Persistent inter-observer variability of breast density assessment using BI-RADS® 5th edition guidelines.

Objectives: Due to most states' legislation, mammographic density categorization has potentially far-reaching implications, but remains subjective based on BIRADS® guidelines. We aimed to determine 1) effect of BI-RADS® 5th edition (5th-ed) vs 4th-edition (4th-ed) guidelines on reader agreement regarding density assessment; 2) 5th-ed vs 4th-ed density distribution, and visual vs quantitative assessment agreement; 3) agreement between experienced vs less experienced readers.

Methods: In a retrospective review, six breast imaging radiologists (BIR) (23-30 years' experience) visually assessed density of 200 screening mammograms performed September 2012-January 2013 using 5th-ed guidelines.

Can Digital Breast Tomosynthesis Replace Full-Field Digital Mammography? A Multireader, Multicase Study of Wide-Angle Tomosynthesis.

The purpose of this study was to test the hypothesis whether two-view wide-angle digital breast tomosynthesis (DBT) can replace full-field digital mammography (FFDM) for breast cancer detection. In a multireader multicase study, bilateral two-view FFDM and bilateral two-view wide-angle DBT images were independently viewed for breast cancer detection in two reading sessions separated by more than 1 month. From a pool of 764 patients undergoing screening and diagnostic mammography, 330 patient-cases were selected.

Optimizing Success and Avoiding Mishaps in the Most Difficult Image-guided Breast Biopsies.

Breast cancer is an increasing challenge in developed and limited resource areas of the world. Early detection of breast cancer offers the best chance for optimal care and best outcomes. A critical step in early detection is to obtain efficient and accurate tissue diagnoses.

Comparing search patterns in digital breast tomosynthesis and full-field digital mammography: an eye tracking study.

As a promising imaging modality, digital breast tomosynthesis (DBT) leads to better diagnostic performance than traditional full-field digital mammograms (FFDM) alone. DBT allows different planes of the breast to be visualized, reducing occlusion from overlapping tissue. Although DBT is gaining popularity, best practices for search strategies in this medium are unclear.

Stereotactic core needle breast biopsy marker migration: An analysis of factors contributing to immediate marker migration.

Objectives: To evaluate breast biopsy marker migration in stereotactic core needle biopsy procedures and identify contributing factors.

Methods: This retrospective study analyzed 268 stereotactic biopsy markers placed in 263 consecutive patients undergoing stereotactic biopsies using 9G vacuum-assisted devices from August 2010-July 2013. Mammograms were reviewed and factors contributing to marker migration were evaluated.

Number of mammography cases read per year is a strong predictor of sensitivity.

Early detection of breast cancers affects the 5-year recurrence rates and treatment options for diagnosed patients, and consequently, many countries have instituted nationwide screening programs. This study compared the performance of expert radiologists from Australia and the United States in detection of breast cancer. Forty-one radiologists, 21 from Australia and 20 from the United States, reviewed 30 mammographic cases containing two-view mammograms.

Positioning in breast MR imaging to optimize image quality.

Improper positioning of the breasts in a dedicated breast coil causes inhomogeneous fat saturation as well as other artifacts that decrease the sensitivity of breast magnetic resonance imaging. Improper positioning can create artifacts that can obscure a malignancy or cause it to be missed. Goals of proper positioning include imaging the maximum area of breast tissue, minimizing skin folds, and achieving homogeneous fat suppression and nondeformed breast parenchyma.

What radiologists need to know about diagnosis and treatment of inflammatory breast cancer: a multidisciplinary approach.

Inflammatory breast cancer (IBC) is a rare breast cancer with a highly virulent course and low 5-year survival rate. Trimodality treatment that includes preoperative chemotherapy, mastectomy, and radiation therapy is the therapeutic mainstay and has been shown to improve prognosis. Proper diagnosis and staging of IBC is critical to treatment planning and requires a multidisciplinary approach that includes imaging.

Variations in physician recommendations for surgery after diagnosis of a high-risk lesion on breast core needle biopsy.

Objective: This article focuses on four high-risk lesions: lobular neoplasia, benign papilloma, radial scar, and flat epithelial atypia. Controversies exist in the management after core biopsy of each of these lesions--whether to perform immediate surgical excision so as not to miss an associated malignancy or imaging follow-up because concomitant malignancy is low. This review is staged in two parts per lesion.

Basal subtype of invasive breast cancer is associated with a higher risk of true recurrence after conventional breast-conserving therapy.

Purpose: To determine whether breast cancer subtype is associated with patterns of ipsilateral breast tumor recurrence (IBTR), either true recurrence (TR) or elsewhere local recurrence (ELR), among women with pT1-T2 invasive breast cancer (IBC) who receive breast-conserving therapy (BCT).

Methods And Materials: From Jan 1998 to Dec 2003, 1,223 women with pT1-T2N0-3 IBC were treated with BCT (lumpectomy plus whole-breast radiation). Ninety percent of patients received adjuvant systemic therapy, but none received trastuzumab.

Controversies on the management of high-risk lesions at core biopsy from a radiology/pathology perspective.

Readers may feel less than satisfied when they discover that there is no consensus on the appropriate recommendations for follow-up of risk lesions following percutaneous core biopsy. The significance of this article is in the details of the methodologies and results, and much less in the numbers. The overall goal is to emphasize the flaws in current studies.

Factors that impact the duration of MRI-guided core needle biopsy.

Objective: The purpose of our study was to determine which patient-related, target lesion-related, or procedure-related variables impact the duration of MRI-guided core needle breast biopsy.

Materials And Methods: Between July 11, 2006, and September 26, 2007, data were collected for 75 single-target MRI-guided 9-gauge vacuum-assisted core needle biopsy procedures using a grid-guidance technique and performed at a single institution. The following variables were studied: MRI suite occupation time, number of operators, patient age and breast size, target morphology and location, approach to target, equipment used, number of image acquisitions and times the patient was moved in and out of the closed magnet, and occurrence of complications.

Comparison of conventional, compounding, computer enhancement, and compounding with computer enhancement in ultrasound imaging of the breast.

Objective: Real-time spatial compounding and computer enhancement (CE) in ultrasound have become commercially available for better visualization of breast masses. This study evaluated image quality and diagnostic information using these techniques as compared with conventional ultrasound in breast imaging.

Materials And Methods: One hundred consecutive lesions in 81 patients with clinically detectable breast lesions were imaged using conventional, compounding, CE, and compounding with CE.

Analysis of the mammographic and sonographic features of pseudoangiomatous stromal hyperplasia.

Objective: The purpose of this study was to describe the imaging findings in 149 patients with pseudoangiomatous stromal hyperplasia (PASH) who had undergone at least 4 years of clinical follow-up for detection of subsequent malignancy.

Conclusion: PASH is a common entity that presents with benign imaging features without evidence of subsequent malignant potential. At our institution, in the absence of suspicious features a diagnosis of PASH at core biopsy is considered sufficient, and surgical excision has been obviated.

Detecting nonpalpable recurrent breast cancer: the role of routine mammographic screening of transverse rectus abdominis myocutaneous flap reconstructions.

Purpose: To perform a retrospective cohort study to determine the rates of recall and cancer detection and then to develop a decision analytic model to evaluate the effectiveness of routine screening of transverse rectus abdominis myocutaneous (TRAM) flap reconstructions.

Materials And Methods: This study was approved by the institutional review board, and the methods comply with HIPAA regulations. A retrospective search of the institutional mammographic results database was done to identify bilateral screening mammographic examinations obtained from January 1, 1999, through July 15, 2005.

Blinded comparison of computer-aided detection with human second reading in screening mammography.

Objective: The purpose of this study was to compare a human second reader with computer-aided detection (CAD) for the reduction of false-negative cases by a primary radiologist. We retrospectively reviewed our clinical practice.

Materials And Methods: We found that 6,381 consecutive screening mammograms were interpreted by a primary reader.

Model-based region-of-interest selection in dynamic breast MRI.

Magnetic resonance imaging (MRI) is emerging as a powerful tool for the diagnosis of breast abnormalities. Dynamic analysis of the temporal pattern of contrast uptake has been applied in differential diagnosis of benign and malignant lesions to improve specificity. Selecting a region of interest (ROI) is an almost universal step in the process of examining the contrast uptake characteristics of a breast lesion.

Radiological reasoning: male breast mass with calcifications.

Objective: We encountered a mammographically calcified breast mass in a 30-year-old man. It was initially thought to be comedo-type ductal carcinoma in situ because of the dense calcifications, but sonography and MRI suggested a highly vascular lesion. The final pathologic diagnosis was hemangioma.

Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer.

Objective: The objective of our study was to determine the relative accuracy of mammography, sonography, and MRI in predicting residual tumor after neoadjuvant chemotherapy for breast cancer as compared with the gold standards of physical examination and pathology.

Subjects And Methods: Forty-one women with stage IIB-III palpable breast cancer were prospectively enrolled in a study investigating the effects of sequential single-agent chemotherapy (doxorubicin followed by paclitaxel or vice versa) on tumor imaging. The study cohort consisted of the first 31 patients (age range, 31-65 years; mean, 45 years) who completed the protocol.

The mammary hamartoma: appreciation of additional imaging characteristics.

Objective: To determine the mammographic and sonographic findings of hamartomas that were not classic on imaging, how pathologists distinguish the hamartoma from benign breast tissue on core samples, and reasons for discrepancies between core and surgical biopsy.

Methods: A retrospective review of all image-recommended core biopsies between 1993 and 2001 was performed. There were 41 cases of hamartomas found on either core or surgical biopsy.

Amphiphysin paraneoplastic syndrome: a delayed diagnosis of breast carcinoma.

We present a rare case of the paraneoplastic disorder, amphiphysin autoimmunity, which is associated with breast cancer. Amphiphysin is a presynaptic protein to which the body can form antibodies usually in cases of carcinoma, particularly of the breast and lung. The diagnosis of malignancy was delayed because of the complexity of the presenting neurologic symptoms related to the autoimmunity.