Muhammad Ali Chaudhry, Presenter: Nothing to Disclose

Emily Fox Conant MD, Abstract Co-Author: Nothing to Disclose

Mitchell Dennis Schnall MD, Abstract Co-Author: Nothing to Disclose

Susan Pae Weinstein MD, Abstract Co-Author: Nothing to Disclose

Steven Gilbert Lee MD, Abstract Co-Author: Nothing to Disclose

Mark Alan Rosen MD, PhD, Abstract Co-Author: Nothing to Disclose

Sarah Englander PhD, Abstract Co-Author: Nothing to Disclose

Russell Localio, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To compare the interpretations of digital mammography (DM), film screen mammography (FS), ultrasound (US) and MRI made in isolation and in combination, with respect to characterizing category 4 breast lesions (index lesions).

An ongoing, prospective study has thus far enrolled 72 women with BIRADS category 4, destined for biopsy, based on conventional imaging or breast exams. All subjects underwent FS, DM, US and MRI. Modalities were interpreted by different radiologists blinded to other modalities (except the interpreter of the ultrasound images had access to the FS). BI-RADS assessments and the likelihood of malignancy (100 point scale) were compared for individual modalities (blinded reads) and then form consensus interpretation. The consensus assessments were compared with biopsy results.

A total of 178 lesions in 72 patients were seen with at least one modality at consensus. 79 lesions in 54 patients were re-categorized at consensus as BI-RADS 4 (n=62) or 5 (n=17). A total of 27 cancers were detected at biopsy for a positive predictive value of 34%. Of these 27 cancers, 6 cancers were not the original index lesion for which the patient entered the study but were found only through the additional imaging. 99 lesions were downgraded at consensus to BI-RADS 0(n=1)1or 2 (n=62) or 3(n=36). With the downgrading at consensus, no cancers were missed.

Multimodality imaging increased the cancer detection rate and would have prevented false positive biopsies in 99 of 151 benign cases (66%).

Chaudhry, M, Conant, E, Schnall, M, Weinstein, S, Lee, S, Rosen, M, Englander, S, Localio, R, et al, , The Impact of Multimodality Imaging in the Evaluation of Category 4 Breast Lesions.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4411651.html