Implementation of Intraoperative Ultrasound Localization for Breast-Conserving Surgery in a Large, Integrated Health Care System is Feasible and Effective.

Background: Intraoperative ultrasound (IUS) localization for breast cancer is a noninvasive localization technique. In 2015, an IUS program for breast-conserving surgery (BCS) was initiated in a large, integrated health care system. This study evaluated the clinical results of IUS implementation.

Mask-Guided Convolutional Neural Network for Breast Tumor Prognostic Outcome Prediction on 3D DCE-MR Images.

In this proof-of-concept work, we have developed a 3D-CNN architecture that is guided by the tumor mask for classifying several patient-outcomes in breast cancer from the respective 3D dynamic contrast-enhanced MRI (DCE-MRI) images. The tumor masks on DCE-MRI images were generated using pre- and post-contrast images and validated by experienced radiologists. We show that our proposed mask-guided classification has a higher accuracy than that from either the full image without tumor masks (including background) or the masked voxels only.

Can Radiologists Predict the Presence of Ductal Carcinoma In Situ and Invasive Breast Cancer?

Objective: We hypothesize that radiologists' estimated percentage likelihood assessments for the presence of ductal carcinoma in situ (DCIS) and invasive cancer may predict histologic outcomes.

Materials And Methods: Two hundred fifty cases categorized as BI-RADS category 4 or 5 at four University of California Medical Centers were retrospectively reviewed by 10 academic radiologists with a range of 1-39 years in practice. Readers assigned BI-RADS category (1, 2, 3, 4a, 4b, 4c, or 5), estimated percentage likelihood of DCIS or invasive cancer (0-100%), and confidence rating (1 = low, 5 = high) after reviewing screening and diagnostic mammograms and ultrasound images.

Inter-reader Variability in the Use of BI-RADS Descriptors for Suspicious Findings on Diagnostic Mammography: A Multi-institution Study of 10 Academic Radiologists.

Rationale And Objectives: The study aimed to determine the inter-observer agreement among academic breast radiologists when using the Breast Imaging Reporting and Data System (BI-RADS) lesion descriptors for suspicious findings on diagnostic mammography.

Materials And Methods: Ten experienced academic breast radiologists across five medical centers independently reviewed 250 de-identified diagnostic mammographic cases that were previously assessed as BI-RADS 4 or 5 with subsequent pathologic diagnosis by percutaneous or surgical biopsy. Each radiologist assessed the presence of the following suspicious mammographic findings: mass, asymmetry (one view), focal asymmetry (two views), architectural distortion, and calcifications.

Improving Screening Mammography Outcomes Through Comparison With Multiple Prior Mammograms.

Objective: The objective of the present study is to evaluate the effect of comparison with multiple prior mammograms on the outcomes of screening mammography relative to comparison with a single prior mammogram.

Materials And Methods: We retrospectively analyzed 46,288 consecutive screening mammograms performed at our institution for 22,792 women. We divided these examinations into three groups: those interpreted without comparison with prior mammograms, those interpreted in comparison with one prior examination, and those interpreted in comparison with two or more prior examinations.

Follow-up outcomes after benign concordant MRI-guided breast biopsy.

Objective: To evaluate outcomes of benign concordant magnetic resonance imaging (MRI)-guided breast biopsy.

Methods: We retrospectively reviewed 611 consecutive MRI-guided breast core biopsies at our institution from 2005 to 2012. Benign concordant cases with MRI follow-up constituted the study group.

Internal mammary lymph nodes as incidental findings at screening breast MRI.

Objective: To evaluate the prevalence of internal mammary lymph nodes (IMLNs) on breast magnetic resonance imaging (MRI) in a screening population.

Materials And Methods: We retrospectively reviewed 92 consecutive screening breast MRI exams. Logistic regression was performed to ascertain the risk of IMLNs in cancer-free subjects and to determine whether the risk varies with age.

Extra-mammary findings on breast MRI: a pictorial review.

Recent improvements in breast coil performance have made detection of extra-mammary findings increasingly common. Some of these findings have important clinical implications. The radiologist should be aware of the spectrum of extra-mammary pathologies found on breast magnetic resonance imaging (MRI) and be able to distinguish clinically significant findings from those that are inconsequential.

Lesion morphology on breast MRI affects targeted ultrasound correlation rate.

Introduction: Suspicious lesions on breast MRI are often initially evaluated using targeted ultrasound. However, workup varies. Data on the rate of correlate detection by morphology [mass, non-mass enhancement (NME), or focus] would be useful for developing practice guidelines.

Imaging features of HER2 overexpression in breast cancer: a systematic review and meta-analysis.

Breast cancer imaging phenotype is diverse and may relate to molecular alterations driving cancer behavior. We systematically reviewed and meta-analyzed relations between breast cancer imaging features and human epidermal growth factor receptor type 2 (HER2) overexpression as a marker of breast cancer aggressiveness. MEDLINE and EMBASE were searched for mammography, breast ultrasound, magnetic resonance imaging (MRI), and/or [(18)F]fluorodeoxyglucose positron emission tomography studies through February 2013.

High resolution in vivo characterization of apparent diffusion coefficient at the tumor-stromal boundary of breast carcinomas: a pilot study to assess treatment response using proximity-dependent diffusion-weighted imaging.

Purpose: To evaluate diffusion changes in the breast tumor-stromal boundary and adjacent tissue in response to neoadjuvant chemotherapy using high resolution diffusion-weighted imaging (HR-DWI).

Materials And Methods: Seven patients with invasive breast cancer were imaged with HR-DWI before and early during treatment. The mean apparent diffusion coefficient (ADC) was plotted in 1-mm increments around the tumor boundary.

High-resolution diffusion-weighted imaging for the separation of benign from malignant BI-RADS 4/5 lesions found on breast MRI at 3T.

Purpose: To determine whether readout-segmented echo-planar diffusion imaging (RESOLVE) improves separation of malignant versus benign lesions compared to standard single-shot echo-planar imaging (ss-EPI) on BI-RADS 4/5 lesions detected on breast magnetic resonance imaging (MRI).

Materials And Methods: Consecutive 3T breast MRI studies with BI-RADS 4/5 designation and subsequent biopsy or benign mastectomy were retrospectively identified. Freehand regions of interest (ROIs) were drawn on lesions and also on normal background fibroglandular tissue for comparison.

Features of occult invasion in biopsy-proven DCIS at breast MRI.

The purpose of this study is to determine if MRI BI-RADS criteria or radiologist perception correlate with presence of invasive cancer after initial core biopsy of ductal carcinoma in situ (DCIS). Retrospective search spanning 2000-2007 identified all core-biopsy diagnoses of pure DCIS that coincided with preoperative MRI. Two radiologists fellowship-trained in breast imaging categorized lesions according to ACR MRI BI-RADS lexicon and estimated likelihood of occult invasion.

Breast MR imaging for extent of disease assessment in patients with newly diagnosed breast cancer.

Breast cancer staging and surgical planning are affected by the burden of pathologically proven cancer detected on clinical examination and/or imaging. Magnetic resonance (MR) imaging has superior sensitivity and accuracy for the detection of invasive and in situ breast cancer as compared with physical examination, mammography, and ultrasound but can be limited in specificity. The use of preoperative breast MR imaging for evaluating the extent of disease remains controversial at present because studies have not definitively shown it to improve overall survival, decrease re-excision rates, or to decrease the cost of care.

Triple-negative and non-triple-negative invasive breast cancer: association between MR and fluorine 18 fluorodeoxyglucose PET imaging.

Purpose: To assess the relationship between parameters measured on dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in primary invasive breast cancer.

Materials And Methods: This HIPAA-compliant study was a retrospective review of medical records and therefore approved by the institutional review board without the requirement for informed consent. Patients with a diagnosis of invasive breast cancer from January 2005 through December 2009 who underwent both DCE MR imaging and FDG PET/CT before treatment initiation were retrospectively identified.

Recognizing artifacts and optimizing breast MRI at 1.5 and 3 T.

Objective: This article will discuss routine 1.5 and 3 T MRI of the breast as well as illustrate several examples of patient-related and technical artifacts one might encounter. Suggestions to help eliminate these artifacts and optimize images will be provided.

High-resolution diffusion-weighted imaging for monitoring breast cancer treatment response.

Rationale And Objectives: The aim of this work was to compare a high-resolution diffusion-weighted imaging (HR-DWI) acquisition (voxel size = 4.8 mm(3)) to a standard diffusion-weighted imaging (STD-DWI) acquisition (voxel size = 29.3 mm(3)) for monitoring neoadjuvant therapy-induced changes in breast tumors.

High-resolution diffusion-weighted magnetic resonance imaging in patients with locally advanced breast cancer.

Rationale And Objectives: The aim of this study was to evaluate differences in tumor depiction and measured tumor apparent diffusion coefficient (ADC) with the use of a high-resolution diffusion-weighted (DW) magnetic resonance imaging (MRI) sequence, compared to a standard DW MRI sequence, in patients with locally advanced breast cancer.

Materials And Methods: Patients with locally advanced breast cancer were scanned with a reduced-field of view (rFOV) DW MRI sequence (high resolution) and a standard-field of view diffusion sequence (standard resolution), and differences between the two sequences were evaluated quantitatively (by calculating tumor ADC distribution parameters) and qualitatively (by radiologists' visual assessments of images).

Results: Although the mean tumor ADC for both sequences was similar, differences were found in other parameters, including the 12.

The impact of preoperative magnetic resonance imaging on surgical treatment and outcomes for ductal carcinoma in situ.

Background: Although magnetic resonance imaging (MRI) is a useful imaging modality for invasive cancer, its role in preoperative surgical planning for ductal carcinoma in situ (DCIS) has not been established. We sought to determine whether preoperative MRI affects surgical treatment and outcomes in women with pure DCIS.

Patients And Methods: We reviewed consecutive records of women diagnosed with pure DCIS on core biopsy between 2000 and 2007.