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Criteria of Diagnostic Accuracy of US for Tumor Less Than 1 cm
S14
Ultrasound in Medicine and Biology
the aid of CAD. After a 1-month washout period, the readers reread with the aid of CAD those cases that were previously read without the aid of CAD and reread without the aid of CAD those cases that were previously read with the aid of CAD.ROC analysis was used to compare the area under the ROC curve (AUC) of the CAD aided readings to those of the un-aided readings. Additionally, the reading time per case for each reader was recorded. Results: The AUC were 0.78 for reading with the aid of CAD and 0.74 for reading without the aid of CAD. This difference is statistically significant (p 5 0.015). Furthermore, the average reading time per case was 9% faster with the aid of CAD. Conclusion: CAD improves radiologist performance in both accuracy and reading time for the detection of breast cancer using ABVS. T2-13-IN10 Clinical Experience and Future of ABUS Sung Hun Kim Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul Hand held US (HHUS) is very useful in the diagnostic setting such as palpable lump, however lack of reproducibility and operator dependency was known to be drawbacks. Automated breast US (ABUS) is designed to make up the weak point of HHUS and was approved to conduct breast cancer screening as an adjunct to mammography. ABUS is also useful for diagnostic setting as well as for screening setting. However, ABUS has limitation of interventional procedure and application of elastography and these drawbacks will be improved in future. Current clinical use and the anticipated features of the future for ABUS are introduced: ABUS screening, second look ABUS, microcalcifications detection, cancer extent evaluation, ductal abnormality and computer aided detection. T2-13-IN11 Ultrasonography for Non-Mass Breast Lesion (Abnormalities) Hidemitsu Yasuda Department of Breast Surgery, National Center for Global Health and Medicine There are various images of breast lesions. The counter of breast tumors are not always clearly defined. Japan Association of Breast and Thyroid Sonology (JABTS) categorized breast lesion into masses and non-mass abnormalities. A non-mass abnormalities refer to lesions that are difficult to recognize as a mass in ultrasound images, which may coexist with mass. A non-mass abnormality may be able to identify by checking for the following five findings. 1st. Abnormalities of the ducts 2nd. Hypoechoic areas within the mammary gland 3rd. Clustered microcysts 4th. Architectural distortion 5th. Echogenic foci without a hypoechoic area If the distribution of abnormalities is diffuse, bilateral, or multisegmented, the lesion is classified as category 2. While the distribution is segmented or localized, the lesion is classified as category 3 or higher. When microcalcifications, increased vascularities and increased stiffness are observed in the same region, the lesion is classified as category 4 or higher. These findings could lead to diagnose non-invasive ductal carcinoma, intraductal papilloma, fibrocystic changes, inflammation disease, and invasive carcinoma.
Volume 43, Number S1, 2017 T2-13-IN12 Criteria of Diagnostic Accuracy of US for Tumor Less Than 1 cm Eriko Tohno,1,2 Kayoko Koshikawa2 1 Tsukuba International Breast Clinic, Tsukuba, Ibaraki, Japan, 2 Tsukuba Total Health Examination Center, Tsukuba, Ibaraki, Japan Because breast tumors less than 1cm are usually asymptomatic and found in screening or incidentally, diagnosing lesions as suspicious or not suspicious is important. To avoid false-positives and overdiagnosis, tumors equal to or less than 5mm do not need further examinations except the lesions showing very suspicious findings such as invasive features or containing echogenic foci. So the main target is tumors between 5mm to 10mm. Cancers of this size show less suspicious features such as irregular shape and even benign lesions are seen somewhat irregular. We attach importance to D/W ratio as an objective indicator. The cut-off level of the D/ W ratio is 0.7. Tsukuba Elastography Scores (ES) and comparison with the previous studies and the age of the examinees are also important factors. T2-13-IN13 How to Reduce False Positive Rates in Breast Ultrasound Screening? Woo Kyung Moon, MD, PhD Seoul National University Hospital, Seoul, Korea Ultrasound detects cancers in about 0.40% of women with mammography-negative dense breasts, with a higher contribution in women younger than 50 years. However, false positives are a major concern in screening ultrasound. Several approaches to ultrasound interpretation and breast imaging management have been developed that substantially reduce the frequency of false-positive cases, involving both recall examinations and biopsies, without meaningfully reducing the detection of nonpalpable favorable-prognosis cancers. Successful methods to reduce the recall rate for screening ultrasound involve (1) obtaining clinical history and physical examination information, (2) confidently and correctly identifying some normal structures and artifacts, and (3) learning to ignore subtle sonographic findings of doubtful significance. Procedure-related changes including fat necrosis and foreign body can be ignored with the proper history. Fat lobule often mimics solid nodule and Cooper’s ligament produces architectural distortion and shadowing. Dilated ducts without intraductal masses are incidental benign findings. Complicated cysts can mimic solid nodules. They are nonparallel orientation and often show curvilinear bright line of anterior wall. Oval circumscribed solid masses less than 1cm in size can be followed. Doppler ultrasound and elastography can help distinguish normal or benign from suspicious solid masses. When a breast lesion categorized as BI-RADS 3 or 4 shows a normal strain on elastography and no vascularity on color Doppler ultrasound, biopsy can be averted. Physicians performed the screening ultrasound could directly evaluate lesions in real-time and reduce patient anxiety and discomfort. By applying these approaches successfully, we will be able to demonstrate convincingly that the benefits of ultrasound far outweigh the risks of false-positive interpretations. T2-13-IN14 Differential Diagnosis of Pre-Invasive Tumor on Ultrasonography Chin-Yu Chen Department of Radiology, Chi-Mei Medical Center, Tainan, Taiwan
Ultrasound in Medicine and Biology
the aid of CAD. After a 1-month washout period, the readers reread with the aid of CAD those cases that were previously read without the aid of CAD and reread without the aid of CAD those cases that were previously read with the aid of CAD.ROC analysis was used to compare the area under the ROC curve (AUC) of the CAD aided readings to those of the un-aided readings. Additionally, the reading time per case for each reader was recorded. Results: The AUC were 0.78 for reading with the aid of CAD and 0.74 for reading without the aid of CAD. This difference is statistically significant (p 5 0.015). Furthermore, the average reading time per case was 9% faster with the aid of CAD. Conclusion: CAD improves radiologist performance in both accuracy and reading time for the detection of breast cancer using ABVS. T2-13-IN10 Clinical Experience and Future of ABUS Sung Hun Kim Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul Hand held US (HHUS) is very useful in the diagnostic setting such as palpable lump, however lack of reproducibility and operator dependency was known to be drawbacks. Automated breast US (ABUS) is designed to make up the weak point of HHUS and was approved to conduct breast cancer screening as an adjunct to mammography. ABUS is also useful for diagnostic setting as well as for screening setting. However, ABUS has limitation of interventional procedure and application of elastography and these drawbacks will be improved in future. Current clinical use and the anticipated features of the future for ABUS are introduced: ABUS screening, second look ABUS, microcalcifications detection, cancer extent evaluation, ductal abnormality and computer aided detection. T2-13-IN11 Ultrasonography for Non-Mass Breast Lesion (Abnormalities) Hidemitsu Yasuda Department of Breast Surgery, National Center for Global Health and Medicine There are various images of breast lesions. The counter of breast tumors are not always clearly defined. Japan Association of Breast and Thyroid Sonology (JABTS) categorized breast lesion into masses and non-mass abnormalities. A non-mass abnormalities refer to lesions that are difficult to recognize as a mass in ultrasound images, which may coexist with mass. A non-mass abnormality may be able to identify by checking for the following five findings. 1st. Abnormalities of the ducts 2nd. Hypoechoic areas within the mammary gland 3rd. Clustered microcysts 4th. Architectural distortion 5th. Echogenic foci without a hypoechoic area If the distribution of abnormalities is diffuse, bilateral, or multisegmented, the lesion is classified as category 2. While the distribution is segmented or localized, the lesion is classified as category 3 or higher. When microcalcifications, increased vascularities and increased stiffness are observed in the same region, the lesion is classified as category 4 or higher. These findings could lead to diagnose non-invasive ductal carcinoma, intraductal papilloma, fibrocystic changes, inflammation disease, and invasive carcinoma.
Volume 43, Number S1, 2017 T2-13-IN12 Criteria of Diagnostic Accuracy of US for Tumor Less Than 1 cm Eriko Tohno,1,2 Kayoko Koshikawa2 1 Tsukuba International Breast Clinic, Tsukuba, Ibaraki, Japan, 2 Tsukuba Total Health Examination Center, Tsukuba, Ibaraki, Japan Because breast tumors less than 1cm are usually asymptomatic and found in screening or incidentally, diagnosing lesions as suspicious or not suspicious is important. To avoid false-positives and overdiagnosis, tumors equal to or less than 5mm do not need further examinations except the lesions showing very suspicious findings such as invasive features or containing echogenic foci. So the main target is tumors between 5mm to 10mm. Cancers of this size show less suspicious features such as irregular shape and even benign lesions are seen somewhat irregular. We attach importance to D/W ratio as an objective indicator. The cut-off level of the D/ W ratio is 0.7. Tsukuba Elastography Scores (ES) and comparison with the previous studies and the age of the examinees are also important factors. T2-13-IN13 How to Reduce False Positive Rates in Breast Ultrasound Screening? Woo Kyung Moon, MD, PhD Seoul National University Hospital, Seoul, Korea Ultrasound detects cancers in about 0.40% of women with mammography-negative dense breasts, with a higher contribution in women younger than 50 years. However, false positives are a major concern in screening ultrasound. Several approaches to ultrasound interpretation and breast imaging management have been developed that substantially reduce the frequency of false-positive cases, involving both recall examinations and biopsies, without meaningfully reducing the detection of nonpalpable favorable-prognosis cancers. Successful methods to reduce the recall rate for screening ultrasound involve (1) obtaining clinical history and physical examination information, (2) confidently and correctly identifying some normal structures and artifacts, and (3) learning to ignore subtle sonographic findings of doubtful significance. Procedure-related changes including fat necrosis and foreign body can be ignored with the proper history. Fat lobule often mimics solid nodule and Cooper’s ligament produces architectural distortion and shadowing. Dilated ducts without intraductal masses are incidental benign findings. Complicated cysts can mimic solid nodules. They are nonparallel orientation and often show curvilinear bright line of anterior wall. Oval circumscribed solid masses less than 1cm in size can be followed. Doppler ultrasound and elastography can help distinguish normal or benign from suspicious solid masses. When a breast lesion categorized as BI-RADS 3 or 4 shows a normal strain on elastography and no vascularity on color Doppler ultrasound, biopsy can be averted. Physicians performed the screening ultrasound could directly evaluate lesions in real-time and reduce patient anxiety and discomfort. By applying these approaches successfully, we will be able to demonstrate convincingly that the benefits of ultrasound far outweigh the risks of false-positive interpretations. T2-13-IN14 Differential Diagnosis of Pre-Invasive Tumor on Ultrasonography Chin-Yu Chen Department of Radiology, Chi-Mei Medical Center, Tainan, Taiwan