Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Follow-Up Intervals for Breast Imaging Reporting and Data System Category 3 Lesions on Screening Ultrasound in Screening and Tertiary Referral Centers

  • Sun Huh (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Hee Jung Suh (Department of Radiology, Severance Check-Up) ;
  • Eun-Kyung Kim (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Min Jung Kim (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Jung Hyun Yoon (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Vivian Youngjean Park (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Hee Jung Moon (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine)
  • Received : 2019.10.08
  • Accepted : 2020.03.12
  • Published : 2020.09.01
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Abstract

Objective: To assess the appropriate follow-up interval, and rate and timepoint of cancer detection in women with Breast Imaging Reporting and Data System (BI-RADS) 3 lesions on screening ultrasonography (US) according to the type of institution. Materials and Methods: A total of 1451 asymptomatic women who had negative or benign findings on screening mammogram, BI-RADS 3 assessment on screening US, and at least 6 months of follow-up were included. The median follow-up interval was 30.8 months (range, 6.8-52.9 months). The cancer detection rate, cancer detection timepoint, risk factors, and clinicopathological characteristics were compared between the screening and tertiary centers. Nominal variables were compared using the chi-square or Fisher's exact test and continuous variables were compared using the independent t test or Mann-Whitney U test. Results: In 1451 women, 19 cancers (1.3%) were detected; two (0.1%) were diagnosed at 6 months and 17 (1.2%) were diagnosed after 12.3 months. The malignancy rates were both 1.3% in the screening (9 of 699) and tertiary (10 of 752) centers. In the screening center, all nine cancers were invasive cancers and diagnosed after 12.3 months. In the tertiary center, two were ductal carcinomas in situ and eight were invasive cancers. Two of the invasive cancers were diagnosed at 6 months and the remaining eight cancers newly developed after 13.1 months. Conclusion: One-year follow-up rather than 6-month follow-up may be suitable for BI-RADS 3 lesions on screening US found in screening centers. However, more caution is needed regarding similar findings in tertiary centers where 6-month follow-up may be more appropriate.

Keywords

Acknowledgement

This study was supported by a faculty research grant of Yonsei University College of Medicine (6-2017-0045).

References

  1. Michaelson JS, Silverstein M, Sgroi D, Cheongsiatmoy JA, Taghian A, Powell S, et al. The effect of tumor size and lymph node status on breast carcinoma lethality. Cancer 2003;98:2133-2143 
  2. Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 2002;225:165-175 
  3. Mandelson MT, Oestreicher N, Porter PL, White D, Finder CA, Taplin SH, et al. Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst 2000;92:1081-1087 
  4. Chae EY, Kim HH, Cha JH, Shin HJ, Kim H. Evaluation of screening whole-breast sonography as a supplemental tool in conjunction with mammography in women with dense breasts. J Ultrasound Med 2013;32:1573-1578 
  5. Gordon PB, Goldenberg SL. Malignant breast masses detected only by ultrasound. A retrospective review. Cancer 1995;76:626-630 
  6. Chang JM, Koo HR, Moon WK. Radiologist-performed hand-held ultrasound screening at average risk of breast cancer: results from a single health screening center. Acta Radiol 2015;56:652-658 
  7. Corsetti V, Ferrari A, Ghirardi M, Bergonzini R, Bellarosa S, Angelini O, et al. Role of ultrasonography in detecting mammographically occult breast carcinoma in women with dense breasts. Radiol Med 2006;111:440-448 
  8. De Felice C, Savelli S, Angeletti M, Ballesio L, Manganaro L, Meggiorini ML, et al. Diagnostic utility of combined ultrasonography and mammography in the evaluation of women with mammographically dense breasts. J Ultrasound 2007;10:143-151 
  9. Girardi V, Tonegutti M, Ciatto S, Bonetti F. Breast ultrasound in 22,131 asymptomatic women with negative mammography. Breast 2013;22:806-809 
  10. Moon HJ, Jung I, Park SJ, Kim MJ, Youk JH, Kim EK. Comparison of cancer yields and diagnostic performance of screening mammography vs. supplemental screening ultrasound in 4394 women with average risk for breast cancer. Ultraschall Med 2015;36:255-263 
  11. Nam SY, Ko EY, Han BK, Shin JH, Ko ES, Hahn SY. Breast imaging reporting and data system category 3 lesions detected on whole-breast screening ultrasound. J Breast Cancer 2016;19:301-307 
  12. Hwang JY, Han BK, Ko EY, Shin JH, Hahn SY, Nam MY. Screening ultrasound in women with negative mammography: outcome analysis. Yonsei Med J 2015;56:1352-1358 
  13. Berg WA, Blume JD, Cormack JB, Mendelson EB, Lehrer D, Bohm-Velez M, et al. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA 2008;299:2151-2163 
  14. Hooley RJ, Greenberg KL, Stackhouse RM, Geisel JL, Butler RS, Philpotts LE. Screening US in patients with mammographically dense breasts: initial experience with Connecticut Public Act 09-41. Radiology 2012;265:59-69 
  15. Chae EY, Cha JH, Shin HJ, Choi WJ, Kim HH. Reassessment and follow-up results of BI-RADS category 3 lesions detected on screening breast ultrasound. AJR Am J Roentgenol 2016;206:666-672 
  16. Barr RG, Zhang Z, Cormack JB, Mendelson EB, Berg WA. Probably benign lesions at screening breast US in a population with elevated risk: prevalence and rate of malignancy in the ACRIN 6666 trial. Radiology 2013;269:701-712 
  17. American College of Radiology. Breast imaging reporting and data system, 5th ed. Reston: American College of Radiology, 2013 
  18. Kim SJ, Chang JM, Cho N, Chung SY, Han W, Moon WK. Outcome of breast lesions detected at screening ultrasonography. Eur J Radiol 2012;81:3229-3233 
  19. Moon HJ, Kim EK, Kwak JY, Yoon JH, Kim MJ. Interval growth of probably benign breast lesions on follow-up ultrasound: how can these be managed? Eur Radiol 2011;21:908-918 
  20. Kaplan SS. Clinical utility of bilateral whole-breast US in the evaluation of women with dense breast tissue. Radiology 2001;221:641-649 
  21. Ruamsup S, Wiratkapun C, Wibulpolprasert B, Lertsithichai P. A comparison between short-interval and regular-interval follow-up for BI-RADS category 3 lesions. Singapore Med J 2010;51:120-125 
  22. Moon HJ, Kim MJ, Yoon JH, Kim EK. Follow-up interval for probably benign breast lesions on screening ultrasound in women at average risk for breast cancer with dense breasts. Acta Radiol 2018;59:1045-1050 
  23. Gruber R, Jaromi S, Rudas M, Pfarl G, Riedl CC, Flory D, et al. Histologic work-up of non-palpable breast lesions classified as probably benign at initial mammography and/or ultrasound (BI-RADS category 3). Eur J Radiol 2013;82:398-403 
  24. Kim SY, Kim MJ, Moon HJ, Yoon JH, Kim EK. Application of the downgrade criteria to supplemental screening ultrasound for women with negative mammography but dense breasts. Medicine (Baltimore) 2016;95:e5279 
  25. Michaels AY, Birdwell RL, Chung CS, Frost EP, Giess CS. Assessment and management of challenging BI-RADS category 3 mammographic lesions. Radiographics 2016;36:1261-1272 
  26. Helvie MA, Pennes DR, Rebner M, Adler DD. Mammographic follow-up of low-suspicion lesions: compliance rate and diagnostic yield. Radiology 1991;178:155-158 
  27. Sickles EA. Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases. Radiology 1991;179:463-468 
  28. Vizcaino I, Gadea L, Andreo L, Salas D, Ruiz-Perales F, Cuevas D, et al. Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. Radiology 2001;219:475-483 
  29. Varas X, Leborgne F, Leborgne JH. Nonpalpable, probably benign lesions: role of follow-up mammography. Radiology 1992;184:409-414 
  30. Cyrlak D. Induced costs of low-cost screening mammography. Radiology 1988;168:661-663 
  31. Berg WA, Zhang Z, Cormack JB, Mendelson EB. Multiple bilateral circumscribed masses at screening breast US: consider annual follow-up. Radiology 2013;268:673-683