Laurie Margolies, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS
Terminology
Imaging
Clinical Issues
TERMINOLOGY
Definitions
Screening mammogram: Testing to detect cancer in women with no signs or symptoms of breast cancer
Diagnostic mammogram: Examination performed with monitoring by on-site radiologist
Symptoms: Lump, nipple discharge or retraction, change in breast size or shape, skin thickening or retraction
Recall from screening for additional imaging or follow-up of abnormality noted on prior breast imaging
Missed cancer: Visible in retrospect on prior breast imaging
True miss: Suspicious finding at cancer site on review
Errors in perception: Finding overlooked
Satisfaction of search, technical problems, inherent features of cancer &/or surrounding tissue (poor lesion conspicuity, subtle findings), fatigue, workplace distractions and interruptions
Errors in interpretation: Finding seen but dismissed as normal or benign
Subthreshold finding: Perceptible finding without characteristics judged as having required further work-up at that time
False-negatives (FN) on audits are specifically defined
Tissue diagnosis of cancer within screening interval (in USA typically within 365 days) after prior screening reported as negative or benign
Or prior diagnostic imaging negative, benign, or probably benign
FN even if cancer not visible in retrospect
FN even if detected by early next screen
If > 1 year (USA, assuming 1-year screening interval suggested) has elapsed since prior examination, it is not FN at audit, even if cancer is visible in retrospect
Actionable: Retrospective determination that finding was present on prior examination at site of malignancy that should have prompted further evaluation
Retrospective blinded studies found actionable findings on 25-41% prior screening mammograms
When normal cases included (2 of 6 studies): 27-29% of missed cancers actionable
Retrospective nonblinded studies of screening mammograms found actionable findings in 23-77%
Interval cancer: Cancers detected clinically between recommended screenings
Time interval varies based on screening recommendations: 12-36 months
10-12% of breast cancers in fatty breasts; > 50% in women with dense breasts
Tend to be larger, higher grade; lymph node metastases more likely compared to screen-detected cancers
Some interval cancers are missed cancers; others are occult on imaging ("true interval" cancer)
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Presentation
Demographics
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Clauser P et al: Motion artifacts, lesion type, and parenchymal enhancement in breast MRI: what does really influence diagnostic accuracy? Acta Radiol. 284185118770918, 2018
Ekpo EU et al: Errors in mammography cannot be solved through technology alone Asian Pac J Cancer Prev. 19(2):291-301, 2018
Mordang JJ et al: The importance of early detection of calcifications associated with breast cancer in screening. Breast Cancer Res Treat. 167(2):451-58, 2018
Schreutelkamp IL et al: Breast cancers missed by screening radiologists can be detected by reading mammograms at a distance. Ir J Med Sci. ePub, 2018
Vreemann S et al: The frequency of missed breast cancers in women participating in a high-risk MRI screening program. Breast Cancer Res Treat. ePub, 2018
Grubstein A et al: Analysis of false-negative readings of automated breast ultrasound studies. J Clin Ultrasound. 45(5):245-51, 2017
Lekanidi K et al: Breast screening: what can the interval cancer review teach us? Are we perhaps being a bit too hard on ourselves? Eur J Radiol. 94:13-15, 2017
Margolies LR et al: The chest radiologist's role in invasive breast cancer detection. Clin Imaging. 50:13-19, 2017
Mohd Norsuddin N et al: An investigation into the mammographic appearances of missed breast cancers when recall rates are reduced. Br J Radiol. 90(1076):20170048, 2017
Warren LM et al: Image processing can cause some malignant soft-tissue lesions to be missed in digital mammography images. Clin Radiol. 72(9):799.e1-799.e8, 2017
Yoon JH et al: Ultrasonographic evaluation of women with pathologic nipple discharge. Ultrasonography. 36(4):310-320, 2017
Yun SJ et al: Benefit of adding digital breast tomosynthesis to digital mammography for breast cancer screening focused on cancer characteristics: a meta-analysis. Breast Cancer Res Treat. 164(3):557-569, 2017
Zuckerman SP et al: Imaging with synthesized 2D mammography: differences, advantages, and pitfalls compared with digital mammography. AJR Am J Roentgenol. 209(1):222-29, 2017
Gubern-Mérida A et al: Automated detection of breast cancer in false-negative screening MRI studies from women at increased risk. Eur J Radiol. 85(2):472-9, 2016
Hayward JH et al: Improving screening mammography outcomes through comparison with multiple prior mammograms. AJR Am J Roentgenol. 207(4):918-24, 2016
Korhonen KE et al: Strategies to increase cancer detection: review of true-positive and false-negative results at digital breast tomosynthesis screening. Radiographics. 36(7):1954-65, 2016
Palazzetti V et al: Analysis of mammographic diagnostic errors in breast clinic. Radiol Med. 121(11):828-33, 2016
Seo M et al: Features of undiagnosed breast cancers at screening breast mr imaging and potential utility of computer-aided evaluation. Korean J Radiol. 17(1):59-68, 2016
Wadhwa A et al: Missed breast cancer: what can we learn? Curr Probl Diagn Radiol. 45(6):402-19, 2016
Geertse TD et al: Value of audits in breast cancer screening quality assurance programmes. Eur Radiol. 25(11):3338-47, 2015
Song SE et al: Undiagnosed breast cancer: features at supplemental screening US. Radiology. 277(2):372-80, 2015
Bae MS et al: Breast cancer detected with screening US: reasons for nondetection at mammography. Radiology. 270(2):369-77, 2014
Uematsu T: Ultrasonographic findings of missed breast cancer: pitfalls and pearls. Breast Cancer. 21(1):10-9, 2014
Yeh ED et al: Positioning in breast MR imaging to optimize image quality. Radiographics. 34(1):E1-17, 2014
Evans KK et al: If you don't find it often, you often don't find it: why some cancers are missed in breast cancer screening. PLoS One. 8(5):e64366, 2013
Hoff SR et al: Breast cancer: missed interval and screening-detected cancer at full-field digital mammography and screen-film mammography-- results from a retrospective review. Radiology. 264(2):378-86, 2012
Nishikawa RM et al: Clinically missed cancer: how effectively can radiologists use computer-aided detection? AJR Am J Roentgenol. 198(3):708-16, 2012
Pages EB et al: Undiagnosed breast cancer at MR imaging: analysis of causes. Radiology. 264(1):40-50, 2012
Obdeijn IM et al: Assessment of false-negative cases of breast MR imaging in women with a familial or genetic predisposition. Breast Cancer Res Treat. 119(2):399-407, 2010
Schnall MD et al: Diagnostic architectural and dynamic features at breast MR imaging: multicenter study. Radiology. 238(1):42-53, 2006
Bassett LW et al: Diagnosis of diseases of the breast. 2nd ed. Philadelphia: Elsevier-Saunders. 193-223, 2005
Wolfe JM et al: Cognitive psychology: rare items often missed in visual searches. Nature. 435(7041):439-40, 2005
Roubidoux MA et al: Invasive cancers detected after breast cancer screening yielded a negative result: relationship of mammographic density to tumor prognostic factors. Radiology. 230(1):42-8, 2004
Ikeda DM et al: Analysis of 172 subtle findings on prior normal mammograms in women with breast cancer detected at follow-up screening. Radiology. 226(2):494-503, 2003
Majid AS et al: Missed breast carcinoma: pitfalls and pearls. Radiographics. 23(4):881-95, 2003
Birdwell RL et al: Mammographic characteristics of 115 missed cancers later detected with screening mammography and the potential utility of computer-aided detection. Radiology. 219(1):192-202, 2001
Ganott MA et al: Analysis of false-negative cancer cases identified with a mammography audit. Breast J. 5(3):166-175, 1999
Siegle RL et al: Rates of disagreement in imaging interpretation in a group of community hospitals. Acad Radiol. 5(3):148-54, 1998
Nodine CF et al: Nature of expertise in searching mammograms for breast masses. Acad Radiol. 3(12):1000-6, 1996
Harvey JA et al: Previous mammograms in patients with impalpable breast carcinoma: retrospective vs blinded interpretation. 1993 ARRS President's Award. AJR Am J Roentgenol. 161(6):1167-72, 1993
Bird RE et al: Analysis of cancers missed at screening mammography. Radiology. 184(3):613-7, 1992
Related Anatomy
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Clinical Issues
TERMINOLOGY
Definitions
Screening mammogram: Testing to detect cancer in women with no signs or symptoms of breast cancer
Diagnostic mammogram: Examination performed with monitoring by on-site radiologist
Symptoms: Lump, nipple discharge or retraction, change in breast size or shape, skin thickening or retraction
Recall from screening for additional imaging or follow-up of abnormality noted on prior breast imaging
Missed cancer: Visible in retrospect on prior breast imaging
True miss: Suspicious finding at cancer site on review
Errors in perception: Finding overlooked
Satisfaction of search, technical problems, inherent features of cancer &/or surrounding tissue (poor lesion conspicuity, subtle findings), fatigue, workplace distractions and interruptions
Errors in interpretation: Finding seen but dismissed as normal or benign
Subthreshold finding: Perceptible finding without characteristics judged as having required further work-up at that time
False-negatives (FN) on audits are specifically defined
Tissue diagnosis of cancer within screening interval (in USA typically within 365 days) after prior screening reported as negative or benign
Or prior diagnostic imaging negative, benign, or probably benign
FN even if cancer not visible in retrospect
FN even if detected by early next screen
If > 1 year (USA, assuming 1-year screening interval suggested) has elapsed since prior examination, it is not FN at audit, even if cancer is visible in retrospect
Actionable: Retrospective determination that finding was present on prior examination at site of malignancy that should have prompted further evaluation
Retrospective blinded studies found actionable findings on 25-41% prior screening mammograms
When normal cases included (2 of 6 studies): 27-29% of missed cancers actionable
Retrospective nonblinded studies of screening mammograms found actionable findings in 23-77%
Interval cancer: Cancers detected clinically between recommended screenings
Time interval varies based on screening recommendations: 12-36 months
10-12% of breast cancers in fatty breasts; > 50% in women with dense breasts
Tend to be larger, higher grade; lymph node metastases more likely compared to screen-detected cancers
Some interval cancers are missed cancers; others are occult on imaging ("true interval" cancer)
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Presentation
Demographics
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Clauser P et al: Motion artifacts, lesion type, and parenchymal enhancement in breast MRI: what does really influence diagnostic accuracy? Acta Radiol. 284185118770918, 2018
Ekpo EU et al: Errors in mammography cannot be solved through technology alone Asian Pac J Cancer Prev. 19(2):291-301, 2018
Mordang JJ et al: The importance of early detection of calcifications associated with breast cancer in screening. Breast Cancer Res Treat. 167(2):451-58, 2018
Schreutelkamp IL et al: Breast cancers missed by screening radiologists can be detected by reading mammograms at a distance. Ir J Med Sci. ePub, 2018
Vreemann S et al: The frequency of missed breast cancers in women participating in a high-risk MRI screening program. Breast Cancer Res Treat. ePub, 2018
Grubstein A et al: Analysis of false-negative readings of automated breast ultrasound studies. J Clin Ultrasound. 45(5):245-51, 2017
Lekanidi K et al: Breast screening: what can the interval cancer review teach us? Are we perhaps being a bit too hard on ourselves? Eur J Radiol. 94:13-15, 2017
Margolies LR et al: The chest radiologist's role in invasive breast cancer detection. Clin Imaging. 50:13-19, 2017
Mohd Norsuddin N et al: An investigation into the mammographic appearances of missed breast cancers when recall rates are reduced. Br J Radiol. 90(1076):20170048, 2017
Warren LM et al: Image processing can cause some malignant soft-tissue lesions to be missed in digital mammography images. Clin Radiol. 72(9):799.e1-799.e8, 2017
Yoon JH et al: Ultrasonographic evaluation of women with pathologic nipple discharge. Ultrasonography. 36(4):310-320, 2017
Yun SJ et al: Benefit of adding digital breast tomosynthesis to digital mammography for breast cancer screening focused on cancer characteristics: a meta-analysis. Breast Cancer Res Treat. 164(3):557-569, 2017
Zuckerman SP et al: Imaging with synthesized 2D mammography: differences, advantages, and pitfalls compared with digital mammography. AJR Am J Roentgenol. 209(1):222-29, 2017
Gubern-Mérida A et al: Automated detection of breast cancer in false-negative screening MRI studies from women at increased risk. Eur J Radiol. 85(2):472-9, 2016
Hayward JH et al: Improving screening mammography outcomes through comparison with multiple prior mammograms. AJR Am J Roentgenol. 207(4):918-24, 2016
Korhonen KE et al: Strategies to increase cancer detection: review of true-positive and false-negative results at digital breast tomosynthesis screening. Radiographics. 36(7):1954-65, 2016
Palazzetti V et al: Analysis of mammographic diagnostic errors in breast clinic. Radiol Med. 121(11):828-33, 2016
Seo M et al: Features of undiagnosed breast cancers at screening breast mr imaging and potential utility of computer-aided evaluation. Korean J Radiol. 17(1):59-68, 2016
Wadhwa A et al: Missed breast cancer: what can we learn? Curr Probl Diagn Radiol. 45(6):402-19, 2016
Geertse TD et al: Value of audits in breast cancer screening quality assurance programmes. Eur Radiol. 25(11):3338-47, 2015
Song SE et al: Undiagnosed breast cancer: features at supplemental screening US. Radiology. 277(2):372-80, 2015
Bae MS et al: Breast cancer detected with screening US: reasons for nondetection at mammography. Radiology. 270(2):369-77, 2014
Uematsu T: Ultrasonographic findings of missed breast cancer: pitfalls and pearls. Breast Cancer. 21(1):10-9, 2014
Yeh ED et al: Positioning in breast MR imaging to optimize image quality. Radiographics. 34(1):E1-17, 2014
Evans KK et al: If you don't find it often, you often don't find it: why some cancers are missed in breast cancer screening. PLoS One. 8(5):e64366, 2013
Hoff SR et al: Breast cancer: missed interval and screening-detected cancer at full-field digital mammography and screen-film mammography-- results from a retrospective review. Radiology. 264(2):378-86, 2012
Nishikawa RM et al: Clinically missed cancer: how effectively can radiologists use computer-aided detection? AJR Am J Roentgenol. 198(3):708-16, 2012
Pages EB et al: Undiagnosed breast cancer at MR imaging: analysis of causes. Radiology. 264(1):40-50, 2012
Obdeijn IM et al: Assessment of false-negative cases of breast MR imaging in women with a familial or genetic predisposition. Breast Cancer Res Treat. 119(2):399-407, 2010
Schnall MD et al: Diagnostic architectural and dynamic features at breast MR imaging: multicenter study. Radiology. 238(1):42-53, 2006
Bassett LW et al: Diagnosis of diseases of the breast. 2nd ed. Philadelphia: Elsevier-Saunders. 193-223, 2005
Wolfe JM et al: Cognitive psychology: rare items often missed in visual searches. Nature. 435(7041):439-40, 2005
Roubidoux MA et al: Invasive cancers detected after breast cancer screening yielded a negative result: relationship of mammographic density to tumor prognostic factors. Radiology. 230(1):42-8, 2004
Ikeda DM et al: Analysis of 172 subtle findings on prior normal mammograms in women with breast cancer detected at follow-up screening. Radiology. 226(2):494-503, 2003
Majid AS et al: Missed breast carcinoma: pitfalls and pearls. Radiographics. 23(4):881-95, 2003
Birdwell RL et al: Mammographic characteristics of 115 missed cancers later detected with screening mammography and the potential utility of computer-aided detection. Radiology. 219(1):192-202, 2001
Ganott MA et al: Analysis of false-negative cancer cases identified with a mammography audit. Breast J. 5(3):166-175, 1999
Siegle RL et al: Rates of disagreement in imaging interpretation in a group of community hospitals. Acad Radiol. 5(3):148-54, 1998
Nodine CF et al: Nature of expertise in searching mammograms for breast masses. Acad Radiol. 3(12):1000-6, 1996
Harvey JA et al: Previous mammograms in patients with impalpable breast carcinoma: retrospective vs blinded interpretation. 1993 ARRS President's Award. AJR Am J Roentgenol. 161(6):1167-72, 1993
Bird RE et al: Analysis of cancers missed at screening mammography. Radiology. 184(3):613-7, 1992
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