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PURPOSE This study aims to describe imaging findings in patients treated with intraoperative electron radiotherapy and compare them with those detected in patients treated with external whole breast radiotherapy (WBRT). METHODS The study population consisted of 25 patients who received intraoperative radiotherapy [IORT (21 Gy)] as single-dose radiotherapy and a control group of 25 patients who received WBRT at the same institution. Mammography and ultrasound (US) findings were divided into three groups: minor, intermediate, and advanced. On mammography, mass lesions were considered advanced, and asymmetries or architectural distortions were considered intermediate. Oil cysts, linear scars, and the increase in parenchymal density were considered minor findings. On US, irregular non-mass lesions were considered advanced, and circumscribed hypoechoic lesions or planar irregular scars with shadowing were considered intermediate. Oil cysts, fluid collections, or linear scars were considered minor findings. RESULTS On mammography, skin thickening (P = 0.001), edema (P < 0.001), increased parenchymal density (P < 0.001), dystrophic calcifications (P = 0.045), and scar/distortion (P = 0.005) were significantly more common in the WBRT group. On US, irregular non-mass lesions, which made interpretation considerably difficult, were significantly more common in the IORT group (P = 0.004). Dominant US findings were fluid collections and postoperative linear or planar scars in the WBRT group. Minor findings were more common in low-density breasts, and major findings (intermediate and advanced) were more common in high-density breasts on both mammographies (P = 0.011) and US (P = 0.027) in the IORT group. CONCLUSION Ill-defined non-mass lesions detected on US in the IORT group have not been defined previously. Radiologists should be aware of these lesions because they can be confusing, especially in early follow-up studies. This study has found that minor findings are seen more frequently in low-density breasts, while major findings are more common in high-density breasts in the IORT group. This has not been reported before, and further studies with more cases are needed to verify these results. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between clinical, radiological, and histopathological findings, biopsy techniques, and the occult invasive component (OIC) in patients diagnosed with ductal carcinoma in situ (DCIS) via percutaneous breast biopsy. Materials and methods: This multicenter retrospective study included women diagnosed with DCIS via imaging-guided needle biopsy who underwent surgical excision between 2011 and 2024. Clinical, radiological, and histopathological findings were assessed. Statistical analyses employed Student’s t-test for continuous variables and the chi-square test or Fisher’s exact test for categorical variables. Results and conclusions: The overall upgrade rate in the final pathology was 18.5% (38/205). The mean size of the lesions was (±SD) 37.3 mm ± 29.4 (range: 4-135). On biopsy pathology, 68.2% (140/205) of lesions were grade 3, 22.9% (47/205) were grade 2, and 8.7% (18/205) were grade 1. Physical examination findings were present in 22.9% (47/205) of cases, whereas 77.1% (158/205) were detected during screening. While 80% (164/205) of the lesions appeared as calcifications or non-mass findings on radiological imaging, 20% (41/205) presented as masses. Out of the cases, 116 (56.5%, 116/205) were diagnosed with ultrasound-guided biopsy, 85 (41.4%, 85/205) with mammographyguided biopsy, and 4 (1.9%, 4/205) with magnetic resonance imaging-guided biopsy. Core needle biopsy (CNB) was used to diagnose 60.9% (125/205) of the cases, whereas vacuum-assisted biopsy was performed in 39.0% (80/205). The mean number of biopsy samples in CNB was (±SD) 7.1±4.3. The presence of physical examination findings (p=0.024), the presence of a mass finding on radiological imaging (p<0.001), the use of ultrasonography as a biopsy modality (p=0.003), the use of CNB as a biopsy technique (p=0.012), and a low number of biopsy samples in CNB (p=0.031) were significantly associated with OIC. Consequently, the risk of underestimation in the presence of these factors must be taken into account. [ABSTRACT FROM AUTHOR]

Purpose: To compare radiological tumor sizes obtained by mammography (MMG), ultrasonography (US) and magnetic resonance imaging (MRI) with pathological sizes and to determine whether there are any changes based on molecular subtypes and the presence of accompanying ductal carcinoma in situ (DCIS). Methods: A total of 559 cases diagnosed with breast cancer in 11 different centers between 2010 and 2022 were included in the study. Tumor sizes were measured on the images downloaded from PACS and compared later with the pathologic sizes reported in the postoperative pathology reports. Comparison was performed based on patient age, imaging findings, breast density, histologic type (invasive/ in situ/ mixed), molecular subtypes and presence of accompanying benign or high-risk lesions. “Mann Whitney U’’ and “Kruskal Wallis H’’ tests were used for comparisons between groups, “Chi-Square or Fisher’s Exact Test” was used to compare categorical variables, and “Spearman Correlation Analysis” was used to examine the relationship between continuous variables. Results: The highest agreement in invasive tumors was obtained with MRI (MRI: 0.831, US: 0.769, MMG: 0.650). In the presence of DCIS, the agreement was strong with MRI (r: 0.770) and moderate with MMG and US (r: 0.517 and r: 0.593, respectively). In mixed tumors, agreement was strong with MRI (r:0.817), moderate with US (r:0.656), and low with mammography (r:0.499). Based on molecular subtypes, highest correlation was obtained with US and MRI in HER-2 (+) tumors (r:0.754, and r:0.715, respectively), and with MRI in other subtypes (Luminal A-B- triple (-)) with MRI (r:0.856-0.815-0.858; respectively). There was no statistically significant difference in terms of other criteria. Conclusion: This multicenter study shows that MRI is the most reliable method in preoperative determination of tumor size for both invasive and in-situ tumors and all molecular subtypes. [ABSTRACT FROM AUTHOR]

Objective: In select cases of early breast cancer, intraoperative electron radiotherapy (IOERT) can be adminitered as partial breast irradiation or as boost. Radiological effects of IOERT are unclear. Aim of this study was to evaluate radiological findings, by ultrasound (US) and/or mammography, in the tumor bed after breast conservation surgery (BCS) and IOERT. Materials and Methods: 43 breast cancer patients (stage I/II) treated between 2012 and 2018 were included and radiological data was available for 22. All patients underwent BCS. IOERT was administered as boost in 3 patients (10Gy) and primary in 19 patients (21Gy). Boost patients received whole breast irradiation after IOERT. Patients were evaluated in 2 groups according to their follow-up period (short term <2 years, longterm >2 years). Follow-up mammography and US images were retrospectively evaluated by two radiologists, experienced in radiological breast imaging. Breast parenchymal pattern, calcifications, masses, distortions and oil cysts were assesed. Minimal distortion and well defined oil cysts were classified as minor, distortion and mass-like lesions were classified as major findings. Results: Median follow-up time was 46 months (6-70months). There were minor findings in 9 patients and major findings in 13 patients. All major findings in early follow-up period patients, partially resolved and stabilized over time. Calcifications were detected 18-48 months after therapy in 6 of the 8 patients who were followed-up for more than 2 years with mammograms. Although 3 calcifications appeared nonuniform at detection, all were typical benign. Relation of these findings to breast density was statistically evaluated. It was found that minor findings were more frequent in fatty breasts (80%) and major findings were more frequent in dense ones (p=0.015). Conclusion: Early radiological findings in the tumor bed after IOERT may be confusing. However, they resolve and stabilize over time. Radiologists and clinicians should be aware of this fact to avoid unnecessary biopsies and further examinations. [ABSTRACT FROM AUTHOR]