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Increasing the diagnosis of multifocal primary breast cancer by the use of bilateral whole-breast ultrasound

      AIM

      The aim of this study was to evaluate the contribution of bilateral whole-breast ultrasound (BBUS) to the diagnosis and management of women with newly diagnosed breast cancer.

      METHODS

      Over a period of 6 months, 102 women presenting with breast cancer underwent BBUS. Data were collected on clinical findings, radiology, histology and surgical outcome. These women were compared with a control group of 124 women presenting over a similar 6-month period 1 year previously, who had undergone targeted breast ultrasound.

      RESULTS

      Multicentric/multifocal tumours were demonstrated in 35 (34%) of the 102 participants and in 18 (15%) of the 124 controls, a statistically significant difference (Fisher's exact test, p=0.001). Multiple tumours were diagnosed preoperatively in 18% of the study population compared with 8% of the controls, and BBUS identified invasive multifocal/multicentric tumours in significantly more women in the study population (11 versus 1 control) (Fisher's exact test, p=0.019). Contralateral cancer was diagnosed in 4 women in the study population and none in the control population (Fisher's exact test, p=0.040). Surgical review showed that the surgical management changed significantly in 8% (95% confidence interval 4 to 14%) of cases in the study population following BBUS. The increase in the number of women undergoing benign biopsies in the study population (10 versus 5 controls) was not statistically significant (Fisher's exact test, p=0.11).

      CONCLUSION

      BBUS increased the preoperative diagnosis of multiple tumours in women presenting with primary breast cancer, resulting in a management change in 8% of cases.

      Keywords

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      References

        • Roche N.A.
        • Given-Wilson R.M.
        • Thomas V.A.
        • Sacks N.P.
        Assessment of a scoring system for breast imaging.
        Br J Surg. 1998; 85: 669-672
        • Martelli G.
        • Pilotti S.
        • Coopmans de Yoldi G.
        • et al.
        Diagnostic efficacy of physical examination, mammography, fine needle aspiration cytology (triple-test) in solid breast lumps: an analysis of 1708 consecutive cases.
        Tumori. 1990; 76: 476-479
        • Wilson R.
        • Asbury D.
        • Cooke J.
        • Michell M.
        • Pattnick J.
        NHSBSP Quality assurance guidelines for breast cancer screening assessment.
        (p. 17) NHS Cancer Screening Programmes. NHSBSP Publication No. 49, Sheffield, UK2001
        • NHSBSP and Association of Breast Surgery at BASO
        An audit of screen detected cancers for the year of screening April 2001 to March 2002.
        (p. 24) West Midlands NHS Breast and Cervical Screening Quality Assurance Reference Centre, Sheffield2003
        • Holland R.
        • Veling S.H.J.
        • Mravunac M.
        • Hendriks J.H.C.L.
        Histologic multifocality of Tis, T1-2 breast carcinomas: implications for clinical trials of breast conserving surgery.
        Cancer. 1985; 56: 979-990
        • Zonderland H.M.
        • Coerkamp E.G.
        • Hermans J.
        • van de Vijver M.J.
        • van Voorthuisen A.E.
        Diagnosis of breast cancer: contribution of US as an adjunct to mammography.
        Radiology. 1999; 213: 413-422
        • Kolb T.M.
        Ultrasound boosts cancer detection in dense breasts.
        Diagnostic Imaging (San Franc). 2000; 22 ([also see p. 107–11]): 103-104
        • Kolb T.M.
        • Lichy J.
        • Newhouse J.H.
        Occult cancer in women with dense breasts: detection with screening US—diagnostic yield and tumour characteristics.
        Radiology. 1998; 207: 191-198
        • Buchberger W.
        • Niehoff A.
        • Obrist P.
        • DeKoekkoek-Doll P.
        • Dunser M.
        Clinically and mammographically occult breast lesions: detection and classification with high resolution sonography.
        Semin Ultrasound CT MR. 2000; 2: 325-336
        • Hlawatsch A.
        • Teifke A.
        • Scmidt M.
        • Thelen M.
        Preoperative assessment of breast cancer: sonography versus MR imaging.
        AJR Am J Roentgenol. 2002; 179: 1493-1501
        • Fisher B.
        • Anderson S.
        • Redmond C.K.
        • Wolmark N.
        • Wickerham D.L.
        • Cronin W.M.
        Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer.
        N Engl J Med. 1995; 333: 1456-1461
        • Rissanen T.J.
        • Makarainen H.P.
        • Meeri A.
        • Apaja-Sarkkinen M.A.
        • Lindholm E.L.
        Mammography and ultrasound in the diagnosis of contralateral breast cancer.
        Acta Radiol. 1995; 36: 358-366
        • Fischer U.
        • Kopka L.
        • Grabbe E.
        Breast carcinoma: effect of pre-operative contrast-enhanced MR imaging on the therapeutic approach.
        Radiology. 1999; 213: 881-888
        • Kramer S.
        • Schultz-Wendtland R.
        • Hagedorn K.
        Magnetic resonance imaging and its role in the diagnosis of multicentric breast cancer.
        Anticancer Res. 1998; 18: 2163-2164
        • Mumtaz H.
        • Hall-Craggs M.A.
        • Davidson T.
        • et al.
        Staging of symptomatic breast cancer with MR imaging.
        AJR Am J Roentgenol. 1997; 169: 417-424
        • Flobbe K.
        • Nelemans P.J.
        • Kessels A.G.
        • von Meyenfeldt M.F.
        • van Engelshoven J.M.
        The role of ultrasonography as an adjunct to mammography in the detection of breast cancer: a systematic review.
        Eur J Cancer. 2002; 38: 1044-1050
        • Moon W.K.
        • Nih D.Y.
        • Im J.G.
        Multifocal, multicentric and contralateral breast cancers: bilateral whole-breast US in the preoperative evaluation of patients.
        Radiology. 2002; 224: 569-576
        • Skaane P.
        The additional value of US to mammography in the diagnosis of breast cancer.
        Acta Radiol. 1999; 40: 486-490
        • Berg W.A.
        • Gilbreath P.L.
        Multicentric and multifocal cancer: whole-breast US in preoperative evaluation.
        Radiology. 2000; 214: 59-66
        • Lee S.G.
        • Orel S.G.
        • Woo I.J.
        • et al.
        MR imaging of the contralateral breast in patients with newly diagnosed beast cancer: preliminary results.
        Radiology. 2003; 226: 773-778
        • Liberman L.
        • Morris E.A.
        • Kim C.M.
        • et al.
        MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer.
        AJR Am J Roentgenol. 2003; 180: 333-341
        • O'Driscoll D.
        • Warren R.
        • Mackay P.
        • Britton P.
        • Day N.E.
        Screening with breast ultrasound in a population at moderate risk due to family history.
        J Med Screen. 2001; 8: 106-109
        • Kolb T.M.
        • Lichy J.
        • Newhouse J.H.
        Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations.
        Radiology. 2002; 225: 165-175
        • Orel S.G.
        • Schnall M.D.
        • Powell C.M.
        • et al.
        Staging of suspected breast cancer: effect of MR imaging and MR guided biopsy.
        Radiology. 1995; 196: 115-122