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Breast cancer (BC) detectability depends on many factors: the type of cancer, breast tissue related factors, the choice and use of technology and human factors. New imaging techniques should provide higher accuracy and less false negatives. To tailor any future virtual imaging trial (VIT), a detailed description of invasive BC lesions was undertaken. In this single-institution retrospective study, imaging characteristics of 100 consecutive invasive BCs diagnosed in our hospital were assessed in terms of a visibility score, BI-RADS descriptors, breast density, lesion size and location on all breast x-ray imaging techniques and ultrasound (US). Seventy-seven out of these 100 invasive BCs were diagnosed using DBT in addition to FFDM and US and in 29 cases MRI was performed. Not all imaging modalities are equally well performing regarding visualization of invasive BC; 29 out of 77 lesions were poorly visible on FFDM, 9 on DBT, 34 on SM, and 11 on US. Four lesions were poorly visible on all these modalities, but fortunately clearly visible on MRI. The studied invasive lesions that are well visible on all modalities are mostly irregular spiculated lesions with a high density, and have in this study a median size of 18mm. The poorly visible lesions are also mostly irregularly shaped, show more variations in their margins and have a smaller median size of 12.5mm. They are equally or highly dense compared to the background tissue and are in general present in slightly denser breasts. Two lesions are not visible on mammography due to the peripheral location of the invasive breast cancer, one was located sternal and one very peripheral in the axillary tail. Both lesions were visible on ultrasound. This database provides detailed information on the imaging characteristics of invasive BCs which could be a valuable input for VITs.
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