Image-guided Localization Techniques for Nonpalpable Breast Lesions: An Opportunity for Multidisciplinary Patient-centered Care.

Selection of a localization method for nonpalpable breast lesions offers an opportunity for institutions to seek multidisciplinary input to promote value-based, patient-centered care. The diverse range of nonpalpable breast and axillary pathologies identified through increased utilization of screening mammography often necessitates image-guided preoperative localization for accurate lesion identification and excision. Preoperative localization techniques for breast and axillary lesions have evolved to include both wire and nonwire methods, the latter of which include radioactive seeds, radar reflectors, magnetic seeds, and radiofrequency identification tag localizers.

Subareolar Tissue Biopsy Predicts Occult Nipple Involvement in Nipple-Sparing Mastectomies.

Objectives: Subareolar tissue is examined during nipple-sparing mastectomy (NSM) to minimize the risk of occult malignancy within the preserved nipple. A positive subareolar tissue biopsy typically warrants subsequent nipple excision. We study the factors associated with a positive subareolar tissue biopsy, the rate of residual malignancy in subsequent nipple excisions, and the value of subareolar tissue biopsy intraoperative frozen section (IOF).

Mucocele-like Lesion of the Breast Diagnosed on Core Biopsy.

Context.—: Mucocele-like lesion of the breast (MLL) is an uncommon entity, and recent studies show low rates of upgrade from core needle biopsy (CNB) to excision.

Objective.

Intraductal Papilloma of the Breast: Prevalence of Malignancy and Natural History Under Active Surveillance.

Background: The optimal management of intraductal papillomas (IPs) without atypia diagnosed on needle core biopsy (NCB) is unclear. This study analyzed the malignancy risk of immediately excised IPs and characterized the behavior of IPs under active surveillance (AS).

Methods: We retrospectively reviewed the pathology and imaging records of patients diagnosed with IPs without atypia on NCB during a 10-year period (1999-2019).

High-Risk Lesions Detected by MRI-Guided Core Biopsy: Upgrade Rates at Surgical Excision and Implications for Management.

The purpose of our study was to evaluate the upgrade rates of high-risk lesions (HRLs) diagnosed by MRI-guided core biopsy and to assess which clinical and imaging characteristics are predictive of upgrade to malignancy. A retrospective review was performed of all women who presented to an academic breast radiology center for MRI-guided biopsy between January 1, 2015, and November 30, 2018. Histopathologic results from each biopsy were extracted.

Lessons learned: A single academic department's unique approach to preventing physician burnout.

Physician burnout is a recognized problem within medicine and its prevalence appears to be increasing. The symptoms include three major components; exhaustion, depersonalization and feeling a lack of accomplishment. The presence of burnout can have major professional and personal consequences.

Performance of 2D Synthetic Mammography Versus Digital Mammography in the Detection of Microcalcifications at Screening.

The purpose of this study is to compare the performance of 2D synthetic mammography (SM) to that of full-field digital mammography (FFDM) in the detection of microcalcifications and to evaluate radiologists' preference between the two imaging modalities for assessing calcifications. A fully crossed, mode-balanced, paired-case ( = 160), retrospective, multireader ( = 3) performance study was implemented to compare screening mammograms acquired with digital breast tomosynthesis and both FFDM and SM between 2015 and 2017. The study cohort included 70 patients with mammograms recalled for microcalcifications (35 with malignant findings and 35 with benign findings) and was supplemented with 90 patients with mammograms with negative findings.

Fibroepithelial Lesions (FELs) of the Breast: Is Routine Excision Always Necessary?

Background: When needle core biopsies (NCBs) of the breast reveal fibroepithelial lesions (FELs), excision is often performed to rule out a phyllodes tumor (PT), despite low malignancy rates. Consequently, the natural history of observed FELs is not well described. We analyzed the malignancy risk in excised FELs and the natural history of FELs undergoing active surveillance (AS).

Beyond appendicitis: ultrasound findings of acute bowel pathology.

Bowel pathology is a common unexpected finding on routine abdominal and pelvic ultrasound. However, radiologists are often unfamiliar with the ultrasound appearance of the gastrointestinal tract due to the underutilization of ultrasound for bowel evaluation in the USA. The purpose of this article is to familiarize radiologists with the characteristic ultrasound features of a variety of bowel pathologies.

Revisiting Nonmass Enhancement in Breast MRI: Analysis of Outcomes and Follow-Up Using the Updated BI-RADS Atlas.

Objective: The purpose of this study is to assess the frequency of reclassification of nonmass enhancement (NME) as background parenchymal enhancement (BPE) and to determine positive predictive values (PPVs) of NME descriptors using the revised BI-RADS atlas.

Materials And Methods: A retrospective review of our institution's MRI database from January 1, 2009, through March 30, 2012, identified 6220 contrast-enhanced breast MRI examinations. All findings prospectively assessed as NME and rated as BI-RADS categories 3, 4, and 5 (n = 386) were rereviewed in consensus by two radiologists who were blinded to pathologic findings with the fifth edition of the BI-RADS lexicon.

Imaging and Histopathologic Features of BI-RADS 3 Lesions Upgraded during Imaging Surveillance.

To evaluate imaging and histopathologic differences between screen-detected benign and malignant upgraded lesions initially assessed as BI-RADS 3 at diagnostic evaluation. An IRB approved retrospective review of the mammography data base from January 1, 2004 to December 31, 2008 identified 1,188 (1.07%) of 110,776 screening examinations assessed as BI-RADS 3 following diagnostic evaluation at our academic center (staffed by breast specialists) or our outpatient center (staffed by general radiologists), 1,017 with at least 24 months follow-up or biopsy.

Assessment and Management of Challenging BI-RADS Category 3 Mammographic Lesions.

Breast Imaging Reporting and Data System (BI-RADS) category 3 lesions are probably benign by definition and are recommended for short-interval follow-up after a diagnostic workup has been completed. Although the original lexicon-derived BI-RADS category 3 definition applied to lesions without prior imaging studies (when stability could not be determined), in clinical practice, many lesions with prior images may be assigned to BI-RADS category 3. Although the BI-RADS fifth edition specifically delineates lesions that are appropriate for categorization as probably benign, it also specifies that the interpreting radiologist may use his or her discretion and experience to justify a "watchful waiting" approach for lesions that do not meet established criteria.

Systemic treatment in breast cancer: a primer for radiologists.

Unlabelled: Cytotoxic chemotherapy, hormonal therapy and molecular targeted therapy are the three major classes of drugs used to treat breast cancer. Imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), (18)F-FDG positron emission tomography (PET)/CT and bone scintigraphy each have a distinct role in monitoring response and detecting drug toxicities associated with these treatments. The purpose of this article is to elucidate the various systemic therapies used in breast cancer, with an emphasis on the role of imaging in assessing treatment response and detecting treatment-related toxicities.

Outcome of cesarean scar pregnancies diagnosed sonographically in the first trimester.

Objectives: The purpose of this study was to determine the outcome of cesarean scar pregnancies diagnosed during the first trimester.

Methods: We retrospectively identified all cesarean scar implantation pregnancies diagnosed by sonography before 14 weeks' gestation between 2000 and 2012 at our institution. We reviewed the patients' sonograms and medical records and recorded sonographic findings and pregnancy outcomes.