Audit on breast ultrasound in women under 25 years

Fibroadenoma of the breast; incidence of malignancy and indicators for surgical intervention: An analysis of 1392 patients

BACKGROUND

Fibroadenomas are common among young females. The size of the lesion used to be an indication for further assessment or excision. With arising of the watch and see proponents, criteria for selecting patients are important to establish.

METHODS

This is a retrospective study of a prospectively maintained database where all patients having the clinical/radiological provisional diagnosis of fibroadenoma and attending our center - from January 2008 to March 2020 - were enrolled. The primary outcome was the incidence of malignancy and the secondary outcomes were the correlation of malignancy-risk with epidemiologic and radiologic criteria.

RESULTS

The study enrolled 1392 patients. The mean age of the patients was 35.7 + ∕- 13.1 years. The median of the longest diameter of the detected breast lesions was 25 mm. The incidence of malignancy was 188 (13.5%). The size of the lesion measured by largest diameter was insignificant (p = 0.99), while the patients' age, marital status, and imaging criteria as measured by BIRADS score were significant (<0.001).

CONCLUSION

Approaching patients with the age above 35 or with BIRADS 4 provisionally diagnosed with fibroadenomas should be cautious with biopsy and short-term follow-ups The size of the tumor alone should not be used as an indication for surgical intervention.

Prevalence of breast fibroadenoma in healthy physical examination population in Guangdong province of China: a cross-sectional study

OBJECTIVE

To provide an accurate assessment of the prevalence of breast fibroadenoma in a large population and to confirm the diagnostic accuracy of ultrasound for fibroadenoma.

DESIGN

This was a cross-sectional survey.

SETTING

This research was conducted at Nanfang Hospital, Guangzhou, Guangdong, China.

PARTICIPANTS

A total of 11 898 women aged 18-40 years who underwent breast screening between 1 January 2019 and 31 December 2019 were included in the fibroadenoma prevalence study. From 1 June 2019 to 31 December 2019, 342 breast lesions with pathology reports and preoperative ultrasound images were collected for diagnostic fibroadenoma testing (vs histological diagnostic testing).

PRIMARY OUTCOME MEASURES

Pearson's χ² test was performed to compare the prevalence of different lesions between age groups, and descriptive statistics were used to report the clinical characteristics of fibroadenoma. For ultrasound diagnosis, fibroadenoma was defined as a well-circumscribed lesion with round or oval shape, consisting of a homogeneously hypoechoic or isoechoic solid mass, located parallel to the chest wall with a smooth margin and no posterior shadowing. Diagnostic test results for breast fibroadenoma were stratified by diagnostic type (histological vs ultrasound).

RESULTS

Of the women aged 18-40 years, 27.6% (3285/11 898) had an ultrasound diagnosis offibroadenoma. Of these, the prevalence of fibroadenoma was stable across age groups (p=0.14) and did not differ between the left and right sides of the breast. Almost two-thirds of women presented with a single fibroadenoma, and most fibroadenomas did not exceed 1 cm in size. The sensitivity and specificity for fibroadenoma were 97.0% (95% CI for sensitivity: 93.7% to 98.8%) and 91.4% (95% CI for specificity: 85.4% to 95.5%) for ultrasonography, respectively.

CONCLUSIONS

The prevalence of fibroadenoma in South China is as high as 27.6%, and ultrasound could be used as a tool to diagnose fibroadenoma.

Family History, Reproductive, and Lifestyle Risk Factors for Fibroadenoma and Breast Cancer

Background

To understand which breast cancer (BC) risk factors also increase the risk of fibroadenoma and investigate whether these factors have the same effect in BC patients with previous fibroadenoma.

Methods

Using multistate survival analysis on a large dataset (n = 58 322), we examined the effects of BC risk factors on transitions between three states: event-free, biopsy-confirmed fibroadenoma, and BC. Hazard ratios and corresponding 95% confidence intervals associated with covariate effects were estimated. Median follow-up time was 25.3 years.

Results

The mean ages at diagnosis of fibroadenoma and BC were 42.6 and 48.3 years, respectively. Participant characteristics known to increase the risk of BC were found to increase the risk of fibroadenoma (family history of BC and higher education). Participant characteristics known to confer protective effects for BC (older age at menarche, more children, and larger childhood body size) were found to reduce fibroadenoma risk. The effect sizes associated with the direct transitions from event-free to fibroadenoma and BC were generally not different for the covariates tested. Age at fibroadenoma diagnosis was associated with the transition from fibroadenoma to BC (hazard ratio_{per year increase} = 1.07 [95% confidence interval = 1.03 to 1.12]).

Conclusion

We showed that biopsy-confirmed fibroadenomas shared many risk factors with BC. More work is needed to understand the relationships between fibroadenoma and BC to identify women who are at high risk of developing BC after a fibroadenoma diagnosis.

Segmentation of Breast Lesions in Ultrasound Images through Multiresolution Analysis Using Undecimated Discrete Wavelet Transform

Earliest detection and diagnosis of breast cancer reduces mortality rate of patients by increasing the treatment options. A novel method for the segmentation of breast ultrasound images is proposed in this work. The proposed method utilizes undecimated discrete wavelet transform to perform multiresolution analysis of the input ultrasound image. As the resolution level increases, although the effect of noise reduces, the details of the image also dilute. The appropriate resolution level, which contains essential details of the tumor, is automatically selected through mean structural similarity. The feature vector for each pixel is constructed by sampling intra-resolution and inter-resolution data of the image. The dimensionality of feature vectors is reduced by using principal components analysis. The reduced set of feature vectors is segmented into two disjoint clusters using spatial regularized fuzzy c-means algorithm. The proposed algorithm is evaluated by using four validation metrics on a breast ultrasound database of 150 images including 90 benign and 60 malignant cases. The algorithm produced significantly better segmentation results (Dice _coef = 0.8595, boundary displacement error = 9.796, d_vi = 1.744, and global consistency error = 0.1835) than the other three state of the art methods.

Ultrasonographic features and clinical implications of benign palpable breast lesions in young women

PURPOSE

The purpose of this study was to describe the breast ultrasonography (US) features and to investigate whether performing a core biopsy is warranted in young women having palpable solid breast masses.

METHODS

A total of 76 solid palpable masses in 68 consecutive women (≤25 years old) underwent tissue diagnosis by percutaneous core biopsy. Two radiologists, who were blinded to the clinical history and histopathology, independently evaluated the US features according to Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The frequency of benign and malignant descriptor terms that were used to characterize the lesions were compared to the final pathology.

RESULTS

All 76 palpable solid masses yielded benign pathology. On the US, the shape of the mass was described by radiologists 1 and 2 as oval or round (63.2% and 71.1%), margin as circumscribed (68.4% and 77.6%) and orientation as parallel (85.5% and 90.8%); the frequency of using all three benign descriptors was 61.8% and 68.5%, respectively. Suspicious descriptors were used less frequently by radiologists 1 and 2 including irregular shape (9.2% and 13.1%), non-circumscribed margin (31.6% and 22.4%) and non-parallel orientation (14.5% and 9.2%); the frequency of using all three suspicious descriptors was 9.2% and 11.8%, respectively.

CONCLUSION

Despite the variable US features, breast malignancy seems extremely low in 25 years or younger women for palpable breast lesions. Using the BI-RADS lexicon, US accurately predicted benignity in about two thirds of our patients, supporting US surveillance as a safe alternative to invasive tissue sampling in this setting.