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• Creation of a database with realistically in shape irregular breast lesions. • Lesion models from breast tomosynthesis and whole-body and cadaver CT images. • Irregular lesions obtained with mathematical algorithms. We present the development and the current state of the MaXIMA Breast Lesions Models Database, which is intended to provide researchers with both segmented and mathematical computer-based breast lesion models with realistic shape. The database contains various 3D images of breast lesions of irregular shapes, collected from routine patient examinations or dedicated scientific experiments. It also contains images of simulated tumour models. In order to extract the 3D shapes of the breast cancers from patient images, an in-house segmentation algorithm was developed for the analysis of 50 tomosynthesis sets from patients diagnosed with malignant and benign lesions. In addition, computed tomography (CT) scans of three breast mastectomy cases were added, as well as five whole-body CT scans. The segmentation algorithm includes a series of image processing operations and region-growing techniques with minimal interaction from the user, with the purpose of finding and segmenting the areas of the lesion. Mathematically modelled computational breast lesions, also stored in the database, are based on the 3D random walk approach. The MaXIMA Imaging Database currently contains 50 breast cancer models obtained by segmentation of 3D patient breast tomosynthesis images; 8 models obtained by segmentation of whole body and breast cadavers CT images; and 80 models based on a mathematical algorithm. Each record in the database is supported with relevant information. Two applications of the database are highlighted: inserting the lesions into computationally generated breast phantoms and an approach in generating mammography images with variously shaped breast lesion models from the database for evaluation purposes. Both cases demonstrate the implementation of multiple scenarios and of an unlimited number of cases, which can be used for further software modelling and investigation of breast imaging techniques. The created database interface is web-based, user friendly and is intended to be made freely accessible through internet after the completion of the MaXIMA project. The developed database will serve as an imaging data source for researchers, working on breast diagnostic imaging and on improving early breast cancer detection techniques, using existing or newly developed imaging modalities. [ABSTRACT FROM AUTHOR]

BACKGROUND: Breast cytology is a significant component of the "Triple approach" for pre-operative diagnosis of breast lumps, the other two being clinical assessment and radiological imaging. The role of Fine needle aspiration cytology (FNAC) as a first line investigation in diagnosing breast lesions is well documented, however histopathology is the gold standard. Cyto-histopathological correlation is of great relevance and also increases precision. AIMS \& OBJECTIVES: The present study was conducted with the aim to categorize breast lesions according to the latest standardized reporting system proposed by International academy of cytologists (IAC) in 2016. Evaluation of diagnostic accuracy, sensitivity and specificity of FNAC in diagnosing breast lesions and cyto-histopathological correlation was planned. MATERIALS AND METHODS: All FNAs of breast lesions over a period of 2 years were included in the study. The cases were grouped into five standardized categories proposed by the International academy of cytology: Category I (Insufficient material), Category II (Benign), Category III (Atypical, probably benign), Category IV (Suspicious, probably in situ or invasive) & Category V (Malignant) respectively. Specificity, sensitivity, diagnostic accuracy, negative and positive predictive value of FNAC were calculated and cyto-histopathological correlation assessed wherever possible. RESULTS: Out of 468 breast lesions reported on FNAC, the category wise distribution was – Category I, II, III, IV & V accounting for 23(4.9%), 342(73.07%), 7(1.5%), 11(2.35%) and 85(18.16%) respectively. Histopathology was performed in 331/468 cases with cyto histological concordance of 98.4% and a type agreement rate of 90.9%. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy was 98.90%, 99.16%, 97.82%, 99.58% and 99.09% respectively. CONCLUSION: FNAC is a simple, reliable, cost effective, first line diagnostic procedure for all breast lumps. In collaboration with physical examination and imaging studies (triple approach), FNAC is a highly sensitive diagnostic tool. Adopting a universally acceptable standardized reporting system for breast cytology can enhance the diagnostic accuracy of FNAC. [ABSTRACT FROM AUTHOR]

OBJECTIVES: A Descriptive cross-sectional study was conducted in the Department of Radiology Allied Hospital, Faisalabad from August 2014 to June 2015 to detect the diagnostic accuracy of magnetic resonance spectroscopy (MRS) In malignant breast lesions using histopathology as gold standard. MATERIALS & METHODS: A total of 110 patients with breast lesions on ultrasound (US) and on mammography and age 20-60 years were included. Patients who took chemotherapy for primary or secondary breast cancer, pregnant or breast feeding females, patients with renal failure and contraindication to MRS were excluded. All the patients were then underwent MRS on 1.5 tesla whole body MR imager. Breast lesion was considered as malignant if there was choline peak on magnetic resonance spectroscopy and choline/creatine ratio was >1.5. Magnetic resonance spectroscopy findings were correlated with histopathological findings. RESULTS: Mean age was 49.31 ± 6.76 years. MRS supported the diagnosis of malignant breast lesions in 72 (65.45%) patients. Histopathology confirmed malignancy in 75 (68.18%) cases. In 72 MRS positive patients, 68 were True Positive and 04 were False Positive. Among, 38 MRS negative patients, 07 were False Negative whereas 31 were True Negative. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of MRS in malignant breast lesions was 90.67%, 88.57%, 94.44%, 81.58% and 90.0% respectively. CONCLUSION: This study concluded that magnetic resonance spectroscopy is a highly sensitive and accurate modality for diagnosing malignant breast lesions, and has improved patient care by accurate and timely diagnosis for taking proper treatment options. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the diagnostic accuracy of shear- wave elastography in determining breast malignancy in suspicious breast lesions needing further radiologic evaluation, keeping histopathology as gold standard. METHODS: This cross-sectional study was conducted in Radiology department, Dr. Ruth K. M Pfau Civil Hospital, Karachi from March 2016 to January 2017. This study included 170 patients referred for shear-wave elastography (SWE) with suspected malignant breast lesions considered BIRADS - 0 or IV on mammography or ultrasound. Elastography was performed after taking detailed history, breast examination, mammography and gray scale ultrasound. Elastography findings were recorded and compared with the histopathology. The primary performance outcomes of shear-wave elastography were determined in terms of sensitivity, specificity, accuracy, positive and negative predictive values against the histopathology. Post stratification chi square test was applied taking p-value < 0.05 as significant. RESULTS: The mean age of the patients was 44.03 ± 9.31 years. Mean size of lump was 2.50 ± 2.29 cm with mean duration of 6.48 ± 3.29 months. Out of the 170 patients, 108 (63.5%) patients were diagnosed as malignant by shear-wave elastography while 109 (64.1%) patients by histopathology. The sensitivity of shear-wave elastography was 88.1% with specificity of 80.3%, positive predictive value of 88.8%, negative predictive value of 79.03% and an overall accuracy of 85.29%. CONCLUSION: SWE is a useful adjunct to mammography and conventional gray scale ultrasound to identify breast malignancy with good accuracy in suspicious breast lesion. [ABSTRACT FROM AUTHOR]

Objective · To explore the value of the 2013 version of the ultrasound breast imaging reporting and data system (BI-RADS) classification diagnostic criteria combined with ultrasound shear wave elastography (SWE) to identify benign and malignant breast lesions. Methods · A total of 175 solid breast masses in 155 women were examined with ultrasound, and were judged to be benign or malignant by BI-RADS classification criteria. Then all the masses were examined with shear wave elastography (SWE) , to obtain shear wave quantitative parameters of benign and malignant breast lesions,the pathological results were used as the gold standard to construct the receiver operating characteristic (ROC) curve of the subjects, which were used to compare the diagnostic value of the two methods alone and in combination. Results · The area under curve (AUC) of the BI-RADS classification diagnostic criteria, the Emax value, and the combination of the two methods to differential diagnosis of benign and malignant breast nodules were 0913, 0.884 and 0.957, respectively. Through pairwise comparison, there was significant difference in AUC between the two methods alone and their combination (BI-RADS classification vs. combination: Z=2.883, P=0.002; SWE vs. combination: Z=4.081, P=0.000) . Conclusion · The combination of BI-RADS classification and SWE technology can improve the diagnostic accuracy of breast lesions. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the diagnostic performance of two-dimensional shear wave elastography in the differentiation of malignant and benign breast lesions. Material and Methods: A total of 83 breast lesions in 76 patients were prospectively investigated with B-mode ultrasonography and two-dimensional shear wave elastography techniques. B-mode ultrasonography findings were classified based on BI-RADS lexicon 5th edition. The mean elasticity and the standard deviation of speed mode (m/s) and elasticity mode (kPa) were calculated for all breast lesions. Diagnostic performances of each quantitative parameters were compared. Results: Of 83 breast lesions, 45 (54.2%) were benign and 38 (45.7%) were malignant. Among the all shear wave elastography parameters, the standard deviation (ESD) of the shear wave speed (m/s) had the highest AUROC (0.953) value. When a cut-off value of 0.85 m/s was used for ESD of speed mode, sensitivity, specificity, accuracy, PPV, and NPV were detected as 94.7%, 88.8%, 91.5%, 87.8%, and 95.2%, respectively. Conclusions: Two-dimensional shear wave elastography has excellent diagnostic performance in the differentiation of benign and malignant breast lesions. The standard deviation (ESD) of speed modehad the best diagnostic performance when compared other quantitative parameters. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Objective of the study was to assess the performance of ultrasound strain elastography combined with conventional B-mode ultrasound to diagnose suspicious breast lesions (BI-RADS 4 and 5). METHODS: Between January 2015 and December 2017, a total of 86 patients (55±17.9 years) with solid or unclear, non-cystic breast lesions were enrolled in the study. The breast lesions were evaluated by B-mode ultrasound and subsequent ultrasound strain elastography. Ultrasound features including echo pattern, lesion shape, marginal characteristics, calcifications, orientation and posterior features are useful for differentiating benign breast lesions from malignant ones. Malignant ultrasound features are irregular shape, hypoechoic pattern, spiculated margin, nonparallel orientation and posterior shadowing. Lesions with benign features such a circumscribed margin were classified as low conspicuous. In patients with highly conspicuous malignant masses ultrasound-guided core needle biopsy or surgical excision was performed. RESULTS: Among the 86 patients, 60 masses were histologically proven and 36 of these were malignant. Of the malignant lesions 26 invasive carcinomas were of no special type (NST), 1 invasive lobular carcinoma, 3 ductal carcinomas in situ and 6 metastases. 20 of these patients had breast density classified as ACR 3 or 4. The mean size of the masses was 1.2 cm (range: 0.5–5 cm). Based on ultrasound B-mode imaging, the lesions were classified as BI-RADS category 4 (n = 20; three 4a, nine 4b and eight 4c) and BI-RADS category 5 (n = 16). One patient had to be reclassified after strain elastographxy to BI-RADS 3. The sensitivity of ultrasound with strain elastography and additional B-Mode ultrasound for the characterization of solid breast lesions was 97%, for conventional B-mode alone 92%; the respective specificities were 82% and 73%, respectively. CONCLUSION: Ultrasound elastography can be a supplementary approach to conventional ultrasound to improve the diagnostic accuracy of malignant breast lesions. [ABSTRACT FROM AUTHOR]

Introduction: MRI Breast came as a promising modality for evaluation of breast pathologies. Dynamic Contrast-Enhanced (DCE) MRI of the breast has recently emerged as the most sensitive (95-100%) instrument for the detection of breast cancer which makes it an excellent tool in specific clinical situations, such as the screening of patients at high risk for breast cancer, evaluation of the extent of disease in patients with a new diagnosis, axillary carcinoma of unknown primary, assessing neoadjuvant chemotherapy treatment response and detection of local recurrence in patients who have received breast-conservation therapy. Aim: To study the characterization of various breast masses and differentiating breast lesions into benign and malignant based on their contrast enhancement curves and correlating them with histopathological diagnosis. Materials and Methods: An observational Study was performed on 52 patients for duration of two years. For MRI imaging; a Philips Achieva 1.5 Tesla MRI Machine was used. All the patients underwent FNAC and/or HPE following MRI. Patients with lump/ pain in breast, nipple discharge/nipple retraction were included in the study. Results: Most of the patients were females and in 41-50 years age group. Most common type enhancement curve in the malignant tumours was the type 3 curve. Majority of the malignant tumours showed diffusion restriction on DWI. On correlation with histopathology, the sensitivity of MRI was found to be 96.29%, specificity 89.47 %, positive predictive value 92.85% and negative predictive value 94.44% and accuracy 93.47%. Conclusions: Dynamic contrast enhanced MRI is useful in accurate diagnosis of breast lesions, its detection and also in monitoring the breast lesions. MRI has the advantage of being non-invasive, three dimensional and the extension of the lesions are better visualised on MRI.

Background: To systematically review the performance of scintimammo-graphy compared with mammography in detecting breast lesions. Methods: A literature search was performed in PubMed and ScienceDirect databases with “scintimammography AND breast lesions,” “mammography AND breast lesions,” “diagnostic value,” and “accuracy” as keywords to identify all related studies published in English from January 1, 2000, to August 1, 2017. Twenty-five studies, with a total of 4094 patients with clinically suspicious breast lesions, were included in the final analysis to assess the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of scintimammography vs. mammography in detecting breast lesions. Results: The sensitivity and specificity of mammography were 75.82 ± 10.53 (95% confidence interval [CI], 50-84) and 59.58 ± 22.79 (95% CI, 20-91.4), respectively. The PPV and NPV of mammography were 75.60 ± 2.21 (95% CI, 42-93) and 61.62 ± 1.67 (95% CI, 39.1-86), respectively. The sensitivity of scintimammography was 86.64 ± 8.84 (95% CI, 58.3-100), and the specificity was 83.42 ± 10.74 (95% CI, 60-100). The PPV and NPV of scintimammography were 82.10 ± 11.65 (95% CI, 58-98.30) and 81.02 ± 17.00 (95% CI, 45-100), respectively. Conclusions: Although mammography has a high sensitivity in the examination of older patients with fatty breast tissue, it is less reliable in detecting breast lesions in young and premenopausal patients with dense breasts. Diagnostic accuracy of scintimammography, as a functional imaging modality, is not affected by breast density, contrary to mammography. Therefore, scintimammography can improve the specificity of mammography.

Introduction: Breast lesions, particularly lumps, pose concerns for females, varying between benign and malignant conditions. Accurate differentiation solely through clinical assessment is challenging, necessitating a definitive diagnostic strategy. Fine-needle aspiration cytology (FNAC) is integral in the "triple approach" to breast evaluation, offering simplicity, reliability, and cost-effectiveness. However, FNAC has limitations, occasionally failing to yield definitive diagnoses due to inherent constraints. Contrarily, frozen-section analysis, a long-standing intraoperative diagnostic method, plays a crucial role in swift diagnosis during surgeries. Despite technological advancements, frozen sections serve specific diagnostic purposes, confirming carcinoma when FNAC is inconclusive and evaluating resected margins. However, freezing artifacts may affect tissue assessment, emphasizing the continued reliance on histopathology for guiding treatment decisions., Objectives: This study was conducted at KVG Medical College and Hospital, Sullia, Karnataka, India. It aimed to analyze the morphological characteristics of benign and malignant breast lesions using FNAC, frozen section, and histopathology and evaluate the sensitivity, specificity, and predictive values of FNAC and frozen section against histopathology as the reference standard., Methods: A cross-sectional investigation was carried out at a tertiary care hospital's Department of Pathology, on 60 female patients who presented with palpable breast masses over a span of two and a half years. FNAC was conducted, and the observations were classified into five categories as per the International Academy of Cytology guidelines. In addition, intraoperative frozen-section analysis was undertaken. A comparative analysis was conducted between the FNAC and intraoperative frozen-section findings, juxtaposed with the subsequent histopathological diagnoses., Results: FNAC revealed 51.7% malignant, 45% benign, and 3.3% inadequate cases; the frozen-section analysis indicated 51.6% malignant, 45% benign, and 3.3% deferred cases; histopathology showed 53.3% malignant, 45% benign, and 1.6% borderline cases. FNAC demonstrated 93.9% sensitivity, 100% specificity, 100% positive predictive value (PPV), 93.1% negative predictive value (NPV), and 96.7% accuracy. The frozen-section analysis exhibited 96.9% sensitivity, 100% specificity, 100% PPV, 96.4% NPV, and 98.3% accuracy., Conclusion: Intraoperative frozen-section analysis displays superior diagnostic utility compared to preoperative FNAC. However, histopathology remains the definitive gold standard. Integrating all three diagnostic modalities is crucial for precise diagnosis and effective patient management., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Sharma et al.)

A non-malignant lesion of cutaneous and subcutaneous tissue known as Papillary Endothelial Hyperplasia (PEH) is of rare occurrence. It is still more uncommon in the breast tissue. Often it is wrongly diagnosed as angiosarcoma. The differentiating features are papillary endothelial hyperplasia existing in an organized thrombus and absence of significant cell atypia (1). Three cases of PEH are discussed in patients treated by radiation therapy for breast carcinoma. [ABSTRACT FROM AUTHOR]

Background: Diffusion-weighted imaging (DWI) is valuable in the screening, diagnosis, and grading of breast lesions. However, conventional DWI (C-DWI) is prone to chemical shift and distortion. ZOOMit DWI (Z-DWI), as an advanced magnetic resonance imaging (MRI) technique, applies two spatially selective parallel excitation pulses to focus sampling in the hope of obtaining more valuable information. This study aimed to evaluate and compare the image quality and feasibility of Z-DWI with those of C-DWI in breast lesions., Methods: The study included 51 patients with breast lesions who underwent breast MRI from May 2021 to February 2022. All patients received Z-DWI and C-DWI sequences, with b values selected as 50 and 800 s/mm 2 (Z-DWI b50 , Z-DWI b800 , C-DWI b50 , and C-DWI b800 ). Apparent diffusion coefficient (ADC) values based on Z-DWI and C-DWI were calculated. For qualitative analysis, four image quality parameters were selected and assessed on a 4-point Likert scale (1 = poor and 4 = excellent). For quantitative analysis, ADC, relative ADC (rADC), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and tumor-to-parenchymal contrast (TPC) values were selected for comparison., Results: Z-DWI had higher scores compared to C-DWI in terms of lesion conspicuity, anatomical details, distortion and artifacts, and overall image quality (P<0.05). Meanwhile, the agreement between the two readers was reasonably good [intraclass correlation coefficient (ICC) range, 0.360-0.881]. The SNR of Z-DWI b800 was better than that of C-DWI b800 (P<0.001). The Z-DWI ADC and rADC values of breast lesions were statistically significantly lower than those of C-DWI (mean ADC: P<0.001; rADC; P=0.005)., Conclusions: Z-DWI sequences were shown to have superior image quality. The ADC map of Z-DWI is more conducive to the imaging evaluation of breast lesions., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-415/coif). The authors have no conflicts of interest to declare., (2023 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Background: The value of contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE) and their combination in the diagnosis of benign and malignant breast lesions have not been systematically evaluated. This study aimed to evaluate the diagnostic value of CEUS combined with SWE in benign and malignant breast lesions., Methods: We searched six electronic databases for literature to evaluate the value of CEUS combined with SWE in the diagnosis of benign and malignant breast lesions from inception to May 2023. Review Manager 5.4 (Cochrane), Meta-DiSc 1.4, and Stata 14.0 (StataCorp) were used for meta-analysis. The pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the curve (AUC) were calculated to evaluate the diagnostic performance., Results: Ultimately, 17 studies were analyzed including 1,962 lesions in total. The overall quality of the included literature was acceptable, and no significant publication bias was found among the included studies. The pooled diagnostic performance measures for CEUS were as follows: SEN: 0.86 [95% confidence interval (CI): 0.84-0.88], SPE: 0.78 (95% CI: 0.75-0.80), PLR: 4.10 (95% CI: 2.86-5.90), NLR: 0.20 (95% CI: 0.15-0.25), DOR: 23.68 (95% CI: 16.77-33.44), and AUC: 0.90 (95% CI: 0.87-0.93); while, for SWE, SEN: 0.83 (95% CI: 0.81-0.86), SPE: 0.81 (95% CI: 0.78-0.83), PLR: 4.36 (95% CI: 3.18-5.97), NLR: 0.22 (95% CI: 0.17-0.29), DOR: 23.13 (95% CI: 14.70-36.40), and AUC: 0.90 (95% CI: 0.87-0.92). The measures for the pooled diagnostic performance of CEUS combined with SWE were as follows: SEN: 0.92 (95% CI: 0.90-0.94), SPE: 0.87 (95% CI: 0.85-0.89), PLR: 7.10 (95% CI: 5.24-9.61), NLR: 0.11 (95% CI: 0.07-0.16), DOR: 83.51 (95% CI: 49.67-140.39), and AUC: 0.96 (95% CI: 0.94-0.98). There was no statistically significant difference in SEN, SPE, and accuracy (ACC) between CEUS and SWE (P>0.05), but they were significantly lower than those of CEUS combined with SWE (P<0.001)., Conclusions: The diagnostic performance of CEUS combined with SWE is higher than that of using CEUS or SWE alone and can further improve the diagnosis of breast lesions., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-23-333/coif). The authors have no conflicts of interest to declare., (2023 Gland Surgery. All rights reserved.)

Rationale and Objectives: Clinical research is crucial for evaluating new medical procedures and devices. It is important for healthcare units and hospitals to minimize the disruptions caused by conducting clinical studies; however, complex clinical pathways require dedicated recruitment and study designs.This work presents the effective introduction of novel microwave breast imaging (MBI), via MammoWave apparatus, into the clinical routine of an operative screening and diagnostic breast imaging department for conducting a multicentric clinical study., Materials and Methods: Microwave breast imaging, using MammoWave apparatus, was performed on volunteers coming from different clinical pathways. Clinical data, comprising demographics and conventional radiologic reports (used as reference standard), was collected; a satisfaction questionnaire was filled by every volunteer. Microwave images were analyzed by an automatic clinical decision support system, which quantified their corresponding features to discriminate between breasts with no relevant radiological findings (NF) and breasts with described findings (WF)., Results: Conventional breast imaging (DBT, US, MRI) and MBI were performed and adapted to assure best clinical practices and optimum pathways. 180 volunteers, both symptomatic and asymptomatic, were enrolled in the study. After microwave images' quality assessment, 48 NF (15 dense) and 169 WF (88 dense) breasts were used for the prospective study; 48 (18 dense) breasts suffered from a histology-confirmed carcinoma. An overall sensitivity of 85.8 % in breasts lesions' detection was achieved by the microwave imaging apparatus., Conclusion: An optimum recruitment strategy was implemented to assess MBI. Future trials may show the clinical usefulness of microwave imaging, which may play an important role in breast screening., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Gianluigi Tiberi reports a relationship with Umbria Bioengineering Technologies that includes: employment and equity or stocks. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Various congenital and neoplastic lesions of the mammary gland are shown in children. Often these diseases are benign and temporary and are considered a major problem by parents and children or adolescents, and they become anxious. When the congenital and normal development of breast tissue is known, the treatment and diagnosis of most benign pathologies can be done without problems or even without a surgical procedure. In this review, the diagnosis and treatment of breast lesions that are common in childhood will be mentioned. [ABSTRACT FROM AUTHOR]

Highlights • Computational models of breast lesions with irregular shapes. • Breast tomosynthesis and CT images to extract tumor shapes. • Realistic in shape segmented lesions as evaluated by radiologists. • User friendly software tool implemented in MATLAB facilitates the tumor delineation. • Creation of a database with segmented lesions. Abstract This paper presents a method for creation of computational models of breast lesions with irregular shapes from patient Digital Breast Tomosynthesis (DBT) images or breast cadavers and whole-body Computed Tomography (CT) images. The approach includes six basic steps: (a) normalization of the intensity of the tomographic images; (b) image noise reduction; (c) binarization of the lesion area, (d) application of morphological operations to further decrease the level of artefacts; (e) application of a region growing technique to segment the lesion; and (f) creation of a final 3D lesion model. The algorithm is semi-automatic as the initial selection of the region of the lesion and the seeds for the region growing are done interactively. A software tool, performing all of the required steps, was developed in MATLAB. The method was tested and evaluated by analysing anonymized sets of DBT patient images diagnosed with lesions. Experienced radiologists evaluated the segmentation of the tumours in the slices and the obtained 3D lesion shapes. They concluded for a quite satisfactory delineation of the lesions. In addition, for three DBT cases, a delineation of the tumours was performed independently by the radiologists. In all cases the abnormality volumes segmented by the proposed algorithm were smaller than those outlined by the experts. The calculated Dice similarity coefficients for algorithm-radiologist and radiologist-radiologist showed similar values. Another selected tumour case was introduced into a computational breast model to recursively assess the algorithm. The relative volume difference between the ground-truth tumour volume and the one obtained by applying the algorithm on the synthetic volume from the virtual DBT study is 5% which demonstrates the satisfactory performance of the proposed segmentation algorithm. The software tool we developed was used to create models of different breast abnormalities, which were then stored in a database for use by researchers working in this field. [ABSTRACT FROM AUTHOR]

Abstract Objectives Comparing the diagnostic accuracy of different MRI techniques in characterization of breast lesions. Methods The study was performed using 1.5T MRI and included 35 females with detected 47 breast lesions. Lesions were analyzed regarding their morphology, kinetic curve pattern, DWI and tCho peak measurement. The results of each MRI parameter were correlated to histo-pathology. Results The study included 35 females with 47 breast lesions. Sensitivity and specificity were 87.5% and 93.3% using morphology alone. By using curve pattern, they were 96.9% and 73.3%. DWI was 96.9% sensitive, 66.7% specific, and MRS was 74.2% sensitive and 71.4% specific. The cut-off ADC value was 1.063 × 10−3 mm2/s. Choline cut-off value was (0.36 mmol/l). Sensitivity and specificity were increased to 100% and 93.3% after combining either kinetic curve or DWI with morphology. Sensitivity was increased to 90.3%, after combining MRS with morphology, however this slightly reduced the specificity to 92.9%. Conclusion MRI is very sensitive for detection of breast lesions, however it lacks specificity. Post-processing tools and functional MRI have improved the specificity. MRS has increased the sensitivity, however specificity has been slightly decreased. Advances in knowledge Functional MRI is very helpful for characterization of different breast lesions, thus avoiding unnecessary intervention. [ABSTRACT FROM AUTHOR]

With the development of ultrasound imaging modern methods such as contrast- -enhanced ultrasound (CEUS) have become part of everyday practice. This imaging method has already gained an important role in the diagnostic algorithm of liver and kidney lesions. However, its use in other fields is still a marginal issue. The role of CEUS in the differential diagnostic algorithm of breast lesions is a topic of many foreign literature studies. The following text describes the methodology of breast CEUS and discusses its inclusion into daily radiology practice. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer is the most common malignant lesion in women. Tru-cut biopsy (TCB) is an accurate, reliable and a safe method of establishing the diagnosis in patients with breast lesions. Aim: The study was undertaken toassess the diagnostic accuracy of TCB in breast lesions. Material and Methods: A histopathological study was carried out on fifty-five patients who had undergone TCB of breast masses at Sheth L.G. General Hospital, AMC MET Medical College, Ahmedabad, Gujarat, India, from June- 2016 to May- 2018. The lesions were categorized & exact diagnosis was rendered whenever possible. Comparative statistical analysis was made between TCB specimens &post operative histopathology specimens whenever available. Results: Total 55 TCB cases were studied; of which 32 were benign and 15 were malignant. One case fell into atypical / indeterminate category & two cases fell in suspicious malignant category. Five TCBs were inadequate for reporting. Amongst the benign category, fibroadenoma& amongst the malignant category, invasive ductal carcinoma, not otherwise specified type were the predominant lesions. In malignant lesions gradation, 85.7% agreement was found between TCB &post operative histopathology specimens. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) & accuracy of TCBs were 83.3%, 100%, 100%, 91.4% and 94%, respectively. Conclusion: TCB can be used as the initial investigation of choice for pre-operative diagnosis of breast lesions since it provides a sufficient amount of tissue to make an accurate histopathological diagnosis. Tumor type & grade are highly correlated with post surgical specimen reports. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the diagnostic value of combined conventional ultrasound (US) and acoustic radiation force impulse (ARFI) imaging for the differential diagnosis of BI-RADS category 4 breast lesions of different sizes. MATERIALS AND METHODS: From April 2013 to January 2015, 283 patients (with a total of 292 breast lesions) who underwent US and ARFI examination were included in this retrospective study. The SWV for the lesion and adjacent normal breast tissue were measured and the SWV ratio was calculated. VTI grade was also assessed. The lesions were separated into three groups on the basis of size, and two combinations of ARFI parameters (SWV + VTI and SWV ratio + VTI) were applied to reassess the BI-RADS categories. Diagnoses were confirmed by pathological examination after biopsy or surgery. ROC analysis was performed to assess the diagnostic efficiency of each method. The Z test was used to compare the difference between AUC of the two methods. RESULTS: Significant improvement was seen in the diagnostic performance of US with the use of the ARFI parameters SWV + VTI (77/179 [43.0%] of BI-RADS category 4A breast lesions were downgraded) and SWV ratio + VTI (64/179 [35.8%] of BI-RADS category 4A breast lesions were downgraded, including two malignant cases that were misdiagnosed as benign) (P < 0.01). The difference between the performances of the two combinations—SWV + VTI and SWV ratio + VTI—was significant only in breast lesions <10 mm in size, where the AUC of SWV ratio + VTI was significantly greater than the AUC of SWV + VTI (0.929 vs. 0.874; P < 0.01). CONCLUSION: Combination of US with ARFI can improve diagnostic performance and help avoid unnecessary biopsy in BI-RADS category 4 breast lesions. The combination of SWV ratio + VTI can improve BI-RADS classification of small lesions (<10 mm size). [ABSTRACT FROM AUTHOR]

We describe the histological and immunohistochemical features of the changes produced by spiral coil localization wires in the breast parenchyma and lymph nodes of a total of 100 patients undergoing surgery for different breast lesions. Coil wires produced cystic lesions containing a hyaline, mucous-like, PAS-negative fluid. Cavities were lined by cells of variable morphology ranging from synovial-like cells (with a conspicuous epithelial appearance) to mononuclear or multinucleate histiocytic cells that expressed CD68, but were negative for keratins. CD3-positive/CD8-positive T lymphocytes predominated in the inflammatory reaction. Pathologists should be aware of these changes in order to differentiate coil-related lesions from other granulomatous or epithelial lesions, including mucocele-like and ductal carcinoma in situ lesions. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the diagnostic efficiency of coronal ultrasonic characteristics by automated breast volume scanning (ABVS) in differentiating benign from malignant breast lesions, and further compare the differential diagnostic values of handheld ultrasound (HHUS), ABVS, HUUS combined with ABVS, and molybdenum target X-ray (MTXR) in benign and malignant lesions. Materials and Methods: This study was retrospectively performed in 84 patients with 87 breast lesions. All breast lesions were diagnosed by ABVS, HHUS, and MTXR, then confirmed using histopathologic examination. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated, as well as receiver operating characteristic (ROC) curve with the area under the curve (AUC) was analyzed to predict the diagnostic values of coronal ultrasonic characteristics by ABVS as well as HHUS, ABVS, HHUS combined with ABVS, and MTXR in breast benign and malignant lesions. Results: Convergence sign and lotus root sign of malignant lesions and the weeping willow sign of benign lesions could be observed in ABVS coronal image. Mass margin and surrounding halo also had high sensitivity, specificity, accuracy, PPV, and NPV. In addition, HHUS combined with ABVS, HHUS, ABVS, and MTXR had similar sensitivity, specificity, accuracy, PPV, NPV, and AUC in differentiating benign from malignant breast lesions. Conclusions: ABVS coronal image have high application value in differential diagnosis of benign and malignant breast lesions. In addition, HHUS combined with ABVS, HHUS, ABVS or MTXR have similar diagnostic efficiencies in differentiating benign and malignant lesions. [ABSTRACT FROM AUTHOR]

Introduction: Screening and diagnostic efforts for breast cancer are critical because the disease has a high rate of successful outcomes with early identification and treatment. The mammography (MG) and Ultrasonography/ ultrasound (USG) are individually effective diagnostic modalities for detection of breast pathologies.Materials and Methods: This cross-sectional, prospective, hospital-based study was carried out with an aim to evaluate breast lesions using digital MG and ultrasonography (USG) independently and in combination with fine-needle aspiration cytology (FNAC) correlation.Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MG in detecting carcinoma breast were 77.77%, 97.72%, 87.5%, and 95.55%, respectively. The sensitivity, specificity, PPV, and NPV of USG in detecting carcinoma breast were 55.55%, 97.72%, 83.33%, and 91.48%, respectively. In our study population, 83.01% of breast lesions were benign, and of them, 77.27% were diagnosed by MG alone and 72.72% were diagnosed by USG alone. When these modalities were combined, 97.72% of the lesions were diagnosed. The correlation coefficients of MG alone (0.792), USG alone (0.631), and MG and USG combination (0.884) with FNAC are all positive, and P values are significant of all the modalities.Conclusion: This study confirms that the MG and ultrasound (USG) when combined have significantly higher sensitivity and NPV than observed for a single modality in detecting the both benign and malignant lesions of the breast. [ABSTRACT FROM AUTHOR]

Objectives: To explore factors affecting the quality of quasistatic ultrasound elastograms of the breast and to evaluate their accuracy in distinguishing benign and malignant breast lesions. Methods: A total of 663 patients with 702 breast lesions were recruited. All patients received both conventional ultrasonography and quasistatic elastography. Patients' breast lesions were divided into A and B groups according to satisfactory and unsatisfactory elastographic examinations. Group A included 590 satisfactory elastograms, whereas Group B included 112 unsatisfactory elastograms. Various factors—maximum depth of the lesion, maximum transverse diameter of the lesion, thickness of the adipose layer, thickness of the glandular layer, thickness of the breast, distance between the nipple and lesion, age, body mass index, and menopausal status—were analyzed and compared between the groups to gauge their effects on the quality of the elastograms. Results: Significantly deeper lesions, higher maximum transverse lesion diameters, thicker adipose layers, thicker glandular layers, and thicker breasts were identified in group B patients compared to group A patients (P < .05). Multivariate logistic regression analyses showed that the maximum depth of the lesion, thickness of the adipose layer, and thickness of the breast were independent factors in the quality of elastograms. The area under the curve for the maximum depth of the lesion was 0.986 with the optimal cutoff threshold of 2.5 cm. Conclusions: Quasistatic elastography can be a supplementary approach to conventional ultrasonography in helping improve the diagnostic accuracy of breast lesions. The depth and size of breast lesions are correlated with the quality of elastograms. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate a special kind of ultrasound (US) shear wave elastography for differential diagnosis of breast lesions, using a new qualitative analysis (i.e. the elasticity score in the travel time map) compared with conventional quantitative analysis. METHODS: From June 2014 to July 2015, 266 pathologically proven breast lesions were enrolled in this study. The maximum, mean, median, minimum, and standard deviation of shear wave speed (SWS) values (m/s) were assessed. The elasticity score, a new qualitative feature, was evaluated in the travel time map. The area under the receiver operating characteristic (AUROC) curves were plotted to evaluate the diagnostic performance of both qualitative and quantitative analyses for differentiation of breast lesions. RESULTS: Among all quantitative parameters, SWS-max showed the highest AUROC (0.805; 95% CI: 0.752, 0.851) compared with SWS-mean (0.786; 95% CI:0.732, 0.834; P = 0.094), SWS-median (0.775; 95% CI:0.720, 0.824; P = 0.046), SWS-min (0.675; 95% CI:0.615, 0.731; P = 0.000), and SWS-SD (0.768; 95% CI:0.712, 0.817; P = 0.074). The AUROC of qualitative analysis in this study obtained the best diagnostic performance (0.871; 95% CI: 0.825, 0.909, compared with the best parameter of SWS-max in quantitative analysis, P = 0.011). CONCLUSIONS: The new qualitative analysis of shear wave travel time showed the superior diagnostic performance in the differentiation of breast lesions in comparison with conventional quantitative analysis. [ABSTRACT FROM AUTHOR]

In the current study, we sought to evaluate the diagnostic efficacies of conventional ultrasound (US), contrastenhanced US (CEUS), combined US and CEUS and magnetic resonance imaging (MRI) in detecting focal solid breast lesions. Totally 117 patients with 120 BI-RADS category 4A-5 breast lesions were evaluated by conventional US and CEUS, and MRI, respectively. SonoVue was used as contrast agent in CEUS and injected as an intravenous bolus; nodule scan was performed 4 minutes after bolus injection. A specific sonographic quantification software was used to obtain color-coded maps of perfusion parameters for the investigated lesion, namely the time-intensity curve. The pattern of contrast enhancement and related indexes regarding the time-intensity curve were used to describe the lesions, comparatively with pathological results. Histopathologic examination revealed 46 benign and 74 malignant lesions. Sensitivity, specificity, and accuracy of US in detecting malignant breast lesions were 90.14%, 95.92%, and 92.52%, respectively. Meanwhile, CE-MRI showed sensitivity, specificity, and accuracy of 88.73%, 95.92%, and 91.67%, respectively. The area under the ROC curve for combined US and CEUS in discriminating benign from malignant breast lesions was 0.936, while that of MRI was 0.923, with no significant difference between them, as well as among groups. The time-intensity curve of malignant hypervascular fibroadenoma and papillary lesions mostly showed a fast-in/fast-out pattern, with no good correlation between them (kappa < 0.20). In conclusion, the combined use of conventional US and CEUS displays good agreement with MRI in differentiating benign from malignant breast lesions. [ABSTRACT FROM AUTHOR]

Objective This study aimed to assess the diagnostic value of a combined imaging protocol of diffusion-weighted MRI, apparent diffusion coefficient (ADC) values, and MR spectroscopy(MRS) in discriminating benign and malignant breast lesions. Patients and methods twenty-six female patients complaining from breast lesions were included in this study. Diffusion weighted images, apparent diffusion coefficients value, and magnetic resonance spectroscopy were obtained to all patients. Results Combined ADC value and MRS in discriminating benign breast lesions from malignant tumors were false-positive in 3 patients , true-positive in 14 patients, false-negative in 1 patient and true-negative in 8 patients with specificity of 72.7%, sensitivity of 93.3%, NPV of 88.9%, PPV of 82.4% and accuracy of 84.6%. Conclusion A great advantage of ADC value is the significant difference between benign and malignant lesions, because of this it plays an important role in characterization of breast lesions. MRS is the only in vivo technique which can detect tissue metabolites. In our study combined MRS with ADC value increased sensitivity in detecting lesions, while the specificity remained at lower level than that of the ADC value alone. [ABSTRACT FROM AUTHOR]

Objective: US elastography is an emerging technique that can be used during breast US examination. The increasing awareness of breast cancer led to an increase in mammography and breast US examinations. The specificity of these techniques is not high enough to prevent unnecessary biopsies. There is still a need for a more specific technique that can overcome this problem. This study aimed to evaluate the value of strain elastography in breast lesions.Materials and Methods: In this study, 110 lesions of 96 patients were evaluated with strain elastography. Five score system was used for lesion scoring. The histopathologic results of lesions were obtained and were accepted as gold standard. The sensitivity, specificity, PPV and NPV of the technique were calculated. Histopathologic and strain elastography results were correlated.Results: The sensitivity of US strain elastography was calculated as 83%, the specificity as 89%, the positive predictive value as 79% and the negative predictive value as 91%.There were no score 1 lesions. All score 2 lesions were benign. Score 5 had the highest true positivity rate.Conclusion: We believe that ultrasound elastography is an effective imaging technique that can be used as an adjunct for differential diagnosis, prior to the decision to biopsy a lesion in certain cases.

Mucocele-like lesions of the breast (MLL) are believed to be due to mucinous ducts extruding their contents into the surrounding stroma. MLLs are a rare entity usually identified by calcifications noted on routine screening mammography. Surgical excision has been recommended due to the propensity for these lesions to harbor atypical ductal hyperplasia (ADH) or malignancy. A 44-year-old female patient presented to the breast center after undergoing routine mammography which showed a group of coarse appearing microcalcifications in the outer third of the breast. After further workup, a core needle biopsy was obtained with pathology showing benign breast tissue with acellular stromal mucin pools containing dystrophic calcifications. The patient underwent surgical excision with final pathology revealing ductal carcinoma in-situ and ADH with prominent mucin production throughout the stroma. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the application of whole-lesion histogram analysis of pharmacokinetic parameters for differentiating malignant from benign breast lesions on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Materials and Methods: In all, 92 women with 97 breast lesions (26 benign and 71 malignant lesions) were enrolled in this study. Patients underwent dynamic breast MRI at 3T using a prototypical CAIPIRINHA-Dixon-TWIST-VIBE (CDT-VIBE) sequence and a subsequent surgery or biopsy. Inflow rate of the agent between plasma and interstitium (Ktrans ), outflow rate of agent between interstitium and plasma (Kep ), extravascular space volume per unit volume of tissue (ve ) including mean value, 25th/50th/75th/90th percentiles, skewness, and kurtosis were then calculated based on the whole lesion. A single-sample Kolmogorov-Smirnov test, paired t-test, and receiver operating characteristic curve (ROC) analysis were used for statistical analysis.Results: Malignant breast lesions had significantly higher Ktrans , Kep , and lower ve in mean values, 25th/50th/75th/90th percentiles, and significantly higher skewness of ve than benign breast lesions (all P < 0.05). There was no significant difference in kurtosis values between malignant and benign breast lesions (all P > 0.05). The 90th percentile of Ktrans , the 90th percentile of Kep , and the 50th percentile of ve showed the greatest areas under the ROC curve (AUC) for each pharmacokinetic parameter derived from DCE-MRI. The 90th percentile of Kep achieved the highest AUC value (0.927) among all histogram-derived values.Conclusion: The whole-lesion histogram analysis of pharmacokinetic parameters can improve the diagnostic accuracy of breast DCE-MRI with the CDT-VIBE technique. The 90th percentile of Kep may be the best indicator in differentiation between malignant and benign breast lesions.Level Of Evidence: 4 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2018;47:91-96. [ABSTRACT FROM AUTHOR]

Purpose: Identifying an additional MRI-detected breast lesion on second-look ultrasonography (US) is technically challenging because of lesion displacement with the patient's position change. The aim of this study is to help identify MRI-detected lesions on second-look US by developing a probing area, called 'the predictive detection area' (PDA), and by assessing the PDA. Methods: We measured the nipple-to-lesion distances (NLDs) for 16 breast lesions on prone- and supine-position MRI sets and calculated the difference and angle between the two NLD vectors, representing the lesion displacement. The minimum and maximum differences and angles were chosen to form the PDA. Another 22 breast lesions, detected in the prone MRI, were identified on US by probing the PDA to evaluate the probability of existence. Results: The width between the minimum and maximum differences in two NLDs and the angle to form the PDA for the upper-inner, upper-outer, and lower-outer quadrants were 23.0 mm and 95.0°, 29.0 mm and 41.0°, and 18.0 mm and 17.0°, respectively. The respective probabilities of existence were 100, 80, and 100%. Conclusions: The PDA had a high probability of existence and was acceptably accurate; therefore, the PDA in a second-look US has the potential to help operators to quickly identify additional MRI-detected lesions. [ABSTRACT FROM AUTHOR]

Purpose The aim of this paper is to provide access to a database consisting of the raw radio-frequency ultrasonic echoes acquired from malignant and benign breast lesions. The database is freely available for study and signal analysis. Acquisition and validation methods The ultrasonic radio-frequency echoes were recorded from breast focal lesions of patients of the Institute of Oncology in Warsaw. The data were collected between 11/2013 and 10/2015. Patients were examined by a radiologist with 18 yr' experience in the ultrasonic examination of breast lesions. The set of data includes scans from 52 malignant and 48 benign breast lesions recorded in a group of 78 women. For each lesion, two individual orthogonal scans from the pathological region were acquired with the Ultrasonix SonixTouch Research ultrasound scanner using the L14-5/38 linear array transducer. All malignant lesions were histologically assessed by core needle biopsy. In the case of benign lesions, part of them was histologically assessed and another part was observed over a 2-year period. Data format and usage notes The radio-frequency echoes were stored in Matlab file format. For each scan, the region of interest was provided to correctly indicate the lesion area. Moreover, for each lesion, the BI- RADS category and the lesion class were included. Two code examples of data manipulation are presented. The data can be downloaded via the Zenodo repository () or the website . Potential applications The database can be used to test quantitative ultrasound techniques and ultrasound image processing algorithms, or to develop computer-aided diagnosis systems. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether a novel method that combines breast imaging reporting and data system (BI-RADS) with strain elastography contributes to diagnostic performance in differentiation of malignant and benign breast lesions. Methods: In 81 patients, 81 breast lesions were prospectively investigated. Breast lesions were separately evaluated with ultrasonography and strain elastography. While evaluations with ultrasonography were based on 2003 BI-RADS-US, strain elastography evaluations were based on a 5-point scale and strain ratio. Diagnostic performances of ultrasonography, strain elastography, and the combined method were compared. Results: Among 81 lesions, 43 (53.1%) were benign and 38 (46.9%) were malignant. When a cutoff point of category 3 was used, sensitivity, specificity, positive and negative predictive values, and accuracy for BI-RADS were 100, 11.6, 50, 100, and 53%, respectively. When BI-RADS and strain ratio were combined, sensitivity, specificity, positive and negative predictive values, and accuracy were 89.5, 93, 91.9, 90.9, and 91.3%, respectively. When BI-RADS and elastography scores were combined, sensitivity, specificity, positive and negative predictive values, and accuracy were 86.8, 97.7, 97.1, 89.4, and 92.5%, respectively. Conclusions: The combination of strain elastography and BI-RADS was found to have better diagnostic performances to diagnose breast lesions than BI-RADS alone. [ABSTRACT FROM AUTHOR]

Purpose New ultrafast view-sharing sequences have enabled breast dynamic contrast-enhanced magnetic resonance imaging ( DCE- MRI) to be performed at high spatial and temporal resolution. The aim of this study is to evaluate the diagnostic potential of textural features that quantify the spatiotemporal changes of the contrast-agent uptake in computer-aided diagnosis of malignant and benign breast lesions imaged with high spatial and temporal resolution DCE- MRI. Method The proposed approach is based on the textural analysis quantifying the spatial variation of six dynamic features of the early-phase contrast-agent uptake of a lesion's largest cross-sectional area. The textural analysis is performed by means of the second-order gray-level co-occurrence matrix, gray-level run-length matrix and gray-level difference matrix. This yields 35 textural features to quantify the spatial variation of each of the six dynamic features, providing a feature set of 210 features in total. The proposed feature set is evaluated based on receiver operating characteristic ( ROC) curve analysis in a cross-validation scheme for random forests ( RF) and two support vector machine classifiers, with linear and radial basis function ( RBF) kernel. Evaluation is done on a dataset with 154 breast lesions (83 malignant and 71 benign) and compared to a previous approach based on 3D morphological features and the average and standard deviation of the same dynamic features over the entire lesion volume as well as their average for the smaller region of the strongest uptake rate. Result The area under the ROC curve ( AUC) obtained by the proposed approach with the RF classifier was 0.8997, which was significantly higher ( P = 0.0198) than the performance achieved by the previous approach ( AUC = 0.8704) on the same dataset. Similarly, the proposed approach obtained a significantly higher result for both SVM classifiers with RBF ( P = 0.0096) and linear kernel ( P = 0.0417) obtaining AUC of 0.8876 and 0.8548, respectively, compared to AUC values of previous approach of 0.8562 and 0.8311, respectively. Conclusion The proposed approach based on 2D textural features quantifying spatiotemporal changes of the contrast-agent uptake significantly outperforms the previous approach based on 3D morphology and dynamic analysis in differentiating the malignant and benign breast lesions, showing its potential to aid clinical decision making. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the value of combining conventional ultrasonography with virtual touch tissue imaging quantification (VTIQ) for differential diagnosis of breast lesions smaller than 10 mm. METHODS: A total of 98 breast lesions smaller than 10mm were examined by conventional ultrasound and VTIQ using a Siemens ACUSON S3000 ultrasound machine. Pathologic diagnosis was established after surgery or fine needle biopsy. RESULTS: Malignant lesions were characterized by taller-than-wide shape, poorly circumscribed margin, and marked hypoechogenicity. The mean VTIQ shear wave velocity (SWV) value of malignant lesions was 4.88±1.87 m/s (range, 1.75-9.34 m/s), significantly higher than that of benign lesions (2.68±1.02 m/s; range, 1.18-4.67 m/s). The optimal cutoff SWV value was 3.27 m/s, with sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 86.20%, 95.65%, 92.86%, 89.29%, and 94.29%, respectively. The combination of SWV >3.27 m/s plus the US feature of poorly circumscribed margin had the highest sensitivity (93.33%) and specificity (100%) for diagnosis of malignant breast lesions. CONCLUSION: Features such as taller-than-wide shape, poorly circumscribed margin, and marked hypoechogenicity on conventional US, and SWV >3.27 m/s on VTIQ, are indicators of malignancy in breast lesions with diameter <10 mm. The combination of poorly circumscribed margin and SWV >3.27 m/s provides the highest specificity and diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Aim Assess accuracy of contrast enhanced spectral mammography (CESM) versus conventional mammography and ultrasound in evaluation of BI-RADS 3 and 4 breast lesions with pathological correlation. Patients and methods Thirty female patients with 35 breast lesions diagnosed by conventional imaging as BI-RADS 3 and 4, presented to Women’s Imaging Unit of Radiology Department between January and December 2015, age ranged from 23 to 70 years. All patients underwent conventional mammography and ultrasound then CESM. Results Patients divided into two groups, benign and malignant lesions group according to histological analysis. Mammography results that malignant lesions detected in 18/35 (51.4%) while benign lesions 17/35 (48.6%). Ultrasound revealed 27/35 (77.1%) lesions were malignant and 8/35 (22.9%) lesions benign. But CESM, revealed 25/35 (71.4%) lesions were malignant & 10/35 (28.6%) lesions benign. Among 7 patients with multifocal/ multi-centric histologically proven malignant lesions, all detected by CESM 7/7 cases (100%) versus 2/7 cases (28.6%) and 6/7 cases (85.7%) detected by mammography and ultrasound respectively. Based on, CESM had 95.2% sensitivity and 82.9% diagnostic accuracy. Conclusion CESM has better diagnostic accuracy than mammography alone and mammography plus ultrasound. CESM has 82.9% diagnostic accuracy in comparison to 51.4% for mammography and 77.1% for ultrasound. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: This study aimed to compare the diagnostic value of automated breast volume scanning (ABVS) to that of handheld ultrasonography (HHUS) using breast magnetic resonance imaging (MRI) as the gold standard.Materials and Methods: Twenty-eight patients with 39 examined breasts with at least one lesion visible in breast MRI underwent HHUS and ABVS. Detection rate, localization, maximum diameter, and Breast Imaging Reporting and Data System classification were compared. Sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value were calculated for HHUS and ABVS. Lesion localization and maximum diameters based on HHUS and ABVS were compared to size measurement in MRI. Breast Imaging Reporting and Data System categories based on each method were compared to the MRI diagnosis (malignant or benign) or, if available (21 cases), with the histologic diagnosis.Results: MRI detected 72 lesions, ABVS 59 lesions, and HHUS 54 lesions. Malignancy was proven histopathologically in 15 cases. There was no significant difference between ABVS and HHUS in terms of sensitivity (93.3% vs. 100%), specificity (83.3% vs. 83.3%), diagnostic accuracy (87.2% vs. 89.7%), positive predictive value (77.8% vs. 78.9%), and negative predictive value (95.2% vs. 100%). Agreement regarding lesion localization (same quadrant) was 94.3% for ABVS and MRI and 91.2% for HHUS and MRI. Lesion size compared to MRI lesion size was assessed correctly (+/- 3 mm) in 79.4% (HHUS) and 80% (ABVS). The correlation of size measurement was slightly higher for ABVS-MRI (r = 0.89) than for HHUS-MRI (r = 0.82) with P < .001.Conclusions: ABVS can be used as an alternative to HHUS. ABVS has the advantage of operator independence and better reproducibility although it is limited in evaluating axillary lymph nodes and lacks Doppler or elastrography capabilities, which sometimes provide important supplementary information in HHUS. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the common malignant lesion in women. Fine-needle aspiration cytology (FNAC) of the breast is a minimally invasive yet maximally diagnostic method. Aim: The aim was to study the cytomorphological features of breast lesions and to evaluate the diagnostic accuracy of fine needle aspiration cytologyin breast lesions. Methods: This study was carried out on 175 patients who presented with palpable lumps in breast in the Department of Pathology; AMC MET Medical College, Ahmadabad, India, from January2015 to August 2016. Cytological diagnosis was given and histopathological correlation was made, whenever available. Results: Out of 175 cases of breast lesions, 128 (73.14%) were benign& 41 (23.43%) were malignant. Fibro adenoma (40%) was the most common benign lesion and ductal carcinoma (23.43%) was the most common malignant lesion. Sensitivity, specificity, positive predictive value & negative predictive value were found to be 97.5%, 100%, 100% &98.48% respectively with diagnostic accuracy to be 99.04%.Conclusion: FNAC is a simple, cost effective procedure that can be carried out at outpatient department. FNAC should be practised as there is high diagnostic accuracy of the method. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the diagnostic performance of two different shear wave elastography (SWE) techniques in distinguishing malignant breast lesions from benign ones. MATERIALS AND METHODS: From March 2016 to May 2016, a total of 153 breast lesions (mean diameter, 16.8mm±10.5; range 4.1-90.0 mm) in 153 patients (mean age, 46.4 years±15.1; age range 20-86 years) were separately performed by two different SWE techniques (i.e. T-SWE, Aplio500, Toshiba Medical System, Tochigi, Japan; and S-SWE, the Aixplorer US system, SuperSonic Imagine, Provence, France). The maximum (Emax), mean (Emean) and standard deviation (ESD) of elasticity modulus values in T-SWE and S-SWE were analyzed. All the lesions were confirmed by ultrasound (US)-guided core needle biopsy (n = 26), surgery (n = 122), or both (n = 5), with pathological results as the gold standard. The areas under the receiver operating characteristic curves (AUROCs) were calculated. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) were calculated to assess the diagnostic performance between T-SWE and S-SWE. Operator consistency was also evaluated. RESULTS: Among the 153 lesions, 41 (26.8%) were malignant and 112 (73.2%) were benign. Emax (T-SWE: 40.10± 37.14 kPa vs. 118.78±34.41 kPa; S-SWE: 41.22±22.54 kPa vs. 134.77±60.51 kPa), Emean (T-SWE: 19.75±16.31 kPa vs. 52.93±25.75 kPa; S-SWE: 20.95±10.98 kPa vs. 55.95±22.42 kPa) and ESD (T-SWE: 9.00±8.55 kPa vs. 38.44± 12.30 kPa; S-SWE: 8.17±6.14 kPa vs. 29.34±13.88 kPa) showed statistical differences in distinguishing malignant lesions from benign ones both in T-SWE and S-SWE (all p < 0.05). In T-SWE, the diagnostic performance of ESD was the highest (AUROC= 0.958), followed by Emax (AUROC= 0.909; p = 0.001 in comparison with ESD) and Emean (AUROC= 0.892; p < 0.001 in comparison with ESD), while in S-SWE, the diagnostic performance of Emax was the highest (AUROC= 0.967), followed by ESD (AUROC= 0.962, p > 0.05 in comparison with Emax) and Emean (AUROC= 0.930, p = 0.034 in comparison with Emax).AUROC-max (T-SWE: 0.909 vs. S-SWE: 0.967),AUROC-mean (T-SWE: 0.892 vs. S-SWE: 0.930) and AUROCSD (T-SWE: 0.958 vs. S-SWE: 0.962) showed no significant difference between T-SWE and S-SWE (all p > 0.05). The intra-class correlation coefficients (ICC) of the intra-operator consistency and inter-operator consistency respectively were 0.961 and 0.898 in T-SWE, while 0.954 and 0.897 in S-SWE. CONCLUSION: T-SWE and S-SWE are equivalent for distinguishing the breast lesions. In T-SWE, ESD had the best diagnostic performance, while in S-SWE, Emax had the best diagnostic performance. [ABSTRACT FROM AUTHOR]

Objective To compare contrast -enhanced ultrasound (CEUS) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the diagnosis of BI-RADS 4 breast lesions. Methods 86 lesions were underwent by ultrasonic CEUS and DCE-MRI. Using the pathologic findings as the gold standard, the diagnostic sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 86 lesions on CEUS and DCE-MRI were calculated. Results In 65 malignant and 21 benign lesions, the 89.23% sensitivity, 80.95% specificity, 93.55% PPV and 70.83% NPV of CEUS were not significantly different from that of DCE-MRI (92.31%, 85.71%, 95,24%, 78.26%). Conclusion CEUS is valuable in the differential diagnosis of BI-RADS 4 breast lesions and has a good agreement with DCE-MRI. [ABSTRACT FROM AUTHOR]

Background: Ultrasound elastography (UE) is a novel imaging method. The purpose of this study was to determine the utility of Virtual Touch tissue imaging in the evaluation of solid breast lesions. Patients and Methods: 209 breast solid lesions in 192 patients that had been evaluated using ultrasound (US) and UE were reviewed and analyzed. Results: The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for UE, US, and US plus UE in the differentiation of malignant from benign breast lesions were 80.8, 75.6, 77.9, 73.1, and 82.8% for UE, 87.2, 86.1, 86.6, 83.7, and 89.2% for US, and 92.5, 86.9, 89.5, 85.3, and 93.4% for US plus UE. There were significant differences between UE and US plus UE (all p < 0.05). Except for accuracy, there were no significant differences between UE and US or US and US plus UE (all p > 0.05). The area under the curve obtained from the ROC curve for UE, US, and US plus UE in differentiating malignant from benign lesions was 0.845, 0.884, and 0.922, respectively. Conclusion: The UE scoring system is not superior to BI-RADS in the sonographic evaluation of solid breast lesions. Combined use may improve the performance. [ABSTRACT FROM AUTHOR]

Benign breast masses are uncommon but are becoming more recognized among the pediatric population.Malignant breast lesions are very rare. The aim of our study was to review and compare the demographics, clinical presentation, treatment, and outcomes of breast lesions, including primary malignancies, and to discuss theories that may explain why there is an increased rate of breast cancers diagnosed at a younger age in the Egyptian population. A total of 1031 cases were reviewed. Comparisons were made between the Egyptian (n = 846) and US (n = 185) cohorts. There were 30 (3.5%) malignant tumors in the Egyptian group with 17 (2%) deaths versus 3 (1.6%) malignant tumors in the US group with 2 (1%) deaths (p = 0.247). The relative risk of breast cancer in the Egyptian group was 2.16 (95% confidence interval (CI): 0.67–7.01) compared with the US group. The trend for increased risk of breast cancer in Egypt may be due to delayed diagnosis because of decreased awareness. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate whether the combination of B-mode ultrasound, elastography score (ES) and strain ratio (SR) improves diagnostic performance with respect to breast lesions. One hundred thirty lesions were prospectively evaluated by B-mode ultrasound and strain elastography, followed by fine-needle aspiration cytology/biopsy in 117 woman who were scheduled for regular breast BUS. The median ES (4.5 vs. 2.9, p < 0.001) and SR (4.9 vs. 2.3, p < 0.001) were significantly higher for malignant than for benign lesions. A sensitivity of 90.5% and specificity of 93.2% for the ES (cutoff point = 3.8) and a sensitivity of 87.5% and specificity of 87.6% for the SR (cutoff point = 3.5) were obtained. Elastography combined with B-mode ultrasound improved the specificity, accuracy and positive predictive value. Receiver operating characteristic curves yielded a higher value for the combined technique for diagnosis of breast lesions. Routine use of such a diagnostic algorithm could reduce the number of unnecessary biopsies. [ABSTRACT FROM AUTHOR]

Background: The study aimed to improve breast cancer diagnosis with new ultrasound (US) modalities. We examined whether real-time elastography (RTE) complements the diagnostic performance of US.Methods: The Ethical Committee approved the study. Patients provided written informed consent and received a whole breast workup. Breast lesions were evaluated by US and RTE. Lesions were assessed by BI-RADS, Tsukuba score (TS) and strain ratio (SR).Results: The study included 164 breast lesions of which 101 were benign and 63 malignant. Women with benign lesions were predominantly premenopausal with sonographic dense breast tissue. Women with breast cancer were mostly postmenopausal, with a low sonographic density. Benign lesions had a mean TS of 2.05, which was significantly lower than the mean TS of 3.25 for malignant lesions. The SR for benign lesions (SR 1.83) was significantly smaller than for breast cancer (SR 4.83). Sensitivity and specificity was 95 and 81% for BI-RADS, 39 and 94% for TS, and 57 and 83% for SR, with a cutoff at 2.5. The combination of BI-RADS, TS and SR yielded a sensitivity of 95% and a specificity of 85%.Conclusion: Besides morphologic features revealed by US, elastic properties of breast lesions obtained by RTE can be exploited for diagnostic breast imaging. [ABSTRACT FROM AUTHOR]

The aim of the study was evaluate the 3.0 T magnetic resonance (MR) perfusion imaging scanning time window following contrast injection for differentiating benign and malignant breast lesions and to determine the optimum scanning time window for increased scanner usage efficiency and reduced diagnostic adverse risk factors. A total of 52 women with breast abnormalities were selected for conventional MR imaging and T1 dynamic-enhanced imaging. Quantitative parameters [volume transfer constant (Ktrans), rate constant (Kep) and extravascular extracellular volume fraction (Ve)] were calculated at phases 10, 20, 30, 40 and 50, which represented time windows at 5, 10, 15, 20 and 25 min, respectively, following injection of contrast agent. The association of the parameters at different phases with benign and malignant tumor diagnosis was analyzed. MR perfusion imaging was verified as an effective modality in the diagnosis of breast malignancies and the best scanning time window was identified: i) Values of Ktrans and Kep at all phases were statistically significant in differentiating benign and malignant tumors (P<0.05), while the value of Ve had statistical significance only at stage 10, but not at any other stages (P>0.05); ii) values of Ve in benign tumors increased with phase number, but achieved no obvious changes at different phases in malignant tumors; iii) the optimum scanning time window of breast perfusion imaging with 3.0 T MR was between phases 10 and 30 (i.e., between 5 and 15 min after contrast agent injection). The variation trend of Ve values at different phases may serve as a diagnostic reference for differentiating benign and malignant breast abnormalities. The most efficient scanning time window was indicated to be 5 min after contrast injection, based on the observation that the Ve value only had statistical significance in diagnosis at stage 10. However, the optimal scanning time window is from 5 to 15 min following the injection of contrast agent, since that the variation trend of Ve is able to serve as a diagnostic reference. [ABSTRACT FROM AUTHOR]