Early detection reduces deaths due to breast cancer. The US Preventive Services Task Force analysis of 7 randomized trials of mammographic screening found that the point estimate of the reduction in mortality from screening mammography was 22% in women aged 50 years or older and 15% among women between 40 and 49 years,¹ with some individual trials showing far greater benefits in both age groups and with any specific age distinction arbitrary. The magnitude of reduction in mortality seen in individual trials parallels reductions in size distribution² and rates of node-positive breast cancer.³

Six previous single-center studies^1-6 and 3 multicenter trials^7-9 have shown supplemental screening breast ultrasound significantly increases detection of node-negative invasive breast cancer in women with mammographically dense breast tissue on the first prevalence screen, consistently increasing cancer detection (yield) by 3.5 per 1000 in single-center studies and from 4.2 to 4.4 per 1000 in multicenter trials. The vast majority of cancers detected only by ultrasound have been node-negative invasive breast cancers. Until now, it was unclear whether continuing ultrasound screening annually (ie, incidence screening) would result in a detection benefit.

To determine whether adding shear-wave (SW) elastographic features could improve accuracy of ultrasonographic (US) assessment of breast masses. From September 2008 to September 2010, 958 women consented to repeat standard breast US supplemented by quantitative SW elastographic examination in this prospective multicenter institutional review board-approved, HIPAA-compliant protocol. B-mode Breast Imaging Reporting and Data System (BI-RADS) features and assessments were recorded. SW elastographic evaluation (mean, maximum, and minimum elasticity of stiffest portion of mass and surrounding tissue; lesion-to-fat elasticity ratio; ratio of SW elastographic-to-B-mode lesion diameter or area; SW elastographic lesion shape and homogeneity) was performed. Qualitative color SW elastographic stiffness was assessed independently. Nine hundred thirty-nine masses were analyzable; 102 BI-RADS category 2 masses were assumed to be benign; reference standard was available for 837 category 3 or higher lesions. Considering BI-RADS category 4a or higher as test positive for malignancy, effect of SW elastographic features on area under the receiver operating characteristic curve (AUC), sensitivity, and specificity after reclassifying category 3 and 4a masses was determined. Median participant age was 50 years; 289 of 939 (30.8%) masses were malignant (median mass size, 12 mm). B-mode BI-RADS AUC was 0.950; eight of 303 (2.6%) BI-RADS category 3 masses, 18 of 193 (9.3%) category 4a lesions, 41 of 97 (42%) category 4b lesions, 42 of 57 (74%) category 4c lesions, and 180 of 187 (96.3%) category 5 lesions were malignant. By using visual color stiffness to selectively upgrade category 3 and lack of stiffness to downgrade category 4a masses, specificity improved from 61.1% (397 of 650) to 78.5% (510 of 650) (P<.001); AUC increased to 0.962 (P=.005). Oval shape on SW elastographic images and quantitative maximum elasticity of 80 kPa (5.2 m/sec) or less improved specificity (69.4% [451 of 650] and 77.4% [503 of 650], P<.001 for both), without significant improvement in sensitivity or AUC. Adding SW elastographic features to BI-RADS feature analysis improved specificity of breast US mass assessment without loss of sensitivity.

Mammography is not widely available in all countries, and breast cancer incidence is increasing. We considered performance characteristics using ultrasound (US) instead of mammography to screen for breast cancer. Two thousand eight hundred nine participants were enrolled at 20 sites in the United States, Canada, and Argentina in American College of Radiology Imaging 6666. Two thousand six hundred sixty-two participants completed three annual screens (7473 examinations) with US and film-screen (n = 4351) or digital (n = 3122) mammography and had biopsy or 12-month follow-up. Cancer detection, recall, and positive predictive values were determined. All statistical tests were two-sided. One hundred ten women had 111 breast cancer events: 89 (80.2%) invasive cancers, median size 12mm. The number of US screens to detect one cancer was 129 (95% bootstrap confidence interval [CI] = 110 to 156), and for mammography 127 (95% CI = 109 to 152). Cancer detection was comparable for each of US and mammography at 58 of 111 (52.3%) vs 59 of 111 (53.2%, P = .90), with US-detected cancers more likely invasive (53/58, 91.4%, median size 12mm, range = 2–40mm), vs mammography at 41 of 59 (69.5%, median size 13mm, range = 1–55mm, P < .001). Invasive cancers detected by US were more frequently node-negative, 34 of 53 (64.2%) vs 18 of 41 (43.9%) by mammography ( P = .003). For 4814 incidence screens (years 2 and 3), US had higher recall and biopsy rates and lower PPV of biopsy (PPV3) than mammography: The recall rate was 10.7% (n = 515) vs 9.4% (n = 453, P = .03), the biopsy rate was 5.5% (n = 266) vs 2.0% (n = 97, P < .001), and PPV3 was 11.7% (31/266) vs 38.1% (37/97, P < .001). Cancer detection rate with US is comparable with mammography, with a greater proportion of invasive and node-negative cancers among US detections. False positives are more common with US screening.

Our study results suggest that there may be a large group of women at elevated risk of breast cancer for whom MR imaging would not be acceptable; for these women, supplemental screening with US com... PurposeTo determine reasons for nonparticipation in a trial of supplemental screening with magnetic resonance (MR) imaging after mammography and ultrasonography (US). Materials and MethodsWomen(n =...

Overall, 61 (16%) of 388 participants had an appropriate change in surgical management based on MR findings—more than the 41 (11%) participants with an appropriate change based on positron emission mammography (PEM) findings (P = .003) and fewer than the 71 (18%) participants with an appropriate change based on combined PEM and MR findings (P = .004 for comparison with MR imaging alone); 25 (6.4%) women had excessive excisions on the basis of MR findings compared with 19 (4.9%) women who had them on the basis of PEM findings (P = .26) and 32 (8.2%) women who had them after undergoing combined PEM and MR imaging (P = .023 for comparison with MR imaging alone). PurposeTo determine the performance of positron emission mammography (PEM), as compared with magnetic resonance (MR) imaging, including the effect on surgical management, in ipsilateral breasts with cancer.Materials and MethodsFour hundred seventy-two women with newly diagnosed breast cancer who were offered breast-conserving surgery consented from September 2006 to November 2008 to participate in a multicenter institutional review board–approved, HIPAA-compliant protocol. Participants underwent contrast material–enhanced MR imaging and fluorine 18 fluorodeoxyglucose PEM in randomized order; resultant images were interpreted independently. Added biopsies and changes in surgical procedure for the ipsilateral breast were correlated with histopathologic findings. Performance characteristics were compared by using the McNemar test and generalized estimating equations.ResultsThree hundred eighty-eight women (median age, 58 years; age range, 26–93 years; median estimated tumor size, 1.5 cm) completed the study....