A cross-sectional study exploring the BI-RADS score discordance rates of routine mammography screening versus adjunctive ultrasonography in Southeast Asian women

Objective: The present study aimed to evaluate the most accurate method of breast cancer screening by analyzing the benefits provided by additional breast ultrasonography on top of routine mammography, stratified by breast density. Method: 49 middle-aged Bangkokian women were recruited by convenient sampling. All participants had undergone both mammography and ultrasonography. BI-RADS categories were assigned based on mammography results alone and based on combined mammography and ultrasonography results. Concordance/discordance rates between the 2 radiographic techniques were compared in women classified based on their breast densities. Results: Discordance rates of BI-RADS score between mammography versus the usage of adjunctive ultrasonography was highest in extremely dense breast (60%), which was followed by heterogeneous dense breast (50%). Heterogeneous fibroglandular breast density was the most common breast density in our study, which presented with over 65% concordance rates between the two modalities. Conclusion: The usage of additional ultrasonography presented a higher accuracy most evident in women with denser breasts, as reflected in a higher BI-RADS score detected. Our study suggested that a differentiation of breast cancer screening practice should be based on breast density. Women with extremely dense breasts ought to be screened by both mammography and ultrasonography, while women with less dense breasts may be evaluated by mammography alone.

Is sentinel lymph node biopsy without frozen section in early stage breast cancer sufficient in accordance with ACOSOG-Z0011? A retrospective review from King Chulalongkorn Memorial Hospital

Abstract Background In 2021, there is an increased global trend for sending sentinel lymph node biopsy (SLNB) specimens for permanent section (PS) without intraoperative frozen sections (FS). This pilot study conducted in Thailand determines the re-operation rate for SLNB without FS. Method We retrospectively reviewed 239 SLNB cases without FS at King Chulalongkorn Memorial Hospital from April 2016 to April 2021. The patients were diagnosed with primary invasive breast cancer with clinically negative nodes. The clinical nodal status was assessed from physical examination. The re-operation rate was determined by the number of positive SLNs; where 3 more nodal metastases were subjected to a second surgical procedure. Result Between April 2016 and April 2021, 239 patients who had undergone SLNB in accordance with ACOSOG Z0011 criteria with PS alone was enrolled. A total of 975 SLNs were removed from these 239 patients, with an average of 4.15 nodes per patient. Out of 239 patients, 21 (8.8%) and 6 (2.5%) had metastatic disease in 1 and 2 nodes, respectively. The remaining 212 (88.7%) patients had no nodal metastasis. None of the patients were subjected to a second surgical procedure. Conclusion We conclude that the implementation of SLNB with PS analysis alone in patients who satisfy the ACOSOG Z0011 criteria, with a re-operation rate of 0%, does not have outcomes that would be altered by the standard of care additional FS analysis. With ommision of FS analysis, operation cost, operative time and anesthetic side effects are projected to decrease