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BI-RADS 3 on dense breast screening ultrasound after digital mammography versus digital breast tomosynthesis

  • Elizabeth H. Dibble
    Correspondence
    Corresponding author at: The Warren Alpert Medical School of Brown University, Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, United States of America.
    Affiliations
    Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, United States of America
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  • Tisha M. Singer
    Affiliations
    Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, United States of America
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  • Grayson L. Baird
    Affiliations
    Lifespan Biostatistics Core and Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, United States of America
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  • Ana P. Lourenco
    Affiliations
    Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, United States of America
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      Highlights

      • Patients with prior digital breast tomosynthesis screening had a lower risk of encountering BI-RADS 3 findings on screening ultrasound compared to patients with prior digital mammography screening.
      • Many patients with BI-RADS 3 results on screening ultrasound did not complete recommended imaging follow-up.
      • BI-RADS 3 findings on screening ultrasound had an extremely low rate of being cancer.

      Abstract

      Objective

      Compare the BI-RADS 3 rate and follow-up of dense breast ultrasound (US) screening following digital mammography (DM) versus digital breast tomosynthesis (DBT).

      Methods

      IRB-approved, HIPAA compliant retrospective search was performed of databases at two tertiary breast centers and an office practice for BI-RADS 3 screening US examinations performed 10/1/14–9/30/16. Prior DM versus DBT, downgrade and upgrade rate, and timing and pathology results were recorded. Differences were compared using the two-sample proportions test.

      Results

      3183 screening US examinations were performed, 1434/3183 (45.1%) after DM and 1668/3183 (52%) after DBT (2.5% (81/3183) no prior mammogram available). 13.9% (199/1434) had BI-RADS 3 results after DM and 10.6% (177/1668) after DBT (p < 0.01). Median imaging follow-up after DM was 12 months (IQR 6, 24) versus 18 after DBT (IQR 11, 25), p = 0.02. 19.5% (73/375) of patients were lost to follow-up (19.2% (38/198) after DM (68.4% (26/38) no follow-up after initial exam) versus 19.8% (35/177) after DBT (54.3% (19/35) no follow-up after initial exam). 1.3% (5/375) of patients elected biopsy (1.5% (3/198) after DM and 1.1% (2/177) after DBT). 75.2% (282/375) of patients were downgraded (75.3% (149/198) after DM and 75.1% (133/177) after DBT). 2.5% (5/198) were upgraded after DM and 0.6% (1/177) after DBT. Median time to upgrade was 6 months after both DM and DBT. 0.3% (1/375) of patients with BI-RADS 3 results had cancer on follow-up.

      Conclusion

      Patients with prior DBT had a lower risk of encountering BI-RADS 3 findings on screening ultrasound. BI-RADS 3 findings on screening ultrasound had an extremely low rate of being cancer.

      Keywords

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