Position paper on screening for breast cancer by the European Society of Breast Imaging (EUSOBI) and 30 national breast radiology bodies from Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Israel, Lithuania, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Spain, Sweden, Switzerland and Turkey.

EUSOBI and 30 national breast radiology bodies support mammography for population-based screening, demonstrated to reduce breast cancer (BC) mortality and treatment impact. According to the International Agency for Research on Cancer, the reduction in mortality is 40 % for women aged 50-69 years taking up the invitation while the probability of false-positive needle biopsy is <1 % per round and overdiagnosis is only 1-10 % for a 20-year screening. Mortality reduction was also observed for the age groups 40-49 years and 70-74 years, although with "limited evidence". Thus, we firstly recommend biennial screening mammography for average-risk women aged 50-69 years; extension up to 73 or 75 years, biennially, is a second priority, from 40-45 to 49 years, annually, a third priority. Screening with thermography or other optical tools as alternatives to mammography is discouraged. Preference should be given to population screening programmes on a territorial basis, with double reading. Adoption of digital mammography (not film-screen or phosphor-plate computer radiography) is a priority, which also improves sensitivity in dense breasts. Radiologists qualified as screening readers should be involved in programmes. Digital breast tomosynthesis is also set to become "routine mammography" in the screening setting in the next future. Dedicated pathways for high-risk women offering breast MRI according to national or international guidelines and recommendations are encouraged. KEY POINTS: • EUSOBI and 30 national breast radiology bodies support screening mammography. • A first priority is double-reading biennial mammography for women aged 50-69 years. • Extension to 73-75 and from 40-45 to 49 years is also encouraged. • Digital mammography (not film-screen or computer radiography) should be used. • DBT is set to become "routine mammography" in the screening setting in the next future.

Large rodlike calcifications at mammography: analysis of morphologic features.

OBJECTIVE: The purpose of this article is to prospectively determine the prevalence and morphologic features of typically benign large rodlike calcifications at mammography and to provide evidence-based data for this descriptor in a future version of the BI-RADS lexicon. SUBJECTS AND METHODS: In the 1-year period of 2011, large rodlike calcifications were detected in 239 of 7935 (3%) consecutive women undergoing screening or diagnostic mammography. Analysis of morphologic features was performed in 165 of the 239 women (69%; mean age, 71.1 years; range, 39-86 years), who had a minimum number of six calcific particles and in whom benignity was assessed by lack of suspicious change compared with prior mammograms. Two of the 165 women had undergone a mastectomy previously. RESULTS: The mean length of the longest calcification was 4.2 (SD, 2.4) mm (median, 3.5 mm; range, 1-14 mm). The mean width of the widest calcification was 0.6 (SD, 0.5) mm (median, 0.5 mm; range 0.2-3 mm). Bilaterality was found in 131 of 163 women (80.4%) with two breasts, periductal calcifications were found in 18 of 165 women (10.9%), and branching calcifications were found in another 18 women (10.9%). One hundred fifty-five of 165 women (93.9%) had almost entirely fat or scattered areas of fibroglandular tissue; 10 women (6.1%) had heterogeneously dense or extremely dense tissue. CONCLUSION: Our results partially contradict the current description (size, diameter, and bilaterality versus unilaterality) of large rodlike calcifications in the BI-RADS lexicon. Content for this descriptor should be modified in a future version of the lexicon.

Probably benign breast masses at US: is follow-up an acceptable alternative to biopsy?

PURPOSE: To retrospectively determine whether nonpalpable solid breast masses that were partially or completely obscured at mammography and diagnosed as probably benign only at ultrasonography (US) can be safely managed with follow-up. MATERIALS AND METHODS: The local ethics committee approved this study; informed consent was not required. In 409 women, 448 nonpalpable solid masses were identified and classified as probably benign at US; at mammography these masses were either partially or completely obscured by dense fibroglandular tissue. Of the 448 masses, 445 were followed up, while biopsy was performed after initial imaging in the remaining three. False-negative rates, negative predictive values (NPVs), and exact 95% confidence intervals (CIs) were calculated. RESULTS: Of the 445 masses, 442 remained stable at follow-up (range, 2-5 years; mean, 3.3 years). Two masses increased (fibroadenomas at biopsy). One mass became palpable, and cancer was diagnosed at biopsy. The three masses in which initial biopsy was performed were fibroadenomas. The false-negative rate was 0.2% (one of 448; NPV, 99.8%; 95%CI: 0.0%, 1.23%). CONCLUSION: Follow-up US appears to be an acceptable alternative to biopsy for solid masses with benign morphologic features seen at US owing to the extremely high NPV (99.8%).

Follow-up of palpable circumscribed noncalcified solid breast masses at mammography and US: can biopsy be averted?

PURPOSE: To determine whether palpable noncalcified solid breast masses with benign morphology at mammography and ultrasonography (US) can be managed similarly to nonpalpable probably benign lesions (Breast Imaging Reporting and Data System [BI-RADS] category 3)-that is, with periodic imaging surveillance-and to determine whether biopsy can be averted in these lesions. MATERIALS AND METHODS: No institutional review board approval or patient consent was required. This retrospective analysis, based on final imaging reports, included 152 patients (age range, 28-77 years; mean age, 48.3 years) with 157 palpable noncalcified solid masses that were classified as probably benign at initial mammography and US. Of 152 patients, 108 underwent follow-up with mammography and US (6-month intervals for 2 years, then 12-month intervals). The remaining 44 patients underwent surgical or needle biopsy after initial imaging. Lesions were analyzed at initial and follow-up examinations. Statistical analysis included Student t test and corresponding exact 95% confidence intervals. RESULTS: In 108 patients who underwent follow-up only, 112 lesions were palpable. In 102 (94.4%) of 108 patients, masses remained stable during follow-up. Lesions were followed for at least 2 years (mean, 4.1 years; range, 2-7 years). In six (5.6%) patients, palpable lesions increased in size during follow-up; these lesions were benign at subsequent open biopsy. No breast carcinoma was diagnosed in the 44 patients with 45 palpable lesions who underwent biopsy after initial imaging. Of 157 lesions, no malignant tumors were observed (exact one-sided 95% confidence interval: 0%, 1.95%). CONCLUSION: The data strongly suggest that palpable noncalcified solid breast masses with benign morphology at mammography and US can be managed similarly to nonpalpable BI-RADS category 3 lesions, with short-term follow-up (6-month intervals for 2 years). More data, based on a larger series, are required to determine whether this conclusion is correct.