Abstract Archives of the RSNA, 2014
Relevance of Additional Mammography and Ultrasonography for Newly Diagnosed Breast Cancer Patients (BI-RADS 6)
Presented on December 5, 2014
Presented as part of SST01: Breast Imaging (Multi-Modality Imaging)
Rosalind Pitpitan Candelaria MD, Presenter: Nothing to Disclose
Monica Liwen Huang MD, Abstract Co-Author: Nothing to Disclose
Beatriz E. Adrada MD, Abstract Co-Author: Nothing to Disclose
Wei Tse Yang MD, Abstract Co-Author: Researcher, Hologic, Inc
This study aims to determine if repeat diagnostic mammography (DM) and ultrasonography (US) performed at a tertiary cancer referral center for patients with newly diagnosed breast cancer yields incremental cancer detection.
An institutional review board-approved retrospective, single institution database review was performed on 1000 patients diagnosed with primary breast cancer from January 1, to December 31, 2010. All patients had DM and US at an outside institution prior to referral to our cancer center. Exclusion criteria were prior breast MRI/PET-CT, prior excisional surgical biopsy, neoadjuvant chemotherapy, or stage IV disease. Data collected included tumor size, nipple/chest wall/skin involvement, regional nodal involvement, multifocal/multicentric (MF/MC) and contralateral (CL) disease, and surgical treatment (segmentectomy or mastectomy). The gold standard for diagnosis of malignancy was biopsy cytopathology and histopathology.
Final analyses included 404 patients. Median patient age was 54 years, range 21 to 92; median tumor size 2.4 cm, range 0.4 to 18. A total of 147 breast biopsies were performed in 109 women; 211 nodal biopsies in 173 women. PPV3 (positive predictive value for biopsies) was 45%. Upon initial referral to our center, 353/404(87.4%) patients had unifocal (UF) disease, 22(5.4%) MC, 26(6.4%) MF, and 3(0.7%) CL. Repeat DM and US yielded 292/404(72.3%) patients with UF disease, 54(13.4%) MC, 49(12.1%) MF and 9(2.2%) CL. Surgical management changed from segmentectomy to mastectomy in 50/404(12.4%) patients. Additionally, 9.6%(5/52) stage 0, 39.2%(62/158) stage I, and 44.6%(33/74) stage II patients were upstaged leading to a total upstage rate of 25%(100/404 patients). Restaging was more likely for older patients compared to younger (p=0.004), African-American or Hispanic patients compared to Caucasian or Asian (p=0.0008), ER- patients compared to ER+ (p=0.02), and HER2+ patients compared to HER2- (p=0.004).
Repeat DM and US in newly diagnosed breast cancer patients in a tertiary cancer center yields significant incremental cancer detection which impacts locoregional treatment.
Rigorous staging work-up with DM and US in dedicated breast imaging centers may reduce disease burden underestimation in breast cancer patients and contribute to cost minimization of health care delivery.
Relevance of Additional Mammography and Ultrasonography for Newly Diagnosed Breast Cancer Patients (BI-RADS 6). Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004880.html