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Analysis of 172 Subtle Findings on Prior Normal Mammograms in Women with Breast Cancer Detected at Follow-up Screening¹

¹ From the Department of Radiology, Stanford University Medical Center, Rm S-068A, 300 Pasteur Dr, Stanford, CA 94305-5105 (D.M.I., R.L.B.); R2Technology, Sunnyvale, Calif (K.F.O.); Tower–St Johns Imaging Eisenberg Keefer Breast Center, John Wayne Cancer Institute, St John’s Health Center, Santa Monica, Calif (R.J.B.); and Department of Radiology, University of California, San Francisco (E.A.S.). From the 1999 RSNA scientific assembly. Received October 5, 2001; revision requested December 18; revision received March 14, 2002; accepted July 24. Address correspondence to D.M.I.

View larger version (110K): [in a new window]   Figure 1a. Focal island of normal tissue rated as BI-RADS category 1 at unblinded review and cited for recall by only one of five radiologists at blinded review. (a) Craniocaudal and (b) mediolateral oblique views in a 64-year-old woman show a focal region of normal-appearing glandular tissue (arrow) perceived on the mediolateral oblique view only. Note that the finding has lucent areas within it. Thirteen months later, (c) craniocaudal and (d) mediolateral oblique mammograms show a 1.0-cm suspicious mass (arrows) in the same location. Biopsy results indicated grade II invasive ductal carcinoma.

View larger version (107K): [in a new window]   Figure 1b. Focal island of normal tissue rated as BI-RADS category 1 at unblinded review and cited for recall by only one of five radiologists at blinded review. (a) Craniocaudal and (b) mediolateral oblique views in a 64-year-old woman show a focal region of normal-appearing glandular tissue (arrow) perceived on the mediolateral oblique view only. Note that the finding has lucent areas within it. Thirteen months later, (c) craniocaudal and (d) mediolateral oblique mammograms show a 1.0-cm suspicious mass (arrows) in the same location. Biopsy results indicated grade II invasive ductal carcinoma.

View larger version (105K): [in a new window]   Figure 1c. Focal island of normal tissue rated as BI-RADS category 1 at unblinded review and cited for recall by only one of five radiologists at blinded review. (a) Craniocaudal and (b) mediolateral oblique views in a 64-year-old woman show a focal region of normal-appearing glandular tissue (arrow) perceived on the mediolateral oblique view only. Note that the finding has lucent areas within it. Thirteen months later, (c) craniocaudal and (d) mediolateral oblique mammograms show a 1.0-cm suspicious mass (arrows) in the same location. Biopsy results indicated grade II invasive ductal carcinoma.

View larger version (110K): [in a new window]   Figure 1d. Focal island of normal tissue rated as BI-RADS category 1 at unblinded review and cited for recall by only one of five radiologists at blinded review. (a) Craniocaudal and (b) mediolateral oblique views in a 64-year-old woman show a focal region of normal-appearing glandular tissue (arrow) perceived on the mediolateral oblique view only. Note that the finding has lucent areas within it. Thirteen months later, (c) craniocaudal and (d) mediolateral oblique mammograms show a 1.0-cm suspicious mass (arrows) in the same location. Biopsy results indicated grade II invasive ductal carcinoma.

View larger version (110K): [in a new window]   Figure 2a. Benign-appearing area, too small to prompt recall, rated as BI-RADS category 2 at unblinded review and recalled by no radiologists at blinded review. (a) Craniocaudal and (b) mediolateral oblique mammograms in a 64-year-old woman show a 3-mm round dense area (arrows) in the upper inner quadrant of the right breast. Twelve months later, (c) craniocaudal and (d) mediolateral oblique mammograms show a 7-mm mass (arrows) in the same location. Biopsy results indicated grade III invasive ductal carcinoma.

View larger version (111K): [in a new window]   Figure 2b. Benign-appearing area, too small to prompt recall, rated as BI-RADS category 2 at unblinded review and recalled by no radiologists at blinded review. (a) Craniocaudal and (b) mediolateral oblique mammograms in a 64-year-old woman show a 3-mm round dense area (arrows) in the upper inner quadrant of the right breast. Twelve months later, (c) craniocaudal and (d) mediolateral oblique mammograms show a 7-mm mass (arrows) in the same location. Biopsy results indicated grade III invasive ductal carcinoma.

View larger version (118K): [in a new window]   Figure 2c. Benign-appearing area, too small to prompt recall, rated as BI-RADS category 2 at unblinded review and recalled by no radiologists at blinded review. (a) Craniocaudal and (b) mediolateral oblique mammograms in a 64-year-old woman show a 3-mm round dense area (arrows) in the upper inner quadrant of the right breast. Twelve months later, (c) craniocaudal and (d) mediolateral oblique mammograms show a 7-mm mass (arrows) in the same location. Biopsy results indicated grade III invasive ductal carcinoma.

View larger version (114K): [in a new window]   Figure 2d. Benign-appearing area, too small to prompt recall, rated as BI-RADS category 2 at unblinded review and recalled by no radiologists at blinded review. (a) Craniocaudal and (b) mediolateral oblique mammograms in a 64-year-old woman show a 3-mm round dense area (arrows) in the upper inner quadrant of the right breast. Twelve months later, (c) craniocaudal and (d) mediolateral oblique mammograms show a 7-mm mass (arrows) in the same location. Biopsy results indicated grade III invasive ductal carcinoma.

View larger version (131K): [in a new window]   Figure 3a. Benign-appearing calcifications that could be easily overlooked, rated as BI-RADS category 2 at unblinded review and recalled by no radiologists at blinded review. Magnification of (a) craniocaudal and (b) mediolateral oblique mammograms in a 69-year-old woman show three benign-appearing calcifications (arrows). Fourteen months later, (c) craniocaudal and (d) mediolateral oblique mammograms show a 4-mm cluster of pleomorphic calcifications (arrows) in the same location. Biopsy results indicated DCIS with an intermediate grade.

View larger version (145K): [in a new window]   Figure 3b. Benign-appearing calcifications that could be easily overlooked, rated as BI-RADS category 2 at unblinded review and recalled by no radiologists at blinded review. Magnification of (a) craniocaudal and (b) mediolateral oblique mammograms in a 69-year-old woman show three benign-appearing calcifications (arrows). Fourteen months later, (c) craniocaudal and (d) mediolateral oblique mammograms show a 4-mm cluster of pleomorphic calcifications (arrows) in the same location. Biopsy results indicated DCIS with an intermediate grade.

View larger version (130K): [in a new window]   Figure 3c. Benign-appearing calcifications that could be easily overlooked, rated as BI-RADS category 2 at unblinded review and recalled by no radiologists at blinded review. Magnification of (a) craniocaudal and (b) mediolateral oblique mammograms in a 69-year-old woman show three benign-appearing calcifications (arrows). Fourteen months later, (c) craniocaudal and (d) mediolateral oblique mammograms show a 4-mm cluster of pleomorphic calcifications (arrows) in the same location. Biopsy results indicated DCIS with an intermediate grade.

View larger version (139K): [in a new window]   Figure 3d. Benign-appearing calcifications that could be easily overlooked, rated as BI-RADS category 2 at unblinded review and recalled by no radiologists at blinded review. Magnification of (a) craniocaudal and (b) mediolateral oblique mammograms in a 69-year-old woman show three benign-appearing calcifications (arrows). Fourteen months later, (c) craniocaudal and (d) mediolateral oblique mammograms show a 4-mm cluster of pleomorphic calcifications (arrows) in the same location. Biopsy results indicated DCIS with an intermediate grade.

View larger version (120K): [in a new window]   Figure 4a. Benign-appearing mass rated as BI-RADS category 2 at unblinded review that was recalled by no radiologists at blinded review. (a) Craniocaudal and (b) mediolateral oblique mammograms in a 64-year-old woman show several benign-appearing equal-density masses, with one of the masses (arrows) in the area of interest. Subsequent screening (c) craniocaudal and (d) mediolateral mammograms obtained 14 months later show a 1-cm mass (arrows) in the left breast, which was pathologically proven to be grade I invasive ductal carcinoma with cribriform and micropapillary DCIS.

View larger version (109K): [in a new window]   Figure 4b. Benign-appearing mass rated as BI-RADS category 2 at unblinded review that was recalled by no radiologists at blinded review. (a) Craniocaudal and (b) mediolateral oblique mammograms in a 64-year-old woman show several benign-appearing equal-density masses, with one of the masses (arrows) in the area of interest. Subsequent screening (c) craniocaudal and (d) mediolateral mammograms obtained 14 months later show a 1-cm mass (arrows) in the left breast, which was pathologically proven to be grade I invasive ductal carcinoma with cribriform and micropapillary DCIS.

View larger version (114K): [in a new window]   Figure 4c. Benign-appearing mass rated as BI-RADS category 2 at unblinded review that was recalled by no radiologists at blinded review. (a) Craniocaudal and (b) mediolateral oblique mammograms in a 64-year-old woman show several benign-appearing equal-density masses, with one of the masses (arrows) in the area of interest. Subsequent screening (c) craniocaudal and (d) mediolateral mammograms obtained 14 months later show a 1-cm mass (arrows) in the left breast, which was pathologically proven to be grade I invasive ductal carcinoma with cribriform and micropapillary DCIS.

View larger version (106K): [in a new window]   Figure 4d. Benign-appearing mass rated as BI-RADS category 2 at unblinded review that was recalled by no radiologists at blinded review. (a) Craniocaudal and (b) mediolateral oblique mammograms in a 64-year-old woman show several benign-appearing equal-density masses, with one of the masses (arrows) in the area of interest. Subsequent screening (c) craniocaudal and (d) mediolateral mammograms obtained 14 months later show a 1-cm mass (arrows) in the left breast, which was pathologically proven to be grade I invasive ductal carcinoma with cribriform and micropapillary DCIS.

View larger version (144K): [in a new window]   Figure 5a. (a) Craniocaudal mammogram in a 62-year-old woman with clustered microcalcifications (arrow) in the right breast, which were rated as BI-RADS category 0 at unblinded review and were recalled by only one of five radiologists at blinded review. (b) Screening craniocaudal mammogram obtained 13 months later shows a 1.2-cm DCIS, seen as pleomorphic calcifications (arrow).

View larger version (135K): [in a new window]   Figure 5b. (a) Craniocaudal mammogram in a 62-year-old woman with clustered microcalcifications (arrow) in the right breast, which were rated as BI-RADS category 0 at unblinded review and were recalled by only one of five radiologists at blinded review. (b) Screening craniocaudal mammogram obtained 13 months later shows a 1.2-cm DCIS, seen as pleomorphic calcifications (arrow).

View larger version (101K): [in a new window]   Figure 6a. (a) Mediolateral oblique (left) and craniocaudal (right) mammograms in a 75-year-old woman with a subtle spiculated mass (arrows) in the right breast. The mass was rated as BI-RADS category 0 at unblinded review and was recalled by only one of five radiologists at blinded review. (b) Mediolateral oblique (left) and craniocaudal (right) mammograms obtained 12 months later show a larger spiculated mass (arrows). Note that the mass is slightly more anterior on the mediolateral oblique view than on the mediolateral oblique view in a because of differences in obliquity. Pathologic findings showed a 1.5-cm invasive lobular carcinoma.

View larger version (99K): [in a new window]   Figure 6b. (a) Mediolateral oblique (left) and craniocaudal (right) mammograms in a 75-year-old woman with a subtle spiculated mass (arrows) in the right breast. The mass was rated as BI-RADS category 0 at unblinded review and was recalled by only one of five radiologists at blinded review. (b) Mediolateral oblique (left) and craniocaudal (right) mammograms obtained 12 months later show a larger spiculated mass (arrows). Note that the mass is slightly more anterior on the mediolateral oblique view than on the mediolateral oblique view in a because of differences in obliquity. Pathologic findings showed a 1.5-cm invasive lobular carcinoma.