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Jan Endrikat,1,2 Gilda Schmidt,2 Bhagyashree Oak,3 Viplav Shukla,3 Prakirti Nangia,3 Nicolas Schleyer,1 John Crocker,3 Ruud Pijnapppel4 1Radiology, Bayer AG, Berlin, Germany; 2Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg, Saar, Germany; 3Trinity Life Sciences, Waltham, MA, 02451, USA; 4Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the NetherlandsCorrespondence: Jan Endrikat, Bayer AG, Müllerstr. 178, Berlin, 13353, Germany, Tel +49 175 3095846, Email jan.endrikat@bayer.comPurpose: Women with high breast density (HBD) carry an increased risk for breast cancer (BC). The aim of the study was to provide data on awareness and knowledge gaps among women with vs w/o HBD about BC risk factors (BCRFs), which is the basis for effective communication about screening.Patients and Methods: This was a web-based survey of 3000 women aged ≥ 30 and ≤ 70 from six countries. It comprised of 45 questions. T-tests and chi-square tests with False Discovery Rate adjustments were conducted as applicable, with significant differences reported at α=0.05.Results: Three-thousand women were included in the analysis, 733 (24.4%) had HBD. Overall, 39% of women were familiar with the concept of HBD in the context of BC. Thirty-one percent of women were aware of HBD as BCRF and for 24% of women HBD was personally applicable. A significantly higher proportion of women with HBD were aware of almost all BCRFs compared to women w/o HBD (p ≤ 0.05). Similarly, a significantly higher proportion of women with HBD have undergone screening procedures compared to women w/o HBD (p ≤ 0.05). Women with HBD were significantly better aware of basic facts about BC (p ≤ 0.05). A total of 1617 women underwent mammography, 904 ultrasound and 150 MRI during their last screening. The most relevant source of information about BC was the health care professional, as reported by 63% of women.Conclusion: Overall 39% of women were familiar with HBD as BCRF. Lack of BCRF awareness may contribute to delayed screenings, missed opportunities for early detection, and potentially poorer outcomes for individuals with dense breast tissue. Thus, this information should be communicated more widely.Keywords: breast cancer risk factors, dense breast, screening, imaging modalities, sources of information

Abstract Background Patients with dense breasts have a higher risk factor for developing breast cancer. Digital mammography (DM) exhibits a reduced sensitivity in dense breast tissue as a result of overlapping fibro-glandular tissue. Digital breast tomosynthesis (DBT) solves this problem, so allows better characterization of masses, asymmetries, and parenchymal distortion. It is useful in screening studies for early detection of breast lesions by accurate detection and description of their margins, shape, and extent as well as surrounding structures. Objective We aimed to evaluate the added value of DBT in characterizing of different breast lesions in dense breasts compared to DM. Methods A Prospective Cohort study involved ninety female cases having dense breast parenchyma (ACR C & ACR D) having breast complaint lesions detected by DM or ultrasound or recalled from screening units, during the period from June 2021 to Jan 2023. All patient underwent DM and DBT with correlation with the pathological finding or follow up. Results As regards the characterization of breast mass DBT had higher sensitivity, higher specificity (98%, 87% respectively). However, DM showed less sensitivity, less specificity (58%, 80%,) with (p

Background: High breast density found using mammographs (MGs) reduces positivity rates and is considered a risk factor for breast cancer. Research on the relationship between Volpara density grade (VDG) and compressed breast thickness (CBT) in the Japanese population is still lacking. Moreover, little attention has been paid to pseudo-dense breasts with CBT < 30 mm among high-density breasts. We investigated VDG, CBT, and apparent high breast density in patients with breast cancer. Methods: Women who underwent MG and breast cancer surgery at our institution were included. VDG and CBT were measured. VDG was divided into a non-dense group (NDG) and a dense group (DG). Results: This study included 419 patients. VDG was negatively correlated with CBT. The DG included younger patients with lower body mass index (BMI) and thinner CBT. In the DG, patients with CBT < 30 mm had lower BMI and higher VDG; however, no significant difference was noted in the positivity rate of the two groups. Conclusions: Younger women tend to have higher breast density, resulting in thinner CBT, which may pose challenges in detecting breast cancer on MGs. However, there was no significant difference in the breast cancer detection rate between CBT < 30 mm and CBT ≥ 30 mm. [ABSTRACT FROM AUTHOR]

Background: Patients with dense breasts have a higher risk factor for developing breast cancer. Digital mammography (DM) exhibits a reduced sensitivity in dense breast tissue as a result of overlapping fibro-glandular tissue. Digital breast tomosynthesis (DBT) solves this problem, so allows better characterization of masses, asymmetries, and parenchymal distortion. It is useful in screening studies for early detection of breast lesions by accurate detection and description of their margins, shape, and extent as well as surrounding structures. Objective: We aimed to evaluate the added value of DBT in characterizing of different breast lesions in dense breasts compared to DM. Methods: A Prospective Cohort study involved ninety female cases having dense breast parenchyma (ACR C & ACR D) having breast complaint lesions detected by DM or ultrasound or recalled from screening units, during the period from June 2021 to Jan 2023. All patient underwent DM and DBT with correlation with the pathological finding or follow up. Results: As regards the characterization of breast mass DBT had higher sensitivity, higher specificity (98%, 87% respectively). However, DM showed less sensitivity, less specificity (58%, 80%,) with (p < 0.0001, p = 0.0005 respectively). Conclusions: DBT effectively visualizes overlapping tissue in dense breasts. DBT is important due to its ability to detect breast cancer earlier, characterize lesions accurately, and inspect the margins of masses precisely, along with decreasing recall rates for false-positive results. [ABSTRACT FROM AUTHOR]

Background. Three-dimensional automated breast ultrasound (ABUS) is an innovative technology that allows global visualization of the breast and eliminates the operator-dependence of hand held ultrasound. Three-projection scanning during ABUS is provided by an ultra-long (15.4 cm) probe with a frequency of 14–16 MHz, and then the slices are reconstructed on a workstation. At the same time, high-frequency converters create high-resolution images. Through a special coronal projection, ABUS identifies variants of minimal, non-palpable breast cancer, including those with women with high mammographic breast density, which makes it a promising additional (supplemental screening) method of oncomammoscreening.Aim. To assess the use of ABUS as a supplemental screening tool in women with high mammographic breast density.Materials and methods. The study was conducted in 2018 at the N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia. As part of the study, 192 women underwent mammography, ABUS, and multiparametric ultrasound (B-mode, color Doppler, elatography) in standard manual mode.Results. In the course of the study, in 192 patients, mammography revealed 42 cases of breast cancer, while using the AUS and manual ultrasound, additionally were identified 9 cases of breast cancer. Also, the ABUS showed high accuracy in assessment of the distribution of breast cancer – multifocal, multicentric and bilateral.Conclusion. ABUS is a promising and highly effective diagnostic method in women with high mammographic breast density, with its advantages and disadvantages, which can be used in combination with mammography as a supplemental screening tool, especially in women at high risk of developing breast cancer.

Abstract Background Full-field digital mammography (FFDM) is the primary screening method for breast cancer, yet the number of cancers that can be missed with mammography is considerable, notably in female with dense breast. In this study, we compared the diagnostic yield and the clinical significance of FFDM for breast cancer detection in female with dense breasts versus its performance when complemented by automated breast ultrasound (ABUS). Results This retrospective study was performed during the period between January 2022 and December 2022 including 500 females with dense breast (ACR C&D), who underwent screening using FFDM and ABUS. The images were retrospectively interpreted, and statistical assessments were done comparing the FFDM results alone and after complemented with ABUS. Significance was considered at a p value less than 0.05. The use of FFDM with supplemental ABUS has reduced the numbers of recall and showed improved breast cancer detection with increased positive predictive value (from 74.5 to 83.5%). In comparison, using FFDM alone and associated with ABUS, there was moderate agreement with a kappa test of 0.51; p

Abstract Mammographic screening has contributed to a significant reduction in breast cancer mortality. Several studies have highlighted the correlation between breast density, as detected through mammography, and a higher likelihood of developing breast cancer. A polygenic risk score (PRS) is a numerical score that is calculated based on an individual's genetic information. This study aims to explore the potential roles of PRS as candidate markers for breast cancer development and investigate the genetic profiles associated with clinical characteristics in Asian females with dense breasts. This is a retrospective cohort study integrated breast cancer screening, population genotyping, and cancer registry database. The PRSs of the study cohort were estimated using genotyping data of 77 single nucleotide polymorphisms based on the PGS000001 Catalog. A subgroup analysis was conducted for females without breast symptoms. Breast cancer patients constituted a higher proportion of individuals in PRS Q4 (37.8% vs. 24.8% in controls). Among dense breast patients with no symptoms, the high PRS group (Q4) consistently showed a significantly elevated breast cancer risk compared to the low PRS group (Q1–Q3) in both univariate (OR = 2.25, 95% CI 1.43–3.50, P

Mammographic screening has contributed to a significant reduction in breast cancer mortality. Several studies have highlighted the correlation between breast density, as detected through mammography, and a higher likelihood of developing breast cancer. A polygenic risk score (PRS) is a numerical score that is calculated based on an individual's genetic information. This study aims to explore the potential roles of PRS as candidate markers for breast cancer development and investigate the genetic profiles associated with clinical characteristics in Asian females with dense breasts. This is a retrospective cohort study integrated breast cancer screening, population genotyping, and cancer registry database. The PRSs of the study cohort were estimated using genotyping data of 77 single nucleotide polymorphisms based on the PGS000001 Catalog. A subgroup analysis was conducted for females without breast symptoms. Breast cancer patients constituted a higher proportion of individuals in PRS Q4 (37.8% vs. 24.8% in controls). Among dense breast patients with no symptoms, the high PRS group (Q4) consistently showed a significantly elevated breast cancer risk compared to the low PRS group (Q1–Q3) in both univariate (OR = 2.25, 95% CI 1.43–3.50, P < 0.001) and multivariate analyses (OR: 2.23; 95% CI 1.41–3.48, P < 0.001). The study was extended to predict breast cancer risk using common low-penetrance risk variants in a PRS model, which could be integrated into personalized screening strategies for Taiwanese females with dense breasts without prominent symptoms. [ABSTRACT FROM AUTHOR]

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Background: High breast density found using mammographs (MGs) reduces positivity rates and is considered a risk factor for breast cancer. Research on the relationship between Volpara density grade (VDG) and compressed breast thickness (CBT) in the Japanese population is still lacking. Moreover, little attention has been paid to pseudo-dense breasts with CBT < 30 mm among high-density breasts. We investigated VDG, CBT, and apparent high breast density in patients with breast cancer. Methods: Women who underwent MG and breast cancer surgery at our institution were included. VDG and CBT were measured. VDG was divided into a non-dense group (NDG) and a dense group (DG). Results: This study included 419 patients. VDG was negatively correlated with CBT. The DG included younger patients with lower body mass index (BMI) and thinner CBT. In the DG, patients with CBT < 30 mm had lower BMI and higher VDG; however, no significant difference was noted in the positivity rate of the two groups. Conclusions: Younger women tend to have higher breast density, resulting in thinner CBT, which may pose challenges in detecting breast cancer on MGs. However, there was no significant difference in the breast cancer detection rate between CBT < 30 mm and CBT ≥ 30 mm.

Background: Sonography has been used as adjunct to mammography to increase the accuracy during screening. Breast MRI is the most sensitive tool in imaging of breast cancer. Diffusion weighted imaging (DWI) does not depend on intra-venous contrast injection and is currently investigated to be added to screening of females with dense beast. Diffusion tensor imaging is a rising technique that can be of value in breast imaging. Objective: The aim of the current study was to evaluate the diagnostic accuracy of MRI and MRI with diffusion techniques and compare it with sonomammography which is the routine exam for dense breasts. Patient and methods: A diagnostic study was carried out and included 88 patients (age range 40-67 years) referred to Radiology Department of Mansoura University Hospital. All patients were subjected to proper history taking, sonomammography, conventional, contrast enhanced, diffusion weighted MRI and DTI. This study was using a 7-11 MHz hand held ultrasound, full field digital mammography and 1.5 T MRI scanner. Results: The sensitivity of sonomammography was found to be 71%, with a specificity of 90%, a Positive Predicative Value (PPV) of 89%, a Negative Predictive Value (NPV) of 93%, and an overall accuracy of 91%. However, the sensitivity and specificity of sonomammography were significantly lower than those of MRI with DWI and MRI with DTI, as indicated by the lower values of these parameters (P<0.001) for sonomammography compared to MRI with DWI and DTI. Specifically, MRI with DWI had a sensitivity of 82% and a specificity of 85%, with a PPV of 91.4% and a NPV of 89.5%, resulting in an overall accuracy of 90.7%. Similarly, MRI with DTI had a sensitivity of 82% and a specificity of 90%, with a PPV of 94.3% and an NPV of 94.7%, resulting in an overall accuracy of 94.4%. Conclusion: MRI with diffusion techniques is a more reliable imaging modality in mammographically dense breasts, with higher sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Purpose of Review: This article aims to provide an updated overview of the indications for diagnostic breast magnetic resonance imaging (MRI), discusses the available and novel imaging exams proposed for breast cancer detection, and discusses considerations when performing breast MRI in the clinical setting. Recent Findings: Breast MRI is superior in identifying lesions in women with a very high risk of breast cancer or average risk with dense breasts. Moreover, the application of breast MRI has benefits in numerous other clinical cases as well; e.g., the assessment of the extent of disease, evaluation of response to neoadjuvant therapy (NAT), evaluation of lymph nodes and primary occult tumor, evaluation of lesions suspicious of Paget's disease, and suspicious discharge and breast implants. Summary: Breast cancer is the most frequently detected tumor among women around the globe and is often diagnosed as a result of abnormal findings on mammography. Although effective multimodal therapies significantly decline mortality rates, breast cancer remains one of the leading causes of cancer death. A proactive approach to identifying suspicious breast lesions at early stages can enhance the efficacy of anti-cancer treatments, improve patient recovery, and significantly improve long-term survival. However, the currently applied mammography to detect breast cancer has its limitations. High false-positive and false-negative rates are observed in women with dense breasts. Since approximately half of the screening population comprises women with dense breasts, mammography is often incorrectly used. The application of breast MRI should significantly impact the correct cases of breast abnormality detection in women. Radiomics provides valuable data obtained from breast MRI, further improving breast cancer diagnosis. Introducing these constantly evolving algorithms in clinical practice will lead to the right breast detection tool, optimized surveillance program, and individualized breast cancer treatment. [ABSTRACT FROM AUTHOR]

Purpose: Dense breast (DB) is recognized as a breast cancer (BC) risk factor. Although DB is common in Japanese women, the incidence of BC is lower than in Caucasians. We evaluated whether DB is a risk factor or whether there are other risk factors for BC in Japanese women. Materials and methods: We retrospectively analyzed 635 BC patients and 999 controls who received a mammography at our hospital between February 2019 and March 2021. Volumetric breast density percentage (VBD%), breast volume (BV), and fibroglandular volume (FGV) were measured using Volpara™, an automated, three-dimensional image analysis program. A VBD% of 7.5% or higher was classified as DB. The association between the VBD%, BV, and FGV, and BC risk were assessed using logistic regression. Results: Of the BC group and the control group, 77% and 79% had DB. The stratified FGV was positively associated with BC risk (odds ratio: 2.84; 95% confidence interval 1.58–5.12; P < 0.001). No significant association was found between either the VBD% or BV and BC risk. Conclusion: The proportion of Japanese women with DB was high, suggesting that DB might not be significantly associated with BC risk. However, our results also suggested that the FGV may be related to BC risk in Japanese women. [ABSTRACT FROM AUTHOR]

Abstract Background The evaluation of breast density is important, because dense breast has been shown to be associated with increased risk of breast cancer and a greater risk of a false-negative diagnostic performance due to masking a tumor. Although the relationship between parity and dense breast is under investigation, conclusive evidence is lacking. We aimed to investigate whether parity affects breast density. Methods The study design is a cross-sectional study. The subjects are healthy Japanese women who underwent opportunistic mammographic screening at the center for preventive medicine at a single institution from January 2016 to December 2018. Clinical characteristics and lifestyle factors were obtained from questionnaires. Breast density was categorized into 4 groups, namely, almost entirely fatty dense, scattered fibroglandular dense, heterogeneously dense, and extremely dense, according to the Breast Imaging Reporting and Data System. Heterogeneously and extremely dense were considered collectively as dense breast. Multivariate logistic regression analysis was conducted to investigate the relationship between parity and dense breast among premenopausal and postmenopausal women separately. Results 7612 premenopausal and 9252 postmenopausal women were investigated. Dense breast was shown in 62.6% of nulliparity, 57.3% of single parity, 47.3% of two parity, 37.6% of more than two parity among premenopausal women, and in 41.6% of nulliparity, 31.1% of single parity, 19.3% of two parity, 10.1% of more than two parity among postmenopausal women. For premenopausal women, two parity, single parity and nulliparity showed a higher risk for dense breast with statistically significance (Odds Ratio (OR) adjusted for potential confounding factors: 1.458 (95% Confidence interval (CI); 1.123–1.894), 2.349 (95%CI; 1.801–3.064), 3.222 (95%CI; 2.500–4.151), respectively), compared with more than two parity. For postmenopausal women, two parity, single parity and nulliparity had a higher risk (OR: 1.849 (95%CI; 1.479–2.312), 3.023 (95%CI; 2.385–3.830), 4.954 (95%CI; 3.975–6.174), respectively) with statistically significance, compared with more than two parity. Conclusions Parity showed an inverse trend of having dense breast among both premenopausal and postmenopausal women. In particular, nulliparous women need to recognize their higher risk of dense breast. In the future, the declining fertility rate may affect the prevalence of dense breast in the world.

• The age-standardized proportion of Korean women with breast tissue classified as dense has steadily increased since 2010. • The increased prevalence of dense breasts is associated with the increase in the breast cancer incidence rate in Korean women. • In Korean women, the factors associated with breast density and the incidence of breast cancer overlap, except for a history of not breastfeeding. This study investigated the trends in breast density in Korean women and their association with the incidence of breast cancer, incorporating the trends in the known risk factors for breast cancer from an ecological perspective. The prevalence of risk factors for breast cancer from the National Health and Nutrition Survey, breast density from Korea's national breast cancer screening program, and breast cancer incidence from the Korea Central Cancer Registry during 2010–2018 were applied after age-standardization to the population at the middle of the year 2000. The association between the prevalence of risk factors for breast cancer, the prevalence of dense breast, and the incidence rate of breast cancer was estimated using linear regression. The proportion of age-standardized dense breasts steadily increased from 45.8 % in 2010 to 51.5 % in 2018. The increased prevalence of dense breasts in women was positively related to the prevalence of smoking, drinking, lack of exercise, early menarche age (<15 years old), premenopausal status, nulliparity, and no history of breastfeeding, and negatively related to the prevalence of obesity. The increased prevalence of the dense breast was associated with an increase in the incidence of breast cancer, and 96 % of the variation in breast cancer incidence could be explained by the variation in the prevalence of dense breast. The factors associated with dense breast and breast cancer incidence overlapped. Trends in breast cancer risk factors were associated with an increased prevalence of dense breast, which, in turn, was associated with an increased incidence of breast cancer in Korea. [ABSTRACT FROM AUTHOR]

Background: Recent imaging modality named automated breast ultrasound was encountered for mammographic substitution. Our study aims to compare ABUS and mammography as screening modalities with special concern to dense breasts. Method: Eighty participants from our breast screening program were examined with mammography and ABUS. The patient's mean age is about 46 years ranging from 32 to 67 years. The study was carried out during the period from September 2020 to October 2021. Results: The percentage of lesions detection in BIRAD II and BIRAD III in mammograms was 31.25% and 12.5%, however, in ABUS, it was 32.5% and 11.25%, respectively. Also, in BIRAD IV and BIRAD V lesions were detected in mammogram in 20% and 11.25% of cases, and there is an increase using ABUS to about 22.5% and 12.5%, respectively; thus, ABUS is a valuable tool in detecting benign, probably benign and malignant lesions in comparison to the mammogram. Also, it was noted that in participants with dense and extremely dense breasts, ABUS has significantly more added value over mammography in picking breast lesions with a statistically significant difference. ABUS was about 100% sensitive meaning that ABUS can detect all cases found in the mammogram study without significant change, but it was about 85% specific. Conclusions: ABUS is a scientific improvement in breast radiology with the advantage of innovative diagnostic precision of breast pathologies in terms of initial recognition, better classification, and meticulous evaluation. It is operator independent, saves time, and permits whole breast assessment with no radiation hazard, improved picking of few millimeters' pathologies, particularly in dense breast parenchyma. ABUS plus mammography will be augmented in the future breast screening program. [ABSTRACT FROM AUTHOR]

Background: Mammographic breast composition is associated with breast cancer risk. However, evidence in a Japanese cohort investigating this association is scarce. Thus, we aimed to compare breast cancer risk between women with and without dense breasts. Methods: All Japanese women who underwent breast cancer screening at a tertiary care academic hospital-affiliated preventive center at least twice with known baseline mammographic breast composition were included in this study. A single-center retrospective cohort study was conducted among 24,863 women who had 125,566 screening opportunities between April 1, 2005, and March 31, 2015. All women were categorized into two groups based on their baseline breast composition: women with dense breasts (13,815) and women with non-dense breasts (11,048). We compared the demographic characteristics between the two groups. After calculating person-years, Cox proportional hazards analyses were performed to estimate the hazard ratio (HR) of developing breast cancer according to breast composition status. Results: During the study period, 358 breast cancer cases were identified. The dense and non-dense groups differed significantly by age, body mass index, family history of breast cancer, physical activity, history of smoking and alcohol consumption, number of pregnancies, and number of deliveries. After adjusting for these factors, Cox proportional hazards analyses showed that women with dense breasts had a significantly higher HR for developing breast cancer than women without dense breasts. The association was even stronger in younger women (≤ 50 years old), but it did not achieve statistical significance in older women. Conclusion: Dense breasts at baseline are a risk factor for developing breast cancer in Japanese women. However, this association was only observed in women aged 50 years or younger at the time of entry into the screening program. [ABSTRACT FROM AUTHOR]

Automated breast ultrasound is a three-dimensional ultrasonographic technique allowing the evaluation of women with dense glandular breast tissue. In this group of patients, mammography has a low sensitivity because dense breasts can obscure breast cancer on mammogram. On the other hand, women with dense breast tissue, types C and D on the BI-RADS scale, are at an increased risk of developing breast cancer compared to women with fatty breast tissue. Automated breast ultrasound is a standardized and reproducible ultrasound technique which improves breast cancer detection and is promising in the screening and diagnostic settings: it increases the detection of breast cancer, and helps to differentiate benign and malignant lesions. Unfortunately, automated breast ultrasound also has its limitations and disadvantages due to artifacts caused by poor positioning, and lesion and patient characteristics. Many artifacts can be avoided by training and experience of the performing technician. Furthermore, familiarity of the interpreting breast radiologist with these artifacts and pitfalls will decrease false negative diagnosis of true lesions. [ABSTRACT FROM AUTHOR]

Abstract Background Mammography plays a great role in reducing breast cancer mortality as it is the standard method of breast imaging and screening. But the accuracy of mammography performance reduces in cancer detection in women with dense breast due to the summation of images and overlapping of breast tissue. ABUS and tomosynthesis both recently help to detect breast cancer in dense breasted women. This prospective study was done in the female imaging unit and approved by its research and ethical committee; all the patients did an informed consent during the period from October 2018 to March 2019. The study was conducted on 38 patients with 38 lesions subjected to digital mammography, tomosynthesis and automated breast ultrasound (ABUS), who all had dense breast in mammography. Results Automated breast ultrasound (ABUS) showed 100% in all sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) as well as accuracy, while the digital mammography tomosynthesis showed 100% in specificity, 87.5% in sensitivity, 100% in PPV, 82.4% in NPV and 92.1% accuracy. Conclusion Automated breast ultrasound (ABUS) together with tomosynthesis makes a revolution in breast screening and detecting cancer in women with dense breasts.

Abstract Background Primary breast edema can cause marked increase in skin thickness, breast density and echogenicity due to dense breast tissue filled with fluid and so causes subsequent significant attenuation of both the x-ray and ultrasound beams. The study aim is to assess the value of contrast-enhanced digital mammography (CEDM) in assessment and characterization of the obscured underlying breast lesions in cases of primary breast edema. Results Fifty five female participants were evaluated, of median age 51 years old and IQR 21. CEDM shows high sensitivity and specificity in the lesion detection as well as local extension delineation in cases associated with primary breast edema. It was accurate in detection of multifocal/multi-centric disease. CEDM is considered as a good negative test in cases of metastatic axillary lymph nodes to exclude and assess any associated obscured breast lesions, as it is good in delineating breast masses obscured by condensed parenchymal tissue. The calculated sensitivity of DM & CEDM was 87.5%, 95.8%, specificity was 55.5%, 72%, the PPV and NPV were 91, 93.6% and 45%, 77.8%, respectively. Conclusions CEDM has an important additional diagnostic value in the assessment, characterization and better delineation of breast lesions in primary edematous breast cases.

Abstract Background Contrast-enhanced spectral mammography (CESM) is a relatively newly developed advanced application with modification of digital mammography by the use of a contrast agent, but still has little known efficacy among Egyptian patients. Our aim in this study is to share our initial experience in evaluating symptomatic patients with different ACR breast parenchyma especially in dense breast parenchyma as it is always challenging in diagnosis. Results CESM in this study gave a sensitivity of 92% and specificity of 85% in characterization of benign and malignant lesions. For postoperative cases, sensitivity was 85% and specificity was 60%. For chemotherapy cases, sensitivity was 85% and specificity was 76%. Contrast uptake was noted in 68% of masses. Cavitary benign lesions were noted in 22.1% of cases. Multifocal and multicentric carcinomas were detected in 39.7% of pathologically proved malignant masses. Statistical analysis revealed sensitivity, specificity, and accuracy of 82.9%, 76.5%, and 81.0% for conventional mammograms as compared to 92.7%, 82.4%, and 89.7% for CESM respectively. Conclusion CESM is a promising technique that can enhance the specificity of conventional mammograms. It is an easy, simple, and rapid contrast-based procedure, especially for characterization of lesions in dense breast parenchyma. It performs proper diagnosis for high-risk patients and follow-up response to different lines of management.

Background: Although mammography is a powerful screening tool in detection of early breast cancer, it is imperfect, particularly for women with dense breast, which have a higher risk to develop cancer and decrease the sensitivity of mammogram, Automated breast ultrasound is a recently introduced ultrasonography technique, developed with the purpose to standardize breast ultrasonography and overcome some limitations of handheld ultrasound, this study aims to evaluate the diagnostic efficacy of Automated breast ultrasound and compare it with handheld ultrasound in the detection and characterization of breast lesions in women with dense breasts. Objectives: To evaluate the diagnostic efficacy of Automated breast ultrasound and compare it with hand held ultrasound in detection and characterization of breast lesions in women with dense breast. Subjects and Methods: A prospective observational study conducted at Oncology Teaching Hospital during the period of ten months from 1st of February till 1st of December 2020. Included 62 women with dense breasts on diagnostic mammograms. All women underwent technician performed automated breast ultrasound and radiologist performed handheld ultrasound for both breasts. All suspicious lesions with selected probably benign lesions underwent biopsy, handheld ultrasound detected 48 masses (67.6%), 15 of them (21.1%) were cystic, automated breast ultrasound detected 54 masses (76.1%); 20 of them (28.2%) were cystic. The sensitivity of handheld ultrasound was=87.5%, Specificity=58.8%, the sensitivity of automated breast ultrasound was=93.8%, Specificity=70.6%. Conclusion: Automated breast ultrasound is an effective modality to detect occult breast lesion in women with dense breasts, automated breast ultrasound and handheld ultrasound have a reliable agreement in detection and characterization of breast lesions with higher accuracy of automated breast ultrasound in the evaluation of malignant lesions.

Abstract Objective To compare hand-held breast ultrasound (HHBUS) and automated breast ultrasound (ABUS) as screening tool for cancer. Methods A cross-sectional study in patients with mammographically dense breasts was conducted, and both HHBUS and ABUS were performed. Hand-held breast ultrasound was acquired by radiologists and ABUS by mammography technicians and analyzed by breast radiologists. We evaluated the Breast Imaging Reporting and Data System (BI-RADS) classification of the exam and of the lesion, as well as the amount of time required to perform and read each exam. The statistical analysis employed was measures of central tendency and dispersion, frequencies, Student t test, and a univariate logistic regression, through the odds ratio and its respective 95% confidence interval, and with p

Background: The evaluation of breast density is important, because dense breast has been shown to be associated with increased risk of breast cancer and a greater risk of a false-negative diagnostic performance due to masking a tumor. Although the relationship between parity and dense breast is under investigation, conclusive evidence is lacking. We aimed to investigate whether parity affects breast density.Methods: The study design is a cross-sectional study. The subjects are healthy Japanese women who underwent opportunistic mammographic screening at the center for preventive medicine at a single institution from January 2016 to December 2018. Clinical characteristics and lifestyle factors were obtained from questionnaires. Breast density was categorized into 4 groups, namely, almost entirely fatty dense, scattered fibroglandular dense, heterogeneously dense, and extremely dense, according to the Breast Imaging Reporting and Data System. Heterogeneously and extremely dense were considered collectively as dense breast. Multivariate logistic regression analysis was conducted to investigate the relationship between parity and dense breast among premenopausal and postmenopausal women separately.Results: 7612 premenopausal and 9252 postmenopausal women were investigated. Dense breast was shown in 62.6% of nulliparity, 57.3% of single parity, 47.3% of two parity, 37.6% of more than two parity among premenopausal women, and in 41.6% of nulliparity, 31.1% of single parity, 19.3% of two parity, 10.1% of more than two parity among postmenopausal women. For premenopausal women, two parity, single parity and nulliparity showed a higher risk for dense breast with statistically significance (Odds Ratio (OR) adjusted for potential confounding factors: 1.458 (95% Confidence interval (CI); 1.123-1.894), 2.349 (95%CI; 1.801-3.064), 3.222 (95%CI; 2.500-4.151), respectively), compared with more than two parity. For postmenopausal women, two parity, single parity and nulliparity had a higher risk (OR: 1.849 (95%CI; 1.479-2.312), 3.023 (95%CI; 2.385-3.830), 4.954 (95%CI; 3.975-6.174), respectively) with statistically significance, compared with more than two parity.Conclusions: Parity showed an inverse trend of having dense breast among both premenopausal and postmenopausal women. In particular, nulliparous women need to recognize their higher risk of dense breast. In the future, the declining fertility rate may affect the prevalence of dense breast in the world. [ABSTRACT FROM AUTHOR]

Abstract Background Mammography has been the mainstay for the detection of breast cancer over decades. It has gradually advanced from screen film to full-field digital mammography. Tomosynthesis has evolved as advanced imaging for early diagnosis of breast lesions with a promising role in both diagnostic and screening settings, particularly in dense and treated breasts. Results This study included 90 female patients according to our inclusion criteria. All patients perform full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) and were classified according to breast density and age groups. Breast imaging reporting and data system (BI-RADS) scoring was assigned for each case. This was correlated with the final diagnosis; the diagnostic indices of mammography were a sensitivity of 64.44%, a specificity of 77.78%, a positive predictive value (PPV) 74.63%, a negative predictive value (NPV) of 68.63%, and a diagnostic accuracy of 71.11%. Diagnostic indices of DBT were a sensitivity of 100%, a specificity of 97.77%, PPV 97.78%, NPV 100%, and diagnostic accuracy of 97.7%. In patients with dense breasts American College of Radiology (ACR) (c and d), 61% of cases had changed their BIRADS scoring with the addition of tomosynthesis. Yet, in non-dense breast ACR (a and b), 45% of cases had changed BIRADS scoring with the addition of DBT to FFDM. Conclusion DBT is a promising imaging modality offering better detection and characterization of different breast abnormalities, especially in young females, and those with dense breasts with an increase of sensitivity and specificity than FFDM. This leads to a reduction in the recalled cases, negative biopsies, and assessing the efficacy of therapy as it enables improving detection of breast cancer and different breast lesions not visualized by conventional mammography

Abstract Background Breast cancer is the most common malignancy in females around the world representing 25.1% of all cancers. The high prevalence and need for early treatment of breast malignancy highlight the importance of early and accurate diagnosis. In order to achieve this target, it is necessary to select the most appropriate modality for investigation. Early detection of breast cancer by conventional mammography tends to reduce mortality; however, it has a low sensitivity and specificity in young females with dense breasts owing to reduced contrast between a possible tumor and the surrounding breast tissue with superimposition of the glandular tissue obscuring underlying lesions. Our study included 25 patients with dense breasts presented with different breast symptoms, yet the breast lump was the most common complaint. The aim of our study is to evaluate the supplementary value of contrast-enhanced spectral mammography in the assessment of symptomatic patients with dense breasts. Results In our study, the enrolled subjects underwent both contrast-enhanced spectral mammography (CESM) and conventional full-field digital mammography (FFDM). CESM was shown to be better than FFDM in terms of sensitivity, positive predictive value, negative predictive value, and accuracy, measuring 100%, 77.8%, 100%, and 84%, compared to 56%, 75%, 46%, and 60%, respectively, yet both modalities showed low specificity, measuring 63.6% and 66.6% for CESM and FFDM, respectively. The added value of CESM was assessed in terms of ability to detect and correctly characterize the lesions in correlation to histopathological results where CESM could detect 88% of the lesions included in our study and correctly characterized 84% of the lesions; on the other side, FFDM detected only 20% of the lesions and correctly characterized 60% of the lesions. CESM changed the treatment plan to a more extensive surgery +/− neoadjuvant chemotherapy in 57% out of fourteen cases diagnosed with breast cancer emphasizing the role of CESM in assessing the extent of the disease, multicentricity, and multifocality and consequently tailoring the most appropriate treatment plan suitable for each patient. Conclusion Contrast-enhanced spectral mammography is superior to full-field digital mammography in patients with dense breasts with a significant supplementary value in detection, characterization of lesions, and tailoring the appropriate treatment plan.

Background: Mammography (MG) is widely used for screening examinations. Dense breast reduces MG screening sensitivity, possibly delaying diagnosis. However, little is known about the characteristics of breast cancers without MG findings indicative of malignancy. Hence, we investigated breast cancer patients with tumors not detected by MG. Patients and methods: In total, 1758 Japanese patients with breast cancer, undergoing curative surgery between 2012 and 2018 without neo-adjuvant chemotherapy, were retrospectively investigated. Clinicopathological features were compared between patients without (MG-negative) and with (MG-positive) cancer-specific findings on MG. The current study included cases who came to our hospital after experiencing subjective symptoms, or whose tumors were detected by MG and/or US-screening. We reviewed results of both MG and US conducted at our institution. Results: There were 201 MG-negative cases (11.4%). In patients with invasive disease, multivariate analysis revealed MG-negative patients to have higher breast density on MG (p

Background. Even though the sensitivity of contrast-enhanced breast magnetic resonance mammography (CE-MRM) is consistently high in the range of 94-100%, conventionally, digital mammography and sonomammography continue as standard imaging modalities for the detection and evaluation of breast disease. The objective of the study was to detect additional lesions that go undetected by routine digital mammography and sonomammography using CE-MRM. Materials and Methods. In a prospective study, 68 patients who came for screening diagnostic mammogram and had breast lesions of Breast Imaging-Reporting and Data System category 3-6 were evaluated. All patients underwent bilateral digital mammography and targeted high-frequency sonomammography of the primary lesion. Those patients who were thought to possibly have breast cancer and to be candidates for surgical management were offered bilateral CE-MRM. Results. In this prospective study, we included 68 patients (mean age - 50.6 years, range - 30-73 years). A total of 74 lesions were evaluated. In detecting these lesions, digital mammography had a sensitivity of 40.0%, specificity of 100% and diagnostic accuracy of 63.5%. CE-MRM sensitivity was found to be 71.7%, specificity - 96.6% and diagnostic accuracy - 83.7%. Among the 27 additional lesions detected by CE-MRM, histopathological evaluation confirmed only 19, indicating the sensitivity of 100%, specificity of 85.4%, positive predictive value of 67.8%, negative predictive value of 100%, diagnostic accuracy of 89.2%. Conclusions. The diagnostic accuracy of CE-MRM was found to be 83.7%, with a specificity of 96.6%. CE-MRM detected 19 additional lesions that were undetected by either digital mammography or ultrasonography. CE-MRM is sensitive in detecting additional malignant lesions which are not detected by other imaging modalities.

Purpose: We evaluated the contribution to cancer detection of supplemental breast ultrasound screening in women with dense breasts based on a single center experience by comparing our results with similar programs elsewhere. Methods: We performed a retrospective review of handheld sonographer-performed screening ultrasound exams at our academic breast imaging center, from January 1st to December 31st, 2019. Breast density, breast cancer risk factors, BI-RADS assessment, and lesion pathology were reviewed and tallied, followed by derivation of the biopsy rate, breast cancer detection rate, PPV3 and average tumor size. These values were compared to published results of breast screening programs elsewhere. Results: 695 screening breast ultrasounds for women with dense breasts and negative mammograms were performed in 2019. The biopsy rate was 1.3%, breast cancer detection rate was 7 in 1000, PPV3 was 42%, and the average tumor size was 9.0 ± 1.4 mm. Conclusions: The first-year data of the breast screening ultrasound program at our practice are promising, demonstrating comparable cancer detection rate, higher PPV3, and similar biopsy rate in those with dense breasts compared with similar programs elsewhere. Longitudinal analysis and larger sample size are required for validation. Comparison of incidence and prevalence screening data is also warranted to elucidate the true value of this program. [ABSTRACT FROM AUTHOR]

Breast cancer (BC) is the most common cancer worldwide among women. In Japan, the incidence of BC gradually increased. The recent number of adolescent and young adult (AYA)-BC patients is approximately 4,000–5,000 every year, accounting for 5% of all BC cases. BC in young people has been attracting attention since Japan's third basic plan to promote cancer control programs incorporated cancer control measures for pediatric (age ≤ 14 years) and adolescent and young adult (AYA)-generation (age 15–39 years) cancers in 2018. Attention is needed to detect AYA-BC because of the presence of dense breasts. AYA-BC patients are clinically characterized by larger tumor size, more lymph node metastases, advanced stages, and a higher rate of aggressive phenotypes, such as triple-negative or HER2-positive subtypes, and are strongly associated with family history and genetic germline alterations, including hereditary breast and ovarian cancers. Given that AYA-BC patients show a poorer prognosis than older BC patients, they often require intensive therapies, including surgery, radiation, chemotherapy, and endocrine therapy. We must solve many survivorship-associated problems in AYA-BC patients, including fertility preservation, comorbidity after treatment, and long-term follow-up. Under these circumstances, national and local governments and various academic societies have started addressing these problems by formulating laws and guidelines, establishing medical systems, and offering financial support to conquer cancer and maintain a better quality of life. This review summarizes the current trends of AYA-BC worldwide and in Japan. Further Japan-specific data on AYA-BC are required to clarify its characteristics and improve prognosis and survivorship. [ABSTRACT FROM AUTHOR]

Background: Mammography plays a great role in reducing breast cancer mortality as it is the standard method of breast imaging and screening. But the accuracy of mammography performance reduces in cancer detection in women with dense breast due to the summation of images and overlapping of breast tissue. ABUS and tomosynthesis both recently help to detect breast cancer in dense breasted women. This prospective study was done in the female imaging unit and approved by its research and ethical committee; all the patients did an informed consent during the period from October 2018 to March 2019. The study was conducted on 38 patients with 38 lesions subjected to digital mammography, tomosynthesis and automated breast ultrasound (ABUS), who all had dense breast in mammography. Results: Automated breast ultrasound (ABUS) showed 100% in all sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) as well as accuracy, while the digital mammography tomosynthesis showed 100% in specificity, 87.5% in sensitivity, 100% in PPV, 82.4% in NPV and 92.1% accuracy. Conclusion: Automated breast ultrasound (ABUS) together with tomosynthesis makes a revolution in breast screening and detecting cancer in women with dense breasts. [ABSTRACT FROM AUTHOR]

Abstract Background Breast cancer is the most commonly diagnosed malignancy in women worldwide. Women with dense breast tend to have 15–25% lifetime risk of breast cancer due to decrease of mammographic sensitivity. Automated breast ultrasound (ABUS) is a new promising tool for detection of breast lesions masked by dense glandular tissue at mammography. Results The sensitivity of digital mammography in detecting breast lesions was 60.7%, specificity 91.6%, PPV 85%, NPV 75%, and accuracy 78%. The sensitivity of ABUS in detecting breast lesions was 92.86%, specificity 77.78%, PPV 76.47%, NPV 93.33%, and accuracy 84.38%. The sensitivity of handheld ultrasound (HHUS) in detecting breast lesions was 89.29%, specificity 88.89%, PPV 86.21%, NPV 91.43%, and accuracy 89.06%. Conclusion The sensitivity of ABUS in detecting breast lesions was much higher than mammography in dense breast while the digital mammography (DM) had higher specificity. So, implementation of both DM and ABUS to get benefit of DM specificity as well as ABUS sensitivity were highly recommended.

Abstract Background Mammography is accused of having low sensitivity and specificity in dense breast parenchyma. Also, women with dense breasts show an increased risk of developing breast cancer. Breast ultrasound has been used for several years for a better characterization of breast lesions. Contrast-enhanced mammography and tomosynthesis are relative novel imaging techniques that have been implicated in breast cancer detection and diagnosis. We aimed to compare breast tomosynthesis, contrast-enhanced mammography, and breast ultrasound as complementary techniques to mammography in dense breast parenchyma. Results The study included 37 patients with 63 inconclusive mammography breast lesions. They all performed contrast-enhanced mammography, single-view tomosynthesis, and breast ultrasound. Mammography had a sensitivity of 83%, a specificity of 48%, a positive predictive value of 68%, a negative predictive value of 68%, and a diagnostic accuracy of 68%. Contrast-enhanced mammography had a sensitivity of 89%, a specificity of 89%, a positive predictive value of 91%, a negative predictive value of 86%, and a diagnostic accuracy of 89%. Tomosynthesis had a sensitivity of 86%, a specificity of 81%, a positive predictive value of 86%, a negative predictive value of 81%, and a diagnostic accuracy of 84%. Breast ultrasound had a sensitivity of 97%, a specificity of 85%, a positive predictive value of 90%, a negative predictive value of 96%, and a diagnostic accuracy of 92%. Conclusion Breast ultrasound, tomosynthesis, and contrast-enhanced mammography showed better performance compared to mammography in dense breasts. However, ultrasound being safe with no radiation hazards should be the second step modality of choice after mammography in the assessment of mammography dense breasts. Adding tomosynthesis to mammography in screening increases its sensitivity. Contrast-enhanced mammography should be reserved for cases with inconclusive sonomammographic results.

Purpose: In Japan, radiologists perform qualitative visual classification to define four categories of mammary gland density. However, an objective estimation of mammary gland density is necessary. To address this, we developed an automatic classification software using image similarity., Methods: We prepared 741 cases of mediolateral oblique images (MLO) for evaluation, and they were diagnosed as normal among the mammography images taken at our hospital. Image matching was performed using the evaluation images and an image database for breast density determination. In this study, the image similarity used zero normalized cross-correlation (ZNCC) as an index. In addition, if the breast thickness is less than 30 mm and each breast density category ZNNC has the same value, the category is evaluated on the fat side. We compared the results of qualitative visual classification and automatic classification methods to assess consistency., Results: The agreement with the subjective breast composition classification was 78.5%, and the weighted kappa coefficient was 0.98. One mismatched case was evaluated on the higher density side with the same ZNCC value between categories and a breast thickness greater than 30 mm., Conclusion: Image similarity provides an excellent estimation of quantification of breast density. This system could contribute to improving the efficiency of the mammography screening system.

Purpose: While increased breast density is a risk factor for breast cancer, the effect of fatty liver disease on breast density is unknown. We investigated whether fatty liver is a risk factor for changes in breast density over ~ 4 years of follow-up in pre- and postmenopausal women. Methods: This study included 74,781 middle-aged Korean women with mammographically determined dense breasts at baseline. Changes in dense breasts were identified by more screening mammograms during follow-up. Hepatic steatosis (HS) was measured using ultrasonography. Flexible parametric proportional hazards models were used to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs), and a Weibull accelerated failure time model (AFT) was used to determine the time ratios (TRs) and 95% CIs. Results: During a median follow-up of 4.1 years, 4022 women experienced resolution of the dense breasts. The association between HS and dense breast resolution differed by the menopause status (P for interaction < 0.001). After adjusting for body mass index and other covariates, the aHRs (95% CI) for dense breast resolution comparing HS to non-HS were 0.81 (0.70–0.93) in postmenopausal women, while the association was converse in premenopausal women with the corresponding HRs of 1.30 (1.18–1.43). As an alternative approach, the multivariable-adjusted TR (95% CI) for dense breast survival comparing HS to non-HS were 0.81 (0.75–0.87) and 1.19 (1.06–1.33) in premenopausal and postmenopausal women, respectively. Conclusion: The association between HS and changes in dense breasts differed with the menopause status. HS increased persistent dense breast survival in postmenopausal women but decreased it in premenopausal women. [ABSTRACT FROM AUTHOR]

Background: Primary breast edema can cause marked increase in skin thickness, breast density and echogenicity due to dense breast tissue filled with fluid and so causes subsequent significant attenuation of both the x-ray and ultrasound beams. The study aim is to assess the value of contrast-enhanced digital mammography (CEDM) in assessment and characterization of the obscured underlying breast lesions in cases of primary breast edema. Results: Fifty five female participants were evaluated, of median age 51 years old and IQR 21. CEDM shows high sensitivity and specificity in the lesion detection as well as local extension delineation in cases associated with primary breast edema. It was accurate in detection of multifocal/multi-centric disease. CEDM is considered as a good negative test in cases of metastatic axillary lymph nodes to exclude and assess any associated obscured breast lesions, as it is good in delineating breast masses obscured by condensed parenchymal tissue. The calculated sensitivity of DM & CEDM was 87.5%, 95.8%, specificity was 55.5%, 72%, the PPV and NPV were 91, 93.6% and 45%, 77.8%, respectively. Conclusions: CEDM has an important additional diagnostic value in the assessment, characterization and better delineation of breast lesions in primary edematous breast cases. [ABSTRACT FROM AUTHOR]

Background: Contrast-enhanced spectral mammography (CESM) is a relatively newly developed advanced application with modification of digital mammography by the use of a contrast agent, but still has little known efficacy among Egyptian patients. Our aim in this study is to share our initial experience in evaluating symptomatic patients with different ACR breast parenchyma especially in dense breast parenchyma as it is always challenging in diagnosis. Results: CESM in this study gave a sensitivity of 92% and specificity of 85% in characterization of benign and malignant lesions. For postoperative cases, sensitivity was 85% and specificity was 60%. For chemotherapy cases, sensitivity was 85% and specificity was 76%. Contrast uptake was noted in 68% of masses. Cavitary benign lesions were noted in 22.1% of cases. Multifocal and multicentric carcinomas were detected in 39.7% of pathologically proved malignant masses. Statistical analysis revealed sensitivity, specificity, and accuracy of 82.9%, 76.5%, and 81.0% for conventional mammograms as compared to 92.7%, 82.4%, and 89.7% for CESM respectively. Conclusion: CESM is a promising technique that can enhance the specificity of conventional mammograms. It is an easy, simple, and rapid contrast-based procedure, especially for characterization of lesions in dense breast parenchyma. It performs proper diagnosis for high-risk patients and follow-up response to different lines of management. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the diagnostic value of digital breast tomography (DBT) combined with breast energy spectrum imaging (CESM) in patients whit dense breast lesions. From March 2018 to July 2020, 70 cases of suspected breast disease in our hospital were selected. DBT was performed on them firstly, and then CESM was performed. It was found that the detection rate of dense breast Wons by DBT was 84. 29%, which was lower than 95. 71% by CESM (2 = 5. 079, P = 0. 024). DBT showed signs of heterogeneous dense type and highly dense type with dear edges, while CESM showed signs of heterogeneous dense type and highly dense type with burr, the difference was statistically significant (P$0. 05). The sensitivity and accuracy of DBT combined with CESM for dense breast Wons were higher than any single one, and the difference was statistically significant (P$0. 05). It is suggested that DBT combined with CESM have a significant effect on the diagnosis of dense intramammary lesions, which can be complementary examinations. [ABSTRACT FROM AUTHOR]

Mammography is the only screening method with evidence in support of reduced breast cancer mortality, but yields poor accuracy outcomes in women with dense breast tissue. The Japan Strategic Anti-cancer Randomized Trial (J-START) was conducted as part of the measures implemented to deal with women with dense breast tissue. Although the sensitivity was increased, the specificity was significantly lower in the intervention group because further examination was required in all positive cases classified by either mammography or ultrasound in the J-START. To address the issue, an overall assessment system of combined mammography and adjunctive ultrasound for breast cancer screening has been developed in Japan. The basic concept is based on a comprehensive assessment that includes a mammography assessment followed by an adjunctive assessment for ultrasound similar to the clinical setting. Currently, mammography alone is recommended for population-based breast cancer screening in Japan, but additional ultrasonography is extensively available for women, especially for women with dense breasts with shared decision-making for personalized breast cancer screening. The overall assessment system is recommended for use in Japan when breast cancer screening is conducted using both mammography and ultrasonography. In this article, we summarize the advantages of the overall assessment and the simultaneous mammography/ultrasound method, the basic approach used in Japan to assign the overall assessment category for breast cancer screening, and we outline the future directions of adjunctive screening ultrasound. [ABSTRACT FROM AUTHOR]

To compare the role of MR for assessment of extent of disease in women newly diagnosed with breast cancer imaged with digital mammography (DM) alone versus digital breast tomosynthesis (DBT). Retrospective review was conducted of 401 consecutive breast MR exams (10/1/2013–7/31/2015) from women who underwent preoperative MR for newly diagnosed breast cancer by either DM or DBT, leaving 388 exams (201 DM and 187 DBT). MR detection of additional, otherwise occult, disease was stratified by modality, breast density, and background parenchymal enhancement. A true-positive finding was defined as malignancy in the ipsilateral-breast >2 cm away from the index-lesion or in the contralateral breast. 50 additional malignancies were detected in 388 exams (12.9%), 37 ipsilateral and 13 contralateral. There was no difference in the MR detection of additional disease in women imaged by either DM versus DBT (p = 0.53). In patients with DM, there was no significant difference in the rate of MR additional cancer detection in dense versus non-dense breasts (p = 0.790). However, in patients with DBT, MR detected significantly more additional sites of malignancy in dense compared to non-dense breasts (p = 0.017). There was no difference in false-positive MR exams (p = 0.470) for DM versus DBT. For both DM and DBT cohorts, higher MR background parenchymal enhancement was associated with higher false-positive (p = 0.040) but no significant difference in true-positive exams. Among patients with DBT imaging at cancer diagnosis, women with dense breasts appear to benefit more from preoperative MR than non-dense women. In women imaged only with DM, MR finds additional malignancy across all breast densities. • The performance of MR for detection of additional disease was similar in patients initially imaged with DM versus DBT. • Patients with dense breasts are more likely to have additional disease found on preoperative MR, even with prior DBT exams • Superior efficacy of combination DBT for evaluation of disease extent in patients with non-dense breast • Higher BPE is significantly associated with higher rate of discordant and false positive MR findings [ABSTRACT FROM AUTHOR]

Background: Mammography has been the mainstay for the detection of breast cancer over decades. It has gradually advanced from screen film to full-field digital mammography. Tomosynthesis has evolved as advanced imaging for early diagnosis of breast lesions with a promising role in both diagnostic and screening settings, particularly in dense and treated breasts. Results: This study included 90 female patients according to our inclusion criteria. All patients perform full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) and were classified according to breast density and age groups. Breast imaging reporting and data system (BI-RADS) scoring was assigned for each case. This was correlated with the final diagnosis; the diagnostic indices of mammography were a sensitivity of 64.44%, a specificity of 77.78%, a positive predictive value (PPV) 74.63%, a negative predictive value (NPV) of 68.63%, and a diagnostic accuracy of 71.11%. Diagnostic indices of DBT were a sensitivity of 100%, a specificity of 97.77%, PPV 97.78%, NPV 100%, and diagnostic accuracy of 97.7%. In patients with dense breasts American College of Radiology (ACR) (c and d), 61% of cases had changed their BIRADS scoring with the addition of tomosynthesis. Yet, in non-dense breast ACR (a and b), 45% of cases had changed BIRADS scoring with the addition of DBT to FFDM. Conclusion: DBT is a promising imaging modality offering better detection and characterization of different breast abnormalities, especially in young females, and those with dense breasts with an increase of sensitivity and specificity than FFDM. This leads to a reduction in the recalled cases, negative biopsies, and assessing the efficacy of therapy as it enables improving detection of breast cancer and different breast lesions not visualized by conventional mammography [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common malignancy in females around the world representing 25.1% of all cancers. The high prevalence and need for early treatment of breast malignancy highlight the importance of early and accurate diagnosis. In order to achieve this target, it is necessary to select the most appropriate modality for investigation. Early detection of breast cancer by conventional mammography tends to reduce mortality; however, it has a low sensitivity and specificity in young females with dense breasts owing to reduced contrast between a possible tumor and the surrounding breast tissue with superimposition of the glandular tissue obscuring underlying lesions. Our study included 25 patients with dense breasts presented with different breast symptoms, yet the breast lump was the most common complaint. The aim of our study is to evaluate the supplementary value of contrast-enhanced spectral mammography in the assessment of symptomatic patients with dense breasts. Results: In our study, the enrolled subjects underwent both contrast-enhanced spectral mammography (CESM) and conventional full-field digital mammography (FFDM). CESM was shown to be better than FFDM in terms of sensitivity, positive predictive value, negative predictive value, and accuracy, measuring 100%, 77.8%, 100%, and 84%, compared to 56%, 75%, 46%, and 60%, respectively, yet both modalities showed low specificity, measuring 63.6% and 66.6% for CESM and FFDM, respectively. The added value of CESM was assessed in terms of ability to detect and correctly characterize the lesions in correlation to histopathological results where CESM could detect 88% of the lesions included in our study and correctly characterized 84% of the lesions; on the other side, FFDM detected only 20% of the lesions and correctly characterized 60% of the lesions. CESM changed the treatment plan to a more extensive surgery +/− neoadjuvant chemotherapy in 57% out of fourteen cases diagnosed with breast cancer emphasizing the role of CESM in assessing the extent of the disease, multicentricity, and multifocality and consequently tailoring the most appropriate treatment plan suitable for each patient. Conclusion: Contrast-enhanced spectral mammography is superior to full-field digital mammography in patients with dense breasts with a significant supplementary value in detection, characterization of lesions, and tailoring the appropriate treatment plan. [ABSTRACT FROM AUTHOR]

Aim of the study: To analyse the diagnostic performance of contrast-enhanced spectral mammography (CESM) based on morphologic and enhancement patterns of mass lesions in dense breast using different protocols: CESM without delayed image and CESM with delayed image. Material and methods: A total of 151 informed women with suspicious for malignancy mass lesions in dense breast were included in this study. All of them underwent CESM using 2 protocols. A total of 155 lesions were pathomorphologically verified. We analysed morphologic patterns on low-energy (LE) images and recombined images (RI) by defining the shape, margin, and dynamic patterns based on delayed images. Results: The comparative analysis revealed that the shape and margins on RI were more significant than those on LE images. The dynamic indicators of CESM were found to be highly significant in dense breasts. The correlation between kinetic curve and histological results demonstrated that a persistent type of curve was common for benign lesions, accounting for 15/22 (68.1%); plateau and washout - for malignant lesions, accounting for 24/89 (26.9%) and 61/89 (68.5%), respectively. Delayed image leads to an increase of specificity up to 12.4%, which is statistically significant. The area under the curve (AUC) in CESM with delayed image is larger than that in CESM without delayed image (p < 0.01). Conclusions: CESM is sensitive for the differential diagnosis of breast lesions. CESM with delayed image has higher specificity than CESM without delayed image. Delayed images with plateau and washout are typical for malignancy. [ABSTRACT FROM AUTHOR]