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Background and Objectives: The surge in breast-related surgeries in Korea underscores the critical need for an accurate early diagnosis of silicone breast implant-related issues. Complications such as BIA-ALCL and BIA-SCC add complexity to breast health concerns, necessitating vigilant monitoring. Despite advancements, discrepancies persist between ultrasonographic and pathologic classifications of silicone implant ruptures, highlighting a need for enhanced diagnostic tools. This study explores the reliability of ultrasonography in diagnosing silicone breast implant ruptures and determining the extent of silicone migration, specifically with a focus on guiding potential capsulectomy based on pathology. Materials and Methods: A comprehensive review of medical records encompassing 5557 breast implants across 2790 patients who underwent ultrasound-assisted examinations was conducted. Among the screened implants, 8.9% (249 cases) were diagnosed with silicone breast implant rupture through ultrasonography. Subsequently, 89 women underwent revisional surgery, involving capsulectomy. The pathological analysis of 111 periprosthetic capsules from these cases aimed to assess the extent of silicone migration, and the findings were juxtaposed with the existing ultrasonographic rupture classification. Results: The diagnostic agreement between preoperative sonography and postoperative findings reached 100% for silicone breast implant ruptures. All eighty prosthetic capsules exhibiting a snowstorm sign in ultrasonography demonstrated silicone migration to capsules upon pathologic findings. Conclusions: High-resolution ultrasonography emerged as a valuable and reliable imaging modality for diagnosing silicone breast implant ruptures, with a notable ability to ascertain the extent of free silicone migration to capsules. This diagnostic precision is pivotal in informing decisions about potential capsulectomy during revisional surgery. The study advocates for an update to the current binary ultrasonographic classification, suggesting a more nuanced categorization into three types (subcapsular, intracapsular, and extracapsular) based on pathology. [ABSTRACT FROM AUTHOR]

Screening mammography programs have been implemented in numerous Western countries with the aim of reducing breast cancer mortality. However, despite over 20 years of population-based screening mammography, the mortality rates in Japan and Korea continue to rise. This may be due to the fact that screening mammography is not as effective for Japanese and Korean women, who often have dense breasts. This density decreases the sensitivity of mammography due to a masking effect. Therefore, the early detection of small invasive cancers requires more than just mammography, particularly for women in their 40s. This review discusses the limitations and challenges of screening mammography, as well as the keys to successful population-based breast cancer screening in Japan and Korea. This includes a focus on breast ultrasonography techniques, which are based on histopathologic anatomical knowledge, and personalized screening strategies that are based on risk assessments measured by glandular tissue components. [ABSTRACT FROM AUTHOR]

Background: Mammography (MMG) and ultrasonography (US) have been used as standard imaging modalities for the diagnosis of breast cancer. However, several drawbacks have been attributed to these modalities. Breast-specific gamma imaging (BSGI), as a nuclear medicine imaging technique, has been introduced as a supplementary tool for diagnosing breast cancer. Objectives: This study aimed to determine whether the addition of BSGI to MMG or US interpretations could improve the diagnostic accuracy and reduce the need for further examinations or unnecessary biopsies of breast lesions. Patients and Methods: This retrospective study was conducted on 548 patients with 638 breast lesions from February 2013 to December 2018. The performance of BSGI, MMG, and US was examined for identifying breast cancer and high-risk lesions. Subgroups were classified by adding the results of BSGI for BI-RADS 0 and 4a lesions on MMG and BI-RADS 4a lesions on US. The diagnostic performance of each subgroup was then compared. The sensitivity, specificity, positive predictive value, and negative predictive value were also calculated. The diagnostic accuracy was determined by measuring the area under the receiver operating characteristic curve (AUC). Besides, factors associated with false-positive and false-negative results of BSGI were extracted. Results: The BSGI showed a sensitivity of 88.26% for breast cancer diagnosis, which was comparable to the sensitivity of MMG (87.95%) and lower than that of US (97.83%). The specificity and AUC of BSGI (81.62% and 0.85, respectively) were superior to those of MMG(66.83% and 0.77, respectively) and US (15.20% and 0.57, respectively). In the subgroup analysis of MMG, the sensitivity, positive predictive value, and AUC of MMG0+BSGI and MMG4a+BSGI increased significantly compared to MMG alone. In the MMG4a+BSGI group, the specificity also significantly increased. In the US subgroups, the specificity and AUC of US4a+BSGI increased significantly compared to US alone. Based on the results, a low Ki-67 index was associated with a false-negative result of BSGI. Conclusion: The addition of BSGI to MMG or US could improve the diagnostic performance, especially for BI-RADS 0 and 4a lesions. Additionally, the concomitant use of BSGI with MMG or US might reduce the need for an additional examination or unnecessary biopsy. [ABSTRACT FROM AUTHOR]

In this article the author talks out Breast cancer (BC) is the most prevalent cancers in women, and women were diagnosed with BC in 2012, and survival rate has improved although survival rate is improving, there is still a risk of recurrence, thus, the follow‐up and surveillance of patients after surgery for primary BC are important. It mentions that surveillance method varied widely, emphasize the role of asymptomatic surveillance of regional nodal evaluation including breast ultrasound.

Purpose: The purpose of this study was to record and evaluate interobserver agreement as quality control for the modified categorization of screening breast ultrasound developed by the Alliance for Breast Cancer Screening in Korea (ABCS-K) for the Mammography and Ultrasonography Study for Breast Cancer Screening Effectiveness (MUST-BE) trial. Methods: Eight breast radiologists with 4-16 years of experience participated in 2 rounds of quality control testing for the MUST-BE trial. Two investigators randomly selected 125 and 100 cases of breast lesions with different ratios of malignant and benign lesions. Two versions of the modified categorization were tested. The initially modified classification was developed after the first quality control workshop, and the re-modified classification was developed after the second workshop. The re-modified categorization established by ABCS-K added size criteria and the anterior-posterior ratio compared with the initially modified classification. After a brief lecture on the modified categorization system prior to each quality control test, the eight radiologists independently categorized the lesions using the modified categorization. Interobserver agreement was measured using kappa statistics. Results: The overall kappa values for the modified categorizations indicated moderate to substantial degrees of agreement (initially modified categorization and re-modified categorization: κ=0.52 and κ=0.63, respectively). The kappa values for the subcategories of category 4 were 0.37 (95% confidence interval [CI], 0.24 to 0.52) and 0.39 (95% CI, 0.31 to 0.49), respectively. The overall kappa values for both the initially modified categorization and the re-modified categorization indicated a substantial degree of agreement when dichotomizing the interpretation as benign or suspicious. Conclusion: The preliminary results demonstrated acceptable interobserver agreement for the modified categorization. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to determine the significance of a non-mass lesion (NML) which is recognized during screening breast ultrasound (US).Materials and Methods: We included patients with a NML on screening breast US and no suspicious finding on mammography between March 2008 and June 2012. The final diagnoses were based on pathology results and a clinical or sonographic follow-up for more than 12 months. We calculated the incidence, likelihood of malignancy, and positive predictive value (PPV) of biopsy with a review of imaging and histopathological findings.Results: A total of 17868 screening breast US were performed in 8856 asymptomatic patients. Ninety-five NMLs were detected in 88 patients (1.0%). Among the 93 lesions that were followed or confirmed histopathologically, 2 (2.2%) were malignant, 89 (95.6%) were benign, and 2 (2.2%) were high risk lesions. The likelihood of malignancy in a NML on screening breast US was 2.2% and the PPV of biopsy was 6.3% (2 of 32).Conclusion: The likelihood of malignancy for a NML on screening breast US was greater than 2%. It could be classified as a BI-RADS category 4a lesion and tissue diagnosis is warranted. This provides the potential management guidelines for a NML in screening patients and further prospective studies in a large, multicenter screening population are required. [ABSTRACT FROM AUTHOR]

To compare the performance of combined screening with digital mammography and ultrasound, using modified criteria for breast ultrasound screening, versus conventional screening with digital mammography alone in Korea. From May 2016 to March 2018, 5,969 asymptomatic women aged 40–59 years old were enrolled in a prospective cohort study from 12 university-affiliated hospitals participating in the MUST-BE (Mammography and Ultrasonography STudy for Breast cancer screening Effectiveness) trial. Full-field digital mammography and radiologist-performed hand-held breast ultrasound were obtained in all cases. For this study, new criteria for breast ultrasound screening were established via modification of the BI-RADS (Breast Imaging Reporting and Data System) criteria. In the combined screening, the same radiologist interpreted both mammography and ultrasound; in the conventional screening, a second radiologist in another hospital interpreted the mammography on a monthly basis without any ultrasound findings or follow-up results. We identified positive cases, including those probably benign or inconclusive and those suspicious, and compared the recall rate, positive predictive value (PPV), and cancer detection rate (CDR) per 1,000 women screened by one of the two screening methods. The reference standard was obtained from histological results and a 12-month breast ultrasound follow-up period. There were 421 probably benign and 287 suspicious cases in the combined screening, and 618 inconclusive and 48 suspicious cases in the conventional screening. We performed biopsy in 231 and 89 women and detected 45 and 31 cancer patients in the combined and conventional screenings, respectively. The recall rate was 11.9% and 11.2%, respectively (p=0.03). The preliminary PPV1 was 6.4% and 4.7%, respectively (p=0.17) and the CDR was 7.5 and 5.2 per 1,000 women screened, respectively (p=0.11). Using the MUST-BE criteria, the combined screening with digital mammography and ultrasound might result in similar PPV1 and CDR compared to conventional screening with digital mammography alone but a higher recall rate. [ABSTRACT FROM AUTHOR]