Skip to main content

Challenges in Breast Imaging

  • 3255 Accesses

Abstract

Breast imaging is fraught with unique challenges in decision making and patient management. The objective of not missing early-stage disease so as to fulfill the prime goal of diagnosing nonpalpable cancers to be balanced with keeping false positives low presents unique practice patterns and challenges. The list of controversies in breast imaging is long; some of the important ones are discussed in this chapter: inappropriate indications for mammography, breast intervention (intraductal masses, follow-up after concordant biopsy results, cytology of cyst aspirates), dense breast law, double reads, clinical breast exam during screening, imaging the male breast, overdiagnosis of breast cancer with screening mammography, and isolated abnormal axillary nodes.

Keywords

  • Breast Cancer
  • Dense Breast
  • Recall Rate
  • Male Breast
  • Male Breast Cancer

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Di Maggio C. State of the art of current modalities for the diagnosis of breast lesions. Eur J Nucl Med Mol Imaging. 2004;31 Suppl 1:S56–69.

    CrossRef  PubMed  Google Scholar 

  2. Shiffman MA. Mammograms in cosmetic breast surgery. Indian J Plast Surg. 2005;38:100–4.

    CrossRef  Google Scholar 

  3. Perras C. Fifteen years of mammography in cosmetic surgery of the breast. Aesthetic Plast Surg. 1990;14(2):81–4.

    CrossRef  PubMed  CAS  Google Scholar 

  4. Kroll SS, Schusterman MA, Tadjalli HE, Singletary SE, Ames F. Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy. Ann Surg Oncol. 1997;4(3):193–7.

    CrossRef  PubMed  CAS  Google Scholar 

  5. Sim YT, Litherland JC. The use of imaging in patients post breast reconstruction. Clin Radiol. 2012;67(2):128–33.

    CrossRef  PubMed  CAS  Google Scholar 

  6. Destounis S, Morgan R, Arieno A, Seifert P, Somerville P, Murphy P. A review of breast imaging following mastectomy with or without reconstruction in an outpatient community center. Breast Cancer. 2011;18(4):259–67.

    CrossRef  PubMed  Google Scholar 

  7. Helvie MA, Wilson TE, Roubidoux MA, Wilkins EG, Chang AE. Mammographic appearance of recurrent breast carcinoma with TRAM flap breast reconstructions. Radiology. 1998;209:711–5.

    CrossRef  PubMed  CAS  Google Scholar 

  8. Helvie M, Bailey J, Roubidoux M, Pass H, Chang A, Pierce L, et al. Mammographic screening of TRAM flap breast reconstructions for detection of non-palpable recurrent cancer. Radiology. 2002;224:211–6.

    CrossRef  PubMed  Google Scholar 

  9. Howard MB, Battaglia T, Prout M, Freund K. The effect of imaging on the clinical management of breast pain. J Gen Intern Med. 2012;27(7):817–24.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  10. Lumachi F, Ermani M, Brandes AA, et al. Breast complaints and risk of breast cancer. Population-based study of 2,879 self-selected women and long-term follow-up. Biomed Pharmacother. 2002;56(2):88–92.

    CrossRef  PubMed  CAS  Google Scholar 

  11. Smith RL, Pruthi S, Fitzpatrick LA. Evaluation and management of breast pain. Mayo Clin Proc. 2004;79(3):353–72.

    CrossRef  PubMed  Google Scholar 

  12. Duijm LEM, Guit GL, Hendriks JHCL, Zaat JOM, Mali WPTM. Value of breast imaging in women with painful breasts: observational follow up study. Br Med J. 1998;317(7171):1492–5.

    CrossRef  CAS  Google Scholar 

  13. Chang JM, Moon WK, Cho N, Han W, Noh DY, Park IA, Jung EJ. Risk of carcinoma after subsequent excision of benign papilloma initially diagnosed with an ultrasound (US)-guided 14-gauge core needle biopsy: a prospective observational study. Eur Radiol. 2010;20(5):1093–100.

    CrossRef  PubMed  Google Scholar 

  14. Liberman L, Tornos C, Huzjan R, Bartella L, Morris EA, Dershaw DD. Is surgical excision warranted after benign, concordant diagnosis of papilloma at percutaneous breast biopsy? AJR Am J Roentgenol. 2006;186:1328–34.

    CrossRef  PubMed  Google Scholar 

  15. Kim WH, Chang JM, Moon WK, Cho N, Yi A, Koo HR, Kim SJ. Intraductal mass on breast ultrasound: final outcomes and predictors of malignancy. AJR Am J Roentgenol. 2013;200(4):932–7.

    CrossRef  PubMed  Google Scholar 

  16. Shin S, Schneider HB, Cole Jr FJ, Laronga C. Follow-up recommendations for benign breast biopsies. Breast J. 2006;12(5):413–7.

    CrossRef  PubMed  Google Scholar 

  17. Daly CP, Bailey JE, Klein KA, Helvie MA. Complicated breast cysts on sonography: is aspiration necessary to exclude malignancy? Acad Radiol. 2008;15(5):610–7.

    CrossRef  PubMed  Google Scholar 

  18. Ciatto S, Cariaggi P, Bulgaresi P. The value of routine cytologic examination of breast cyst fluids. Acta Cytol. 1987;31(3):301–4.

    PubMed  CAS  Google Scholar 

  19. Berg WA, Campassi CI, Ioffe OB. Cystic lesions of the breast: sonographic-pathologic correlation. Radiology. 2003;227(1):183–91.

    CrossRef  PubMed  Google Scholar 

  20. Sanders LM, Lacz NL, Lara J. 16 year experience with aspiration of noncomplex breast cysts: cytology results with focus on positive cases. Breast J. 2012;18(5):443–52.

    CrossRef  PubMed  Google Scholar 

  21. Gottlieb S. Ultrasound plus mammography may detect more early cancers. BMJ. 2002;325:678.

    CrossRef  PubMed Central  Google Scholar 

  22. Stomper PC, D’Souza DJ, DiNitto PA, Arredondo MA. Analysis of parenchymal density on mammograms in 1353 women 25–79 years old. AJR Am J Roentgenol. 1996;167:1261–5.

    CrossRef  PubMed  CAS  Google Scholar 

  23. Boyd NF, Guo H, Martin LJ, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med. 2007;356:227–336.

    CrossRef  PubMed  CAS  Google Scholar 

  24. Berg WA, Blume JD, Cormack JB, et al. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA. 2008;299:2151–63.

    CrossRef  PubMed  CAS  PubMed Central  Google Scholar 

  25. Weigert J, Steenbergen S. The Connecticut experiment: the role of ultrasound in the screening of women with dense breasts. Breast J. 2012;18(6):517–22.

    CrossRef  PubMed  Google Scholar 

  26. Parris T, Wakefield D, Frimmer H. Real world performance of screening breast ultrasound following enactment of Connecticut Bill 458. Breast J. 2013;19(1):64–70.

    CrossRef  PubMed  Google Scholar 

  27. Hooley RJ, Greenberg KL, Stackhouse RM, Geisel JL, Butler RS, Philpotts LE. Screening US in patients with mammographically dense breasts: initial experience with Connecticut Public Act 09–41. Radiology. 2012;265(1):59–69.

    CrossRef  PubMed  Google Scholar 

  28. Dinnes J, Moss S, Melia J, Blanks R, Song F, Kleijnen J. Effectiveness and cost-effectiveness of double reading of mammograms in breast cancer screening: findings of a systematic review. Breast. 2001;10(6):455–63.

    CrossRef  PubMed  CAS  Google Scholar 

  29. Duijm LE, Groenewoud JH, Hendriks JH, de Koning HJ. Independent double reading of screening mammograms in The Netherlands : effect of arbitration following reader disagreements. Radiology. 2004;231(2):564–70.

    CrossRef  PubMed  Google Scholar 

  30. Gilbert FJ, Astley SM, McGee MA, Gillan MG, Boggis CR, Griffiths PM, Duffy SW. Single reading with computer-aided detection and double reading of screening mammograms in the United Kingdom National Breast Screening Program. Radiology. 2006;241(1):47–53.

    CrossRef  PubMed  Google Scholar 

  31. Taylor P, Potts HW. Computer aids and human second reading as interventions in screening mammography: two systematic reviews to compare effects on cancer detection and recall rate. Eur J Cancer. 2008;44(6):798–807.

    CrossRef  PubMed  Google Scholar 

  32. Bennett RL, Blanks RG, Moss SM. Does the accuracy of single reading with CAD (computer-aided detection) compare with that of double reading?: A review of the literature. Clin Radiol. 2006;61(12):1023–8.

    CrossRef  PubMed  CAS  Google Scholar 

  33. Brown J, Bryan S, Warren R. Mammography screening: an incremental cost effectiveness analysis of double versus single reading of mammograms. BMJ. 1996;312(7034):809–12.

    CrossRef  PubMed  CAS  PubMed Central  Google Scholar 

  34. Cairns J, Van Der Pol M. Cost-effectiveness of non-consensus double reading. Breast. 1998;7(5):243–6.

    CrossRef  Google Scholar 

  35. Chiarelli AM, Majpruz V, Brown P, Thériault M, Shumak R, Mai V. The contribution of clinical breast examination to the accuracy of breast screening. J Natl Cancer Inst. 2009;101(18):1236–43.

    CrossRef  PubMed  Google Scholar 

  36. Bancej C, Decker K, Chiarelli A, Harrison M, Turner D, Brisson J. Contribution of clinical breast examination to mammography screening in the early detection of breast cancer. J Med Screen. 2003;10(1):16–21.

    CrossRef  PubMed  CAS  Google Scholar 

  37. Feigin KN, Keating DM, Telford PM, Cohen MA. Clinical breast examination in a comprehensive breast cancer screening program: contribution and cost. Radiology. 2006;240(3):650–5.

    CrossRef  PubMed  Google Scholar 

  38. Nguyen C, Kettler MD, Swirsky ME, Miller VI, Scott C, Krause R, Hadro JA. Male breast disease : pictorial review with radiologic-pathologic correlation. Radiographics. 2013;33(3):763–79.

    CrossRef  PubMed  Google Scholar 

  39. Günhan-Bilgen I, Bozkaya H, Ustün E, Memiş A. Male breast disease: clinical, mammographic, and ultrasonographic features. Eur J Radiol. 2002;43(3):246–55.

    CrossRef  PubMed  Google Scholar 

  40. Adibelli ZH, Oztekin O, Gunhan-Bilgen I, Postaci H, Uslu A, Ilhan E. Imaging characteristics of male breast disease. Breast J. 2010;16(5):510–8.

    CrossRef  PubMed  Google Scholar 

  41. Chen L, Chantra PK, Larsen LH, Barton P, Rohitopakarn M, Zhu EQ, Bassett LW. Imaging characteristics of malignant lesions of the male breast. Radiographics. 2006;26(4):993–1006.

    CrossRef  PubMed  Google Scholar 

  42. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277–300.

    CrossRef  PubMed  Google Scholar 

  43. Bleyer A, Welch HG. Effect of three decades of screening mammography on breast-cancer incidence. N Engl J Med. 2012;367(21):1998–2005.

    CrossRef  PubMed  CAS  Google Scholar 

  44. Gur D, Sumkin JH. Screening for early detection of breast cancer: overdiagnosis versus suboptimal patient management. Radiology. 2013;268(2):327–8.

    CrossRef  PubMed  Google Scholar 

  45. Lanitis S, Behranwala KA, Al-Mufti R, Hadjiminas D. Axillary metastatic disease as presentation of occult or contralateral breast cancer. Breast. 2009;18(4):225–7.

    CrossRef  PubMed  CAS  Google Scholar 

  46. Patel T, Given-Wilson RM, Thomas V. The clinical importance of axillary lymphadenopathy detected on screening mammography: revisited. Clin Radiol. 2005;60(1):64–71.

    CrossRef  PubMed  CAS  Google Scholar 

  47. Rosen PP, Kimmel M. Occult breast carcinoma presenting with axillary lymph node metastases: a follow-up study of 48 patients. Hum Pathol. 1990;21(5):518–23.

    CrossRef  PubMed  CAS  Google Scholar 

  48. Shetty MK, Carpenter WS. Sonographic evaluation of isolated abnormal axillary lymph nodes identified on mammograms. J Ultrasound Med. 2004;23(1):63–71.

    PubMed  Google Scholar 

  49. Görkem SB, O’Connell AM. Abnormal axillary lymph nodes on negative mammograms: causes other than breast cancer. Diagn Interv Radiol. 2012;18(5):473–9.

    PubMed  Google Scholar 

  50. de Bresser J, de Vos B, van der Ent F, Hulsewé K. Breast MRI in clinically and mammographically occult breast cancer presenting with an axillary metastasis: a systematic review. Eur J Surg Oncol. 2010;36(2):114–9.

    CrossRef  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mahesh K. Shetty MD, FRCR, FACR, FAIUM .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Shetty, M.K. (2015). Challenges in Breast Imaging. In: Shetty, M. (eds) Breast Cancer Screening and Diagnosis. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1267-4_14

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1267-4_14

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1266-7

  • Online ISBN: 978-1-4939-1267-4

  • eBook Packages: MedicineMedicine (R0)