patients with breast cancer, novel radiotracers and imaging systems continue to broaden the application of PET for patients with breast cancer. National Comprehensive Cancer Network guidelines for FDG PET/CT for patients with breast cancer are reviewed. Emphasis is given where FDG PET/CT has shown clinical effect. |
4 |
| 138. Groheux D, Giacchetti S, Espie M, et al. The yield of 18F-FDG PET/CT in patients with clinical stage IIA, IIB, or IIIA breast cancer: a prospective study. J Nucl Med. 52(10):1526-34, 2011 Oct. |
Observational-Dx |
131 patients |
To prospectively evaluate the role of (18)F-FDG PET/CT in patients with stage IIA, IIB, or IIIA breast cancer. |
Of the 131 examined patients, 36 had clinical stage IIA (34 T2N0 and 2 T1N1), 48 stage IIB (20 T3N0 and 28 T2N1), and 47 stage IIIA (29 T3N1, 9 T2N2, and 9 T3N2). (18)F-FDG PET/CT modified staging for 5.6% of stage IIA patients, for 14.6% of stage IIB patients, and for 27.6% of stage IIIA patients. However, within stage IIIA, the yield was specifically high among the 18 patients with N2 disease (56% stage modification). When considering stage IIB and primary operable IIIA (T3N1) together, the yield of (18)F-FDG PET/CT was 13% (10/77); extraaxillary regional lymph nodes were detected in 5 and distant metastases in 7 patients. In this series, (18)F-FDG PET/CT outperformed bone scanning, with only 1 misclassification versus 8 for bone scanning (P = 0.036). |
3 |
| 139. Ulaner GA, Castillo R, Wills J, Gonen M, Goldman DA. 18F-FDG-PET/CT for systemic staging of patients with newly diagnosed ER-positive and HER2-positive breast cancer. European Journal of Nuclear Medicine & Molecular Imaging. 44(9):1420-1427, 2017 Aug.Eur J Nucl Med Mol Imaging. 44(9):1420-1427, 2017 Aug. |
Observational-Dx |
238 patients with ER+/HER2- and 245 patients with HER2+ |
To assess 18F-FDG-PET/CT for patients with newly diagnosed estrogen receptor-positive/human epidermal growth factor receptor-negative (ER+/HER2-) and human epidermal growth factor receptor-positive (HER2+) breast cancer. |
A total of 238 patients with ER+/HER2- and 245 patients with HER2+ who met inclusion criteria were evaluated. For patients with ER+/HER2-breast cancer, 18F-FDG-PET/CT revealed unsuspected distant metastases in 3/71 (4%) initial stage IIA, 13/95 (14%) stage IIB, and 15/57 (26%) stage III. For patients with HER2+ breast cancer, 18F-FDG-PET/CT revealed unsuspected distant metastases in 3/72 (4%) initial stage IIA, 13/93 (14%) stage IIB, and 13/59 (22%) stage III. The overall upstaging rate for IIB was 14% (95% confidence interval (CI): 9-20%). |
2 |
| 140. Neal CH, Daly CP, Nees AV, Helvie MA. Can preoperative axillary US help exclude N2 and N3 metastatic breast cancer?. Radiology. 257(2):335-41, 2010 Nov. |
Observational-Dx |
435 consecutive patients with breast cancer aged 25-88 years who underwent preoperative axillary US |
To determine the false-negative rate of axillary ultrasonography (US) with respect to stage N2 and N3 metastatic disease in patients with newly diagnosed breast cancer. |
Of the 208 axillae with negative findings at US, 14 (6.7%) had a final node stage of N2 or N3. Twelve of the 208 axillae (5.8%) had stage N2 disease and two (1.0%) had stage N3 disease. Of the 14 axillae with stage N2 or N3 disease, eight (57.1%) had lobular histologic characteristics and six (42.9%) had ductal histologic characteristics. The false-negative rate for N2 and N3 disease was 4.1% (six of 146 axillae) for invasive ductal cancer and 17% (eight of 47 axillae) for invasive lobular cancer (P < .01). None of the 14 axillae with stage N2 or N3 disease were "triple negative" (ie, estrogen receptor negative, progesterone receptor negative, and human epidermal growth factor receptor type 2 negative). |
4 |
| 141. Diepstraten SC, Sever AR, Buckens CF, et al. Value of preoperative ultrasound-guided axillary lymph node biopsy for preventing completion axillary lymph node dissection in breast cancer: a systematic review and meta-analysis. [Review]. Ann Surg Oncol. 21(1):51-9, 2014 Jan. |
Meta-analysis |
31 studies (9,232 cases of preoperative axillary staging procedures in 9,212 breast cancer patients) |
To evaluate the utility of preoperative axillary ultrasound combined with US-guided lymph node biopsy if indicated (AUS ± biopsy), in terms of staging the axilla and preventing two-step axillary surgery in the form of sentinel node biopsy (SNB) followed by completion axillary lymph node (ALN) dissection. |
The pooled FNR was 25 % (95 % confidence interval [CI] = 24-27) and the pooled sensitivity was 50 % (95 % CI = 43-57). There was substantial heterogeneity across studies for both FNR (I (2) = 69.42) and sensitivity (I (2) = 93.25), which was not explained by between-study differences in biopsy technique, mean/median tumor size, biopsy indication, or study design. Sensitivity was increased in studies with a high prevalence of ALN metastases. |
Good |
| 142. McDonald ES, Clark AS, Tchou J, Zhang P, Freedman GM. Clinical Diagnosis and Management of Breast Cancer. J Nucl Med 2016;57 Suppl 1:9S-16S. |
Review/Other-Dx |
N/A |
To review the diagnosis and treatment of breast cancer, including screening, staging, and multidisciplinary management. |
No results provided |
4 |
| 143. Hamaoka T, Madewell JE, Podoloff DA, Hortobagyi GN, Ueno NT. Bone imaging in metastatic breast cancer. [Review] [100 refs]. J Clin Oncol. 22(14):2942-53, 2004 Jul 15. |
Review/Other-Dx |
N/A |
To discuss the pros and cons of each modality for diagnosing bone metastases and for assessing their response to treatment and we present a practical approach for diagnosis and assessment of bone metastasis. |
No results provided |
4 |
| 144. Bansal GJ, Vinayan Changaradil D. Planar Bone Scan Versus Computerized Tomography in Staging Locally Advanced Breast Cancer in Asymptomatic Patients: Does Bone Scan Change Patient Management Over Computerized Tomography?. J Comput Assist Tomogr. 42(1):19-24, 2018 Jan/Feb. |
Observational-Dx |
156 breast cancer patients |
To perform a head-to-head comparison of bone scan and CT scan in locally advanced breast cancer patients. The aim of this study was to evaluate the utility of planar bone scan in changing the stage or management of locally advanced breast cancer patients. |
One hundred five of 156 patients had both CT TAP and bone scan within 10 days of each other. Of the total of 105 patients, 33 (31.4%) had concordant normal results on CT TAP and bone scan. There were 18/105 (17.1%) patients with extraosseous metastasis on CT with negative or inconclusive bone scan. Bone scans diagnosed peripheral osseous metastasis in 5/105 (4.7%), which were either skull or extremity metastasis outside CT TAP field of view. All of these 5 patients had other metastatic lesions within axial skeleton or soft tissues on CT and led to no change in patient management. |
3 |
| 145. Chu QD, Henderson A, Kim RH, et al. Should a routine metastatic workup be performed for all patients with pathologic N2/N3 breast cancer?. J Am Coll Surg. 214(4):456-61; discussion 461-2, 2012 Apr. |
Observational-Dx |
256 patients with pathologic N2/N3 diseases |
To hypothesize that for patients with operable pathologic N2/N3 diseases, a metastatic workup should only be considered for patients with T3/T4 lesions. |
There were 158 patients with N2 disease (62%) and 98 with N3 disease (38%). Overall, 16% had stage IV disease (N2 = 15%, N3 = 16%). There was no significant difference in age (p = 0.37), tumor size (p = 0.89), tumor grade (p = 0.09), estrogen-receptor status (p = 0.23), or progesterone-receptor status (p = 0.35) between the N2 and N3 groups. Incidences of stage IV disease were T0/T1, 0%; T2, 6%; T3, 22%; and T4, 36%. Multivariate analysis demonstrated that only T stage (p = 0.0006) and grade (p = 0.026) were independent predictors of overall survival. |
4 |
| 146. Krammer J, Engel D, Schnitzer A, et al. Is the assessment of the central skeleton sufficient for osseous staging in breast cancer patients? A retrospective approach using bone scans. Skeletal Radiol. 42(6):787-91, 2013 Jun. |
Review/Other-Dx |
291 bone scans in 172 patients |
To determine whether the assessment of the central skeleton is sufficient for osseous staging in breast cancer patients. |
In all 172 patients bone metastases were seen in the central skeleton (including the proximal third of humerus and femur). In 34 patients (19.8 %) peripheral metastases of the extremities (distally of the proximal third of humerus and femur) could be detected. Sixty-four patients (37.2 %) showed metastases of the skull. Summarizing the metastases of the distal extremities and skull, 79 patients (45.9 %) had peripheral metastases. None of the patients showed peripheral metastases without any affliction of the central skeleton. The incidence of peripheral metastases significantly correlated with the extent of central skeleton involvement (p<0.001). |
4 |
| 147. Piatek CI, Ji L, Kaur C, et al. Value of routine staging imaging studies for patients with stage III breast cancer. J Surg Oncol. 114(8):917-921, 2016 Dec. |
Observational-Dx |
420 patients with stage III BC |
To determine whether routine staging imaging studies (RSIS) in stage III breast cancer (BC) affected treatment or patient outcomes. |
Of 420 patients, 362 (86.2%) received RSIS. RSIS were negative in 264 (72.9%), indeterminate in 77 (18.3%), and positive in 21 patients (5.0%) for metastatic disease. Treatment was altered in 21 (5.8%) patients based on RSIS results (20 with metastatic disease, 1 with indeterminate disease). There was no difference in RFS with RSIS use on multivariate analysis (hazard ratio 1.3; 95% confidence interval 0.73-2.5, P = 0.32). |
4 |
| 148. Bychkovsky BL, Guo H, Sutton J, et al. Use and Yield of Baseline Imaging and Laboratory Testing in Stage II Breast Cancer. Oncologist. 21(12):1495-1501, 2016 12. |
Review/Other-Dx |
411 patients with clinical stage II BC |
To evaluate factors associated with the decision to order staging studies and whether such factors were associated with true differences in the presence or absence of metastatic involvement at diagnosis. |
Among 411 patients, 233 (57%) had liver function testing, 134 (33%) had tumor marker tests, and 237 (58%) had computed tomography (CT) as part of their initial diagnostic workup. Median age was 52 (range, 23-90 years). On multivariable analysis, young age, more advanced stage, and tumor subtype (human epidermal growth receptor-positive [HER2+] and triple-negative breast cancer [TNBC]) were significantly associated with baseline CT. The rate of detection of true metastatic disease with use of baseline staging imaging was 2.1% (95% confidence interval, 0.7%-5%). It was 2.2% (3 of 135) for estrogen receptor/progesterone receptor-positive disease, 1.9% (1 of 54) for HER2+ disease, and 2.1% (1 of 48) for TNBC. At 5 years of follow-up, 46 of 406 patients were diagnosed with metastatic breast cancer. Thirty-four of 46 (73.9%) who developed recurrent disease had imaging at their initial diagnosis, and of these, five had abnormalities on their initial imaging that was correlated with where they developed metastatic disease. |
4 |
| 149. Alberini JL, Lerebours F, Wartski M, et al. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging in the staging and prognosis of inflammatory breast cancer. Cancer 2009;115:5038-47. |
Observational-Dx |
62 women with unilateral inflammatory breast tumors |
To prospectively assess fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) staging and prognosis value in patients with suspected inflammatory breast cancer (IBC). |
PET/CT scan was positive for the primary malignant tumor in 100% and false positive in 2 of 3 benign mastitis. In 59 IBC patients, FDG nodal foci were detected in axillary (90%; n = 53) and extra-axillary areas (56%; n = 33) ipsilateral to the cancer. Compared with clinical examination, the axillary lymph node status by PET/CT was upstaged and downstaged in 35 and 5 patients, respectively. In 7 of 9 N0 patients, the axillary lymph node positivity on PET/CT was correct, as revealed by pathological postsurgery assessment (not available in the 2 remaining patients). The nodal foci were compared with preoperative fine needle aspiration and/or pathological postchemotherapy findings available in 44 patients and corresponded to 38 true positive, 4 false-negative, and 2 false-positive cases. In 18 of 59 IBC patients (31%), distant lesions were found. On the basis of a univariate analysis of the first enrolled patients (n = 42), among 28 patients who showed intense tumoral uptake (standard uptake value(max)>5), the 11 patients with distant lesions had a worse prognosis than the 17 patients without distant lesions (P = .04). |
3 |
| 150. Carkaci S, Macapinlac HA, Cristofanilli M, et al. Retrospective study of 18F-FDG PET/CT in the diagnosis of inflammatory breast cancer: preliminary data. J Nucl Med 2009;50:231-8. |
Review/Other-Dx |
41 women newly diagnosed IBC |
To retrospectively evaluate 18F-FDG PET/CT in the initial staging of inflammatory breast cancer (IBC). |
All patients presented with unilateral IBC. PET/CT showed hypermetabolic uptake in the skin in all patients, in the affected breast in 40 (98%), in the ipsilateral axillary nodes in 37 (90%), and in the ipsilateral subpectoral nodes in 18 (44%). Twenty patients (49%) were found to have distant metastases at staging, 7 (17%) of whom were not known to have metastases before undergoing PET/CT. Disease sites included bone, liver, contralateral axilla, lung, chest wall, pelvis, and the subpectoral, supraclavicular, internal mammary, mediastinal, and abdominal nodes. |
4 |
| 151. Champion L, Lerebours F, Cherel P, et al. (1)(8)F-FDG PET/CT imaging versus dynamic contrast-enhanced CT for staging and prognosis of inflammatory breast cancer. Eur J Nucl Med Mol Imaging 2013;40:1206-13. |
Observational-Dx |
50 women with IBC |
To compare the performances of FDG PET/CT and dynamic contrast-enhanced (DCE) CT in locoregional staging of Inflammatory breast cancer (IBC) and to assess their respective prognostic values. |
The PET/CT scans showed intense FDG uptake in all primary tumours. Concordance rate between PET/CT and DCE CT for breast tumour localization was 92%. No significant correlation was found between SUVmax and CT enhancement parameters in primary tumours (p > 0.6). PET/CT and DCE CT results were poorly correlated for skin infiltration (kappa = 0.19). Ipsilateral foci of increased axillary FDG uptake were found in 47 patients (median SUV: 7.9 ± 5.4), whereas enlarged axillary lymph nodes were observed on DCE CT in 43 patients. Results for axillary node involvement were fairly well correlated (kappa = 0.55). Nineteen patients (38%) were found to be metastatic on PET/CT scan with a significant shorter progression-free survival than patients without distant lesions (p = 0.01). In the primary tumour, no statistically significant difference was observed between high and moderate tumour FDG uptake on survival, using an SUVmax cut-off of 5 (p = 0.7 and 0.9), or between high and low tumour enhancement on DCE CT (p > 0.8). |
3 |
| 152. Fuster D, Duch J, Paredes P, et al. Preoperative staging of large primary breast cancer with [18F]fluorodeoxyglucose positron emission tomography/computed tomography compared with conventional imaging procedures. J Clin Oncol 2008;26:4746-51. |
Observational-Dx |
60 consecutive patients with large (> 3 cm) primary breast cancer |
To evaluate the utility of positron emission tomography (PET) and [(18)F]fluorodeoxyglucose in the initial staging of large primary breast tumors. |
Primary tumor was identified by both PET/CT and MRI in all patients. Multifocal and/or multicentric tumors were found in 19 patients by MRI. Axillary lymph node metastases were found in 20 of 52 patients. Extra-axillary metastatic lymph nodes were also found in three patients. One patient showed an infiltrated lymph node in the contralateral axilla. The sensitivity and specificity for PET/CT to detect axillary lymph nodes metastases were 70% and 100%, respectively. PET/CT diagnosed all extra-axillary lymph nodes. The overall sensitivity and specificity of PET/CT in detecting distant metastases were 100% and 98%, respectively; whereas the sensitivity and specificity of conventional imaging were 60% and 83%, respectively. PET led to a change in the initial staging in 42% of patients. |
3 |
| 153. Groheux D, Moretti JL, Baillet G, et al. Effect of (18)F-FDG PET/CT imaging in patients with clinical Stage II and III breast cancer. Int J Radiat Oncol Biol Phys. 2008; 71(3):695-704. |
Observational-Dx |
39 patients |
Prospective study to evaluate the potential effect of FDG-PET/CT in the initial assessment of patients with clinical stage II or III breast cancer. |
PET/CT can provide information on extra-axillary lymph node involvement and can uncover occult distant metastases in most patients. Initial PET/CT is recommended in patients with Stage II and III breast cancer. |
2 |
| 154. Heusner TA, Kuemmel S, Umutlu L, et al. Breast cancer staging in a single session: whole-body PET/CT mammography. J Nucl Med 2008;49:1215-22. |
Observational-Dx |
40 women with suspected breast cancer |
To compare the diagnostic accuracy of an all-in-one protocol of whole-body 18F-FDG PET/CT and integrated 18F-FDG PET/CT mammography with the diagnostic accuracy of a multimodality algorithm for initial breast cancer staging. |
No significant differences were found in the detection rate of breast cancer lesions (18F-FDG PET/CT, 95%; MRI, 100%; P = 1). 18F-FDG PET/CT correctly classified lesion focality significantly more often than did MRI (18F-FDG PET/CT, 79%; MRI, 73%; P < 0.001). MRI correctly defined the T stage significantly more often than did 18F-FDG PET/CT (MRI, 77%; 18F-FDG PET/CT, 54%; P = 0.001). 18F-FDG PET/CT detected axillary lymph node metastases in 80% of cases; clinical investigation/ultrasound, in 70%. This difference was not statistically significant (P = 0.067). Distant metastases were detected with 18F-FDG PET/CT in 100% of cases, and the multimodality algorithm identified distant metastases in 70%. This difference was not statistically significant (P = 1). Three patients had extraaxillary lymph node metastases that were detected only by PET/CT (cervical, retroperitoneal, mediastinal/internal mammary group). 18F-FDG PET/CT changed patient management in 12.5% of cases. |
3 |
| 155. Riedl CC, Slobod E, Jochelson M, et al. Retrospective analysis of 18F-FDG PET/CT for staging asymptomatic breast cancer patients younger than 40 years. J Nucl Med. 55(10):1578-83, 2014 Oct. |
Observational-Dx |
134 patients with initial breast cancer stage I to III |
To evaluate the impact of 18F-FDG PET/CT staging in clinical stage I–III breast cancer patients younger than 40 y and compared the rate of upstaging between biologic subgroup categories. |
One hundred thirty-four patients with initial breast cancer stage I to IIIC met inclusion criteria. PET/CT findings led to upstaging to stage III or IV in 28 patients (21%). Unsuspected extra-axillary regional nodes were found in 15 of 134 patients (11%) and distant metastases in 20 of 134 (15%), with 7 of 134 (5%) demonstrating both. PET/CT revealed stage IV disease in 1 of 20 (5%) patients with initial clinical stage I, 2 of 44 (5%) stage IIA, 8 of 47 (17%) stage IIB, 4 of 13 (31%) stage IIIA, 4 of 8 (50%) stage IIIB, and 1 of 2 (50%) stage IIIC. All 20 patients upstaged to stage IV were histologically confirmed. Four synchronous thyroid and 1 rectal malignancies were identified. |
2 |
| 156. Segaert I, Mottaghy F, Ceyssens S, et al. Additional value of PET-CT in staging of clinical stage IIB and III breast cancer. Breast J. 16(6):617-24, 2010 Nov-Dec. |
Review/Other-Dx |
70 consecutive patients with biopsy-proven clinical stage IIB and III breast cancer |
To evaluate retrospectively the accuracy of integrated PET/CT, against PET, CT, or conventional staging in breast cancer. |
Descriptive statistics of integrated PET/CT for the primary tumor, nodal status and metastasis detection were compared to PET, CT with contrast, and conventional staging (biochemistry, chest X-ray, liver ultrasound, and bone scintigraphy). Sensitivity of PET/CT for primary tumor and nodal status was 97.1% and 62.5%, respectively. Specificity and negative predictive value for nodal status were 100% and 66.6%, respectively. The values for conventional staging for nodal involvement were 100% and 85.7% with a sensitivity of 87.5%. PET/CT showed metastatic disease in seven women despite normal conventional staging. PET/CT is able to visualize most clinical stage IIB and III primary breast cancers. |
4 |
| 157. Ulaner GA, Castillo R, Goldman DA, et al. (18)F-FDG-PET/CT for systemic staging of newly diagnosed triple-negative breast cancer. Eur J Nucl Med Mol Imaging 2016;43:1937-44. |
Observational-Dx |
232 patients with TNBC |
To assess 18F-FDG-PET/CT for systemic staging of newly diagnosed triple-negative breast cancer (or TNBC). |
A total of 232 patients with TNBC met inclusion criteria. 18F-FDG-PET/CT revealed unsuspected distant metastases in 30 (13%): 0/23 initial stage I, 4/82 (5%) stage IIA, 13/87 (15%) stage IIB, 4/23 (17%) stage IIIA, 8/14 (57%) stage IIIB, and 1/3 (33%) stage IIIC. Twenty six of 30 patients upstaged to IV by 18F-FDG-PET/CT were confirmed by pathology, with the remaining 4 confirmed by follow-up imaging. In addition, 7 unsuspected synchronous malignancies were identified in 6 patients. Initial stage 2B patients who were upstaged to 4 by 18F-FDG-PET/CT had significantly shorter survival compared to initial stage 2B patients who were not (3 year Kaplan Meier estimate 0.33, 95% CI 0.13–0.55 versus 0.97, CI 0.76–0.93, p<.0001). |
2 |
| 158. Yang WT, Le-Petross HT, Macapinlac H, et al. Inflammatory breast cancer: PET/CT, MRI, mammography, and sonography findings. Breast Cancer Res Treat 2008;109:417-26. |
Review/Other-Dx |
80 patients |
To describe the role of Positron Emission Tomography/Computed Tomography (PET/CT), Magnetic Resonance Imaging (MRI), sonography, and mammography in patients with inflammatory breast cancer (IBC). |
Eighty patients (median age, 51 years, [range, 25-78 years]) were included in this study: 75 (94%) had undergone mammography, 76 (95%) sonography, 33 (41%) MRI, and 24 (30%) PET/CT. A primary BPL was found in 60 patients (80%) on mammography (mass or calcifications), 72 (95%) on sonography (mass or architectural distortion), 23 (96%) on PET/CT (hypermetabolic BPL), and 33 (100%) on MRI (enhancing BPL). Regional axillary nodal disease was found in 74 patients (93%) by histologic or cytologic examination, in 71 patients (93%) on sonography, in 21 (88%) on PET/CT, in 29 (88%) on MRI, and in 34 (45%) on mammography. Distant metastases in the bone, liver, and contralateral lymph nodes were diagnosed in nine patients (38%) on PET/CT. |
4 |
| 159. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA: a Cancer Journal for Clinicians. 68(1):7-30, 2018 01. |
Review/Other-Dx |
N/A |
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data. |
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2014, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2015, were collected by the National Center for Health Statistics. In 2018, 1,735,350 new cancer cases and 609,640 cancer deaths are projected to occur in the United States. Over the past decade of data, the cancer incidence rate (2005-2014) was stable in women and declined by approximately 2% annually in men, while the cancer death rate (2006-2015) declined by about 1.5% annually in both men and women. The combined cancer death rate dropped continuously from 1991 to 2015 by a total of 26%, translating to approximately 2,378,600 fewer cancer deaths than would have been expected if death rates had remained at their peak. Of the 10 leading causes of death, only cancer declined from 2014 to 2015. In 2015, the cancer death rate was 14% higher in non-Hispanic blacks (NHBs) than non-Hispanic whites (NHWs) overall (death rate ratio [DRR], 1.14; 95% confidence interval [95% CI], 1.13-1.15), but the racial disparity was much larger for individuals aged <65 years (DRR, 1.31; 95% CI, 1.29-1.32) compared with those aged >/=65 years (DRR, 1.07; 95% CI, 1.06-1.09) and varied substantially by state. For example, the cancer death rate was lower in NHBs than NHWs in Massachusetts for all ages and in New York for individuals aged >/=65 years, whereas for those aged <65 years, it was 3 times higher in NHBs in the District of Columbia (DRR, 2.89; 95% CI, 2.16-3.91) and about 50% higher in Wisconsin (DRR, 1.78; 95% CI, 1.56-2.02), Kansas (DRR, 1.51; 95% CI, 1.25-1.81), Louisiana (DRR, 1.49; 95% CI, 1.38-1.60), Illinois (DRR, 1.48; 95% CI, 1.39-1.57), and California (DRR, 1.45; 95% CI, 1.38-1.54). Larger racial inequalities in young and middle-aged adults probably partly reflect less access to high-quality health care. |
4 |
| 160. Morris PG, Lynch C, Feeney JN, et al. Integrated positron emission tomography/computed tomography may render bone scintigraphy unnecessary to investigate suspected metastatic breast cancer. J Clin Oncol. 28(19):3154-9, 2010 Jul 01. |
Observational-Dx |
163 patients |
Retrospective, single-institution study to compare the diagnostic performance of integrated PET/CT and bone scintigraphy in women with suspected metastatic breast cancer. |
Overall, PET/CT and bone scintigraphy were highly concordant for reporting osseous metastases with 132 paired studies (81%); 32 (20%) were positive, and 100 (61%) were negative. 31 occurrences (19%) were discordant. 12 of these (39%) had pathology confirming osseous metastases: 9/18 were PET/CT positive and bone scintigraphy negative; 1/3 was PET/CT positive and bone scintigraphy equivocal; and 2/2 were PET/CT equivocal and bone scintigraphy negative. This study supports the use of PET/CT in detecting osseous metastases for suspected metastatic breast cancer. Whether PET/CT may supplant bone scintigraphy in this setting is unknown. |
3 |
| 161. Niikura N, Costelloe CM, Madewell JE, et al. FDG-PET/CT compared with conventional imaging in the detection of distant metastases of primary breast cancer. Oncologist. 16(8):1111-9, 2011. |
Observational-Dx |
225 patients with primary breast cancer |
To compare the sensitivity and specificity of PET/CT and conventional imaging (CT, ultrasonography, radiography, and skeletal scintigraphy) for the detection of distant metastases in patients with primary breast cancer. |
The mean patient age at diagnosis was 53.4 years (range, 23-84 years). The sensitivity and specificity in the detection of distant metastases were 97.4% and 91.2%, respectively, for PET/CT and 85.9% and 67.3%, respectively, for conventional imaging. The sensitivity and specificity of PET/CT were significantly higher than those of conventional imaging (p = .009 and p < .001, respectively). Eleven cases of distant metastases detected by PET/CT were clinically occult and not evident on conventional imaging. |
4 |
| 162. Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017. |
Review/Other-Dx |
N/A |
To classify patients with cancer, define prognosis, and determine the best treatment approaches. |
No abstract available. |
4 |
| 163. Barnholtz-Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P, Sawaya RE. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol 2004;22:2865-72. |
Review/Other-Dx |
16,210 patients who developed brain metastases after diagnosis with single primary lung, melanoma, breast, renal, or colorectal cancers |
To calculate population-based incidence proportions (IPs) of brain metastases from single primary lung, melanoma, breast, renal, or colorectal cancer. |
Total IP percentage (IP%) of brain metastases was 9.6% for all primary sites combined, and highest for lung (19.9%), followed by melanoma (6.9%), renal (6.5%), breast (5.1%), and colorectal (1.8%) cancers. Racial differences were seen with African Americans demonstrating higher IP% of brain metastases compared with other racial groups for most primary sites. IP% was significantly higher for female patients with lung cancer, and significantly higher for male patients with melanoma. The highest IP% of brain metastases occurred at different ages at diagnoses: age 40 to 49 years for primary lung cancer; age 50 to 59 years for primary melanoma, renal, or colorectal cancers; and age 20 to 39 for primary breast cancer. IP% significantly increased as SEER stage of primary cancer advanced for all primary sites. |
4 |
| 164. Pelletier EM, Shim B, Goodman S, Amonkar MM. Epidemiology and economic burden of brain metastases among patients with primary breast cancer: results from a US claims data analysis. Breast Cancer Res Treat 2008;108:297-305. |
Observational-Dx |
779 incident and 995 prevalent BCBM patients and 8,518 primary breast cancer patients |
To estimate the incidence, prevalence, and economic burden of secondary breast cancer brain metastases (BCBM) among a US-based population of patients with primary breast cancer. |
From 2002 to 2004, 779 incident and 995 prevalent BCBM patients and 8,518 primary breast cancer patients were identified. The incidence of BCBM during this time period was 9.1% (95% CI=8.5%, 9.8%); the prevalence of BCBM was 11.7% (95% CI=11.0%, 12.4%), with rates increasing from 2002 to 2004. About 22% of incident patients died (based on a proxy measure) during the follow-up period, an average of 158 days (95% CI=131.1, 183.9) from the index BCBM diagnosis. A 1:1 match of incident BCBM patients to controls resulted in 775 patients in each group. At 6 months follow-up (N=398), incident BCBM patients had significantly more hospital stays (mean 1.1 vs. 0.5, P<0.001) and remained hospitalized for a longer period (mean 8.0 days vs. 2.5 days, P<0.001) compared to controls. Incident BCBM patients also averaged more physician office visits (32.8 vs. 24.3, P<0.001) as well as pharmacy claims (56.0 vs. 39.1, P<0.001). Similar differences were found at 12 months (N=230). Average total costs for incident BCBM patients at 6 months were $60,045 compared to $28,193 for controls (P<0.001); this difference was driven by higher mean inpatient ($17,462 vs. $5,362, P<0.001) and outpatient ($26,209 vs. $11,652, P<0.001) costs among incident BCBM patients. At 12 months, higher mean total costs persisted in incident BCBM patients ($99,899 vs. $47,719, P<0.001). After adjusting for key variables, mean costs for these patients were 123% higher than those for control group patients. |
4 |
| 165. Martin AM, Cagney DN, Catalano PJ, et al. Brain Metastases in Newly Diagnosed Breast Cancer: A Population-Based Study. JAMA Oncol. 3(8):1069-1077, 2017 Aug 01. |
Observational-Dx |
968 patients with brain metastases at the time of diagnosis of breast cancer |
To characterize the incidence proportions and median survivals of patients with breast cancer and brain metastases at the time of cancer diagnosis. |
e identified 968 patients with brain metastases at the time of diagnosis of breast cancer, representing 0.41% of the entire cohort and 7.56% of the subset with metastatic disease to any site. A total of 57 were 18 to 40 years old, 423 were 41 to 60 years old, 425 were 61-80 years old, and 63 were older than 80 years. Ten were male and 958 were female. Incidence proportions were highest among patients with hormone receptor (HR)-negative human epidermal growth factor receptor 2 (HER2)-positive (1.1% among entire cohort, 11.5% among patients with metastatic disease to any distant site) and triple-negative (0.7% among entire cohort, 11.4% among patients with metastatic disease to any distant site) subtypes. Median survival among the entire cohort with brain metastases was 10.0 months. Patients with HR-positive HER2-positive subtype displayed the longest median survival (21.0 months); patients with triple-negative subtype had the shortest median survival (6.0 months). |
4 |
| 166. Ramakrishna N, Temin S, Chandarlapaty S, et al. Recommendations on disease management for patients with advanced human epidermal growth factor receptor 2-positive breast cancer and brain metastases: American Society of Clinical Oncology clinical practice guideline. [Review]. J Clin Oncol. 32(19):2100-8, 2014 Jul 01. |
Review/Other-Dx |
N/A |
To provide formal expert consensus-based recommendations to practicing oncologists and others on the management of brain metastases for patients with human epidermal growth factor receptor 2 (HER2) -positive advanced breast cancer. |
No studies or existing guidelines met the systematic review criteria; therefore, ASCO conducted a formal expert consensus-based process. |
4 |
| 167. Kurtz JM, Amalric R, Brandone H, et al. Local recurrence after breast-conserving surgery and radiotherapy. Frequency, time course, and prognosis. Cancer 1989;63:1912-7. |
Observational-Dx |
1593 patients with Stage I and II breast cancer |
To analyze the development of breast recurrence as a function of time and studies the prognosis after treatment of local failure. |
The actuarial freedom from mammary recurrence was 93% at 5, 86% at 10, 82% at 15, and 80% at 20 years. Seventy-nine percent of the recurrences were in the vicinity of the tumor bed, but with increasing time interval, an increasing percentage of recurrences was located elsewhere in the breast. A majority of recurrences after 10 years could be considered new tumors. Only ten of 181 patients with recurrence had prior or concomitant distant metastases, and 159 of 171 isolated mammary recurrences (93%) were operable. Uncorrected overall survival after operable recurrence was 69% at 5 and 57% at 10 years. Prognosis after late recurrence (after 5 years) was favorable (84% 5-year survival). Operable early recurrences retained a favorable prognosis if smaller than 2 cm and confined to the breast (74% 5-year survival). Disease-free interval and histologic grade also appeared to be important prognostic factors after early recurrence. Survival after recurrence did not depend upon the type of salvage operation. Locoregional control was 88% at 5 years after salvage mastectomy and 64% after breast-conserving salvage procedures. |
4 |
| 168. Recht A, Silen W, Schnitt SJ, et al. Time-course of local recurrence following conservative surgery and radiotherapy for early stage breast cancer. Int J Radiat Oncol Biol Phys 1988;15:255-61. |
Review/Other-Dx |
607 breasts (697 women) |
To examine the time-course and patterns of breast recurrence as a first site of treatment failure in a group of 607 AJCC clinical Stage I or II invasive breast carcinomas treated from 1968-81. |
Sixty-seven patients had a breast failure (11%), corresponding to 5- and 10-year actuarial rates of 10% and 16%. The hazard rate (i.e., the risk per unit time of a failure) for any breast failure increased over the first 2 years, was fairly constant at about 2.5%/year over the period from 2 to 6 years after treatment, and then decreased to about 1%/year at 8 years. The majority of failures were at or near the primary tumor site (33 true recurrences (TR) and 15 marginal misses (MM). In addition there were 12 failures at sites at least several cm from the boosted volume (E), 6 recurrences in the skin without a parenchymal mass (S), and 1 patient with an unclassifiable failure. Recurrences at or near the primary site (TR/MM) occurred earlier (median 38.5 mo, range 12-87 mo) than recurrences at distant sites in the breast (E) (median 64.5 mo, range 26-90). The hazard rate for TR/MM increased over the first 2-1/2 years to reach approximately 2%/year, remained at that level till about 5 years after treatment, and then decreased to about 0.5%/year at 8 years following RT. By contrast, the hazard rate for E increased slowly with time to approximately 1%/year at 5 years, with little change in the rate after that time. We conclude that the time-course of the development of local recurrence after S+RT is protracted. The majority of failures appear at or near the primary tumor site; these are seen mainly in the first 7 years following RT. Recurrences at distant sites in the breast have an even more protracted time-course. Such recurrences are rare in the first 4 years following RT. |
4 |
| 169. Buchholz TA, Ali S, Hunt KK. Multidisciplinary Management of Locoregional Recurrent Breast Cancer. J Clin Oncol 2020;38:2321-28. |
Review/Other-Dx |
N/A |
To identify prognostic variables associated with the treatment outcome of LRR disease; discuss the roles of surgery, radiation, and systemic treatments; and define reasonable treatment algorithms to aid in the evaluation and management of patients. |
No abstract available |
4 |
| 170. Valachis A, Mamounas EP, Mittendorf EA, et al. Risk factors for locoregional disease recurrence after breast-conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy: An international collaboration and individual patient meta-analysis. Cancer 2018;124:2923-30. |
Meta-analysis |
9 studies (4125 patients) |
To identify potential risk factors for local disease recurrence (LR) and locoregional disease recurrence (LRR) after neoadjuvant chemotherapy (NCT) and breast-conserving therapy (BCT). |
A total of 9 studies (4125 patients) provided their data sets. The 10-year LR rate was 6.5%, whereas the 10-year LRR rate was 10.3%. Four factors were found to be associated with a higher risk of LR: 1) estrogen receptor-negative disease; 2) cN + disease; 3) a lack of pathologic complete response in axilla (pN0); and 4) pN2 to pN3 disease. The predictive score for LR determined 3 risk groups: a low-risk, intermediate-risk, and high-risk group with 10-year LR rates of 4.0%, 7.9%, and 20.4%, respectively. Two additional factors were found to be associated with an increased risk of LRR: cT3 to cT4 disease and a lack of pathologic complete response in the breast. The predictive score for LRR determined 3 risk groups; a low-risk, intermediate-risk, and high-risk group with 10-year LRR rates of 3.2%, 10.1%, and 24.1%, respectively. |
Not Assessed |
| 171. Lu WL, Jansen L, Post WJ, Bonnema J, Van de Velde JC, De Bock GH. Impact on survival of early detection of isolated breast recurrences after the primary treatment for breast cancer: a meta-analysis. Breast Cancer Res Treat 2009;114:403-12. |
Meta-analysis |
13 studies (2,263 patients) |
To establish the impact on survival of early detection of a local recurrence of breast cancer as compared to late detection. |
Thirteen studies concerning 2,263 patients were included. Early detection of breast cancer recurrences during follow-up gave a significantly better survival as compared to late detected recurrences (HR: 1.68 (95% CI: 1.48-1.91)). Survival was better when the recurrence was found by mammography instead of physical examination or in patients without symptoms as compared to those with symptoms (HR: 2.44 (95% CI: 1.78-3.35); HR: 1.56 (95% CI: 1.36-1.79), respectively). If all breast cancer recurrences would be detected earlier, that 5-8 deaths (i.e. an absolute reduction in mortality of 17-28%) would be avoided by performing routine follow-up during a 10 year-period for 1,000 breast cancer patients. |
Good |
| 172. NCCN Clinical Practice Guidelines in Oncology. Breast Cancer. NCCN Evidence Blocks. Version 2.2022. Available at: https://www.nccn.org/professionals/physician_gls/pdf/breast_blocks.pdf. |
Review/Other-Dx |
N/A |
Abstract not available |
Abstract not available |
4 |
| 173. ASCO Guidelines. Breast Cancer Follow-Up And Management After Primary Treatment: American Society Of Clinical Oncology Clinical Practice Guideline Update. Available at: https://www.asco.org/sites/new-www.asco.org/files/content-files/practice-and-guidelines/documents/2013-breast-surveillance-summary-recommendations.pdf. |
Review/Other-Dx |
N/A |
No abstract available |
No abstract available |
4 |
| 174. Arasu VA, Joe BN, Lvoff NM, et al. Benefit of semiannual ipsilateral mammographic surveillance following breast conservation therapy. Radiology. 264(2):371-7, 2012 Aug. |
Observational-Dx |
2329 patients |
To compare cancer recurrence outcomes on the basis of compliant semiannual versus noncompliant annual ipsilateral mammographic surveillance following breast conservation therapy (BCT). |
Initially, a total of 10 750 post-BCT examinations among 2329 asymptomatic patients were identified. Excluding initial mammographic follow-up, there were 8234 examinations. Of these, 7169 examinations were semiannual with 94 recurrences detected and 1065 examinations were annual with 15 recurrences detected. There were no differences in demographic risk factors or biopsy rates. Recurrences identified at semiannual intervals were significantly less advanced than those identified at annual intervals (stage I vs stage II, P = .04; stage 0 + stage I vs stage II, P = .03). Nonsignificant findings associated with semiannual versus annual intervals included smaller tumor size (mean, 11.7 vs 15.3 mm; P = .15) and node negativity (98% vs 91%, P = .28). |
3 |
| 175. Lewis JL, Tartter PI. The value of mammography within 1 year of conservative surgery for breast cancer. Ann Surg Oncol. 19(10):3218-22, 2012 Oct. |
Observational-Dx |
1,000 patients with ductal carcinoma in situ, infiltrating ductal carcinoma, or infiltrating lobular carcinoma |
To determine the value of interval mammography. |
Ductal carcinoma in situ, infiltrating ductal carcinoma, and infiltrating lobular carcinoma were found in 1,000 patients who underwent breast-conserving surgery, and 789 patients had complete mammographic follow-up data available. Postoperative interval mammography was performed in 169 patients (21 %), including 23 patients who had preradiation mammography. Ninety percent of the interval mammograms were BI-RADS 1 to 3 and 10 % were BI-RADS 4 or 5. Two cancers were found on interval mammography (1.2 % of 169) and 4 of 620 (0.6 %) patients who did not have interval mammography were found to have malignancy within 1 year of surgery (1.2 % vs. 0.6 %, P = 0.614). The use of interval mammography was not related to the mammographic findings at diagnosis. Interval mammography did not affect local and distant disease-free survival. |
4 |
| 176. Bychkovsky BL, Lin NU. Imaging in the evaluation and follow-up of early and advanced breast cancer: When, why, and how often?. [Review]. BREAST. 31:318-324, 2017 Feb. |
Review/Other-Dx |
N/A |
To discuss: 1) the optimal use of staging imaging in both early (Stage 0-II) and locally advanced (Stage III) breast cancer, 2) the role of surveillance imaging to detect recurrent disease in Stage 0-III breast cancer and 3) how patients with metastatic breast cancer should be followed with advanced imaging. |
No results stated in abstract. |
4 |
| 177. Benveniste AP, Dryden MJ, Bedrosian I, Morrow PK, Bassett RL Jr, Yang W. Surveillance of women with a personal history of breast cancer by tumour subtype. Clin Radiol. 72(3):266.e1-266.e6, 2017 Mar. |
Observational-Dx |
207 patients |
To determine if the rate and timing of a second breast cancer event (SBCE) in women with a personal history of breast cancer varies by disease subtype or breast imaging method. |
Of 207 patients diagnosed with a SBCE, the median age at first diagnosis was 50.6 years, range 24.8 to 80.2; at second diagnosis was 56.2 years, range 25.8 to 87.9. Eleven percent of SBCE were diagnosed >10 years after the primary cancer diagnosis. The median time between the first and second diagnosis for ER-positive patients was 2.7 years (range 0.7-17.4 years); and 1.9 years for ER-negative patients, (range 0.4-23.4 years; p<0.002). Patients with triple-negative breast cancer (TNBC) had a shorter time between diagnoses than others (p=0.0003). At 3, 5, and 10 years, 85%, 92%, and 97% of ER-negative and 54%, 81%, and 95% of ER-positive tumours, respectively, had recurred. ER-negative tumours and TNBC were more likely to be visible at US. |
4 |
| 178. Fung F, Cornacchi SD, Reedijk M, et al. Breast cancer recurrence following radioguided seed localization and standard wire localization of nonpalpable invasive and in situ breast cancers: 5-Year follow-up from a randomized controlled trial. Am J Surg. 213(4):798-804, 2017 Apr. |
Review/Other-Dx |
298 patients |
To compare 5-year breast cancer (BC) recurrence rates in patients randomized to radioguided seed localization (RSL) or wire localization (WL) for non-palpable BC undergoing breast conserving surgery. |
Follow-up data were available for 298 patients (98%) and median follow-up time was 65 months. There were 11 (4%) cases of BC recurrence and median time to recurrence was 26 months. LR occurred in 8 patients (6 WL and 2 RSL; p = 0.28). Positive margins at first surgery (p = 0.024) and final surgery (p = 0.004) predicted for BC recurrence. |
4 |
| 179. Kraeima J, Siesling S, Vliegen IM, Klaase JM, IJzerman MJ. Individual risk profiling for breast cancer recurrence: towards tailored follow-up schemes. Br J Cancer. 109(4):866-71, 2013 Aug 20. |
Observational-Dx |
17,762 patients |
To identify prognostic factors and to estimate individual and time-dependent LRR risk rates. |
Eight prognostic factors were identified: age, tumour size, multifocality, gradation, adjuvant chemo-, adjuvant radiation-, hormonal therapy, and triple-negative receptor status. Risk profiles of the low-, average-, and high-risk example patients showed non-uniform distribution of recurrence risks (2.9, 7.6, and 9.2%, respectively, over a 5-year period). |
4 |
| 180. Witteveen A, Otten JWM, Vliegen IMH, Siesling S, Timmer JB, IJzerman MJ. Risk-based breast cancer follow-up stratified by age. Cancer Medicine. 7(10):5291-5298, 2018 10. |
Observational-Dx |
37,230 patients |
To introduce personalized follow-up schemes by stratifying for age. |
Recurrences could be detected by mammography as well as by self-detection. For all age groups, it was optimal to have more intensive follow-up around the peak in recurrence risk in the second year after diagnosis. For the first age group (<50) with the highest risk, a slightly more intensive follow-up with one extra visit was proposed compared to the current guideline recommendation. The other age groups were recommended less visits: four for ages 50-59, three for 60-69, and three for >/=70. With this model for risk-based follow-up, clinicians can make informed decisions and focus resources on patients with higher risk, while avoiding unnecessary and potentially harmful follow-up visits for women with very low risks. |
4 |
| 181. Chikarmane SA, Cochon LR, Khorasani R, Sahu S, Giess CS. Screening Mammography Performance Metrics of 2D Digital Mammography Versus Digital Breast Tomosynthesis in Women With a Personal History of Breast Cancer. AJR. American Journal of Roentgenology. 217(3):587-594, 2021 09.AJR Am J Roentgenol. 217(3):587-594, 2021 09. |
Observational-Dx |
4091 patients with FFDM and 3647 patients with DBT |
To evaluate the screening mammography performance of digital breast tomosynthesis (DBT) compared with full-field digital mammography (FFDM) among patients with a history of breast cancer undergoing imaging at a large academic oncology center. |
Recall rate was significantly lower with DBT than with FFDM (7.9% vs 10.1%; p < .001). DBT and FFDM did not differ in PPV1 (7.7% vs 6.1%; p = .36) or cancer detection rate (CDR) (6.1/1000 vs 6.0/1000; p = .97). Sensitivity was 96.4% for DBT and 71.4% for FFDM (p = .008). Specificity was 92.3% for DBT and 90.0% for FFDM (p < .001). With stratification by breast density, patients with nondense breast tissue had a lower recall rate with DBT than with FFDM (5.9% vs 8.8%; p < .001) and a nonsignificant increase in PPV1 (12.0% vs 6.4%; p = .05). The metrics were not otherwise different between DBT and FFDM among patients with nondense and those with dense breast tissue. Recall rates were lower with DBT than with FFDM among both patients who underwent mastectomy (7.8% vs 9.1%; p = .09) and those who underwent lumpectomy (7.9% vs 11.0%; p = .002). PPV1 and CDR were not different between DBT and FFDM among patients who underwent mastectomy and those who underwent lumpectomy. |
3 |
| 182. Lee JM, Ichikawa LE, Wernli KJ, et al. Digital Mammography and Breast Tomosynthesis Performance in Women with a Personal History of Breast Cancer, 2007-2016. Radiology. 300(2):290-300, 2021 08. |
Observational-Dx |
32,331 women (117 971 surveillance mammographic examinations) |
To evaluate the performance and outcomes of surveillance mammography (digital mammography and DBT) performed from 2007 to 2016 in women with a personal history of breast cancer and compare with data from 1996 to 2007 and the performance of digital mammography screening benchmarks. |
Among 32 331 women who underwent 117 971 surveillance mammographic examinations (112 269 digital mammographic examinations and 5702 DBT examinations), the mean age at initial diagnosis was 59 years ± 12 (standard deviation). Of 1418 second breast cancers diagnosed, 998 were surveillance-detected cancers and 420 were interval cancers. The recall rate was 8.8% (10 365 of 117 971; 95% CI: 8.6%, 9.0%), the cancer detection rate was 8.5 per 1000 examinations (998 of 117 971; 95% CI: 8.0, 9.0), the interval cancer rate was 3.6 per 1000 examinations (420 of 117 971; 95% CI: 3.2, 3.9), the positive predictive value of biopsy recommendation was 31.0% (998 of 3220; 95% CI: 29.4%, 32.7%), the sensitivity was 70.4% (998 of 1418; 95% CI: 67.9%, 72.7%), and the specificity was 98.1% (114 331 of 116 553; 95% CI: 98.0%, 98.2%). Compared with previously published studies, interval cancer rate was comparable with rates from 1996 to 2007 in women with a personal history of breast cancer and was higher than the published digital mammography screening benchmarks. |
4 |
| 183. McDonald ES, Oustimov A, Weinstein SP, Synnestvedt MB, Schnall M, Conant EF. Effectiveness of Digital Breast Tomosynthesis Compared With Digital Mammography: Outcomes Analysis From 3 Years of Breast Cancer Screening. JAMA Oncology. 2(6):737-43, 2016 Jun 01. |
Observational-Dx |
23958 women |
To determine whether the improved outcomes observed after initial implementation of digital breast tomosynthesis (DBT) screening are sustainable over time at a population level and to evaluate the effect of more than 1 DBT screening at the individual level. |
Screening outcome metrics were evaluated for a total of 44,468 examinations attributable to 23,958 unique women (mean [SD] age, 56.8 [11.0] years) over a 4-year period: year 0 cohort (DM0), 10,728 women; year 1 cohort (DBT1), 11,007; year 2 cohort (DBT2), 11,157; and year 3 cohort (DBT3), 11,576. Recall rates rose slightly for years 1 to 3 of DBT (88, 90, and 92 per 1000 screened, respectively) but remained significantly reduced compared with the DM0 rate of 104 per 1000 screened. Reported as odds ratios (95% CIs), the findings were DM vs DBT1, 0.83 (0.76-0.91, P<.001); DM vs DBT2, 0.85 (0.78-0.93, P<.001); and DM vs DBT3, 0.87 (0.80-0.95, P=.003). The cancer cases per recalled patients continued to rise from DM0 rate of 4.4% to 6.2% (P=.06), 6.5% (P=.03), and 6.7% (P=.02) for years 1 to 3 of DBT, respectively. Outcomes assessed for the most recent screening for individual women undergoing only 1, 2, or 3 DBT screenings during the study period demonstrated decreasing recall rates of 130, 78, and 59 per 1000 screened, respectively (P<.001). Interval cancer rates, determined using available follow-up data, decreased from 0.7 per 1000 women screened with the use of DM to 0.5 per 1000 screened with the use of DBT1. |
4 |
| 184. Lowry KP, Braunstein LZ, Economopoulos KP, et al. Predictors of surveillance mammography outcomes in women with a personal history of breast cancer. Breast Cancer Research & Treatment. 171(1):209-215, 2018 Aug. |
Observational-Dx |
164 patients |
To identify predictors of poor mammography surveillance outcomes based on clinico-pathologic features. |
164 women met inclusion criteria (65 with IBTR, 99 with CBC); 124 had screen-detected second cancers. On univariate analysis, poor surveillance outcome (n = 40) was associated with age at primary cancer diagnosis < 50 years (p < 0.0001), AJCC stage II primary cancers (p = 0.007), and heterogeneously or extremely dense breasts (p = 0.04). On multivariate analysis, age < 50 years at primary breast cancer diagnosis remained a significant predictor of poor surveillance outcome (p = 0.001). |
3 |
| 185. Sung JS, Lebron L, Keating D, et al. Performance of Dual-Energy Contrast-enhanced Digital Mammography for Screening Women at Increased Risk of Breast Cancer. Radiology. 293(1):81-88, 2019 10. |
Observational-Dx |
904 women |
To evaluate the performance of contrast agent–enhanced digital mammography (CEDM) for breast cancer screening. |
In the study period 904 baseline CEDMs were performed. Mean age was 51.8 years ± 9.4 (standard deviation). Of 904 patients, 700 (77.4%) had dense breasts, 247 (27.3%) had a family history of breast cancer in a first-degree relative age 50 years or younger, and 363 (40.2%) a personal history of breast cancer. The final Breast Imaging Reporting and Data System score was 1 or 2 in 832 of 904 (92.0%) patients, score of 3 in 25 of 904 (2.8%) patients, and score of 4 or 5 in 47 of 904 (5.2%) patients. By using CEDM, 15 cancers were diagnosed in 14 of 904 women (cancer detection rate, 15.5 of 1000). PPV3 was 29.4% (15 of 51). At least 1-year follow up was available in 858 women. There were two interval cancers. Sensitivity was 50.0% (eight of 16; 95% confidence interval [CI]: 24.7%, 75.3%) on the low-energy images compared with 87.5% (14 of 16; 95% CI: 61.7%, 98.4%) for the entire study (low-energy and iodine images; P = .03). Specificity was 93.7% (789 of 842; 95% CI: 91.8%, 95.2%); PPV1 was 20.9% (14 of 67; 95% CI: 11.9%, 32.6%), and negative predictive value was 99.7% (789 of 791; 95% CI: 99.09%, 99.97%). |
2 |
| 186. Monticciolo DL, Newell MS, Moy L, Niell B, Monsees B, Sickles EA. Breast Cancer Screening in Women at Higher-Than-Average Risk: Recommendations From the ACR. Journal of the American College of Radiology. 15(3 Pt A):408-414, 2018 03. |
Review/Other-Dx |
N/A |
To provide recommendations for breast cancer screening in women at higher-than-average-risk. |
No results stated in abstract. |
4 |
| 187. Destounis S, Arieno A, Morgan R. Personal History of Premenopausal Breast Cancer as a Risk Factor for Referral to Screening Breast MRI. Acad Radiol. 23(3):353-7, 2016 Mar. |
Observational-Dx |
146 examinations (52 patients with personal history only) and 235 examinations (79 patients with personal history and family history) |
To examine whether patients with premenopausal breast cancer history only can benefit from screening breast magnetic resonance imaging (MRI) by comparing them to patients with both a personal and a family history of breast cancer. |
Total number of MRI examinations performed per patient ranged from 1 to 10, with an average of 2.9 in the PHFH group and 2.8 in the PH only group. Patient age at time of original diagnosis was significantly different between the groups (P = 0.0391). There were 74 (19.4%) suspicious MRI findings: 27 in the PH only group and 47 in the PHFH group. Fifty-two had needle biopsy tissue sampling performed; three additional lesions were sampled at excision. Malignancy was detected in 27.3%: 53.3% in the PHFH group and 46.7% in the PH only group (P = 0.7963). There was no significant difference when the pathology between the PH only group and the PHFH group was compared (P = 0.5692). Of those diagnosed with cancer, average time between diagnoses was 6.9 years for the PHFH group and 7.1 for the PH only group (range 2-16). |
3 |
| 188. Wernli KJ, Ichikawa L, Kerlikowske K, et al. Surveillance Breast MRI and Mammography: Comparison in Women with a Personal History of Breast Cancer. Radiology. 292(2):311-318, 2019 08. |
Review/Other-Dx |
13,266 women |
To compare performance of surveillance mammography with breast MRI. |
Breast MRI was associated with younger age at diagnosis, chemotherapy, and higher education and income. Raw performance measures for breast MRI versus mammography were as follows, respectively: cancer detection rates, 10.8 (95% confidence interval [CI]: 6.7, 14.8) versus 8.2 (95% CI: 7.3, 9.2) per 1000 examinations; sensitivity, 61.4% (27 of 44; 95% CI: 46.5%, 76.2%) versus 70.3% (279 of 397; 95% CI: 65.8%, 74.8%); and biopsy rate, 10.1% (253 of 2506; 95% CI: 8.9%, 11.3%) versus 4.0% (1343 of 33 938; 95% CI: 3.7%, 4.2%). In multivariable models, breast MRI was associated with higher biopsy rate (odds ratio [OR], 2.2; 95% CI: 1.9, 2.7; P < .001) and cancer detection rate (OR, 1.7; 95% CI: 1.1, 2.7; P = .03) than mammography alone. However, there were no differences in sensitivity (OR, 1.1; 95% CI: 0.4, 2.9; P = .84) or interval cancer rate (OR, 1.1; 95% CI: 0.6, 2.2; P = .70). |
4 |
| 189. Berg WA, Zhang Z, Lehrer D, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA. 307(13):1394-404, 2012 Apr 04. |
Observational-Dx |
2,662 women |
To determine supplemental cancer detection yield of ultrasound and MRI in women at elevated risk for breast cancer. |
The 2662 patients underwent 7473 mammograms and US, with 110 women having 111 breast cancers detected, of which 33 were detected on mammography only, 32 on US only, 26 on both mammography and US, and 9 on MRI after mammography and US. Eleven were not detected by any imaging modality. Supplemental incidence-screening US identified 3.7 cancers per 1000 women-screens (95% CI 2.1 to 5.8, p<.001). Sensitivity, specificity, and PPV3 for M +US were 57/75 (0.76, 95% CI 0.65 to 0.85), 3987/4739 (0.84, 95% CI 0.83 to 0.85), and 55/339 (0.16, 95% CI 0.12 to 0.21); and for mammography alone 39/75 (0.52, 95% CI 0.40 to 0.64), 4325/4739 (0.91,95% 0.90 to 0.92), and 37/97 (0.38, 95% CI 0.28 to 0.49) (p<.001 all comparisons). Of 612 analyzable MRI participants, 16 (2.6%) had breast cancer diagnosed. Supplemental yield of MRI was 14.7 per 1000 (95% CI 3.5 to 25.9, p=.004). Sensitivity, specificity, and PPV3 for MRI+M+US were 16/16 (1.00, 95% CI 0.79 to 1.00), 390/596 (0.65, 95% CI 0.61 to 0.69), and 15/81 (0.19, 95% CI 0.11 to 0.29); and for M+US 7/16 (0.44, 95% CI 0.20 to 0.70, p=.004), 503/596 (0.84, 95% CI 0.81 to 0.87, p <.001), and 7/38 (0.18, 95% CI 0.08 to 0.34, p= .98) for M+US. Number of screens needed to detect one cancer was 127(95%CI 99 to 167) for mammography; 234(95%CI 173 to 345) for supplemental ultrasound, and 68 (95%CI 39 to 286) for MRI after negative M+US. |
1 |
| 190. Giess CS, Poole PS, Chikarmane SA, Sippo DA, Birdwell RL. Screening Breast MRI in Patients Previously Treated for Breast Cancer: Diagnostic Yield for Cancer and Abnormal Interpretation Rate. Acad Radiol. 22(11):1331-7, 2015 Nov. |
Observational-Dx |
691 patients |
To determine the cancer detection rate and abnormal interpretation rate of screening breast magnetic resonance imaging (MRI) in previously treated breast cancer patients. |
Mean patient age at initial cancer diagnosis was 46.1 years, and mean patient age during the study interval was 52 years. Cancer detection rate was 10 per 1000 (1%; 95% confidence interval [CI], 0.5%-1.8%]; 12 of 1194 examinations). Overall 10.7% (128 of 1194) of examinations received an abnormal interpretation, including 5.4% (65 of 1194) BI-RADS 4 or 5 and 5.3% (63 of 1194) BI-RADS 3 assessments with a 9.4% positive predictive value (PPV1; 12 of 128 examinations) and a 17.9% PPV3 (12 malignancies per 67 biopsies). |
3 |
| 191. Gweon HM, Cho N, Han W, et al. Breast MR imaging screening in women with a history of breast conservation therapy. Radiology. 272(2):366-73, 2014 Aug. |
Observational-Dx |
607 consecutive women who had breast conservation therapy (BCT) |
To retrospectively investigate the outcomes of single-screening breast magnetic resonance (MR) imaging in women who had a history of breast conservation therapy (BCT) for breast cancers and who had previous negative mammography and ultrasonographic (US) findings. |
Eleven cancers (eight invasive, three ductal carcinoma in situ; median invasive size, 0.8 cm; range, 0.4-1.4 cm; all node negative) were additionally detected with MR imaging in 607 women (18.1 cancers per 1000 women). PPV for recall, PPV for biopsy, sensitivity, and specificity were 9.4% (11 of 117 examinations), 43.5% (10 of 23 examinations), 91.7% (11 of 12 examinations), and 82.2% (489 of 595 examinations), respectively. At multivariate analysis, the independent factors associated with women with MR-detected cancers were age younger than 50 years at initial diagnosis (P < .001) and more than a 24-month interval between initial surgery and screening MR imaging (P = .011). |
3 |
| 192. Lehman CD, Lee JM, DeMartini WB, et al. Screening MRI in Women With a Personal History of Breast Cancer. Journal of the National Cancer Institute. 108(3), 2016 Mar. |
Observational-Dx |
1521 women |
To compare screening MRI performance in women with personal history versus genetic risk or family history of breast cancer. |
Of 1521 women who underwent screening MRI from July 2004 to November 2011, 915 had PH and 606 had GFH of breast cancer. Overall, MRI sensitivity was 79.4% for all cancers and 88.5% for invasive cancers. False-positive exams were lower in the PH vs GFH groups (12.3% vs 21.6%, P < .001), specificity was higher (94.0% vs 86.0%, P < .001), and sensitivity and cancer detection rate were not statistically different (P > .99). Age (P < .001), prior MRI (P < .001), and clinical indication (P < .001) were individually associated with initial false-positive rate; age and prior MRI remained statistically significant in multivariable modeling (P = .001 and P < .001, respectively). |
3 |
| 193. Weinstock C, Campassi C, Goloubeva O, et al. Breast magnetic resonance imaging (MRI) surveillance in breast cancer survivors. Springerplus 2015;4:459. |
Observational-Dx |
249 patients |
To present a retrospective analysis of our experience and compare the sensitivity and specificity of MRI vs. mammography in this setting. |
Of 617 charts reviewed, 249 patients met inclusion criteria, with 571 paired MRI/mammogram results. There were 27 biopsies performed due to MRI findings alone, 10 done due to mammographic findings alone, and 15 done based on abnormalities seen on both imaging modalities. There were 8 malignancies identified based on an abnormal MRI, 3 detected on both MRI and mammography, and none identified via mammography alone. Overall, MRI had a sensitivity of 84.6% (the 95% CI 54.6-98.1) and a specificity of 95.3% (the 95% CI 93.3-96.9); mammography a sensitivity of 23.1% (the 95% CI 5.0-53.8), and a specificity of 96.4% (the 95% CI 94.5-97.8). |
3 |
| 194. Nadler M, Al-Attar H, Warner E, et al. MRI surveillance for women with dense breasts and a previous breast cancer and/or high risk lesion. BREAST. 34:77-82, 2017 Aug. |
Observational-Dx |
198 patients |
To estimate the performance of annual surveillance MRI in women with a combination of mammographically dense breasts, a personal history of breast cancer (BC), atypical hyperplasia (AH), or lobular carcinoma in situ (LCIS). |
This study included 198 patients (266 MRI exams). MRI detected 15 cancers: 11 invasive stage I and 4 in-situ. All but 1 were mammographically occult and there were no interval cancers. The cancer detection rate (CDR) and false positive (FP) rate were 6.1% and 21% for round one and 4.7% and 12.5% for round two, respectively. Not being on anti-estrogen therapy and having a 1st degree relative with BC significantly increased the likelihood of tumor detection. |
3 |
| 195. Buist DSM, Abraham L, Lee CI, et al. Breast Biopsy Intensity and Findings Following Breast Cancer Screening in Women With and Without a Personal History of Breast Cancer. JAMA Internal Medicine. 178(4):458-468, 2018 04 01. |
Observational-Dx |
812164 patients |
To evaluate biopsy rates and yield in the 90 days following screening (mammography vs magnetic resonance imaging with or without mammography) among women with and without a PHBC. |
We included 101103 and 1939455 mammogram screening episodes in women with and without PHBC, respectively; MRI screening episodes included 3763 with PHBC and 4673 without PHBC. Age-adjusted core and surgical biopsy rates (per 1000 episodes) doubled (57.1; 95% CI, 50.3-65.1) following MRI compared with mammography (23.6; 95% CI, 22.4-24.8) in women with PHBC. Differences (per 1000 episodes) were even larger in women without PHBC: 84.7 (95% CI, 75.9-94.9) following MRI and 14.9 (95% CI, 14.7-15.0) following mammography episodes. Ductal carcinoma in situ and invasive biopsy yield (per 1000 episodes) was significantly higher following mammography compared with MRI episodes in women with PHBC (mammography, 404.6; 95% CI, 381.2-428.8; MRI, 267.6; 95% CI, 208.0-337.8) and nonsignificantly higher, but in the same direction, in women without PHBC (mammography, 279.3; 95% CI, 274.2-284.4; MRI, 214.6; 95% CI, 158.7-280.8). High-risk benign lesions were more commonly identified following MRI regardless of PHBC. Higher biopsy rates and lower cancer yield following MRI were not explained by increasing age or higher 5-year breast cancer risk. |
3 |
| 196. Haas CB, Nekhlyudov L, Lee JM, et al. Surveillance for second breast cancer events in women with a personal history of breast cancer using breast MRI: a systematic review and meta-analysis. Breast Cancer Research & Treatment. 181(2):255-268, 2020 Jun. |
Meta-analysis |
11 articles (8338 women with PHBC and 12,335 breast MRIs) |
To compile and compare existing studies that describe the test performance of surveillance breast MRI among women with personal history of breast cancer (PHBC). |
Our review included 11 articles in which unique cohorts were studied, comprised of a total of 8338 women with PHBC and 12,335 breast MRI done for the purpose of surveillance. We predict intervals (PI) for cancer detection rate per 1000 examinations (PI 9-15; I2 = 10%), recall rate (PI 5-31%; I2 = 97%), sensitivity (PI 58-95%; I2 = 47%), specificity (PI 76-97%; I2 = 97%), and PPV3 (PI 16-40%; I2 = 44%). |
Inadequate |
| 197. Suh YJ, Kim MJ, Kim EK, Moon HJ, Kim SI, Park BW. Value of ultrasound for postoperative surveillance of asian patients with history of breast cancer surgery: a single-center study. Ann Surg Oncol. 20(11):3461-8, 2013 Oct. |
Observational-Dx |
390 patients |
To assess the diagnostic performance of postoperative ultrasound (US) surveillance for the detection of malignant lesions and to evaluate the clinical role of US in the postoperative surveillance of patients with breast cancer history. |
Among 2,925 examinations in 287 patients with mastectomy, there were 85 US-positive and 23 final-positive lesions (27 %) in 20 patients at final diagnosis. Among 1,171 examinations in 104 BCS patients, there were 32 US-positive and five final-positive (15.6 %) findings in four patients. The sensitivity, specificity, positive predictive value, and accuracy of US for final-positive lesions after breast cancer surgery were 95.8,97.8, 27.1, and 97.9 % in mastectomy patients and 42.9, 97.5, 9.4, and 97.2 % in BCS patients. Among mastectomy patients, patients with final-positive findings had a higher incidence of distant metastasis than patients without final-positive findings (31.6 vs. 9.3 %, p = 0.01). Among BCS patients, there was no distant metastasis. Among mastectomy patients, the overall survival was not significantly different between patients with only final-positive findings and in patients with final-positive findings and distant metastasis (p > 0.05). |
3 |
| 198. Scheel JR, Lee JM, Sprague BL, Lee CI, Lehman CD. Screening ultrasound as an adjunct to mammography in women with mammographically dense breasts. [Review]. Am J Obstet Gynecol. 212(1):9-17, 2015 Jan. |
Review/Other-Dx |
12 studies |
To conduct a comprehensive literature review of studies assessing the efficacy of screening US to supplement mammography among women with dense breasts. |
From a total of 189 peer-reviewed publications on the performance of screening US, 12 studies were relevant to our analysis. The reporting of breast cancer risk factors varied across studies; however, the study populations tended to be at greater than average risk for developing breast cancer. Overall, US detected an additional 0.3-7.7 cancers per 1000 examinations (median, 4.2) and was associated with an additional 11.7-106.6 biopsies per 1000 examinations (median, 52.2). Significant improvements in cancer detection in dense breasts have been achieved with the transition from film to digital mammography. Thus adjunctive screening with ultrasound should be considered in the context of current screening mammography performance. Clinicians should discuss breast density as 1 of several important breast cancer risk factors, consider the potential harms of adjunctive screening, and arrive at a shared decision consistent with each woman's preferences and values. |
4 |
| 199. Giannotti DG, Hanna SA, Cerri GG, Barbosa Bevilacqua JL. Analysis of Skin Flap Thickness and Residual Breast Tissue After Mastectomy. Int J Radiat Oncol Biol Phys. 102(1):82-91, 2018 09 01. |
Observational-Dx |
367 women who underwent therapeutic or prophylactic mastectomy with reconstruction |
To evaluate the frequency of residual breast tissue (RBT) and provide average thickness skin flap measurements in patients with total mastectomy, skin-sparing mastectomy, and nipple-sparing mastectomy (NSM) followed by breast reconstruction. |
At 9 of the 11 points of measure, the median thickness of the flap exceeded 5.5 mm. Excluding the areolar region, RBT was identified in 29.9% of the cases: 21.3% of the therapeutic mastectomy cases and 51% of the NSM cases. The variables independently associated with the presence of RBT were flap thickness (P < .001), patient height (P < .03), mastectomy indication (P < .001), mastectomy type (P < .012 for skin-sparing mastectomy and P < .001 for NSM and total mastectomy), and breast reconstruction with flap (P < .019). |
4 |
| 200. ESMO Interactive Guidelines. Available at: http://interactiveguidelines.esmo.org/esmo-web-app/toc/index.php?subjectAreaId=8. |
Review/Other-Dx |
N/A |
To provide you with the most important content of the full ESMO Clinical Practice Guidelines (CPGs) and consensus statements on the management of breast cancer. |
No results provided |
4 |
| 201. Chapman MC, Hayward JH, Woodard GA, Joe BN, Lee AY. The Role of Breast MRI in Detecting Asymptomatic Recurrence After Therapeutic Mastectomy. AJR Am J Roentgenol. 215(1):254-261, 2020 07. |
Observational-Dx |
191 women (402 breast MRI studies) |
To determine the utility of breast MRI in detecting asymptomatic locoregional recurrence after therapeutic mastectomy. |
In all, 395 MR images (98.3%) were assessed as showing benign findings on the mastectomy side. Seven (1.7%) were interpreted as showing positive findings on the mastectomy side (BI-RADS category 4, suspicious for malignancy). Biopsy was performed in four of the seven positive interpretations. All four biopsies yielded malignancy for a positive predictive value of biopsy of 100%. The three remaining positive cases did not include biopsy; however, in each case, follow-up imaging showed improvement or resolution of the finding, yielding a positive predictive value of an abnormal examination of 57.1%. Two MRI studies were false-negative, with local recurrence within 12 months after MRI deemed to show benign findings, yielding a negative predictive value of 99.5%. Sensitivity and specificity were 66.7% and 99.2%, respectively. The cancer detection rate in the asymptomatic mastectomy side for all MRI examinations was 10 cancers per 1000 examinations. |
4 |
| 202. Brandt KR, Craig DA, Hoskins TL, et al. Can digital breast tomosynthesis replace conventional diagnostic mammography views for screening recalls without calcifications? A comparison study in a simulated clinical setting. AJR Am J Roentgenol 2013;200:291-8. |
Observational-Dx |
146 women |
To evaluate digital breast tomosynthesis (DBT) as an alternative to conventional diagnostic mammography in the workup of noncalcified findings recalled from screening mammography in a simulated clinical setting that incorporated comparison mammograms and breast ultrasound results. |
Agreement between DBT and diagnostic mammography BI-RADS categories was excellent for readers 1 and 2 (kappa = 0.91 and kappa = 0.84) and good for reader 3 (kappa = 0.68). For readers 1, 2, and 3, sensitivity and specificity of DBT for breast abnormalities were 100%, 100%, and 88% and 94%, 93%, and 89%, respectively. The clinical workup averaged three diagnostic views per abnormality and ultrasound was requested in 49% of the cases. DBT was adequate mammographic evaluation for 93-99% of the findings and ultrasound was requested in 33-55% of the cases. |
2 |
| 203. Sorin V, Yagil Y, Yosepovich A, et al. Contrast-Enhanced Spectral Mammography in Women With Intermediate Breast Cancer Risk and Dense Breasts. AJR. American Journal of Roentgenology. 211(5):W267-W274, 2018 11. |
Observational-Dx |
611 women |
To compare the diagnostic performance of contrast-enhanced spectral mammography (CESM) and ultrasound with that of standard digital mammography for breast cancer screening of women at intermediate risk who have dense breasts. |
Among the 611 women included, 48.3% (295/611) had family or personal history of breast cancer, the BI-RADS breast density score was C or D in 93.1% (569/611). The mean follow-up period was 20 months. Mammography depicted 11 of 21 malignancies, sensitivity of 52.4%, specificity of 90.5% (534/590), positive predictive value of 16.4% (11/67), and negative predictive value of 98.2% (534/544). CESM depicted 19 of 21 malignancies, sensitivity of 90.5%, specificity of 76.1% (449/590), positive predictive value of 11.9% (19/160), and negative predictive value of 99.6% (449/451). Differences in sensitivity (p = 0.008) and specificity (p < 0.001) were statistically significant. Adjunct ultrasound revealed 73 additional suspicious findings; all were false-positive. In 39 women MRI was needed to assess screening abnormalities; two MRI-guided biopsies were performed and yielded one cancer. The incremental cancer detection rate of CESM was 13.1/1000 women (95% CI, 6.1-20.1). Of eight cancers seen only with CESM, seven were invasive (mean size, 9 mm; two of four cancers lymph-node positive). |
2 |
| 204. Olsen ML, Morton MJ, Stan DL, Pruthi S. Is there a role for magnetic resonance imaging in diagnosing palpable breast masses when mammogram and ultrasound are negative? J Womens Health (Larchmt) 2012;21:1149-54. |
Observational-Dx |
77 studies |
To examine the use and utility of breast MRI in evaluating palpable breast masses with negative diagnostic mammogram and ultrasound studies. |
Seventy-seven studies were included, comprising 1.3% of all breast MRI studies performed at our institution during the study period (2005-2011). Twenty-two patients underwent biopsy, and 55 were followed clinically without biopsy. Approximately half (27 of 55) of the patients without biopsy were lost to follow-up after negative MRI, and the rest had no evidence of cancer on imaging or clinical examination at 1 year. Of the 22 patients who underwent biopsy, 2 were diagnosed with cancer, both with positive MRI studies. Sensitivity of MRI when compared to tissue diagnosis was 100%, and specificity was 70%. Positive and negative predictive values were 25% and 100%, respectively. |
3 |
| 205. Amitai Y, Menes TS, Weinstein I, Filyavich A, Yakobson I, Golan O. What is the yield of breast MRI in the assessment of palpable breast findings?. Clin Radiol. 72(11):930-935, 2017 Nov. |
Observational-Dx |
7,782 patients |
To examine the contribution of magnetic resonance imaging (MRI) to characterise palpable breast masses after conventional imaging was found to be non-contributory. |
Investigation of palpable breast finding was the clinical indication for 167 of 7,782 (2%) examinations. Thirty-two (19%) women in the study had positive MRI findings. Most (20, 63%) findings corresponded to the palpable area, resulting in three carcinomas being diagnosed. Only one carcinoma required MRI-guided biopsy for diagnosis. Eighteen women with negative MRI underwent ultrasound-guided biopsy from the palpable area, which resulted in a diagnosis of one carcinoma. One carcinoma was incidentally detected in another location. Within the present population, the sensitivity for detecting malignancy was 80%, specificity 78%, negative predictive value 99%, and positive predictive value 13%. |
3 |
| 206. Yalniz C, Campbell D, Le-Petross C, et al. The role of magnetic resonance imaging in patients with palpable breast abnormalities and negative mammographic and sonographic findings. Breast J 2020;26:1289-95. |
Observational-Dx |
22,004 women with palpable abnormalities |
To determine the frequency of positive findings on breast magnetic resonance imaging (MRI) in patients with palpable breast abnormalities in the setting of negative mammographic and sonographic evaluations. |
22 004 women presented with palpable abnormalities at one breast imaging center between January 1, 2005 and December 31, 2015. Nine thousand and three hundred and thirty-four patients had negative or benign findings on mammography, ultrasound, or mammography plus ultrasound. Thirty-one patients underwent MRI with the complaint of palpable abnormalities despite negative or benign mammographic and/or sonographic findings. Their age range was between 32 and 74 years, and their mean age was 49 years. Of those who had MRI, twenty-one patients had negative MRI findings. Six patients had negative concordant results for the palpable abnormalities and benign incidental findings. Three patients had benign concordant results for the palpable abnormalities, and one patient had incidental atypia. Twenty-eight patients had negative MRI results in the area of the palpable abnormality, and none of these patients underwent biopsy. Of the 31 cases, four patients (13%) underwent additional examinations (three second-look ultrasounds and one bone scan) after MRI. Five patients (16%) underwent MRI-guided biopsies, two patients (6%) underwent ultrasound-guided biopsies, and one patient (3%) had an excision. All biopsies showed benign results. The Gail risk score was calculated for 22 of them and the mean 5-year risk was 1.64 and the mean lifetime risk was 12.51. |
4 |
| 207. Moy L, Heller SL, Bailey L, et al. ACR Appropriateness Criteria® Palpable Breast Masses. J Am Coll Radiol 2017;14:S203-S24. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for palpable breast masses. |
No results stated in abstract. |
4 |
| 208. Holbrook AI, Moy L, Akin EA, et al. ACR Appropriateness Criteria® Breast Pain. J Am Coll Radiol 2018;15:S276-S82. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for breast pain. |
No results stated in abstract. |
4 |
| 209. Lin NU, Thomssen C, Cardoso F, et al. International guidelines for management of metastatic breast cancer (MBC) from the European School of Oncology (ESO)-MBC Task Force: Surveillance, staging, and evaluation of patients with early-stage and metastatic breast cancer. BREAST. 22(3):203-10, 2013 Jun. |
Review/Other-Dx |
N/A |
To summarize the final consensus of the European School of Oncology (ESO)- metastatic breast cancer (MBC) Task Force, update the available data, and discuss opportunities for further research. |
No results stated in abstract. |
4 |
| 210. Senkus E, Kyriakides S, Ohno S, et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 26 Suppl 5:v8-30, 2015 Sep. |
Review/Other-Dx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 211. Whitehead MT, Cardenas AM, Corey AS, et al. ACR Appropriateness Criteria® Headache. J Am Coll Radiol 2019;16:S364-S77. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for headache. |
No results stated in the abstract. |
4 |
| 212. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
