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The chest radiologist's role in invasive breast cancer detection

Published:December 07, 2017DOI:https://doi.org/10.1016/j.clinimag.2017.12.002

      Highlights

      • The breasts can be evaluated on chest CT.
      • Chest CT was able to detect 9/11 invasive breast cancers.
      • A breast assessment and recommendation CT score (BARCS) was created.
      • BARCS and mammogram BI-RADS management recommendations are concordant for 77.1%.
      • Agreement is higher among cases that require no immediate action 87.6% vs. 34.0%.

      Abstract

      Purpose

      To assess the ability of chest CT to identify patients needing further evaluation of the breasts.

      Methods

      IRB approval was obtained with a waiver of consent. Women with chest CT and mammogram within 12 months formed the cohort. A breast assessment and recommendation CT score (BARCS) analogous to mammographic BI-RADS was created and compared to the mammogram BI-RADS.

      Results

      BARCS and mammographic BI-RADS management recommendations were concordant for 77.1%. 11 invasive cancers were detected; all by mammogram while CT missed 2.

      Conclusion

      BARCS score should be studied in prospective trials. Chest CT might be the earliest opportunity to detect breast cancer.

      Keywords

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      References

        • Cancer Research UK
        Breast cancer incidence (invasive) statistics.
        (Available from:) ([April 12])
        • Tabar L.
        • Vitak B.
        • Chen T.H.
        • Yen A.M.
        • Cohen A.
        • Tot T.
        • et al.
        Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades.
        Radiology. 2011; 260: 658-663
        • Kerlikowske K.
        • Grady D.
        • Rubin S.M.
        • Sandrock C.
        • Ernster V.L.
        Efficacy of screening mammography. A meta-analysis.
        JAMA. 1995; 273: 149-154
        • Coldman A.
        • Phillips N.
        • Wilson C.
        • Decker K.
        • Chiarelli A.M.
        • Brisson J.
        • et al.
        Pan-Canadian study of mammography screening and mortality from breast cancer.
        J Natl Cancer Inst. 2014; 106
        • Webb M.L.
        • Cady B.
        • Michaelson J.S.
        • Bush D.M.
        • Calvillo K.Z.
        • Kopans D.B.
        • et al.
        A failure analysis of invasive breast cancer: most deaths from disease occur in women not regularly screened.
        Cancer. 2014; 120: 2839-2846
        • American Cancer Society
        Cancer facts & figures.
        (Available from:)
        • Hooley R.J.
        • Greenberg K.L.
        • Stackhouse R.M.
        • Geisel J.L.
        • Butler R.S.
        • Philpotts L.E.
        Screening US in patients with mammographically dense breasts: initial experience with Connecticut Public Act 09-41.
        Radiology. 2012; 265: 59-69
        • Weigert J.
        • Steenbergen S.
        The Connecticut experiment: the role of ultrasound in the screening of women with dense breasts.
        Breast J. 2012; 18: 517-522
        • Berg W.A.
        • Zhang Z.
        • Lehrer D.
        • Jong R.A.
        • Pisano E.D.
        • Barr R.G.
        • et al.
        Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk.
        JAMA. 2012; 307: 1394-1404
        • Mathis K.L.
        • Hoskin T.L.
        • Boughey J.C.
        • Crownhart B.S.
        • Brandt K.R.
        • Vachon C.M.
        • et al.
        Palpable presentation of breast cancer persists in the era of screening mammography.
        J Am Coll Surg. 2010; 210: 314-318
        • Sharpe R.E.
        • Levin D.C.
        • Parker L.
        • Rao V.M.
        The effect of the controversial US Preventive Services Task Force recommendations on the use of screening mammography.
        J Am Coll Radiol. 2013; 10: 21-24
        • Broder J.
        • Warshauer D.M.
        Increasing utilization of computed tomography in the adult emergency department, 2000–2005.
        Emerg Radiol. 2006; 13: 25-30
        • Eberth J.M.
        • Qiu R.
        • Adams S.A.
        • Salloum R.G.
        • Bell N.
        • Arrington A.K.
        • et al.
        Lung cancer screening using low-dose CT: the current national landscape.
        Lung Cancer. 2014; 85: 379-384
        • Oeffinger K.C.
        • Fontham E.T.
        • Etzioni R.
        • Herzig A.
        • Michaelson J.S.
        • Shih Y.C.
        • et al.
        Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society.
        JAMA. 2015; 314: 1599-1614
        • US Preventive Services Task Force
        Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2009; 151 ([W-236]): 716-726
        • Seah M.K.
        • Murphy C.G.
        • McDonald S.
        • Carrothers A.
        Incidental findings on whole-body trauma computed tomography: experience at a major trauma centre.
        Injury. 2016; 47: 691-694
        • Budoff M.J.
        • Gopal A.
        Incidental findings on cardiac computed tomography. Should we look?.
        J Cardiovasc Comput Tomogr. 2007; 1: 97-105
        • Poyraz N.
        • Emilk G.D.
        • Keskin S.
        • Kalkan H.
        Incidental breast lesions detected on computed thorax tomography.
        J Breast Health. 2015; 11: 163-167
        • Swensen S.J.
        • Jett J.R.
        • Sloan J.A.
        • Midthun D.E.
        • Hartman T.E.
        • Sykes A.M.
        • et al.
        Screening for lung cancer with low-dose spiral computed tomography.
        Am J Respir Crit Care Med. 2002; 165: 508-513
        • Yi J.G.
        • Kim S.J.
        • Marom E.M.
        • Park J.H.
        • Jung S.I.
        • Lee M.W.
        Chest CT of incidental breast lesions.
        J Thorac Imaging. 2008; 23: 148-155
        • Parvaiz M.A.
        • Isgar B.
        Incidental breast lesions detected on diagnostic CT scans: a 4-year prospective study.
        Breast J. 2013; 19: 457-459
        • Hussain A.
        • Gordon-Dixon A.
        • Almusawy H.
        • Sinha P.
        • Desai A.
        The incidence and outcome of incidental breast lesions detected by computed tomography.
        Ann R Coll Surg Engl. 2010; 92: 124-126
        • Meller M.T.
        • Cox J.E.
        • Callanan K.W.
        Incidental detection of breast lesions with computed tomography.
        Clin Breast Cancer. 2007; 7: 634-637
        • Porter G.
        • Steel J.
        • Paisley K.
        • Watkins R.
        • Holgate C.
        Incidental breast masses detected by computed tomography: are any imaging features predictive of malignancy?.
        Clin Radiol. 2009; 64: 529-533
        • Surov A.
        • Fiedler E.
        • Wienke A.
        • Holzhausen H.J.
        • Spielmann R.P.
        • Behrmann C.
        Intramammary incidental findings on staging computer tomography.
        Eur J Radiol. 2012; 81: 2174-2178
        • Lin W.C.
        • Hsu H.H.
        • Li C.S.
        • JC Yu
        • Hsu G.C.
        • CP Yu
        • et al.
        Incidentally detected enhancing breast lesions on chest computed tomography.
        Korean J Radiol. 2011; 12: 44-51
        • Shojaku H.
        • Seto H.
        • Iwai H.
        • Kitazawa S.
        • Fukushima W.
        • Saito K.
        Detection of incidental breast tumors by noncontrast spiral computed tomography of the chest.
        Radiat Med. 2008; 26: 362-367
        • Monzawa S.
        • Washio T.
        • Yasuoka R.
        • Mitsuo M.
        • Kadotani Y.
        • Hanioka K.
        Incidental detection of clinically unexpected breast lesions by computed tomography.
        Acta Radiol. 2013; 54: 374-379
        • Prabhu V.
        • Chhor C.M.
        • Ego-Osuala I.O.
        • Xiao J.M.
        • Hindman N.M.
        • Rosenkrantz A.B.
        Frequency and outcomes of incidental breast lesions detected on abdominal MRI over a 7-year period.
        AJR Am J Roentgenol. 2017; 208: 107-113
        • Bignotti B.
        • Succio G.
        • Nosenzo F.
        • Perinetti M.
        • Gristina L.
        • Barbagallo S.
        • et al.
        Breast findings incidentally detected on body MRI.
        Springerplus. 2016; 5: 781
        • Harish M.G.
        • Konda S.D.
        • MacMahon H.
        • Newstead G.M.
        Breast lesions incidentally detected with CT: what the general radiologist needs to know.
        Radiographics. 2007; 27: S37-51
        • Son J.H.
        • Jung H.K.
        • Song J.W.
        • Baek H.J.
        • Doo K.W.
        • Kim W.
        • et al.
        Incidentally detected breast lesions on chest CT with US correlation: a pictorial essay.
        Diagn Interv Radiol. 2016; 22: 514-518
        • Bach A.G.
        • Abbas J.
        • Jasaabuu C.
        • Schramm D.
        • Wienke A.
        • Surov A.
        Comparison between incidental malignant and benign breast lesions detected by computed tomography: a systematic review.
        J Med Imaging Radiat Oncol. 2013; 57: 529-533
        • Moschetta M.
        • Scardapane A.
        • Lorusso V.
        • Rella L.
        • Telegrafo M.
        • Serio G.
        • et al.
        Role of multidetector computed tomography in evaluating incidentally detected breast lesions.
        Tumori. 2015; 101: 455-460
        • Lin Y.P.
        • Hsu H.H.
        • Ko K.H.
        • Chu C.M.
        • Chou Y.C.
        • Chang W.C.
        • et al.
        Differentiation of malignant and benign incidental breast lesions detected by chest multidetector-row computed tomography: added value of quantitative enhancement analysis.
        PLoS One. 2016; 11e0154569
        • O'Connell A.M.
        • Karellas A.
        • Vedantham S.
        The potential role of dedicated 3D breast CT as a diagnostic tool: review and early clinical examples.
        Breast J. 2014; 20: 592-605
        • Sarno A.
        • Mettivier G.
        • Di Lillo F.
        • Cesarelli M.
        • Bifulco P.
        • Russo P.
        Cone-beam micro computed tomography dedicated to the breast.
        Med Eng Phys. 2016; 38: 1449-1457
        • Reiser I.
        • Nishikawa R.M.
        • Giger M.L.
        • Boone J.M.
        • Lindfors K.K.
        • Yang K.
        Automated detection of mass lesions in dedicated breast CT: a preliminary study.
        Med Phys. 2012; 39: 866-873
        • Boone J.M.
        • Kwan A.L.
        • Yang K.
        • Burkett G.W.
        • Lindfors K.K.
        • Nelson T.R.
        Computed tomography for imaging the breast.
        J Mammary Gland Biol Neoplasia. 2006; 11: 103-111
        • Salvatore M.
        • Margolies L.
        • Kale M.
        • Wisnivesky J.
        • Kotkin S.
        • Henschke C.I.
        • et al.
        Breast density: comparison of chest CT with mammography.
        Radiology. 2014; 270: 67-73
        • Margolies L.
        • Salvatore M.
        • Eber C.
        • Jacobi A.
        • Lee I.J.
        • Liang M.
        • et al.
        The general radiologist's role in breast cancer risk assessment: breast density measurement on chest CT.
        Clin Imaging. 2015; 39: 979-982
        • American College of Radiology
        Breast Imaging Reporting and Data System (BI-RADS).
        American College of Radiology, Reston, VA2013
        • Lee C.I.
        • Forman H.P.
        What we can and cannot see coming.
        Radiology. 2010; 257: 313-314
        • Yip R.
        • Henschke C.I.
        • Yankelevitz D.F.
        • Boffetta P.
        • Smith J.P.
        • Investigators I.E.L.C.
        The impact of the regimen of screening on lung cancer cure: a comparison of I-ELCAP and NLST.
        Eur J Cancer Prev. 2015; 24: 201-208
        • Henschke C.I.
        • Yip R.
        • Boffetta P.
        • Markowitz S.
        • Miller A.
        • Hanaoka T.
        • et al.
        CT screening for lung cancer: importance of emphysema for never smokers and smokers.
        Lung Cancer. 2015; 88: 42-47
        • Hecht H.S.
        • Cronin P.
        • Blaha M.J.
        • Budoff M.J.
        • Kazerooni E.A.
        • Narula J.
        • et al.
        SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: a report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology.
        J Cardiovasc Comput Tomogr. 2016; 2016
        • Azour L.
        • Kadoch M.A.
        • Ward T.J.
        • Eber C.D.
        • Jacobi A.H.
        Estimation of cardiovascular risk on routine chest CT: ordinal coronary artery calcium scoring as an accurate predictor of Agatston score ranges.
        J Cardiovasc Comput Tomogr. 2017; 11: 8-15
        • Shemesh J.
        • Henschke C.I.
        • Shaham D.
        • Yip R.
        • Farooqi A.O.
        • Cham M.D.
        • et al.
        Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease.
        Radiology. 2010; 257: 541-548
        • Romme E.A.
        • Murchison J.T.
        • Phang K.F.
        • Jansen F.H.
        • Rutten E.P.
        • Wouters E.F.
        • et al.
        Bone attenuation on routine chest CT correlates with bone mineral density on DXA in patients with COPD.
        J Bone Miner Res. 2012; 27: 2338-2343
        • Pickhardt P.J.
        • Pooler B.D.
        • Lauder T.
        • del Rio A.M.
        • Bruce R.J.
        • Binkley N.
        Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications.
        Ann Intern Med. 2013; 158: 588-595
        • Liu S.
        • Xie Y.
        • Reeves A.P.
        Automated 3D closed surface segmentation: application to vertebral body segmentation in CT images.
        Int J Comput Assist Radiol Surg. 2016; 11: 789-801
        • Budoff M.J.
        • Malpeso J.M.
        • Zeb I.
        • Gao Y.L.
        • Li D.
        • Choi T.Y.
        • et al.
        Measurement of phantomless thoracic bone mineral density on coronary artery calcium CT scans acquired with various CT scanner models.
        Radiology. 2013; 267: 830-836
        • Raju P.
        • Sallomi D.
        • George B.
        • Patel H.
        • Patel N.
        • Lloyd G.
        Aortic valve calcification - a commonly observed but frequently ignored finding during CT scanning of the chest.
        Int J Clin Pract. 2012; 66: 552-555
        • Chetlen A.
        • Mack J.
        • Chan T.
        Breast cancer screening controversies: who, when, why, and how?.
        Clin Imaging. 2016; 40: 279-282
        • Schramm D.
        • Jasaabuu C.
        • Bach A.G.
        • Tennstedt O.
        • Spielmann R.P.
        • Surov A.
        Costs associated with evaluation of incidental breast lesions identified on computed tomography.
        Br J Radiol. 2016; 8920140847