The Relationship Between Mammographic Density and Factors Affecting Breast Cancer Risk.

Objectives: Although the relationship between breast cancer (BC) risk factors and mammographic density (MD) patterns is not clear, high MD is well known as an independent risk factor for BC. Thus, the aim of this study was to examine the association between MD and BC risk factors in BC patients and find a correlation between MD and tumor characteristics in BC patients. Methods: Our data included 242 patients with BC. Furthermore, the MD (type I - <25%; type II - 25-50%; type III - 51-75%; and type IV - >75%) was categorized according to percentile density, and the various types of MD were compared using risk factors for BC and tumor characteristics of patients. Results: The results of this study indicated that younger age, pre-menopausal status, younger menarche age, nulliparity, low body mass index, and smoking significantly increase the percentage of MD (p<0.001, p<0.001, p=0.04, p<0.001, p=0.003, and p=0.01, respectively). Moreover, the distribution of MD patterns showed significant differences according to tumor subtypes. Type 4 mammographic pattern was higher in patients with human epidermal growth factor receptor 2 (Her2) type of tumor (p=0.01). Conclusion: Higher MD is related to reproductive risk factors and tumor subtypes, especially Her2 type, in BC patients. Further studies are needed to identify the factors related to breast density.

Centralization of mammography reporting with mobile trucks: Turkish experience.

Screening via mammography is a complex process to be implemented. OBJECTIVE: To report the initial results and the effectiveness of newly implemented Turkey's population based breast cancer screening program performed for 40-69 years old women; and effectiveness of the newly implemented out-sourcing mobile trucks and national central report center. The study is conducted prospectively in one year (March 2016-March 2017) in all 81 provinces of Turkey. Mammography images were transferred via on-line web based system to the central reporting center. BI-RADS Scores and KETEM models (Mobile vs. Stationary) were the parameters were compared. In total mammography images of 414.802 patients were transferred from 155 KETEMs to the central reporting center. From these patients; 95.872 (23,1%) were aged between 40 and 44. Among all images, 21.999 (5,3%) were BI-RADS 0-4-5, 391.123 (94,3%) were BI-RADS 1-2. Totally recall rate of the national reporting center was 5.3%. Number of patients screened per day were significantly higher in out-sourcing mobile trucks compared to stationary KETEMs (31.8 vs. 8.9; p < 0.05). This is the first and the largest breast cancer screening study which results of a population based mammography screening for 40-69 years old women are evaluated at the same time with the evaluation of the efficacy of newly implemented centralized reporting center and the mobile screening trucks in comparison with stationary cancer screening centers. According to the initial results; Turkey's newly implemented population based breast cancer screening system seems to be feasible and effective.

The Relationship Between Breast Cancer and Risk Factors: A Single-Center Study.

OBJECTIVE: To determine the relationship between breast cancer and known risk factors in patients who had mammography (MG) for breast cancer screening or ultrasonography and/or MG for diagnostic purposes. MATERIALS AND METHODS: In the period of January-December, 2011, a questionnaire composed of 17 questions was applied to 2862 female patients and MG and/or US examination was performed afterwards. Chi-square and Kruskal-Wallis tests were used for statistical analysis. RESULTS: The mean age was 51.05±8.98, age at menarche was 13.0±1.6 and age at menopause was 47±5.2. The first pregnancy was at 20±4.6. Out of 2862 cases, 242 had breast cancer diagnosis and 32 were newly diagnosed. There was no correlation between menarche age, age at menopause or first pregnancy and breast cancer. There was no relationship between breast cancer risk and hormone replacement therapy or oral contraceptive use. In patients with the diagnosis of breast cancer (242 cases), 61 had (25%) a positive family history. There was a significant correlation between the presence of a positive family history and having breast cancer (p=0.003). CONCLUSION: The presence of breast cancer in the family has the strongest relationship among all risk factors. It is important to have regular followup of these patients and to raise the awareness of patients.

Ultrasound Findings in a Case of Myeloid Sarcoma of the Breast.

Myeloid sarcoma is a rare, solid extramedullary tumor originating from immature granulocytic cells or monocytes. Breast involvement without an aleukemic or myeloproliferative disorder is very infrequent. A 21-year-old female patient was admitted with bilateral palpable breast masses for four months. The patient had given birth approximately one year ago. The ultrasonographic examination revealed multiple, oval shaped-some of them with microlubulated margins-hypoechoic, solid masses of which, the largest mass measured 4.5 × 2.5 cm, evaluated as BI-RADS 4. The histopthological examination suggested hematolymphoid neoplasm. In the differential diagnosis of solid breast lesions, myeloid sarcoma should be kept in mind even without hematological findings. Early diagnosis of this tumor is important for the effectiveness of the medical treatment.

Association of breast arterial calcification and osteoporosis in Turkish women.

OBJECTIVE: Breast arterial calcification (BAC), medial calcific sclerosis of small to medium-sized muscular arteries, is a benign finding of mammographic evaluation. Previous studies have shown the relationships between BAC and systemic disorders such as cardiovascular disease, diabetes mellitus and hypertension. The aim of this study was to determine the association between reduced bone mineral density and BAC. METHODS: The study population consisted of 567 women who had both mammography and bone mineral density evaluation. BAC (+) and BAC (-) women were compared for age, body mass index, postmenopausal duration, number of deliveries, breastfeeding duration, DM, HT, lipid treatment, osteopenia, and osteoporosis. RESULTS: BAC was seen in mammographic evaluation of 179 women and 388 subjects without BAC accepted as the control group. There was a statistically significant relationship between age, postmenopausal duration, number of deliveries, history of DM, HT, lipid treatment and BAC. While the prevalence of osteopenia was higher in control group (52.8%), the rate of osteoporosis (48.7%) was higher in group with BAC. CONCLUSION: There was statistically significant relationship between BAC and osteoporosis in postmenopausal women. Determination of BAC in routine screening mammography might be helpful in both identifying women with risk of cardiovascular disease and osteoporosis.

Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation.

PURPOSE: We aimed to evaluate ultrasonography (US) findings for Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions using BI-RADS US lexicon and determine the positive and negative predictive values (PPV and NPV) of US with respect to biopsy results. METHODS: Sonograms of 186 BI-RADS 4 nonpalpable breast lesions with a known diagnosis were reviewed retrospectively. The morphologic features of all lesions were described using BI-RADS lexicon and the lesions were subcategorized into 4A, 4B, and 4C on the basis of the physician's level of suspicion. Lesion descriptors and biopsy results were correlated. Pathologic results were compared with US features. PPVs of BI-RADS subcategories 4A, 4B, and 4C were calculated. RESULTS: Of 186 lesions, 38.7% were malignant and 61.2% were benign. PPVs according to subcategories 4A, 4B, and 4C were 19.5%, 41.5%, and 74.3%, respectively. Microlobulated, indistinct, and angular margins, posterior acoustic features, and echo pattern were nonspecific signs for nonpalpable BI-RADS 4 lesions. Typical signs of malignancy were irregular shape (PPV, 66%), spiculated margin (PPV, 80%) and nonparallel orientation (PPV, 58.9%). Typical signs of benign lesions were oval shape (NPV, 77.1%), circumscribed margin (NPV, 67.5%), parallel orientation (NPV, 70%), and abrupt interface (NPV, 67.6%). CONCLUSION: BI-RADS criteria are not sufficient for discriminating between malignant and benign lesions, and biopsy is required. Subcategories 4A, 4B, and 4C are useful in predicting the likelihood of malignancy. However, objective and clear subclassification rules are needed.

Interobserver and Intraobserver Agreement of Sonographic BIRADS Lexicon in the Assessment of Breast Masses.

BACKGROUND: BI-RADS was first developed in 1993 for mammography and in 2003 it was redesigned for ultrasonography (US). If the observer agreement is high, the method used in the classification of lesion would be reproducible. OBJECTIVES: The aim of this study is to evaluate the inter- and intraobserver agreement of sonographic BI-RADS lexicon in the categorization and feature characterization of nonpalpable breast lesions. PATIENTS AND METHODS: We included 223 patients with 245 nonpalpable breast lesions who underwent ultrasound-guided wire needle localization. Two radiologists retrospectively described each lesion using sonographic BI-RADS descriptors and final assessment. The observers were blinded to mammographic images, medical history and pathologic results. Inter- and intraobserver agreement was assessed using Kappa (κ) agreement coefficient. RESULTS: The interobserver agreement for sonographic descriptors changed between fair and substantial. The highest agreement was detected for mass orientation (κ=0.66). The lowest agreement was found in the margin (κ=0.33). The interobserver agreement for BI-RADS final category was found as fair (κ=0.35). The intraobserver agreement for sonographic descriptors changed between substantial and almost perfect. The intraobserver agreement of BI-RADS result category was found as substantial for observer 1 (κ=0.64) and excellent for observer 2 (κ=0.83). CONCLUSION: Our results demonstrated that each observer was self-consistent in interpreting US BI-RADS classification, while interobserver agreement was relatively poor. Although it has been ten years since the description of sonographic BI-RADS lexicon, further training and periodic performance evaluations would probably help to achieve better agreement among radiologists.

Bilateral invasive papillary carcinoma of the breast.

Papillary carcinoma, a rare malignant tumor of the breast, accounts for only 1-2% of breast tumors. It predominantly affects elderly women in the sixth decade to the eighth decade of life. The incidence of bilateral papillary carcinomas is very low, with only one case reported in the literature. However, there has been no report of a case of bilateral invasive papillary carcinoma. A case of bilateral invasive papillary carcinoma of the breasts, along with mammography and ultrasound findings, is reported here.