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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

To the Editor: For women who inherit a high risk of developing breast cancer, early detection is a key strategy to reduce morbidity and mortality (1). Multiple studies have found that standard mammographic screening often fails to detect breast cancer early in women at high inherited risk of breast cancer, prompting inclusion of emerging methods such as magnetic resonance imaging (MRI) into high-risk screening protocols (2– 13). The evaluation of breast duct cells is also under investigation as a potential cancer risk assessment technique. Approximately 80 percent of breast cancers originate in the ductal system, and early changes of the ductal epithelium, which might predate malignant transformation, have been reported (14–16); for these reasons, analysis of duct cells is a rational approach to risk stratification and biomarker development. At this time, understanding of the normal breast ductal anatomy, including an appreciation of variation in the number of ducts per breast, continues to evolve (17). A prior anatomic study on mastectomy specimens has also reported wide variation in the proportion of breast volume drained by individual ducts (18). With increasing study of intraductal approaches, a better comprehension of ductal structure and the appearance of the ductal system on MRI has practical relevance. We undertook a pilot study of a novel technique, magnetic resonance (MR) galactography, which combines MRI and intraductal evaluation. Our goals were to map the breast ductal system, quantify the breast volume drained by individual ducts, and evaluate sources of prior cytologic atypia in high-risk women.

Our purpose is to describe the appearance of breast ductal enhancement found on magnetic resonance imaging (MRI) after breast ductal lavage (DL). We describe a novel etiology of enhancement in a ductal pattern on postcontrast MRI of the breast. Knowledge of the potential for breast MRI enhancement subsequent to DL, which can mimic the appearance of a pathologic lesion, is critical to the care of patients who undergo breast MRI and DL or other intraductal cannulation procedures.

A 26-year-old female with a history of reduction mammoplasty at age 17 and subsequent augmentation with subpectoral saline implants at age 24 presented with a firm, circumscribed mass of the left breast. Mammographic imaging showed an ill-defined mass abutting the implant and chest wall, which was confirmed by ultrasound as a hypoechoic mass (Fig. 1). The mass was biopsied with histology showing a spindle cell lesion of unknown malignant potential. On magnetic resonance imaging, a heterogenous, avidly enhancing mass with type II (plateau) and type III (washout) kinetics was visualized at the inferior margin of the implant, abutting the chest wall and extending through the intercostal space (Fig. 2). The mass was surgically removed with histopathological analysis describing a desmoid-type fibromatosis with extensive skeletal muscle invasion and positive margins (Fig. 3). The patient underwent a second operation with no evidence of residual desmoid tumor. Five months later, the patient noticed a nodule below the inframammary fold at her ninth intercostal space, coinciding with the area of a chest tube site. (a) (b) (c)

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.