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Screening Algorithms in Dense Breasts: AJR Expert Panel Narrative Review.

Wendie A Berg¹, Elizabeth A Rafferty², Sarah M Friedewald³

¹Department of Radiology, University of Pittsburgh School of Medicine, UPMC Magee-Womens Hospital, 300 Halket St, Pittsburgh, PA 15213.

AJR. American Journal of Roentgenology

|September 9, 2020

Summary

Screening mammography is less effective for dense breasts. Advanced imaging like digital breast tomosynthesis (DBT) and ultrasound (US) improve cancer detection in dense breast tissue.

Keywords:

MRI breast density contrast-enhanced mammography molecular breast imaging tomosynthesis ultrasound

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Area of Science:

Radiology
Oncology
Medical Imaging

Background:

Screening mammography reduces breast cancer mortality but has reduced performance in women with dense breasts.
Increased breast density is an independent risk factor for breast cancer.
Dense breast notification is becoming a national standard, necessitating optimized screening strategies.

Purpose of the Study:

To review the performance of various supplemental imaging modalities for detecting breast cancer in women with dense breasts.
To compare the effectiveness of digital breast tomosynthesis (DBT), ultrasound (US), molecular breast imaging (MBI), MRI, and contrast-enhanced mammography (CEM) against 2D digital mammography (DM).

Main Methods:

Review of existing studies evaluating supplemental breast imaging techniques in dense breasts.
Comparison of cancer detection rates, recall rates, and interval cancer reduction for different modalities.

Main Results:

DBT, US, MBI, MRI, and CEM show improved cancer detection in dense breasts compared to 2D DM.
DBT reduces recalls; US increases detection but adds false positives; MBI has higher radiation dose; MRI offers greatest detection increase and interval cancer reduction.
CEM shows promise similar to MRI, requiring further validation.

Conclusions:

Understanding the performance of supplemental modalities is crucial for optimizing breast cancer screening in women with dense breasts.
Various advanced imaging techniques offer improved cancer detection in dense breast tissue, addressing limitations of conventional mammography.