Novel factors to improve prediction of nodal positivity in patients with clinical T1/T2 breast cancers.

Background: Memorial Sloan Kettering Cancer Center (MSKCC) and MD Anderson Cancer Center (MDACC) have established nomograms to predict sentinel node positivity. We propose the addition of two novel variables-distance of tumor from the nipple and from the skin-can improve their performance.

Methods: Ultrasounds of clinical T1/T2 tumors were reviewed.

The influence of mammogram acquisition on the mammographic density and breast cancer association in the Mayo Mammography Health Study cohort.

Introduction: Mammographic density is a strong risk factor for breast cancer. Image acquisition technique varies across mammograms to limit radiation and produce a clinically useful image. We examined whether acquisition technique parameters at the time of mammography were associated with mammographic density and whether the acquisition parameters confounded the density and breast cancer association.

Is there a role for magnetic resonance imaging in diagnosing palpable breast masses when mammogram and ultrasound are negative?

Background: The use of breast magnetic resonance imaging (MRI) for screening high-risk patients is well established. However, the role of MRI as a diagnostic problem-solving tool is less well studied. With the increasing availability of MRI, its use for problem solving has increased.

A novel automated mammographic density measure and breast cancer risk.

Background: Mammographic breast density is a strong breast cancer risk factor but is not used in the clinical setting, partly because of a lack of standardization and automation. We developed an automated and objective measurement of the grayscale value variation within a mammogram, evaluated its association with breast cancer, and compared its performance with that of percent density (PD).

Methods: Three clinic-based studies were included: a case-cohort study of 217 breast cancer case subjects and 2094 non-case subjects and two case-control studies comprising 928 case subjects and 1039 control subjects and 246 case subjects and 516 control subjects, respectively.

Should axillary ultrasound be used in patients with a preoperative diagnosis of ductal carcinoma in situ?

Background: We evaluated the usefulness of axillary ultrasound (US) in patients with core biopsy-proven ductal carcinoma in situ (DCIS).

Methods: Preoperative axillary US, fine-needle aspiration (FNA), and sentinel lymph node (SLN) data from women with DCIS were reviewed.

Results: Eighty-two women with DCIS underwent axillary US.

Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk.

Context: Annual ultrasound screening may detect small, node-negative breast cancers that are not seen on mammography. Magnetic resonance imaging (MRI) may reveal additional breast cancers missed by both mammography and ultrasound screening.

Objective: To determine supplemental cancer detection yield of ultrasound and MRI in women at elevated risk for breast cancer.

Distance of breast cancer from the skin and nipple impacts axillary nodal metastases.

Background: Lymphatic drainage of the breast is via subareolar and dermal lymphatics. The aim of this study was to determine whether distance of breast cancers from the skin and/or distance from the nipple impacts the likelihood of axillary nodal metastases.

Methods: A retrospective review was performed of sonographically visible T1 and T2 breast cancers with breast and axillary surgery performed at Mayo Clinic, Rochester, MN.

Predictive value of sonographic features of extranodal extension in axillary lymph nodes.

Objective: The purpose of this study was to assess the accuracy of 5 sonographic features in the prediction of extranodal extension (ENE) in axillary lymph nodes (ALNs) of patients with biopsy-proven breast cancer.

Methods: A review of our institution's surgical and pathologic database was performed for patients with pathologically proven axillary ENE from October 1, 2003, to October 1, 2007. An equivalent number of patients without ENE were included.

Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer.

Context: Screening ultrasound may depict small, node-negative breast cancers not seen on mammography.

Objective: To compare the diagnostic yield, defined as the proportion of women with positive screen test results and positive reference standard, and performance of screening with ultrasound plus mammography vs mammography alone in women at elevated risk of breast cancer.

Design, Setting, And Participants: From April 2004 to February 2006, 2809 women, with at least heterogeneously dense breast tissue in at least 1 quadrant, were recruited from 21 sites to undergo mammographic and physician-performed ultrasonographic examinations in randomized order by a radiologist masked to the other examination results.

Carcinoma of the breast mimicking an areolar dermal lesion.

Objective: This report describes the sonographic features of 2 patients with invasive carcinoma of the breast that sonographically mimicked benign epithelial cysts of the areola.

Methods: We retrospectively reviewed 2 cases of invasive ductal carcinoma that initially were diagnosed as dermal lesions in the areola after sonographic evaluation.

Results: Sonographically, the 2 lesions were centered between the echogenic lines of the deep dermis of the areola.

Screening mammograms: interpretation with computer-aided detection--prospective evaluation.

Purpose: To prospectively determine the effect of a commercially available computer-aided detection (CAD) system on interpretations of screening mammograms.

Materials And Methods: Institutional review board approval was granted; informed consent and HIPAA compliance were waived. A total of 21 349 screening mammograms obtained in 18 096 women were interpreted first without and then with review of CAD images to determine the effect of CAD analysis on the screening breast cancer detection rate, recall rate, and positive predictive value (PPV) for biopsy.

Breast lesions: evaluation with US strain imaging--clinical experience of multiple observers.

Purpose: To prospectively determine the accuracy of using an ultrasonographic (US) strain imaging technique known as lesion size comparison to differentiate benign from malignant breast lesions.

Materials And Methods: Institutional Review Board approval and patient informed consent were obtained for this HIPPA-compliant study. US strain imaging was performed prospectively for 89 breast lesions in 88 patients.

Spontaneous unilateral nipple discharge: when screening tests are negative--a case report and review of current diagnostic management of a pathologic nipple discharge.

We describe a 45-year-old woman who presented with a spontaneous unilateral nipple discharge. With a negative breast examination and screening tests (mammography and ultrasonography) she underwent mammary ductography, which revealed a small 3-4 mm intraluminal filling defect. A core biopsy showed high-grade ductal carcinoma in situ (DCIS).