Kanchan Phalak MD, Presenter: Nothing to Disclose

Basak Erguvan Dogan MD, Abstract Co-Author: Nothing to Disclose

Denai Milton MS, Abstract Co-Author: Nothing to Disclose

Therese Bevers MD, Abstract Co-Author: Nothing to Disclose

Wei Tse Yang MD, Abstract Co-Author: Nothing to Disclose

To investigate the role of US screening as an adjunct to annual mammography (M) in breast cancer detection in women with a history of LN

A retrospective review was performed of the clinicopathology database at a single institution between 11/2004 and 11/2011 and yielded 195 women with biopsy proven lobular carcinoma in situ (LCIS) and/or atypical lobular hyperplasia (ALH) who underwent screening M, screening US, and/or screening MR. Patients with a concurrent diagnosis of breast cancer or those lost to follow-up were excluded. M, US, and when available, MRI findings were reviewed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and cancer detection rate of each screening test was determined.

A total of 138 patients who had mammography, US, or MR available for review and were included in the study. Mean patient age was 53 years (range 30-83).All 138 patients underwent a mean of 3.0 years of screening with M, 115 (83%) a mean of 2.7 years of screening with US, and 30 (20%) patients a mean of 1.9 rounds of screening with MRI. Eleven (8.0%) patients were diagnosed with cancer. Of 115 patients who received both M and US, 10 (8.7%) were diagnosed with cancer. Mammographic cancer detection rate 2.6%. US cancer detection rate was 2.6%, and all these cancers were mammographically occult. A subgroup of 30 patients with LN and lifetime risk >20% received supplemental MRI screening; 5 (16.7%) of whom were diagnosed with cancer. US did not detect any of these 5 cancers, M detected 1 (3%) and MRI detected 2 (6.7%) while remaining 2 were detected clinically. The sensitivity (95% CI) of screening US was 30% (7%-65%), specificity (95% CI), PPV (95% CI), and NPV (95% CI) were 100% (97%-100%), 100% (29%-100%), and 94% (88%-97%), respectively. The sensitivity (95% CI) of screening M was 27% (6%-67%), specificity (95% CI), PPV (95% CI), and NPV (95% CI) were 100% (97%-100%), 100% (29%-100%), and 94% (89%-97%), respectively. The sensitivity of screening MRI was 50% [95% CI: 12%-88%], while NPV was 89% [95% CI: 71%-98%].  

Annual screening US as a supplement to screening M resulted in an incremental cancer detection rate of 2.6% in patients with a history of LN

Supplemental US screening in patients with LN who do not fulfill the American Cancer Society  criteria for high risk MRI screening may help detect mammographically occult malignancy

Phalak, K, Dogan, B, Milton, D, Bevers, T, Yang, W, Supplemental Ultrasound (US) Screening in Patients with a History of Lobular Neoplasia (LN).  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13027415.html