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Objectives: Limited understanding exists regarding non-detected cancers in digital breast tomosynthesis (DBT) screening. This study aims to classify non-detected cancers into true or false negatives, compare them with true positives, and analyze reasons for non-detection.Conducted between 2010 and 2015, the prospective single-center Malmö Breast Tomosynthesis Screening Trial (MBTST) compared one-view DBT and two-view digital mammography (DM). Cancers not detected by DBT, i.e., interval cancers, those detected in the next screening round, and those only identified by DM, underwent a retrospective informed review by in total four breast radiologists. Reviewers classified cancers into true negative, false negative, or non-visible based on both DBT and DM findings and assessed radiographic appearances at screening and diagnosis, breast density, and reasons for non-detection. Statistics included the Pearson X2 test.In total, 89 cancers were not detected with DBT in the MBTST; eight cancers were solely in the DM reading mode, 59 during subsequent DM screening rounds, and 22 interval cancers. The proportion of cancers classified as false negative was 25% (22/89) based on DBT, compared with 18% (14/81) based on DM screening. The primary reason for false negatives was normal-appearing density, 50% (11/22). False negatives exhibited lower rates of high breast density, 36% (8/22), compared with true positives, 61% (78/129), p = 0.04, and spiculated densities were less frequent in false negatives, 41% (9/22) compared with true positives, 68% (88/129), p = 0.01.False negatives in one-view DBT screening commonly presented with spiculated features, but less frequently than true positives, and were missed or misinterpreted due to benign appearances.QuestionCancers not detected in digital breast tomosynthesis screening, including false negatives, remain partly unexplored.FindingsThe most common reason behind false-negative cancers in a large screening trial was a normal-appearing density.Clinical relevanceRecognizing the factors contributing to false negative findings in digital breast tomosynthesis screening is essential to further improve cancer detection.Materials and methods: Limited understanding exists regarding non-detected cancers in digital breast tomosynthesis (DBT) screening. This study aims to classify non-detected cancers into true or false negatives, compare them with true positives, and analyze reasons for non-detection.Conducted between 2010 and 2015, the prospective single-center Malmö Breast Tomosynthesis Screening Trial (MBTST) compared one-view DBT and two-view digital mammography (DM). Cancers not detected by DBT, i.e., interval cancers, those detected in the next screening round, and those only identified by DM, underwent a retrospective informed review by in total four breast radiologists. Reviewers classified cancers into true negative, false negative, or non-visible based on both DBT and DM findings and assessed radiographic appearances at screening and diagnosis, breast density, and reasons for non-detection. Statistics included the Pearson X2 test.In total, 89 cancers were not detected with DBT in the MBTST; eight cancers were solely in the DM reading mode, 59 during subsequent DM screening rounds, and 22 interval cancers. The proportion of cancers classified as false negative was 25% (22/89) based on DBT, compared with 18% (14/81) based on DM screening. The primary reason for false negatives was normal-appearing density, 50% (11/22). False negatives exhibited lower rates of high breast density, 36% (8/22), compared with true positives, 61% (78/129), p = 0.04, and spiculated densities were less frequent in false negatives, 41% (9/22) compared with true positives, 68% (88/129), p = 0.01.False negatives in one-view DBT screening commonly presented with spiculated features, but less frequently than true positives, and were missed or misinterpreted due to benign appearances.QuestionCancers not detected in digital breast tomosynthesis screening, including false negatives, remain partly unexplored.FindingsThe most common reason behind false-negative cancers in a large screening trial was a normal-appearing density.Clinical relevanceRecognizing the factors contributing to false negative findings in digital breast tomosynthesis screening is essential to further improve cancer detection.Results: Limited understanding exists regarding non-detected cancers in digital breast tomosynthesis (DBT) screening. This study aims to classify non-detected cancers into true or false negatives, compare them with true positives, and analyze reasons for non-detection.Conducted between 2010 and 2015, the prospective single-center Malmö Breast Tomosynthesis Screening Trial (MBTST) compared one-view DBT and two-view digital mammography (DM). Cancers not detected by DBT, i.e., interval cancers, those detected in the next screening round, and those only identified by DM, underwent a retrospective informed review by in total four breast radiologists. Reviewers classified cancers into true negative, false negative, or non-visible based on both DBT and DM findings and assessed radiographic appearances at screening and diagnosis, breast density, and reasons for non-detection. Statistics included the Pearson X2 test.In total, 89 cancers were not detected with DBT in the MBTST; eight cancers were solely in the DM reading mode, 59 during subsequent DM screening rounds, and 22 interval cancers. The proportion of cancers classified as false negative was 25% (22/89) based on DBT, compared with 18% (14/81) based on DM screening. The primary reason for false negatives was normal-appearing density, 50% (11/22). False negatives exhibited lower rates of high breast density, 36% (8/22), compared with true positives, 61% (78/129), p = 0.04, and spiculated densities were less frequent in false negatives, 41% (9/22) compared with true positives, 68% (88/129), p = 0.01.False negatives in one-view DBT screening commonly presented with spiculated features, but less frequently than true positives, and were missed or misinterpreted due to benign appearances.QuestionCancers not detected in digital breast tomosynthesis screening, including false negatives, remain partly unexplored.FindingsThe most common reason behind false-negative cancers in a large screening trial was a normal-appearing density.Clinical relevanceRecognizing the factors contributing to false negative findings in digital breast tomosynthesis screening is essential to further improve cancer detection.Conclusion: Limited understanding exists regarding non-detected cancers in digital breast tomosynthesis (DBT) screening. This study aims to classify non-detected cancers into true or false negatives, compare them with true positives, and analyze reasons for non-detection.Conducted between 2010 and 2015, the prospective single-center Malmö Breast Tomosynthesis Screening Trial (MBTST) compared one-view DBT and two-view digital mammography (DM). Cancers not detected by DBT, i.e., interval cancers, those detected in the next screening round, and those only identified by DM, underwent a retrospective informed review by in total four breast radiologists. Reviewers classified cancers into true negative, false negative, or non-visible based on both DBT and DM findings and assessed radiographic appearances at screening and diagnosis, breast density, and reasons for non-detection. Statistics included the Pearson X2 test.In total, 89 cancers were not detected with DBT in the MBTST; eight cancers were solely in the DM reading mode, 59 during subsequent DM screening rounds, and 22 interval cancers. The proportion of cancers classified as false negative was 25% (22/89) based on DBT, compared with 18% (14/81) based on DM screening. The primary reason for false negatives was normal-appearing density, 50% (11/22). False negatives exhibited lower rates of high breast density, 36% (8/22), compared with true positives, 61% (78/129), p = 0.04, and spiculated densities were less frequent in false negatives, 41% (9/22) compared with true positives, 68% (88/129), p = 0.01.False negatives in one-view DBT screening commonly presented with spiculated features, but less frequently than true positives, and were missed or misinterpreted due to benign appearances.QuestionCancers not detected in digital breast tomosynthesis screening, including false negatives, remain partly unexplored.FindingsThe most common reason behind false-negative cancers in a large screening trial was a normal-appearing density.Clinical relevanceRecognizing the factors contributing to false negative findings in digital breast tomosynthesis screening is essential to further improve cancer detection.Key Points: Limited understanding exists regarding non-detected cancers in digital breast tomosynthesis (DBT) screening. This study aims to classify non-detected cancers into true or false negatives, compare them with true positives, and analyze reasons for non-detection.Conducted between 2010 and 2015, the prospective single-center Malmö Breast Tomosynthesis Screening Trial (MBTST) compared one-view DBT and two-view digital mammography (DM). Cancers not detected by DBT, i.e., interval cancers, those detected in the next screening round, and those only identified by DM, underwent a retrospective informed review by in total four breast radiologists. Reviewers classified cancers into true negative, false negative, or non-visible based on both DBT and DM findings and assessed radiographic appearances at screening and diagnosis, breast density, and reasons for non-detection. Statistics included the Pearson X2 test.In total, 89 cancers were not detected with DBT in the MBTST; eight cancers were solely in the DM reading mode, 59 during subsequent DM screening rounds, and 22 interval cancers. The proportion of cancers classified as false negative was 25% (22/89) based on DBT, compared with 18% (14/81) based on DM screening. The primary reason for false negatives was normal-appearing density, 50% (11/22). False negatives exhibited lower rates of high breast density, 36% (8/22), compared with true positives, 61% (78/129), p = 0.04, and spiculated densities were less frequent in false negatives, 41% (9/22) compared with true positives, 68% (88/129), p = 0.01.False negatives in one-view DBT screening commonly presented with spiculated features, but less frequently than true positives, and were missed or misinterpreted due to benign appearances.QuestionCancers not detected in digital breast tomosynthesis screening, including false negatives, remain partly unexplored.FindingsThe most common reason behind false-negative cancers in a large screening trial was a normal-appearing density.Clinical relevanceRecognizing the factors contributing to false negative findings in digital breast tomosynthesis screening is essential to further improve cancer detection.Graphical Abstract: Limited understanding exists regarding non-detected cancers in digital breast tomosynthesis (DBT) screening. This study aims to classify non-detected cancers into true or false negatives, compare them with true positives, and analyze reasons for non-detection.Conducted between 2010 and 2015, the prospective single-center Malmö Breast Tomosynthesis Screening Trial (MBTST) compared one-view DBT and two-view digital mammography (DM). Cancers not detected by DBT, i.e., interval cancers, those detected in the next screening round, and those only identified by DM, underwent a retrospective informed review by in total four breast radiologists. Reviewers classified cancers into true negative, false negative, or non-visible based on both DBT and DM findings and assessed radiographic appearances at screening and diagnosis, breast density, and reasons for non-detection. Statistics included the Pearson X2 test.In total, 89 cancers were not detected with DBT in the MBTST; eight cancers were solely in the DM reading mode, 59 during subsequent DM screening rounds, and 22 interval cancers. The proportion of cancers classified as false negative was 25% (22/89) based on DBT, compared with 18% (14/81) based on DM screening. The primary reason for false negatives was normal-appearing density, 50% (11/22). False negatives exhibited lower rates of high breast density, 36% (8/22), compared with true positives, 61% (78/129), p = 0.04, and spiculated densities were less frequent in false negatives, 41% (9/22) compared with true positives, 68% (88/129), p = 0.01.False negatives in one-view DBT screening commonly presented with spiculated features, but less frequently than true positives, and were missed or misinterpreted due to benign appearances.QuestionCancers not detected in digital breast tomosynthesis screening, including false negatives, remain partly unexplored.FindingsThe most common reason behind false-negative cancers in a large screening trial was a normal-appearing density.Clinical relevanceRecognizing the factors contributing to false negative findings in digital breast tomosynthesis screening is essential to further improve cancer detection. [ABSTRACT FROM AUTHOR]

The article discusses the Hologic PERL ring has a novel localization device comprised of a nitinol-ring tip and flexible 25-cm wire tail preloaded on an 11.5 cm 16-gauge introducer needle. Topics include the surgical approach has similar to standard preoperative wire localization without the inconvenience of same-day placement; and to avoid sharp injuries, the pathology grossing room has alerted prior to handling the surgical specimen.

Focuses on primary squamous cell carcinoma of the breast. Adenocarcinomas with squamous metaplasia; Descriptions of the tumors; Discussion of a case.

Abstract: Microcalcifications discovered by mammography require careful analysis, occasionally leading to core biopsy to exclude associated breast cancer. We report unrecognized milk of calcium layering on small field of view prone digital stereotactic images. We illustrate important features on prone digital images attributed to milk of calcium which can exclude breast neoplasm, suggest this diagnosis, and prevent unnecessary biopsy. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Cost-effectiveness of mutation carriers with breast magnetic resonance imaging," by S. K. Plevritis, A. W. Kunan, and B. M. Sigal in a previous issue.

Abstract: Background and purpose: Pre-treatment breast magnetic resonance imaging (MRI) findings in a cohort of women prospectively evaluated for accelerated partial breast irradiation (APBI) are reviewed and characterized to determine the optimal use of MRI in these patients. Materials and methods: Candidates initially deemed eligible for a prospective APBI trial based on physical examination, mammography, and ultrasound (US) were further evaluated with breast MRI before treatment. All abnormal MRI findings were biopsied. Results: Between 2002 and 2011, 180 women who met inclusion criteria for APBI underwent breast MRI prior to treatment (median age=59; range 38–86). 126 tumors (70%) were invasive carcinomas with or without associated DCIS, while 54 (30%) were pure DCIS. Breast MRI confirmed unifocal disease in 109 patients with 111 cancers (60.5% of MRI cohort). Multifocal disease was identified in 19 patients (10.5% of MRI cohort), while multicentric disease was present in 3 patients (1.6% of MRI cohort). Five patients (4%) had an MRI-detected contralateral cancer. False positive MRI findings were seen in 45 patients (25% of MRI cohort). Pre-menopausal patients and patients with tumors >2cm were more likely to have MRI-detected multifocal/multicentric disease. While there was no statistically significant correlation between multifocal/multicentric disease and breast density, tumor histology, grade, ER status, or Her2/Neu expression, numbers in each category were small, suggesting a lack of statistical power to detect differences that may be clinically meaningful. One hundred and fifty-two of the 180 patients (84.4%) successfully completed lumpectomy and APBI, while 6.7% of the cohort underwent mastectomy. Conclusions: Breast MRI identified additional disease in 12% of APBI candidates. Premenopausal women and patients with tumors >2cm were more likely to have MRI-detected multifocal/multicentric disease. [Copyright &y& Elsevier]

Abstract: Background: Contrast-enhanced breast magnetic resonance imaging (MRI) is highly sensitive for breast cancer. However, adoption of breast MRI is hampered by frequent false positive (FP) findings. Though ultimately proven benign, these suspicious findings require biopsy due to abnormal morphology and/or kinetic enhancement curves that simulate malignancy on MRI. We hypothesized that analysis of a series of FP MRI findings could reveal a pattern of association between certain “suspicious” lesions and benign disease that might help avoid unnecessary biopsy of such lesions in the future. Methods: A retrospective chart review identified women undergoing breast MRI between June 1995 and March 2002 with FP findings identified by MRI alone. Lesions were retrospectively characterized according to an MRI Breast Imaging–Reporting and Data System lexicon and matched to pathology. Results: Twenty-two women were identified with 29 FP lesions. Morphology revealed 1 focus (3.5%), 5 masses less than 5 mm (17%), 11 masses greater than 5 mm (38%), 1 (3.5%) linear enhancement, and 11 (38%) non–mass-like enhancement. Kinetic curves were suspicious in 15 (52%). Histology demonstrated 20 (69%) variants of normal tissue and 9 (31%) benign masses. MRI lesions less than 5 mm (n = 6, 20.5%) were small, well-delineated nodules of benign breast tissue. Conclusion: Suspicious MRI lesions less than 5 mm often represent benign breast tissue and could potentially undergo surveillance instead of biopsy. [Copyright &y& Elsevier]

The article presents a case study of a 49‐year‐old woman underwent ultrasound‐guided core biopsy of a fibroadenoma with marker placement and presents her postbiopsy mammogram that demonstrated a metallic marker in the left breast with no residual mass. It highlights the discovery that the postbiopsy maker was manufactured with an imbedded tubular plug to increase ultrasound visibility.

Objectives: To study how radiologists' perceived ability to interpret digital mammography (DM) images is affected by decreases in image quality. Methods: One view from 45 DM cases (including 30 cancers) was degraded to six levels each of two acquisition-related issues (lower spatial resolution and increased quantum noise) and three post-processing-related issues (lower and higher contrast and increased correlated noise) seen during clinical evaluation of DM systems. The images were shown to fifteen breast screening radiologists from five countries. Aware of lesion location, the radiologists selected the most-degraded mammogram (indexed from 1 (reference) to 7 (most degraded)) they still felt was acceptable for interpretation. The median selected index, per degradation type, was calculated separately for calcification and soft tissue (including normal) cases. Using the two-sided, non-parametric Mann-Whitney test, the median indices for each case and degradation type were compared. Results: Radiologists were not tolerant to increases (medians: 1.5 (calcifications) and 2 (soft tissue)) or decreases (median: 2, for both types) in contrast, but were more tolerant to correlated noise (median: 3, for both types). Increases in quantum noise were tolerated more for calcifications than for soft tissue cases (medians: 3 vs. 4, p = 0.02). Spatial resolution losses were considered less acceptable for calcification detection than for soft tissue cases (medians: 3.5 vs. 5, p = 0.001). Conclusions: Perceived ability of radiologists for image interpretation in DM was affected not only by image acquisition-related issues but also by image post-processing issues, and some of those issues affected calcification cases more than soft tissue cases. Key Points: • Lower spatial resolution and increased quantum noise affected the radiologists' perceived ability to interpret calcification cases more than soft tissue lesion or normal cases. • Post-acquisition image processing-related effects, not only image acquisition-related effects, also impact the perceived ability of radiologists to interpret images and detect lesions. • In addition to current practices, post-acquisition image processing-related effects need to also be considered during the testing and evaluation of digital mammography systems. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 26-year-old female with a history of reduction mammoplasty and subsequent augmentation with subpectoral saline implants and firm, circumscribed mass of the left breast. The patient underwent magnetic resonance imaging (MRI) and histopathological analysis which showed a desmoid-type fibromatosis with extensive skeletal muscle invasion and positive margins. She had taken a repeat MRI due to the growth of nonenhancing soft tissue mass.

Breast density notification laws, passed in 19 states as of October 2014, mandate that patients be informed of their breast density. The purpose of this study is to assess the impact of this legislation on radiology practices, including performance of breast cancer risk assessment and supplemental screening studies. A 20-question anonymous web-based survey was emailed to radiologists in the Society of Breast Imaging between August 2013 and March 2014. Statistical analysis was performed using Fisher's exact test. Around 121 radiologists from 110 facilities in 34 USA states and 1 Canadian site responded. About 50% (55/110) of facilities had breast density legislation, 36% of facilities (39/109) performed breast cancer risk assessment (one facility did not respond). Risk assessment was performed as a new task in response to density legislation in 40% (6/15) of facilities in states with notification laws. However, there was no significant difference in performing risk assessment between facilities in states with a law and those without (p < 0.831). In anticipation of breast density legislation, 33% (16/48), 6% (3/48), and 6% (3/48) of facilities in states with laws implemented handheld whole breast ultrasound ( WBUS), automated WBUS, and tomosynthesis, respectively. The ratio of facilities offering handheld WBUS was significantly higher in states with a law than in states without (p < 0.001). In response to breast density legislation, more than 33% of facilities are offering supplemental screening with WBUS and tomosynthesis, and many are performing formal risk assessment for determining patient management. [ABSTRACT FROM AUTHOR]

Resection of biopsy-proven involved axillary lymph nodes ( iALNs) is important to reduce the false-negative rates of sentinel lymph node ( SLN) biopsy after neo-adjuvant chemotherapy ( NAC) in patients with initially node-positive breast cancer. Preoperative wire localization for iALNs marked with clips placed during biopsy is a technique that may help the removal of iALNs after NAC. However, ultrasound ( US)-guided localization is often difficult because the clips cannot always be reliably visible on US. Computed tomography ( CT)-guided wire localization can be used; however, to date there have been no reports on CT-guided wire localization for iALNs. The aim of this study was to describe a series of patients who received CT-guided wire localization for iALN removal after NAC and to evaluate the feasibility of this technique. We retrospectively analyzed five women with initially node-positive breast cancer (age, 41-52 years) who were scheduled for SLN biopsy after NAC and received preoperative CT-guided wire localization for iALNs. CT visualized all the clips that were not identified on post- NAC US. The wire tip was deployed beyond or at the target, with the shortest distance between the wire and the index clip ranging from 0 to 2.5 mm. The total procedure time was 21-38 minutes with good patient tolerance and no complications. In four of five cases, CT wire localization aided in identification and resection of iALNs that were not identified with lymphatic mapping. Residual nodal disease was confirmed in two cases: both had residual disease in wire-localized lymph nodes in addition to SLNs. Although further studies with more cases are required, our results suggest that CT-guided wire localization for iALNs is a feasible technique that facilitates identification and removal of the iALNs as part of SLN biopsy after NAC in situations where US localization is unsuccessful. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To compare the image quality of three techniques and diagnostic performance in detecting implant rupture. Materials and Methods: The study included 161 implants for the evaluation of image quality, composed of water-saturated short TI inversion recovery (herein called “water-sat STIR”), three-point Dixon techniques (herein called “Dixon”), and short TI inversion recovery fast spin-echo with iterative decomposition of silicone and water using least-squares approximation (herein called “STIR IDEAL”) and included 41 implants for the evaluation of diagnostic performance in detecting rupture, composed of water-sat STIR and STIR IDEAL. Six image quality categories were evaluated and three classifications were used: normal implant, possible rupture, and definite rupture. Results: Statistically significant differences were noted for the image quality categories (p<0.001). STIR IDEAL was superior or equal to water-sat STIR in all image quality categories except artifact effects and superior to Dixon in all categories. Water-sat STIR performed the poorest for water suppression uniformity. The sensitivity and specificity in detecting implant rupture of STIR-IDEAL were 81.8 % and 77.8 % and the difference between two techniques was not statistically significant. Conclusion: STIR-IDEAL is a useful silicone-specific imaging technique demonstrating more robust water suppression and equivalent diagnostic accuracy for detecting implant rupture, than water-sat STIR, at the cost of longer scan time and an increase in minor motion artifacts. [Copyright &y& Elsevier]

Purpose: The aim of the study was to determine the feasibility of using a clinical optical breast scanner with molecular imaging strategies based on modulating light transmission.Procedures: Different concentrations of single-walled carbon nanotubes (SWNT; 0.8-20.0 nM) and black hole quencher-3 (BHQ-3; 2.0-32.0 µM) were studied in specifically designed phantoms (200-1,570 mm(3)) with a clinical optical breast scanner using four wavelengths. Each phantom was placed in the scanner tank filled with optical matching medium. Background scans were compared to absorption scans, and reproducibility was assessed.Results: All SWNT phantoms were detected at four wavelengths, with best results at 684 nm. Higher concentrations (≥8.0 µM) were needed for BHQ-3 detection, with the largest contrast at 684 nm. The optical absorption signal was dependent on phantom size and concentration. Reproducibility was excellent (intraclass correlation 0.93-0.98).Conclusion: Nanomolar concentrations of SWNT and micromolar concentrations of BHQ-3 in phantoms were reproducibly detected, showing the potential of light absorbers, with appropriate targeting ligands, as molecular imaging agents for clinical optical breast imaging. [ABSTRACT FROM AUTHOR]

The main purpose was to compare breast cancer visibility in one-view breast tomosynthesis (BT) to cancer visibility in one- or two-view digital mammography (DM). Thirty-six patients were selected on the basis of subtle signs of breast cancer on DM. One-view BT was performed with the same compression angle as the DM image in which the finding was least/not visible. On BT, 25 projections images were acquired over an angular range of 50 degrees, with double the dose of one-view DM. Two expert breast imagers classified one- and two-view DM, and BT findings for cancer visibility and BIRADS cancer probability in a non-blinded consensus study. Forty breast cancers were found in 37 breasts. The cancers were rated more visible on BT compared to one-view and two-view DM in 22 and 11 cases, respectively, (p < 0.01 for both comparisons). Comparing one-view DM to one-view BT, 21 patients were upgraded on BIRADS classification (p < 0.01). Comparing two-view DM to one-view BT, 12 patients were upgraded on BIRADS classification (p < 0.01). The results indicate that the cancer visibility on BT is superior to DM, which suggests that BT may have a higher sensitivity for breast cancer detection. [ABSTRACT FROM AUTHOR]

To assess which specific morphologic features, enhancement patterns, or pharmacokinetic parameters on breast Magnetic Resonance Imaging (MRI) could predict a false-negative outcome of Proton MR Spectroscopy (1H MRS) exam in patients with invasive breast cancer. Sixteen patients with invasive ductal carcinoma of the breast were prospectively included and underwent both, contrast-enhanced breast MRI and 1H MRS examination of the breast. The MR images were reviewed and the lesions morphologic features, enhancement patterns and pharmacokinetic parameters (k21-value) were scored according to the ACR BI-RADS-MRI lexicon criteria. For the in vivo MRS studies, each spectrum was evaluated for the presence of choline based on consensus reading. Breast MRI and 1H MRS data were compared to histopathologic findings. In vivo 1H MRS detected a choline peak in 14/16 (88%) cancers. A false-negative 1H MRS study occurred in 2/16 (14%) cancer patients. K21 values differed between both groups: the 14 choline positive cancers had k21 values ranging from 0.01 to 0.20/second (mean 0.083/second), whereas the two choline-negative cancers showed k21 values of 0.03 and 0.05/second, respectively (mean 0.040/second). Also enhancement kinetics did differ between both groups; typically both cancers that were choline-negative showed a late phase plateau (100%), whereas this was only shown in 5/14 (36%) of the choline positive cases. There was no difference between both groups with regard to morphologic features on MRI. This study showed that false-negative 1H MRS examinations do occur in breast cancer patients, and that the presence of a choline peak on 1H MRS as malignancy marker is related to the k21 value of the invasive tumor being imaged. [ABSTRACT FROM AUTHOR]

Treatment regimens for Hodgkin’s disease (HD) that have included radiation to lymph node regions in the thorax have contributed to high rates of long-term disease-free survival. However, incidental radiation exposure of breast tissue in young women has significantly increased the risk of breast cancer compared to expected rates in the general population. After informing patients about risks associated with previous treatment of HD, we studied screening mammograms and call-back rates in women at increased risk for developing breast cancer at a younger age. We contacted by mail a cohort of 291 women between 25 and 55 years of age who had received thoracic irradiation before 35 years of age for HD with or without chemotherapy. Subjects were offered information about risks identified after HD therapy with questionnaires to assess response to this information. Ten patients refused participation, 93 did not respond, and 21 were excluded after they reported a prior diagnosis of invasive ( 1 ) or in situ ( 2 ) breast cancer. One hundred and sixty seven women received information about secondary breast cancer risk and were advised to initiate or maintain mammographic screening. Available mammograms were reviewed by two radiologists and classified according to the ACR BI-RADSTM Mammography Lexicon. Abnormal findings were correlated to pathology results from biopsies. One hundred and fifteen subjects reported that they obtained new mammograms during the period of the study. Ninety-nine were available for secondary review. Patients were studied an average of 16.9 years after HD treatment (Range: 4.5–32.5 years) at an average of 41 years of age (range 25–55 years). High density breast tissue was identified in 60% (60/99). Seventeen of the women (17.2%) were recalled for further imaging. This was more common in women with heterogeneously dense breast tissue. Seven of those recalled (41%) were advised to undergo biopsies that identified ductal carcinoma in situ (DCIS) in one and benign findings in the others. Among 16 women whose mammograms were unavailable for review, three were diagnosed with DCIS; two of these had microscopic evidence of invasive breast cancer. The four in situ or microinvasive cancers were diagnosed in the study participants at 25–40 years of age and from 5 to 23 years after HD therapy. Biopsies were performed because mammograms detected microcalcifications without palpable abnormality in three of these cases. Women who have had thoracic nodal irradiation for Hodgkin’s disease have an increased risk of developing secondary breast cancer at an unusually young age. As expected in younger women, high density breast tissue was common on mammography, and the recall and biopsy rates were unusually high. However, early mammographic screening facilitated diagnosis of in situ and early invasive cancer in 3.5% of our subjects. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study investigates the use of contrast-enhanced, T 1-weighted, water-selective spectral–spatial 3D gradient echo magnetic resonance imaging (MRI) with magnetization transfer (3DSSMT) for detecting breast cancer in patients with intraparenchymal silicone. Conclusion: Water-selective 3DSSMT provides superior fat and silicone suppression in patients with free silicone as compared with conventional fat saturation. It enables direct, high-quality, high-spatial-resolution, T 1-weighted breast MRI of contrast enhancement without the need for subtraction processing and aids diagnosis of cancer in the breast with free silicone. [Copyright &y& Elsevier]

The article presents a medical study comparing the cost and effectiveness of screening women with BRCA1/2 mutations with only a mammography versus screening BRCA1/2 carriers with the combination of a mammography and a contrast-enhanced breast magnetic resonance imaging (MRI). According to the article, while breast MRI screening heightens the cost and produces more false-positive results, it can detect cancer at an earlier stage. The article discusses the methods of the study, the characteristics of the patients studied, breast cancer treatment, and the cost-effectiveness of annual MRI screening among various age groups.

Background: We performed this study to determine rates of close or transected cancer margins after magnetic resonance imaging-guided bracket wire localization for nonpalpable breast lesions. Study design: Of 243 women undergoing MRI-guided wire localizations, 26 had MRI bracket wire localization to excise either a known cancer (n = 19) or a suspicious MRI-detected lesion (n = 7). We reviewed patient age, preoperative diagnosis, operative intent, mammographic breast density, MRI lesion size, MRI enhancement curve and morphology, MRI Breast Imaging Reporting and Data System (BI-RADS) assessment code, number of bracket wires, and pathology size. We analyzed these findings for their relationship to obtaining clear margins at first operative excision. Results: Twenty-one of 26 (81%) patients had cancer. Of 21 patients with cancer, 12 (57%) had negative margins at first excision and 9 (43%) had close/transected margins. MRI size ≥ 4 cm was associated with a higher reexcision rate (7 of 9, 78%) than those &#60; 4 cm (2 of 12, 17%) (p = 0.009). MRI BI-RADS score, enhancement curve, morphology, and preoperative core biopsy demonstrating ductal carcinoma in situ (DCIS) were not predictive of reexcision. The average number of wires used for bracketing increased with lesion size, but was not associated with improved outcomes. On pathology, cancer size was smaller in patients with negative margins (12 patients, 1.2 cm) than in those with close/transected margins (9 patients, 4.6 cm) (p &#60; 0.001). Reexcision was based on close/transected margins involving DCIS alone (6, 67%), infiltrating ductal carcinoma and DCIS (2, 22%), or infiltrating ductal carcinoma alone (1, 11%). Reexcision pathology demonstrated DCIS (3, 33%), no residual cancer (5, 55%), and 1 patient was lost to followup (1, 11%). Interestingly, cancer patients who required reexcision were younger (p = 0.022), but breast density was not associated with reexcision. Conclusions: To our knowledge, this is the first report of MRI-guided bracket wire localization. Patients with MRI-detected lesions less than 4 cm had clear margins at first excision; larger MRI-detected lesions were more likely to have close/transected margins. Reexcision was often because of DCIS and was the only pathology found at reexcision, perhaps because MRI is more sensitive for detecting invasive carcinoma than DCIS. [Copyright &y& Elsevier]

The purpose of this study was to assess the utility of contrast-enhanced breast magnetic resonance imaging (MRI) in identifying lesions unidentified on the craniocaudal projection. The authors reviewed five patients with suspicious mammographic lesions not imaged on the craniocaudal mammogram who were referred for contrast-enhanced MRI and underwent subsequent preoperative needle localization in four of the five cases. Five patients, ages 56 to 69 years, had suspicious lesions identified on mediolateral oblique (MLO) or mediolateral (ML) projections only. Ultrasound did not identify the lesion in any of these cases. MRI identified suspicious breast lesions measuring 5 to 12 mm in size. These were located high on the chest wall or in the upper inner quadrant. Suspicious lesions seen only on the MLO or ML projections may reside high on the chest wall or in the upper inner quadrant. Lesions in these locations may be typically excluded on the craniocaudal projection during mammography. Breast MRI has the advantage of imaging the entire breast and is particularly useful for these lesions. In this series, MRI prevented delay in breast cancer diagnosis. [ABSTRACT FROM AUTHOR]

Dedicated breast positron emission tomography (dbPET) is a new diagnostic imaging modality recently used in clinical practice for the detection of breast cancer and the assessment of tumor biology. dbPET has higher spatial resolution than that of conventional whole body PET systems, allowing recognition of detailed morphological attributes of radiotracer accumulation within the breast. 18F-fluorodeoxyglucose (18F-FDG) accumulation in the breast may be due to benign or malignant entities, and recent studies suggest that morphology characterization of 18F-FDG uptake could aid in estimating the probability of malignancy. However, across the world, there are many descriptors of breast 18F-FDG uptake, limiting comparisons between studies. In this article, we propose a lexicon for breast radiotracer uptake to standardize description and reporting of image findings on dbPET, consisting of terms for image quality, radiotracer fibroglandular uptake, breast lesion uptake. [ABSTRACT FROM AUTHOR]

Purpose: To validate a candidate instrument, to be used by different professionals to assess image quality in digital mammography (DM), against detection performance results.Methods: A receiver operating characteristics (ROC) study was conducted to assess the detection performance in DM images with four different image quality levels due to different quality issues. Fourteen expert breast radiologists from five countries assessed a set of 80 DM cases, containing 60 lesions (40 cancers, 20 benign findings) and 20 normal cases. A visual grading analysis (VGA) study using a previously-described candidate instrument was conducted to evaluate a subset of 25 of the images used in the ROC study. Eight radiologists that had participated in the ROC study, and seven expert breast-imaging physicists, evaluated this subset. The VGA score (VGAS) and the ROC and visual grading characteristics (VGC) areas under the curve (AUCROC and AUCVGC) were compared.Results: No large differences in image quality among the four levels were detected by either ROC or VGA studies. However, the ranking of the four levels was consistent: level 1 (partial AUCROC: 0.070, VGAS: 6.77) performed better than levels 2 (0.066, 6.15), 3 (0.061, 5.82), and 4 (0.062, 5.37). Similarity between radiologists' and physicists' assessments was found (average VGAS difference of 10 %).Conclusions: The results from the candidate instrument were found to correlate with those from ROC analysis, when used by either observer group. Therefore, it may be used by different professionals, such as radiologists, radiographers, and physicists, to assess clinically-relevant image quality variations in DM. [ABSTRACT FROM AUTHOR]

To compare positive predictive values (PPVs) of clumped vs non-clumped (homogenous and heterogeneous) internal enhancement on MRI detected linear non-mass enhancement (NME) on MRI-guided vacuum-assisted breast biopsy (MRI-VABB). With IRB (Institutional Review Board) approval, we retrospectively reviewed 598 lesions undergoing MRI-VABB from January 2015 to April 2018 that showed linear NME. We reviewed the electronic medical records for MRI-VABB pathology, any subsequent surgery and clinical follow-up. The X2 test was performed for univariate analysis. There were 120/598 (20%) linear NME MRI-VABB lesions with clumped (52/120, 43%) vs non-clumped (68/120, 57%) internal enhancement, average size 1.8 cm (range 0.6–7.6 cm). On MRI-VABB, cancer was identified in 22/120 (18%) lesions, ductal carcinoma in situ (DCIS) was found in 18/22 (82%) and invasive cancer in 4 (18%). 3/31 (10%) high-risk lesions upgraded to DCIS at surgery, for a total of 25/120 (21%) malignancies. Malignancy was found in 12/52 (23%) clumped lesions and in 13/68 (19%) of non-clumped lesions that showed heterogeneous (5/13, 38%) or homogenous (8/13, 62%) internal enhancement. The PPV of linear NME with clumped internal enhancement (23.1%) was not significantly different from the PPV of non-clumped linear NME (19.1%) (p = 0.597). The PPV of linear NME lesions <1 cm (33.3%) was not significantly different from the PPV of lesions ≥1 cm (18.6%) (p = 0.157). Linear NME showed malignancy in 21% of our series. Linear NME with clumped or non-clumped internal enhancement patterns, regardless of lesion size, might need to undergo MRI-VABB in appropriate populations. Evaluation of linear NME lesions on breast MRI focuses especially on internal enhancement pattern. [ABSTRACT FROM AUTHOR]

Purpose: To develop a candidate instrument to assess image quality in digital mammography, by identifying clinically relevant features in images that are affected by lower image quality.Methods: Interviews with fifteen expert breast radiologists from five countries were conducted and analysed by using adapted directed content analysis. During these interviews, 45 mammographic cases, containing 44 lesions (30 cancers, 14 benign findings), and 5 normal cases, were shown with varying image quality. The interviews were performed to identify the structures from breast tissue and lesions relevant for image interpretation, and to investigate how image quality affected the visibility of those structures. The interview findings were used to develop tentative items, which were evaluated in terms of wording, understandability, and ambiguity with expert breast radiologists. The relevance of the tentative items was evaluated using the content validity index (CVI) and modified kappa index (k*).Results: Twelve content areas, representing the content of image quality in digital mammography, emerged from the interviews and were converted into 29 tentative items. Fourteen of these items demonstrated excellent CVI ≥ 0.78 (k* > 0.74), one showed good CVI < 0.78 (0.60 ≤ k* ≤ 0.74), while fourteen were of fair or poor CVI < 0.78 (k* ≤ 0.59). In total, nine items were deleted and five were revised or combined resulting in 18 items.Conclusions: By following a mixed-method methodology, a candidate instrument was developed that may be used to characterise the clinically-relevant impact that image quality variations can have on digital mammography. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 56-year-old woman with diagnostic mammogram showing fine pleomorphic calcifications in her right breast. Topics discussed include digital mammography of the patient's showed fatty breast tissue, ductal carcinoma in situ (DCIS) is the most common type of noninvasive lesions in the breast, multiple microcalcifications were present in the DCIS, band-like density shows noncalcified portions of the affected lactiferous duct surrounding the calcifications.