Current Concepts in Molecular Breast Imaging.

Molecular breast imaging (MBI) is a functional imaging modality that utilizes technetium 99m sestamibi radiotracer uptake to evaluate the biology of breast tumors. Molecular breast imaging can be a useful tool for supplemental screening of women with dense breasts, for breast cancer diagnosis and staging, and for evaluation of treatment response in patients with breast cancer undergoing neoadjuvant systemic therapy. In addition, MBI is useful in problem-solving when mammography and US imaging are insufficient to arrive at a definite diagnosis and for patients who cannot undergo breast MRI.

Identifying and Reducing Barriers to Breast Imaging.

Purpose Of Review: The purpose of this review is to discuss disparities in breast health care access and outcomes related to race, gender, cultural diversity, sexual orientation, socioeconomic status, geographic location, and disability. The authors recognize the complexity of eliminating inequalities in health care but are optimistic that all patients will one day have equal access to care through dialogue, acknowledgment, recognition, and action.

Recent Findings: After lung cancer, breast cancer is the second leading cause of death among American women.

Quantitative Apparent Diffusion Coefficients From Peritumoral Regions as Early Predictors of Response to Neoadjuvant Systemic Therapy in Triple-Negative Breast Cancer.

Background: Pathologic complete response (pCR) to neoadjuvant systemic therapy (NAST) in triple-negative breast cancer (TNBC) is a strong predictor of patient survival. Edema in the peritumoral region (PTR) has been reported to be a negative prognostic factor in TNBC.

Purpose: To determine whether quantitative apparent diffusion coefficient (ADC) features from PTRs on reduced field-of-view (rFOV) diffusion-weighted imaging (DWI) predict the response to NAST in TNBC.

Review of the Sonographic Features of Interpectoral (Rotter) Lymph Nodes in Breast Cancer Staging.

This article reviews the ultrasound evaluation and staging of breast cancer with respect to the involvement of interpectoral (Rotter) lymph nodes. The primary objective is to demonstrate and assess the characteristic sonographic findings of interpectoral (Rotter) lymph nodes to help provide accurate nodal staging information. We aim to provide a comprehensive review and serve as an imaging guide for the identification and evaluation of Rotter lymph nodes.

Clinical Outcomes Using Magnetic Seeds as a Non-wire, Non-radioactive Alternative for Localization of Non-palpable Breast Lesions.

Background: Nonpalpable breast lesions require precise preoperative localization to facilitate negative margins with breast-conserving therapy. The traditional use of wires has several challenges including patient discomfort, wire migration, and coordination of schedules between radiology and the operating room. Radioactive seed localization overcomes some of these challenges, but radiation safety requirements have limited adoption of this technology.

MRI-guided Breast Biopsy Case-based Review: Essential Techniques and Approaches to Challenging Cases.

MRI-guided breast biopsy is often necessary to distinguish between benign and malignant lesions depicted at MRI, and meticulous preparation and radiologic-pathologic correlation aid in definitive diagnosis.

Team Science: A Practical Approach to Starting Collaborative Projects.

A collaborative approach to treating patients is well taught in medical training. However, collaboration and team building in clinical and laboratory research may have been given less emphasis. More scientific discoveries are now being made with multidisciplinary teams, requiring a thoughtful approach in order to achieve research goals while mitigating potential conflicts.

The Challenging Image-Guided Preoperative Breast Localization: A Modality-Based Approach.

Breast conservation surgery (BCS) is the standard of care for treating patients with early-stage breast cancer and those with locally advanced breast cancer who achieve an excellent response to neoadjuvant chemotherapy. The radiologist is responsible for accurately localizing nonpalpable lesions to facilitate successful BCS. In this article, we present a practical modality-based guide on approaching challenging pre-operative localizations and incorporate examples of challenging localizations performed under sonographic, mammographic, and MRI guidance, as well as under multiple modalities.

Clinicopathological features of and neoadjuvant therapy for human epidermal growth factor receptor 2-positive classic invasive lobular carcinoma.

Human epidermal growth factor receptor 2 (HER2)-positive classic invasive lobular carcinoma (ILC) is a rare entity, and its specific pathological characteristics and clinical behavior are unclear. Therefore, we retrospectively investigated the clinicopathological features of HER2-positive classic ILC and described HER2-targeted neoadjuvant chemotherapy outcome. Fourteen HER2-positive classic ILC cases were identified, their clinicopathological data were collected, and their clinical management was investigated.

A Deep Learning Approach to Re-create Raw Full-Field Digital Mammograms for Breast Density and Texture Analysis.

Purpose: To develop a computational approach to re-create rarely stored for-processing (raw) digital mammograms from routinely stored for-presentation (processed) mammograms.

Materials And Methods: In this retrospective study, pairs of raw and processed mammograms collected in 884 women (mean age, 57 years ± 10 [standard deviation]; 3713 mammograms) from October 5, 2017, to August 1, 2018, were examined. Mammograms were split 3088 for training and 625 for testing.

Fluid-filled breast: A unique clinical presentation of invasive micropapillary carcinoma.

Invasive micropapillary carcinoma is a rare variant of invasive ductal carcinoma of the breast. This variant has been described as clinically aggressive due to its high frequency of lymphovascular invasion, axillary nodal metastases, and a greater degree of loco-regional recurrence. Invasive micropapillary carcinoma can have a variety of imaging presentations, typically presenting as an irregular mass.

Bracketing with Multiple Radioactive Seeds to Achieve Negative Margins in Breast Conservation Surgery: Multiple Seeds in Breast Surgery.

Introduction: Breast conservation surgery (BCS) is the treatment of choice for unifocal, early-stage breast cancer. The ability to offer BCS to a wider subset of patients, including those with multifocal/multicentric cancer as well as extensive ductal carcinoma in situ, has emerged over time, especially in those undergoing joint oncoplastic reconstruction and those treated with neoadjuvant therapy. However, localization techniques using multiple radioactive seeds for bracketing in this patient subset have not been validated.

Early ultrasound evaluation identifies excellent responders to neoadjuvant systemic therapy among patients with triple-negative breast cancer.

Background: Heterogeneity exists in the response of triple-negative breast cancer (TNBC) to standard anthracycline (AC)/taxane-based neoadjuvant systemic therapy (NAST), with 40% to 50% of patients having a pathologic complete response (pCR) to therapy. Early assessment of the imaging response during NAST may identify a subset of TNBCs that are likely to have a pCR upon completion of treatment. The authors aimed to evaluate the performance of early ultrasound (US) after 2 cycles of neoadjuvant NAST in identifying excellent responders to NAST among patients with TNBC.

Mitigating the Transmission of COVID-19 with the Appropriate Usage of Personal Protective Protocols and Equipment in Breast Imaging and Intervention.

The integration of personal protective equipment (PPE) and procedures into breast imaging and intervention practices will mitigate the risk of transmission of COVID-19 during the pandemic. Although supply chain shortages have improved, understanding the proper use of PPE and protocols to mitigate overconsumption are important to ensure efficacious utilization of PPE. Protocols and best practices are reviewed, and guidelines and resource materials are referenced in order to support breast imaging healthcare professionals.

Li-Fraumeni Syndrome and Whole-Body MRI Screening: Screening Guidelines, Imaging Features, and Impact on Patient Management.

Objective: Li-Fraumeni syndrome (LFS) is a rare autosomal-dominant inherited syndrome containing a germline mutation in the gene, which predisposes to oncogenesis. Leukemia and tumors of the brain, soft tissues, breasts, adrenal glands, and bone are the most common cancers associated with this syndrome. Patients with LFS are very susceptible to radiation, therefore the use of whole-body MRI is recommended for regular cancer screening.