title: Sensitivity of imaging for multifocal-multicentric breast carcinoma.
abstract: BACKGROUND
  This retrospective study aims to determine: 1) the sensitivity of preoperative mammography (Mx) and ultrasound (US), and re-reviewed Mx to detect multifocal multicentric breast carcinoma (MMBC), defined by pathology on surgical specimens, and 2) to analyze the characteristics of both detected and undetected foci on Mx and US.
  
  
  METHODS
  Three experienced breast radiologists re-reviewed, independently, digital mammography of 97 women with MMBC pathologically diagnosed on surgical specimens. The radiologists were informed of all neoplastic foci, and blinded to the original mammograms and US reports. With regards to Mx, they considered the breast density, number of foci, the Mx characteristics of the lesions and their BI-RADS classification. For US, they considered size of the lesions, BI-RADS classification and US pattern and lesion characteristics. According to the histological size, the lesions were classified as: index cancer, 2nd lesion, 3rd lesion, and 4th lesion. Any pathologically identified malignant foci not previously described in the original imaging reports, were defined as undetected or missed lesions. Sensitivity was calculated for Mx, US and re-reviewed Mx for detecting the presence of the index cancer as well as additional satellite lesions.
  
  
  RESULTS
  Pathological examination revealed 13 multifocal and 84 multicentric cancers with a total of 303 malignant foci (282 invasive and 21 non invasive). Original Mx and US reports had an overall sensitivity of 45.5% and 52.9%, respectively. Mx detected 83/97 index cancers with a sensitivity of 85.6%. The number of lesions undetected by original Mx was 165/303. The Mx pattern of breasts with undetected lesions were: fatty in 3 (1.8%); scattered fibroglandular density in 40 (24.3%), heterogeneously dense in 91 (55.1%) and dense in 31 (18.8%) cases. In breasts with an almost entirely fatty pattern, Mx sensitivity was 100%, while in fibroglandular or dense pattern it was reduced to 45.5%. Re-reviewed Mx detected only 3 additional lesions. The sensitivity of Mx was affected by the presence of dense breast tissue which obscured lesions or by an incorrect interpretation of suspicious findings.US detected 73/80 index cancers (sensitivity of 91.2%), US missed 117 malignant foci with a mean tumor diameter of 6.5 mm; the sensitivity was 52.9%Undetected lesions by US were those smallest in size and present in fatty breast or in the presence of microcalcifications without a visible mass.US sensitivity was affected by the presence of fatty tissue or by the extent of calcification.
  
  
  CONCLUSIONS
  Mx missed MMBC malignant foci more often in dense or fibroglandular breasts. US missed small lesions in mainly fatty breasts or when there were only microcalcifications. The combined sensitivity of both techniques to assess MMBC was 58%. We suggest larger studies on multimodality imaging.
authors.affiliation: Breast Imaging Unit, Department of Radiology, European Institute of Oncology, Via Ripamonti 435 - 20141 Milan, Italy. anna.bozzini@ieo.it
authors.forename: Anna
authors.initials: A
authors.lastname: Bozzini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Renne
authors.forename: Lorenza
authors.initials: L
authors.lastname: Meneghetti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bandi
authors.forename: Gabriela
authors.initials: G
authors.lastname: Santos
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Vento
authors.forename: Simona
authors.initials: S
authors.lastname: Menna
authors.forename: Stefania
authors.initials: S
authors.lastname: Andrighetto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Viale
authors.forename: Enrico
authors.initials: E
authors.lastname: Cassano
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellomi
mesh_terms: D000273:Adipose Tissue / Q000473:pathology; D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D002114:Calcinosis / Q000473:pathology; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary