title: Undiagnosed Breast Cancer: Features at Supplemental Screening US.
abstract: OBJECTIVE
  To retrospectively investigate the reasons for and features of undiagnosed cancers at previous supplemental screening ultrasonography (US) in women who subsequently received a diagnosis of breast cancer.
  
  
  METHODS
  The institutional review board approved this retrospective study and waived the requirement to obtain informed patient consent. The study consisted of 230 women (median age, 49 years; age range, 29-81 years) with 230 pairs of US examinations (prior and subsequent examinations) performed between December 2003 and August 2013 who were found to have cancer (median interval, 12 months; range, 2-24 months). The authors compared the clinical-pathologic features of patients with negative findings on prior images with those of patients with visible findings on prior images. Findings visible at prior US were classified as actionable or underthreshold by means of a blinded review by five radiologists. Lesions classified as Breast Imaging Reporting and Data System category 4 or 5 by fewer than three readers were determined to be underthreshold. Reasons for undiagnosed cancers and their imaging features were analyzed.
  
  
  RESULTS
  Among the 230 prior US examinations, 72 (31.3%) showed visible findings and 158 (68.7%) showed negative findings. High-nuclear-grade cancers and triple-negative cancers were more common in patients with negative findings than in those with visible findings (P = .023 and P = .006, respectively). Blinded review revealed that 57 of the 72 visible findings (79%) were actionable. Misinterpretation (39% [28 of 72 lesions]) and multiple distracting lesions (17% [12 of 72 lesions]) were the two most common reasons for missing these actionable findings, which showed more noncircumscribed margins than did underthreshold findings (P = .028).
  
  
  CONCLUSIONS
  At supplemental screening breast US, close attention should be paid to the presence of a margin that is not circumscribed, and multiple lesions should be separately assessed to reduce the number of missed breast cancers.
authors.affiliation: From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.).
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Song
authors.affiliation: From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.).
authors.forename: Nariya
authors.initials: N
authors.lastname: Cho
authors.affiliation: From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.).
authors.forename: Ajung
authors.initials: A
authors.lastname: Chu
authors.affiliation: From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.).
authors.forename: Sung Ui
authors.initials: SU
authors.lastname: Shin
authors.affiliation: From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.).
authors.forename: Ann
authors.initials: A
authors.lastname: Yi
authors.affiliation: From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.).
authors.forename: Su Hyun
authors.initials: SH
authors.lastname: Lee
authors.affiliation: From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.).
authors.forename: Won Hwa
authors.initials: WH
authors.lastname: Kim
authors.affiliation: From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.).
authors.forename: Min Sun
authors.initials: MS
authors.lastname: Bae
authors.affiliation: From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.E.S., N.C., A.J.C., S.U.S., A.Y., S.H.L., W.H.K., M.S.B., W.K.M.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (N.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., W.K.M.).
authors.forename: Woo Kyung
authors.initials: WK
authors.lastname: Moon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D012189:Retrospective Studies; D016217:Ultrasonography, Mammary