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Please see the Editorial Comment by Linda M. Sanders discussing this article. Background: There is a paucity of data and consensus guidelines on the utility of preoperative MRI for planned bilatera...

OBJECTIVE. The purpose of this article was to determine the frequency and outcomes of new suspicious findings on breast MRI after initiation of neoadjuvant therapy. MATERIALS AND METHODS. A retrosp...

OBJECTIVE. The purpose of this study was to assess the performance of diagnostic mammography alone for evaluation of palpable symptoms in women with almost entirely fatty breast composition. MATERIALS AND METHODS. All diagnostic mammograms performed for palpable symptoms in women who had been assigned a breast density of "almost entirely fatty" over an 8-year period (2009-2017) at an academic breast center were retrospectively identified. Each symptomatic breast was considered a separate case and analyses were performed at the case level. Clinical, imaging, and pathologic results were reviewed. Descriptive statistics and 2 × 2 contingency table analyses were performed. RESULTS. The study cohort included 323 cases evaluated with mammography. Of these, 294 (91%) had undergone targeted ultrasound. At mammography, 240 (74%) had no correlate to the palpable lump; 38 (12%), a benign correlate; and 45 (14%), a suspicious correlate. Three cases had incidental suspicious mammographic findings, for a total of 48 positive mammography cases. Twenty-seven (8%) cases were malignant. Mammography alone detected all but one cancer, which was detected by ultrasound. In retrospect, the woman from whom this single false-negative mammogram was obtained did not have almost entirely fatty breast density. Mammography alone yielded a negative predictive value of 99.6%, percentage of diagnostic examinations recommended for biopsy that resulted in a tissue diagnosis of malignancy within 1 year of 54%, sensitivity of 96%, and specificity of 93%. Adjunct ultrasound contributed to 11 false-positives but also identified benign correlates in eight cases with no mammographic finding. CONCLUSION. In patients with almost entirely fatty breast tissue presenting with palpable symptoms, mammography alone had a high sensitivity and specificity. Our results support that mammography alone may be sufficient for evaluation of palpable symptoms in these women as long as density criteria are strictly applied.

OBJECTIVE. The objective of this study was to evaluate the feasibility of using a magnetic seed system for preoperative localization of axillary lymph nodes in patients with breast cancer. MATERIALS AND METHODS. We performed a retrospective analysis that included patients with breast cancer who underwent preoperative magnetic seed localization of axillary lymph nodes at our institution between January 1, 2017, and January 1, 2019. Magseed (Endomag) is a nonradioactive inducible magnetic seed that is induced to become a magnet when under the influence of its detector in the operating room. Clinical history, prior axillary sampling and clip placement, and procedure details and surgical outcomes were determined from a search of our PACS and electronic medical records. RESULTS. Thirty-five patients (34 women and one man) composed our study cohort. The mean patient age was 56 years (range, 32-78 years). One patient underwent two separate consecutive localizations for two separate operations, and another patient had bilateral lesions, for a total of 37 axillary lymph node localizations. One case of seed misplacement occurred during the ultrasound-guided localization procedure, resulting in immediate placement of a second seed, for a total of 38 Magseeds placed. All seeds were placed under ultrasound guidance. The mean number of days from seed placement to surgery was 5 days (range, 0-31 days). Thirty-seven of 38 Magseeds (97%) were documented to be successfully retrieved in the operating room. CONCLUSION. Magseed localization appears to be a safe, nonradioactive way to accurately localize axillary lymph nodes preoperatively.

The purpose of this study was to determine the prevalence of very strong family history and extremely dense tissue in women 40-49 years old with breast cancer detected on screening mammography.All cancers detected by screening mammography at our institution between January 1997 and November 2012 in 40- to 49-year-old women were retrospectively identified. Those with a personal history of breast cancer were excluded. Family history, breast density, type of malignancy, hormone receptor status, and lymph node status were recorded.One hundred thirty-six cases of breast cancer were identified on screening mammography in 40- to 49-year-old women; 50% were invasive cancers, and 50%, ductal carcinoma in situ. Very strong family history was absent in 88%, and extremely dense breast tissue was absent in 86%. Seventy-six percent of patients had neither very strong family history nor extremely dense breasts, including 79% of the cases of invasive cancers, of which 25% had axillary nodal involvement and 89% were estrogen receptor positive.Very strong family history and extremely dense breast tissue were absent in most 40- to 49-year-old women with breast cancer detected at screening mammography. These cancers were frequently invasive (often with nodal metastases) and treatable (hormone receptor positive). Reducing the number of women to be screened in this age group by using this risk-based approach would reduce the number of screen-detected cancers by more than 75%, thereby precluding the benefit of mortality reduction. Even using a risk-based strategy with an expanded definition of high risk that included any first-degree family history, extremely dense tissue, or both, 66% of malignancies would still be missed.

OBJECTIVE. The purpose of this article is describe the origins and provisions of breast density legislation and to evaluate these mandates with regard to the balance between the potential benefit of supplementary screening and the substantial risk of false-positive findings and the adjunctive tests they necessitate. CONCLUSION. Many states have passed breast density notification legislation, and federal legislation is pending. These mandates present a number of challenges for patients and physicians. There is no consensus regarding the need for supplementary testing solely because a woman has dense breasts. The failure of density legislation to require insurance coverage in many states further complicates implementation of the mandates.