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Color Doppler Findings of Benign Breast Masses -Jabts Bc-04 Study Part 3-
S24
Ultrasound in Medicine and Biology
malignant masses did not vary with age, that of benign masses was increased in younger patients. We did not consider patient age in our evaluation of color Doppler (CD) results. Our method of CD evaluation in younger patients may thus have yielded overestimates. The purpose of this analysis was to examine the appropriateness of our CD evaluation method. Methods: JABTS BC-04 study data were used for this analysis. We set certain conditions for CD evaluation, and then calculated sensitivity and specificity. Results: In total, 1408 solid masses (malignant: 839, benign: 569) were analyzed. B mode sensitivity and specificity were not significantly improved by CD in this study (sensitivity: 97.5%/97.9%, specificity: 38.3%/ 41.4%). Specificity was lower in premenopausal (,50 years, 39.8%) than in postmenopausal (45.7%) patients. The optimal conditions for CD evaluation were as follows. In premenopausal patients, if vascularity was 3+ or an incident angle near 0 was observed, the B-mode category was increased by one. In patients younger than 40 years of age with oval or lobulated masses, if there was no penetrating flow and vascularity was 0-2+, the B-mode category was reduced by one. Employing this evaluation method, specificity in premenopausal patients was estimated to improve from 39.8% to 48.4% (p50.013). Conclusions: The CD evaluation method should be modified to improve specificity. OPT2-020 Color Doppler Findings of Benign Breast Masses -Jabts Bc-04 Study Part 3Hidemitsu Yasuda,1 Setsuko Kaoku,2 Takanori Watanabe,3 Toshitaka Okuno,4 Takuhiro Yamaguchi,5 Hiroko Yaegashi,6 Ayumi Izumori,7 Hideaki Shirai,8 Kanako Ban,9 Yukio Mitsuzuka10 1 Department of Breast Surgery, National Center for Global Health and Medicine, Japan, 2Department of Ultrasonics, National Hospital Organization Osaka National Hospital, 3Department of Breast Surgery, National Hospital Organization Sendai Medical Center, 4Department of Breast Surgery, Kobe City Nishi-Kobe Medical Center, 5Clinical Research Data Center, Tohoku University Hospital, 6Data Center, Tohoku University Hospital, 7Department of Breast Surgery, Takamatu Heiwa Hospital, 8 Clinical Laboratory, Sapporo Kotoni Breast Clinic, 9Cancer Detection and Diagnosis unit, Tokyo Health Service Association, 10Department of Clinical Functional Physiology, Toho University, Omori Medical Center Objectives: To evaluate the usefulness of color Doppler (CD), we conducted JABTS BC-04 study. In this part, CD findings of benign masses was analyzed. Methods: Pathology-confirmed breast masses on which breast ultrasound examination was performed and masses which showed no significant change in more than two years were also registered from October 2013 to December 2015. B-mode images, CD images and clinical data were collected. Collected images were evaluated by a Centralized Image Interpretation Committee. Results: A total of 569 solid benign masses were analyzed. Mean age of the patients was 44.8612.8 (mean6SD). Vascularity was classified as 0, 1+, 2+, 3+. The frequency of each class was as follows: 0: 114 (20%); 1+: 241 (42%); 2+: 187 (33%); 3+: 27 (5%). There are two types of benign masses, two year follow-up masses (176, 31%) and biopsied masses (393, 69%). In the followup masses, the frequency of typical benign masses (oval shape and circumscribed margin) was high. Furthermore, frequency of low vascularity (p,0.001), penetrating flow (p50.013) and high incident angle (p50.026) was low in the follow-up masses. Vascularity increased as tumor diameter increased (p,0.001) and younger age (p,0.001). The mean age of vascularity 0, 1+, 2+, 3+ was 52.0, 44.6, 41.5, 38.5, respectively. However, in malignant masses, the vascularity did not change with age. Conclusions: In relatively young women, vascularity often increases even in benign masses. This may cause low specificity in relatively young women.
Volume 43, Number S1, 2017 OPT2-021 Is Axillary Scanning Necessary with Negative Finding on Both Mammography and Subsequent Breast Ultrasound? Min Jung Kim,1 In Young Youn2 1 Department of Radiology, Yonsei University, South Korea, 2 Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University Objectives: The purpose of our studywas to assess cancer detection rate and positive predictive value (PPV) for incidentally detected abnormal axillary lymph nodes (LNs) with negative findings on both mammography and subsequent breast ultrasound (US). Methods: We retrospectively reviewed 13,573 records for screened patients from January 2012 to March 2015 with negative mammography and subsequent breast US results. We reviewed medical charts for USguided axillary LN biopsy and cytopathological results, records of follow-up US for at least 12 months, family history, and previous operation and past cancer history. We calculated cancer detection rate, PPV for biopsy, axillary biopsy performed, and cancer rate for patients by family history, previous operation, and past cancer history. Results: We included 7,039 patients (mean age, 52 years) with positive results from US-guided LN biopsy (n52), or follow-up US (n57,037). In two patients with positive LNs, none of them from breast malignancy, but endometrial cancer or follicular lymphoma. The calculated cancer detection rate was 0.3 per 1,000 axillary US, PPV for biopsy was14.3%, and axillary biopsy performed rate was 0.2%. Cancer rates were 0% for patients with a family history or previous operation history, 0.1% with past cancer history, and 0.2% for no family, operation or cancer history. Conclusions: Our results indicated that cancer detection rate and PPV for US were too low to recommend routine axillary scanning including screening breast US in patients with negativefindings on both mammography and subsequent breast US, especially without past history of any cancers. OPT2-022 Bi-Rads 3 Lesions in Screening Automated Breast Volume Scanner: Comparison with 6-Months Follow-Up Hand-Held Breast Us Min Seo Bang, Min Ji Jang, Ji Eun Choi, Yeon Jung Jang Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, South Korea Objectives: To assess the value of automated breast volume scanner as a screening tool for diagnosing BI-RADS category 3 lesions, compared with 6-months follow-up hand-held breast US. Methods: In this study, total 1117 patients with first screening breast ultrasound examination by ABVS from September 2014 to December 2015 were retrospectively evaluated. We included patients with at least one BI-RADS category 3 lesions and a 6 months follow-up hand-held breast ultrasound exam. BI-RADS category assigned at a 6months follow-up handheld breast US and pathologic findings in cases undergoing biopsy were collected. Using the BI-RADS lexicons, the images of the category 3 lesion detected by ABVS were analyzed and reasons for changing the BI-RADS category at follow-up hand-held breast ultrasound exam were discussed. Results: Among the 213 patients was diagnosed as BI-RADS category 3, 41 patients had a 6 months follow-up hand-held breast ultrasound exam. In 41 patients, 62 BI-RADS category 3 lesions were identified. After 6 months, category was downgraded to BIRADS 1/2 in 15/62 (24%) and upgraded to BI-RADS category 4 in 2/62 (3%). BI-RADS category 1 was assigned to 8 cases of misdiagnosed fat lobule and to 4 lesions which were no more detectable. BI-RADS category 2 was assigned to 3 lesions that received a subsequent diagnosis of simple cyst. Biopsy was performed in 2 lesions
Ultrasound in Medicine and Biology
malignant masses did not vary with age, that of benign masses was increased in younger patients. We did not consider patient age in our evaluation of color Doppler (CD) results. Our method of CD evaluation in younger patients may thus have yielded overestimates. The purpose of this analysis was to examine the appropriateness of our CD evaluation method. Methods: JABTS BC-04 study data were used for this analysis. We set certain conditions for CD evaluation, and then calculated sensitivity and specificity. Results: In total, 1408 solid masses (malignant: 839, benign: 569) were analyzed. B mode sensitivity and specificity were not significantly improved by CD in this study (sensitivity: 97.5%/97.9%, specificity: 38.3%/ 41.4%). Specificity was lower in premenopausal (,50 years, 39.8%) than in postmenopausal (45.7%) patients. The optimal conditions for CD evaluation were as follows. In premenopausal patients, if vascularity was 3+ or an incident angle near 0 was observed, the B-mode category was increased by one. In patients younger than 40 years of age with oval or lobulated masses, if there was no penetrating flow and vascularity was 0-2+, the B-mode category was reduced by one. Employing this evaluation method, specificity in premenopausal patients was estimated to improve from 39.8% to 48.4% (p50.013). Conclusions: The CD evaluation method should be modified to improve specificity. OPT2-020 Color Doppler Findings of Benign Breast Masses -Jabts Bc-04 Study Part 3Hidemitsu Yasuda,1 Setsuko Kaoku,2 Takanori Watanabe,3 Toshitaka Okuno,4 Takuhiro Yamaguchi,5 Hiroko Yaegashi,6 Ayumi Izumori,7 Hideaki Shirai,8 Kanako Ban,9 Yukio Mitsuzuka10 1 Department of Breast Surgery, National Center for Global Health and Medicine, Japan, 2Department of Ultrasonics, National Hospital Organization Osaka National Hospital, 3Department of Breast Surgery, National Hospital Organization Sendai Medical Center, 4Department of Breast Surgery, Kobe City Nishi-Kobe Medical Center, 5Clinical Research Data Center, Tohoku University Hospital, 6Data Center, Tohoku University Hospital, 7Department of Breast Surgery, Takamatu Heiwa Hospital, 8 Clinical Laboratory, Sapporo Kotoni Breast Clinic, 9Cancer Detection and Diagnosis unit, Tokyo Health Service Association, 10Department of Clinical Functional Physiology, Toho University, Omori Medical Center Objectives: To evaluate the usefulness of color Doppler (CD), we conducted JABTS BC-04 study. In this part, CD findings of benign masses was analyzed. Methods: Pathology-confirmed breast masses on which breast ultrasound examination was performed and masses which showed no significant change in more than two years were also registered from October 2013 to December 2015. B-mode images, CD images and clinical data were collected. Collected images were evaluated by a Centralized Image Interpretation Committee. Results: A total of 569 solid benign masses were analyzed. Mean age of the patients was 44.8612.8 (mean6SD). Vascularity was classified as 0, 1+, 2+, 3+. The frequency of each class was as follows: 0: 114 (20%); 1+: 241 (42%); 2+: 187 (33%); 3+: 27 (5%). There are two types of benign masses, two year follow-up masses (176, 31%) and biopsied masses (393, 69%). In the followup masses, the frequency of typical benign masses (oval shape and circumscribed margin) was high. Furthermore, frequency of low vascularity (p,0.001), penetrating flow (p50.013) and high incident angle (p50.026) was low in the follow-up masses. Vascularity increased as tumor diameter increased (p,0.001) and younger age (p,0.001). The mean age of vascularity 0, 1+, 2+, 3+ was 52.0, 44.6, 41.5, 38.5, respectively. However, in malignant masses, the vascularity did not change with age. Conclusions: In relatively young women, vascularity often increases even in benign masses. This may cause low specificity in relatively young women.
Volume 43, Number S1, 2017 OPT2-021 Is Axillary Scanning Necessary with Negative Finding on Both Mammography and Subsequent Breast Ultrasound? Min Jung Kim,1 In Young Youn2 1 Department of Radiology, Yonsei University, South Korea, 2 Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University Objectives: The purpose of our studywas to assess cancer detection rate and positive predictive value (PPV) for incidentally detected abnormal axillary lymph nodes (LNs) with negative findings on both mammography and subsequent breast ultrasound (US). Methods: We retrospectively reviewed 13,573 records for screened patients from January 2012 to March 2015 with negative mammography and subsequent breast US results. We reviewed medical charts for USguided axillary LN biopsy and cytopathological results, records of follow-up US for at least 12 months, family history, and previous operation and past cancer history. We calculated cancer detection rate, PPV for biopsy, axillary biopsy performed, and cancer rate for patients by family history, previous operation, and past cancer history. Results: We included 7,039 patients (mean age, 52 years) with positive results from US-guided LN biopsy (n52), or follow-up US (n57,037). In two patients with positive LNs, none of them from breast malignancy, but endometrial cancer or follicular lymphoma. The calculated cancer detection rate was 0.3 per 1,000 axillary US, PPV for biopsy was14.3%, and axillary biopsy performed rate was 0.2%. Cancer rates were 0% for patients with a family history or previous operation history, 0.1% with past cancer history, and 0.2% for no family, operation or cancer history. Conclusions: Our results indicated that cancer detection rate and PPV for US were too low to recommend routine axillary scanning including screening breast US in patients with negativefindings on both mammography and subsequent breast US, especially without past history of any cancers. OPT2-022 Bi-Rads 3 Lesions in Screening Automated Breast Volume Scanner: Comparison with 6-Months Follow-Up Hand-Held Breast Us Min Seo Bang, Min Ji Jang, Ji Eun Choi, Yeon Jung Jang Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, South Korea Objectives: To assess the value of automated breast volume scanner as a screening tool for diagnosing BI-RADS category 3 lesions, compared with 6-months follow-up hand-held breast US. Methods: In this study, total 1117 patients with first screening breast ultrasound examination by ABVS from September 2014 to December 2015 were retrospectively evaluated. We included patients with at least one BI-RADS category 3 lesions and a 6 months follow-up hand-held breast ultrasound exam. BI-RADS category assigned at a 6months follow-up handheld breast US and pathologic findings in cases undergoing biopsy were collected. Using the BI-RADS lexicons, the images of the category 3 lesion detected by ABVS were analyzed and reasons for changing the BI-RADS category at follow-up hand-held breast ultrasound exam were discussed. Results: Among the 213 patients was diagnosed as BI-RADS category 3, 41 patients had a 6 months follow-up hand-held breast ultrasound exam. In 41 patients, 62 BI-RADS category 3 lesions were identified. After 6 months, category was downgraded to BIRADS 1/2 in 15/62 (24%) and upgraded to BI-RADS category 4 in 2/62 (3%). BI-RADS category 1 was assigned to 8 cases of misdiagnosed fat lobule and to 4 lesions which were no more detectable. BI-RADS category 2 was assigned to 3 lesions that received a subsequent diagnosis of simple cyst. Biopsy was performed in 2 lesions