Abstract P1-02-05: An analysis of lesions diagnosed on screening breast ultrasound in women with dense breasts: Four years of data
Authors: Weigert Jean M 
Published: May 2015

Objective: To analyze the type of cancers and high risk lesions diagnosed in women with normal mammograms with dense breasts with the addition of bilateral breast ultrasound and determine whether these lesions make an impact on clinical outcomes.

Methods: Four years of ultrasound data from two sites with five offices in Connecticut was analyzed. The type of lesion including size, nuclear and histologic grade, ER/PR/Her2 status, node status, patient age and risk factors was reviewed.

Results: A total of 532 Ultrasounds with Birads 4 or 5 were reported with 46 cancers or high risk lesions. There were 14 Invasive Ductal Carcinoma, 10 Invasive Lobular Carcinoma, 8 Mixed type, 1 Mucinous, 1 Tubular, 6 Ductal carcinoma in situ, 3 Atypical Ductal Hyperplasia with papilloma and 3 Lobular Carcinoma in situ. Of the invasive cancers and DCIS, 9 were nuclear grade 1, 25 nuclear grade 2 and 7 nuclear grade 3. They ranged in size from .3 to 8 .0 cm and the patient age was 45-77 years. Four patients had positive metastatic lymph nodes. 3 were in tumors that were nuclear grade 3 and one with micro metastasis was in a nuclear grade 2 tumor. 29 cancers had known hormonal status of which 27 were ER/PR+ and 2 were ER+/ PR-. 5 patents had a family history of breast cancer and 2 patients had prior history of their own breast cancer, one had uterine cancer. In the third and fourth year of screening usg, 4 cancers were diagnosed in patients who had a negative usg either one year or two years prior. They ranged in size from .4 to 1.2 cm and were all node negative.

LESION CharacterizationLesion TypeNumberAverage SizeSentinel NodeFamily HistoryPrior Self CancerPrior Screening UsgInvasive Ductal Grade 141.2 cm0300Invasive Ductal Grade 251.7 cm1 micro-met100Invasive Ductal Grade 351.4 cm3 macromet100Invasive Lobular Grade 120.7 cm0001Invasive Lovular Grade 281.5 cm0001Mixed IDC/ILC Grade 11n/a0000Mixed IDC/ILC Grade 261.2 cm0112Mixed IDC/ILC Grade 311.3 cm0000DCIS Grade 251.3 cm0000DCIS Grade 311.9 cm0000LCIS3n/a0010ADH /Pappiloma30.5 cm0000Tubular10.4 cm0000Mucinous18.0 cm0000

Discussion: In our first four years of tracking patients with dense breasts, the addition of bilateral breast ultrasound diagnosed a variety of cancers and high risk lesions. These were not visible on screening mammography and were not palpable. There were 4 with node positive disease diagnosed in high nuclear grade tumors. Most patients had no additional risk factors other than dense breasts. In the third and fourth year, cancers were found in patients who had a prior screening usg. Their mammograms remained negative. The cancers were small and node negative.

Conclusion: The successful treatment of breast cancer is based on several variables including type of cancer, grade, size at diagnosis, and stage at diagnosis. We do not know at what point these lesions diagnosed with screening breast usg would have been clinically evident, either on mammography or physical examination. One might consider that the treatment outcome would be altered if the lesions were larger and with more positive lymph nodes.

Citation Format: Jean M Weigert. An analysis of lesions diagnosed on screening breast ultrasound in women with dense breasts: Four years of data [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-02-05.