Application of the downgrade criteria to supplemental screening ultrasound for women with negative mammography but dense breasts

Soo Yeon Kim, minjung Kim, Hee Jung Moon, Jung Hyun Yoon, Eunkyung Kim

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

We investigated whether the application of the downgrade criteria to supplemental screening ultrasound (US) for women with negative mammography but dense breasts can reduce the rate of Breast Imaging Reporting and Data System (BI-RADS) categories 3 to 4a without a loss of cancer detection. This retrospective studywas approved by the Institutional ReviewBoard, and the need to obtain informedconsentwas waived.Atotal of 3171 consecutivewomen(978women, 1173women, and 1020womenin the first, second, and third year, respectively) with negative mammography but dense breast who underwent radiologist-performed, hand-held supplemental screening US from March 2010 to February 2013 were included. Downgrade criteria for BI-RADS category 2 were complicated cysts-5mmobserved as circumscribed, homogeneous, and hypoechoic lesions and circumscribed oval-shaped solid masses 5mm. Changes in the distribution of BI-RADS category, biopsy rate, and cancer detection yield over 3 years were analyzed. Performances of less-experienced (12 fellows with <2 years of experience) and experienced (3 staffs with >12 years of experience) radiologists were compared. Outcomes of initial examinations (prevalence screening) and noninitial examinations (incidence screening) were compared. Application of the downgrade criteria reduced BI-RADS categories 3 to 4a in both less-experienced (from 39.4% to 16.0%, P<0.001) and experienced radiologists (from 22.6% to 11.1%, P<0.001) over 3 years. Biopsy rates also significantly decreased from 6.5% to 2.4% (P<0.001).Cancer detection yield of supplemental screeningUSwas 2.8 per 1000 examinations (9 of 3171: 2 ductal carcinoma in situ and 7 invasive cancers). There were no differences in cancer detection yield per each year (P=0.539). There was no interval cancer. In noninitial examinations, BI-RADS categories 3 to 4a rates, biopsy rates, and cancer detection rates were lower compared to initial examinations. Application of the downgrade criteria reduced BI-RADS categories 3 to 4a without a loss of cancer detection. We suggest that our downgrade criteria can be used to reduce the false positive rate in the supplemental screening US. Further large-scale, multicenter, prospective studies are needed to validate the effectiveness of the downgrade criteria.

Original languageEnglish
Article numbere5279
JournalMedicine (United States)
Volume95
Issue number44
DOIs
Publication statusPublished - 2016 Jan 1

Fingerprint

Mammography
Breast
Information Systems
Neoplasms
Biopsy
Carcinoma, Intraductal, Noninfiltrating
Multicenter Studies
Cysts
Hand
Prospective Studies
Incidence
Radiologists

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

@article{096babc9e4b94091bb34fd7dbe0fe77b,
title = "Application of the downgrade criteria to supplemental screening ultrasound for women with negative mammography but dense breasts",
abstract = "We investigated whether the application of the downgrade criteria to supplemental screening ultrasound (US) for women with negative mammography but dense breasts can reduce the rate of Breast Imaging Reporting and Data System (BI-RADS) categories 3 to 4a without a loss of cancer detection. This retrospective studywas approved by the Institutional ReviewBoard, and the need to obtain informedconsentwas waived.Atotal of 3171 consecutivewomen(978women, 1173women, and 1020womenin the first, second, and third year, respectively) with negative mammography but dense breast who underwent radiologist-performed, hand-held supplemental screening US from March 2010 to February 2013 were included. Downgrade criteria for BI-RADS category 2 were complicated cysts-5mmobserved as circumscribed, homogeneous, and hypoechoic lesions and circumscribed oval-shaped solid masses 5mm. Changes in the distribution of BI-RADS category, biopsy rate, and cancer detection yield over 3 years were analyzed. Performances of less-experienced (12 fellows with <2 years of experience) and experienced (3 staffs with >12 years of experience) radiologists were compared. Outcomes of initial examinations (prevalence screening) and noninitial examinations (incidence screening) were compared. Application of the downgrade criteria reduced BI-RADS categories 3 to 4a in both less-experienced (from 39.4{\%} to 16.0{\%}, P<0.001) and experienced radiologists (from 22.6{\%} to 11.1{\%}, P<0.001) over 3 years. Biopsy rates also significantly decreased from 6.5{\%} to 2.4{\%} (P<0.001).Cancer detection yield of supplemental screeningUSwas 2.8 per 1000 examinations (9 of 3171: 2 ductal carcinoma in situ and 7 invasive cancers). There were no differences in cancer detection yield per each year (P=0.539). There was no interval cancer. In noninitial examinations, BI-RADS categories 3 to 4a rates, biopsy rates, and cancer detection rates were lower compared to initial examinations. Application of the downgrade criteria reduced BI-RADS categories 3 to 4a without a loss of cancer detection. We suggest that our downgrade criteria can be used to reduce the false positive rate in the supplemental screening US. Further large-scale, multicenter, prospective studies are needed to validate the effectiveness of the downgrade criteria.",
author = "Kim, {Soo Yeon} and minjung Kim and Moon, {Hee Jung} and Yoon, {Jung Hyun} and Eunkyung Kim",
year = "2016",
month = "1",
day = "1",
doi = "10.1097/MD.0000000000005279",
language = "English",
volume = "95",
journal = "Medicine (United States)",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "44",

}

Application of the downgrade criteria to supplemental screening ultrasound for women with negative mammography but dense breasts. / Kim, Soo Yeon; Kim, minjung; Moon, Hee Jung; Yoon, Jung Hyun; Kim, Eunkyung.

In: Medicine (United States), Vol. 95, No. 44, e5279, 01.01.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Application of the downgrade criteria to supplemental screening ultrasound for women with negative mammography but dense breasts

AU - Kim, Soo Yeon

AU - Kim, minjung

AU - Moon, Hee Jung

AU - Yoon, Jung Hyun

AU - Kim, Eunkyung

PY - 2016/1/1

Y1 - 2016/1/1

N2 - We investigated whether the application of the downgrade criteria to supplemental screening ultrasound (US) for women with negative mammography but dense breasts can reduce the rate of Breast Imaging Reporting and Data System (BI-RADS) categories 3 to 4a without a loss of cancer detection. This retrospective studywas approved by the Institutional ReviewBoard, and the need to obtain informedconsentwas waived.Atotal of 3171 consecutivewomen(978women, 1173women, and 1020womenin the first, second, and third year, respectively) with negative mammography but dense breast who underwent radiologist-performed, hand-held supplemental screening US from March 2010 to February 2013 were included. Downgrade criteria for BI-RADS category 2 were complicated cysts-5mmobserved as circumscribed, homogeneous, and hypoechoic lesions and circumscribed oval-shaped solid masses 5mm. Changes in the distribution of BI-RADS category, biopsy rate, and cancer detection yield over 3 years were analyzed. Performances of less-experienced (12 fellows with <2 years of experience) and experienced (3 staffs with >12 years of experience) radiologists were compared. Outcomes of initial examinations (prevalence screening) and noninitial examinations (incidence screening) were compared. Application of the downgrade criteria reduced BI-RADS categories 3 to 4a in both less-experienced (from 39.4% to 16.0%, P<0.001) and experienced radiologists (from 22.6% to 11.1%, P<0.001) over 3 years. Biopsy rates also significantly decreased from 6.5% to 2.4% (P<0.001).Cancer detection yield of supplemental screeningUSwas 2.8 per 1000 examinations (9 of 3171: 2 ductal carcinoma in situ and 7 invasive cancers). There were no differences in cancer detection yield per each year (P=0.539). There was no interval cancer. In noninitial examinations, BI-RADS categories 3 to 4a rates, biopsy rates, and cancer detection rates were lower compared to initial examinations. Application of the downgrade criteria reduced BI-RADS categories 3 to 4a without a loss of cancer detection. We suggest that our downgrade criteria can be used to reduce the false positive rate in the supplemental screening US. Further large-scale, multicenter, prospective studies are needed to validate the effectiveness of the downgrade criteria.

AB - We investigated whether the application of the downgrade criteria to supplemental screening ultrasound (US) for women with negative mammography but dense breasts can reduce the rate of Breast Imaging Reporting and Data System (BI-RADS) categories 3 to 4a without a loss of cancer detection. This retrospective studywas approved by the Institutional ReviewBoard, and the need to obtain informedconsentwas waived.Atotal of 3171 consecutivewomen(978women, 1173women, and 1020womenin the first, second, and third year, respectively) with negative mammography but dense breast who underwent radiologist-performed, hand-held supplemental screening US from March 2010 to February 2013 were included. Downgrade criteria for BI-RADS category 2 were complicated cysts-5mmobserved as circumscribed, homogeneous, and hypoechoic lesions and circumscribed oval-shaped solid masses 5mm. Changes in the distribution of BI-RADS category, biopsy rate, and cancer detection yield over 3 years were analyzed. Performances of less-experienced (12 fellows with <2 years of experience) and experienced (3 staffs with >12 years of experience) radiologists were compared. Outcomes of initial examinations (prevalence screening) and noninitial examinations (incidence screening) were compared. Application of the downgrade criteria reduced BI-RADS categories 3 to 4a in both less-experienced (from 39.4% to 16.0%, P<0.001) and experienced radiologists (from 22.6% to 11.1%, P<0.001) over 3 years. Biopsy rates also significantly decreased from 6.5% to 2.4% (P<0.001).Cancer detection yield of supplemental screeningUSwas 2.8 per 1000 examinations (9 of 3171: 2 ductal carcinoma in situ and 7 invasive cancers). There were no differences in cancer detection yield per each year (P=0.539). There was no interval cancer. In noninitial examinations, BI-RADS categories 3 to 4a rates, biopsy rates, and cancer detection rates were lower compared to initial examinations. Application of the downgrade criteria reduced BI-RADS categories 3 to 4a without a loss of cancer detection. We suggest that our downgrade criteria can be used to reduce the false positive rate in the supplemental screening US. Further large-scale, multicenter, prospective studies are needed to validate the effectiveness of the downgrade criteria.

UR - http://www.scopus.com/inward/record.url?scp=84995899169&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84995899169&partnerID=8YFLogxK

U2 - 10.1097/MD.0000000000005279

DO - 10.1097/MD.0000000000005279

M3 - Article

VL - 95

JO - Medicine (United States)

JF - Medicine (United States)

SN - 0025-7974

IS - 44

M1 - e5279

ER -