Classification and reviewing of prior screening mammograms from screen-detected breast cancer cases

Abstract

This study aimed at conducting a review of the prior mammograms of screen-detected breast cancers, found on full-field digital mammograms based on independent double reading with arbitration. The prior mammograms of 607 women diagnosed with breast cancer during routine breast cancer screening were categorized into “Missed”, “Prior Vis”, and “Prior Invis” . The prior mammograms of “Missed” and “Prior Vis” cases showed actionable and non-actionable visible cancer signs, respectively. The “Prior Invis” cases had no overt cancer signs on the prior mammograms. The percentage of cases classified as “Missed”, “Prior Vis”, and “Prior Invis” categories were 25.5%, 21.7%, 52.7%, respectively. The proportion of high-density cases showed no significant differences among the three categories (p-values<0.05). The breakdown of cases into “Missed”, “Prior Vis”, and “Prior Invis” categories did not differ between invasive (488) and in-situ (119) cases. In the invasive category, the progesterone (p-value=0.015) and estrogen (p-value=0.007) positivity and the median ki-67 score (p-value=0.006) differed significantly among the categories with the “Prior Invis” cases exhibiting the highest percentage of hormone receptors negativity. In the invasive cases, the percentage of cancers graded as 3 (i.e., more aggressive) were significantly more in the “Prior Invis” category compared to both “Missed” and “Prior Vis” categories (both p-values<0.05). The status of receptors and breast cancer grade for the in-situ cases did not differ significantly among the three categories. Prior images categorization can predict the aggressiveness of breast cancer. Techniques to better interrogate prior images as shown elsewhere may yield important patient outcomes.