Management of Incidental Breast Lesions Detected at Nuclear Medicine Examinations.

Nuclear medicine studies are often performed in patients with breast cancer; however, incidental radiotracer uptake in the breasts can be observed in patients with nonbreast malignancies. Benign and malignant lesions can be identified on planar, SPECT, and PET scans. This review will outline the molecular and radiographic imaging appearance of benign and malignant breast lesions on sestamibi scans, bone scans, radioiodine studies, as well as PET studies using fluorine 18 (F) fluorodeoxyglucose, gallium 68 (Ga) tetraazacyclododecane tetraacetic acid octreotate (or DOTATATE), Ga prostate-specific membrane antigen, and F-fluciclovine radiotracers.

Digital breast tomosynthesis: observer performance of clustered microcalcification detection on breast phantom images acquired with an experimental system using variable scan angles, angular increments, and number of projection views.

Purpose: To investigate the dependence of microcalcification cluster detectability on tomographic scan angle, angular increment, and number of projection views acquired at digital breast tomosynthesis ( DBT digital breast tomosynthesis ).

Materials And Methods: A prototype DBT digital breast tomosynthesis system operated in step-and-shoot mode was used to image breast phantoms. Four 5-cm-thick phantoms embedded with 81 simulated microcalcification clusters of three speck sizes (subtle, medium, and obvious) were imaged by using a rhodium target and rhodium filter with 29 kV, 50 mAs, and seven acquisition protocols.

A similarity study of content-based image retrieval system for breast cancer using decision tree.

Purpose: We are developing a decision tree content-based image retrieval (DTCBIR) CADx system to assist radiologists in characterization of breast masses on ultrasound images.

Methods: Three DTCBIR configurations, including decision tree with boosting (DTb), decision tree with full leaf features (DTL), and decision tree with selected leaf features (DTLs) were compared. For DTb, features of a query mass were combined first into a merged feature score and then masses with similar scores were retrieved.

Breast mass characterization using 3-dimensional automated ultrasound as an adjunct to digital breast tomosynthesis: a pilot study.

Objectives: The purpose of this study was to retrospectively evaluate the effect of 3-dimensional automated ultrasound (3D-AUS) as an adjunct to digital breast tomosynthesis (DBT) on radiologists' performance and confidence in discriminating malignant and benign breast masses.

Methods: Two-view DBT (craniocaudal and mediolateral oblique or lateral) and single-view 3D-AUS images were acquired from 51 patients with subsequently biopsy-proven masses (13 malignant and 38 benign). Six experienced radiologists rated, on a 13-point scale, the likelihood of malignancy of an identified mass, first by reading the DBT images alone, followed immediately by reading the DBT images with automatically coregistered 3D-AUS images.

Similarity evaluation in a content-based image retrieval (CBIR) CADx system for characterization of breast masses on ultrasound images.

Purpose: The authors are developing a content-based image retrieval (CBIR) CADx system to assist radiologists in characterization of breast masses on ultrasound images. In this study, the authors compared seven similarity measures to be considered for the CBIR system. The similarity between the query and the retrieved masses was evaluated based on radiologists' visual similarity assessments.

Can preoperative axillary US help exclude N2 and N3 metastatic breast cancer?

Purpose: To determine the false-negative rate of axillary ultrasonography (US) with respect to stage N2 and N3 metastatic disease in patients with newly diagnosed breast cancer.

Materials And Methods: The study was approved by the institutional review board and complied with the HIPAA; the requirement for informed consent was waived. A retrospective search of radiology records identified 435 consecutive patients with breast cancer aged 25-88 years who underwent preoperative axillary US from January 1, 2006, to December 31, 2007.

Multi-modality CADx: ROC study of the effect on radiologists' accuracy in characterizing breast masses on mammograms and 3D ultrasound images.

Rationale And Objectives: To investigate the effect of a computer-aided diagnosis (CADx) system on radiologists' performance in discriminating malignant and benign masses on mammograms and three-dimensional (3D) ultrasound (US) images.

Materials And Methods: Our dataset contained mammograms and 3D US volumes from 67 women (median age, 51; range: 27-86) with 67 biopsy-proven breast masses (32 benign and 35 malignant). A CADx system was designed to automatically delineate the mass boundaries on mammograms and the US volumes, extract features, and merge the extracted features into a multi-modality malignancy score.

Axillary staging prior to neoadjuvant chemotherapy for breast cancer: predictors of recurrence.

Background: The value of axillary staging prior to delivery of neoadjuvant chemotherapy (NEO) for breast cancer is controversial. Our goal was to analyze the prognostic and therapeutic impact of axillary staging on recurrence.

Methods: The study cohort included 161 patients undergoing comprehensive evaluation by a multidisciplinary approach during the period 1996-2006.

Digital mammography: are there advantages in screening for breast cancer?

Digital mammography separates the processes of image acquisition, processing, and display, which allows for the optimization of each process. The result addresses some of the limitations of screen film mammography. This work reviews the advantages of the decoupling of the processes and the clinical trials comparing digital mammography with film-screen mammography in the screening setting.

Multi-modality 3D breast imaging with X-Ray tomosynthesis and automated ultrasound.

This study evaluated the utility of 3D automated ultrasound in conjunction with 3D digital X-Ray tomosynthesis for breast cancer detection and assessment, to better localize and characterize lesions in the breast. Tomosynthesis image volumes and automated ultrasound image volumes were acquired in the same geometry and in the same view for 27 patients. 3 MQSA certified radiologists independently reviewed the image volumes, visually correlating the images from the two modalities with in-house software.

Sentinel lymph node biopsy performed after neoadjuvant chemotherapy is accurate in patients with documented node-positive breast cancer at presentation.

Background: The optimal strategy for incorporating lymphatic mapping and sentinel lymph node biopsy into the management of breast cancer patients receiving neoadjuvant chemotherapy remains controversial. Previous studies of sentinel node biopsy performed following neoadjuvant chemotherapy have largely reported on patients whose prechemotherapy, pathologic axillary nodal status was unknown. We report findings using a novel comprehensive approach to axillary management of node-positive-patients receiving neoadjuvant chemotherapy.

Malignant and benign breast masses on 3D US volumetric images: effect of computer-aided diagnosis on radiologist accuracy.

Purpose: To retrospectively investigate the effect of using a custom-designed computer classifier on radiologists' sensitivity and specificity for discriminating malignant masses from benign masses on three-dimensional (3D) volumetric ultrasonographic (US) images, with histologic analysis serving as the reference standard.

Materials And Methods: Informed consent and institutional review board approval were obtained. Our data set contained 3D US volumetric images obtained in 101 women (average age, 51 years; age range, 25-86 years) with 101 biopsy-proved breast masses (45 benign, 56 malignant).

Outcome of men presenting with clinical breast problems: the role of mammography and ultrasound.

The purpose of this study was to determine the outcome of men presenting with clinical breast problems for breast imaging and to evaluate the role of mammography and ultrasound in the diagnosis of benign and malignant breast problems. We retrospectively reviewed clinical, radiographic, and pathologic records of 165 consecutive symptomatic men presenting to Breast Imaging over a 4 year period. We assessed the clinical indication for referral, mammographic findings, sonographic findings, histologic results, and clinical outcomes.

Breast masses: computer-aided diagnosis with serial mammograms.

Purpose: To retrospectively evaluate effects of computer-aided diagnosis (CAD) involving an interval change classifier (which uses interval change information extracted from prior and current mammograms and estimates a malignancy rating) on radiologists' accuracy in characterizing masses on two-view serial mammograms as malignant or benign.

Materials And Methods: The data collection protocol had institutional review board approval. Patient informed consent was waived for this HIPAA-compliant retrospective study.

Lobular carcinoma in situ or atypical lobular hyperplasia at core-needle biopsy: is excisional biopsy necessary?

Purpose: To retrospectively determine frequency of invasive cancer or ductal carcinoma in situ (DCIS) at excisional biopsy in women with atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) at percutaneous core-needle biopsy (CNB).

Materials And Methods: Review of results in 6,081 consecutive patients who underwent CNB at two institutions revealed that in 35 (0.58%), LCIS (n = 15) or ALH (n = 20) was the pathologic finding with highest risk.