Sung Eun Song MD, Presenter: Nothing to Disclose

Nariya Cho MD, Abstract Co-Author: Nothing to Disclose

A Jung Chu MD, Abstract Co-Author: Nothing to Disclose

Sung Ui Shin MD, Abstract Co-Author: Nothing to Disclose

Ann Yi MD, PhD, Abstract Co-Author: Nothing to Disclose

Su Hyun Lee MD, Abstract Co-Author: Nothing to Disclose

Won Hwa Kim MD, PhD, Abstract Co-Author: Nothing to Disclose

Min Sun Bae MD, PhD, Abstract Co-Author: Nothing to Disclose

Woo Kyung Moon, Abstract Co-Author: Nothing to Disclose

To retrospectively investigate the presumptive reasons for a missed diagnosis on prior screening ultrasonography (US) examinations in women subsequently diagnosed with breast cancers.

Between 2003 and 2011, 230 pairs of US examinations including prior images with negative or benign findings and subsequent images with developed cancers (mean interval, 11.2 months; range, 2– 24 months) were found. Mean size of detected cancers was 2.3 cm (range, 0.1 – 8.2 cm) for invasive cancers (n=182) and 2.4 cm (range, 0.3 – 7cm) for DCIS (n=48). Mammographic density, background echotexture, lesion visibility, features on prior US, and reasons for missed diagnoses as well as their actionability were classified by two experienced radiologists in consensus. Differences between visible versus non-visible cases and actionable versus underthreshold findings were compared.

Of the 230 prior US images, 32% (74 of 230) had visible findings (mean size on US, 0.8cm; range, 0.2- 2.5 cm) correlated with subsequent cancers and 68% (156 of 230) did not. No differences were found in mammographic density (P=0.966) or background echotexture between visible and non-visible cases (P=0.229). Of the 74 visible findings, reasons for missed diagnoses were misinterpretation (41%, 30/74), benign appearance (30%, 22/74), small lesion size < 5mm (9%, 7/74), multiple distracting lesions (8%, 6/74), stability > 24 months (7%, 5/ 74), or missed core biopsy (5%, 4/74). Fifty-three percent (39/74) of them were classified as actionable and 47% (35/74) as underthreshold. Actionable findings showed more irregular shape (P <0.001), non-circumscribed margin (P=0.004), non-parallel orientation (P =0.046), and larger lesion size (P =0.049) than underthreshold findings.

Breast cancer findings on prior screening US are mainly missed due to misinterpretation (41%), benign appearance (30%), small size < 5mm (9%), or multiple distracting lesions (8%).

To avoid missing early cancers on screening breast US, close attention should be paid to subtle suspicious findings as well as separate assessment of multiple findings.

Song, S, Cho, N, Chu, A, Shin, S, Yi, A, Lee, S, Kim, W, Bae, M, Moon, W, Analysis of Missed Breast Cancers on Prior Screening US of Women Subsequently Diagnosed with Breast Cancers.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009765.html