AJR

Accuracy of Screening Mammography in Older Women

2011-10-21T12:18:00.000-07:00

Accuracy of Screening Mammography in Older Women
Natalie Sinclair, Benjamin Littenberg, Berta Geller, and Hyman Muss
AJR 2011;197:1268-1273

Link to Journal

VERMONT data:
The objective of this study was to determine the operating characteristics of mammography screening— that is, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and cancer detection rate—in women as they age

Screening mammography is more accurate in older women than in younger women, suggesting that it may be of value in assessing women in all age groups. These data do not address the impact of mammography screening on mortality or breast cancer outcomes

MRI Findings of Pure Ductal Carcinoma in Situ: Kinetic Characteristics Compared According to Lesion Type and Histopathologic Factors

2011-05-24T02:55:00.000-07:00

MRI Findings of Pure Ductal Carcinoma in Situ: Kinetic Characteristics Compared According to Lesion Type and Histopathologic Factors
Jeong-Ah Kim, Eun Ju Son, Ji Hyun Youk, Eun-Kyung Kim, Min Jung Kim, Jin Young Kwak, and Joon Jeong
AJR 2011;196:1450-1456

Link to Journal

RESULTS:
The dominant morphologic appearance was a non-mass lesion with segmental and clumped or heterogeneous enhancement. The pure ductal carcinoma in situ lesions exhibited variable enhancement patterns consisting of persistent (34.3%), plateau (52.2%), and washout (13.4%) curves. The mean initial enhancement slope (p < 0.005) and time to peak enhancement (p < 0.05) correlated with MRI lesion type, and time to peak enhancement (p < 0.05) correlated with the sonographic findings. No statistically significant correlations were observed between the kinetic characteristics and histopathologic factors or mammographic findings (p > 0.05).

CONCLUSION:
Non-mass lesions and plateau curve enhancement were the dominant MRI findings of pure ductal carcinoma in situ. The lesions with mass appearance at MRI had more suspicious kinetic characteristics than did non-mass lesions

Full-Field Digital Mammographic Interpretation With Prior Analog Versus Prior Digitized Analog Mammography: Time for Interpretation

2011-05-24T02:53:00.001-07:00

Full-Field Digital Mammographic Interpretation With Prior Analog Versus Prior Digitized Analog Mammography: Time for Interpretation
Akshay S. Garg, Jocelyn A. Rapelyea, Lauren R. Rechtman, Jessica Torrente, Rebecca B. Bittner, Caitrin M. Coffey, and Rachel F. Brem
AJR 2011;196:1436-1438

Link to Journal

RESULTS:
For each radiologist, the mean reading time for FFDM with digitized priors was significantly shorter in length in comparison with the mean reading time calculated for interpreting FFDM using analog film priors. The differences in times recorded between digitized analog versus analog ranged from 11.31 to 74.18 seconds. The reading times for the four readers ranged from 17.32 to 185.94 seconds, with a mean of 58.56 seconds when using analog film prior mammograms. When using digitized analog prior mammograms, the reading times for the four readers ranged from 11.32 to 109.11 seconds with a mean of 39.76 seconds. The average difference in reading time was calculated to be 18.80 seconds, showing that there is a 32% increase in interpretation speed when using a digitized prior analog for comparison studies as opposed to an analog prior.

CONCLUSION:
There is a statistically significant 32.1% average improvement in interpretation time when FFDM screening mammograms use digitized analog comparison mammograms than if FFDM is interpreted with the original analog film mammograms. This should allow more FFDMs to be interpreted in the same amount of time if digitized prior analog mammograms are used

Mucocele-Like Tumors of the Breast as Cystic Lesions: Sonographic-Pathologic Correlation

2011-05-24T02:52:00.001-07:00

Mucocele-Like Tumors of the Breast as Cystic Lesions: Sonographic-Pathologic Correlation
Sun Mi Kim, Hak Hee Kim, Doo Kyung Kang, Hee Jung Shin, Nariya Cho, Jeong Mi Park, and Joo Hee Cha
AJR 2011;196:1424-1430

Link to Journal

RESULTS:
Mammography showed 53 lesions had calcifications without (n = 39) or with (n = 14) a mass. Calcifications of intermediate concern or associated with higher probability of malignancy were found more frequently in mucocele-like tumors associated with ADH or malignancy than in pure mucocele-like tumors (92.3% vs 62.9%, p = 0.019). At ultrasound, 69 of the mucocele-like tumors (95.8%) were seen as a cystic mass. Cysts with thick septations, clustered cysts, and complex masses were more frequently seen in mucocele-like tumors associated with ADH or malignancy (89.7% vs 32.5%, p < 0.001). The positive predictive value for BI-RADS category 4 was 13.3% (95% CI, 6.9–24.2%) and was 50% for BI-RADS category 5 (95% CI, 15–85%).

CONCLUSION:
Mucocele-like tumors associated with ADH or malignancy were more frequently seen as clustered cysts, cysts with thick septations, and complex masses associated with calcifications of intermediate concern or higher probability of malignancy. BI-RADS can be used in the management of mucocele-like tumors.

Hyperechoic Lesions of the Breast: Not Always Benign

2011-04-25T12:52:00.000-07:00

Hyperechoic Lesions of the Breast: Not Always Benign
Anna Linda, Chiara Zuiani, Michele Lorenzon, Alessandro Furlan, Rossano Girometti, Viviana Londero, and Massimo Bazzocchi
AJR 2011; 196:1219-1224

Link to Journal

Of all biopsied lesions, 25 (0.6%) were hyperechoic.Among the 1849 malignant lesions, nine (0.4%) were hyperechoic.The remaining 16 were benign. None of the hyperechoic malignancieswas a "purely" sonographic lesion, because all were palpable,mammographically visible, or detectable on breast MRI. Malignantlesions were more likely than benign lesions to have noncircumscribedmargins (9/9 vs 7/16; p = 0.008) and nonparallel orientation(6/9 vs 1/16; p = 0.003).

When encountering a hyperechoic nodule, malignantnature cannot be excluded. Suspicious sonographic signs andcorrelation with other imaging techniques may help avoid misdiagnosis.

Variation of Breast Vascular Maps on Dynamic Contrast-Enhanced MRI After Primary Chemotherapy of Locally Advanced Breast Cancer

2011-04-25T12:49:00.000-07:00

Variation of Breast Vascular Maps on Dynamic Contrast-Enhanced MRI After Primary Chemotherapy of Locally Advanced Breast Cancer
Laura Martincich, Ilaria Bertotto, Filippo Montemurro, Riccardo Ponzone, Luca A. Carbonaro, Daniele Regge, and Francesco Sardanelli
AJR 2011; 196:1214-1218

Link to Journal

Before primary chemotherapy, DCE-MRI vascular mapswere asymmetrically increased ipsilaterally to the LABC. Afterprimary chemotherapy, vascular maps significantly changed onlyin the breast harboring the cancer, with significant differencesbetween responders and nonresponders.

Application of MR Mammography Beyond Local Staging: Is There a Potential to Accurately Assess Axillary Lymph Nodes? Evaluation of an Extended Protocol in an Initial Prospective Study

2011-04-25T12:48:00.000-07:00

Application of MR Mammography Beyond Local Staging: Is There a Potential to Accurately Assess Axillary Lymph Nodes? Evaluation of an Extended Protocol in an Initial Prospective Study
Pascal A. T. Baltzer, Matthias Dietzel, Hartmut P. Burmeister, Ramy Zoubi, Mieczyslaw Gajda, Oumar Camara, and Werner A. Kaiser
AJR 2011; 196:641-647

Link to Journal

Most significant predictors (p < 0.001) of presentmetastasis were "irregular margin" (diagnostic OR, 14.0), "inhomogeneouscortex" (diagnostic OR, 8.4), "perifocal edema" (positive likelihoodratio, 100) and "asymmetry" (diagnostic OR, 19.5). CHAID treeidentified "asymmetry" and "irregular margin" as significantpredictors (adjusted-p < 0.05) for present metastasis (PPV:100%), whereas absence of "asymmetry" and "homogeneous internalstructure" were highly predictive of absent metastasis (negativepredictive value, 94.3%). Combination of significant descriptorsusing binary logistic regression revealed an area under thereceiver operating characteristic curve of 0.93 (p < 0.001).Inter-rater agreement was "almost-perfect" ( = 0.95).

Combined T-staging and locoregional staging (N-staging) waspossible within one imaging session using the proposed protocol.Despite a minimal increase in examination time, high diagnosticaccuracy and excellent interrater reliability were achieved

Interpretation of Positron Emission Mammography and MRI by Experienced Breast Imaging Radiologists: Performance and Observer Reproducibility

2011-04-25T12:46:00.000-07:00

Interpretation of Positron Emission Mammography and MRI by Experienced Breast Imaging Radiologists: Performance and Observer Reproducibility
Deepa Narayanan, Kathleen S. Madsen, Judith E. Kalinyak, and Wendie A. Berg
AJR 2011; 196:971-981

Link to Journal

Across 36 observers, mean sensitivity, specificity,and area under the curve (AUC) for PEM were 96% (range, 75–100%),84% (range, 66–97%), and 0.95 (range, 0.82–1.0),respectively. Mean sensitivity, specificity, and AUC for theMRI task were 82% (range, 45–100%), 67% (range, 38–91%),and 0.80 (range, 0.48–0.96), respectively. Interobserveragreement for PEM findings ranged from moderate to substantial,with kappa values of 0.57 for lesion type and 0.63 for final assessments.

With minimal training, experienced breast imagersshowed high performance in interpreting PEM images. Performancein MRI interpretation by the same observers validated expectedclinical practice.

Interpretation of Positron Emission Mammography: Feature Analysis and Rates of Malignancy

2011-04-25T12:44:00.000-07:00

Interpretation of Positron Emission Mammography: Feature Analysis and Rates of Malignancy
Deepa Narayanan, Kathleen S. Madsen, Judith E. Kalinyak, and Wendie A. Berg
AJR 2011; 196:956-970

Link to Journal

Use of standardized terminology to report PEM findings willfacilitate effective communication of results and consistentmanagement. A probably benign category 3 assessment carrieda substantial rate of malignancy for lesions seen on PEM, andbiopsy may be more appropriate than follow-up.

Breast MRI Using a High-Relaxivity Contrast Agent: An Overview

2011-04-25T12:42:00.000-07:00

Breast MRI Using a High-Relaxivity Contrast Agent: An Overview
Luca A. Carbonaro, Federica Pediconi, Nicola Verardi, Rubina M. Trimboli, Massimo Calabrese, and Francesco Sardanelli
AJR 2011; 196:942-955

Link to Journal

Thanks to its high relaxivity, gadobenate dimeglumine offersvaluable advantages in terms of lesion conspicuity, detectionrate, and sensitivity for malignant breast lesions. However,a higher enhancement of benign lesions should be taken intoaccount to avoid reduced specificity

Development of an Adjustable Model Breast for Mammographic Dosimetry Assessment in Taiwanese Women

2011-04-25T12:40:00.000-07:00

Development of an Adjustable Model Breast for Mammographic Dosimetry Assessment in Taiwanese Women
Shang-Lung Dong, Tieh-Chi Chu, Gong-Yau Lan, Yung-Chien Lin, Yu-Hsiu Yeh, and Keh-Shih Chuang
AJR 2011; 196:476-481

Link to Journal

Compressed breast thickness is useful for quantifying dimensionsand percentage glandular content of a model breast. The adjustable modelbreast developed in this study can offer greater flexibilityin the determination of breast dimensions for mammographic dosimetryassessment of Taiwanese women

MRI Appearance of Tumor Recurrence in Myocutaneous Flap Reconstruction After Mastectomy

2011-04-25T12:25:00.000-07:00

MRI Appearance of Tumor Recurrence in Myocutaneous Flap Reconstruction After Mastectomy
Chenjing Peng, C. Belinda Chang, Hilda H. Tso, Christopher I. Flowers, Nola M. Hylton, and Bonnie N. Joe
AJR 2011; 196:471-475

Link to Journal

A top article from a top institution (but then I am biased). This is a study based on our work at UCSF looking at patients with TRAMOGRAMS who have a local recurrence in the augmented breast, often found BEFORE it is palpable.

Work has previously been presented at ARRS by ourselves on the mammographic appearances.

The Augmented Breast: A Pictorial Review of the Abnormal and Unusual

2011-04-25T12:21:00.001-07:00

The Augmented Breast: A Pictorial Review of the Abnormal and Unusual
Natalie Yang and Derek Muradali
AJR 2011; 196:451-460

Link to Journal

Indications for Breast MRI: Case-Based Review

2011-04-25T12:20:00.000-07:00

Indications for Breast MRI: Case-Based Review
Amy Argus and Mary C. Mahoney
AJR 2011; 196:1-14

Link to Journal

ALSO a Self Assessment Module (SAM) on the same topic -

Indications for Breast MRI: Self-Assessment Module
Amy Argus and Mary C. Mahoney
AJR 2011; 196:29-33

Link to Journal

Interobserver Variability of Ultrasound Elastography: How It Affects the Diagnosis of Breast Lesions

2011-04-25T11:01:00.000-07:00

Interobserver Variability of Ultrasound Elastography: How It Affects the Diagnosis of Breast Lesions
Jung Hyun Yoon, Myung Hyun Kim, Eun-Kyung Kim, Hee Jung Moon, Jin Young Kwak, and Min Jung Kim
AJR 2011; 196:730-736

Link to Journal

Of the 65 lesions, 43 (66.2%) were benign, and 22 (33.8%) weremalignant. Specificity (20.2–33.3%), positive predictivevalue (38.7–45.1%), and accuracy (46.7–55.4%) weresignificantly improved in combined ultrasound and elastography(p < 0.001). Area under the curve (AUC) values for all threeperformers did not show significant differences in ultrasound(AUC, 0.959) and combined ultrasound and elastography (AUC,0.957) (p = 0.92). Interobserver agreement was not improvedwith combined ultrasound and elastography ( = 0.25) in comparisonto ultrasound only ( = 0.37). Interobserver agreement of real-timeelastography was fair in both fat-to-lesion ratio (intraclass correlationcoefficient score, 0.25) and elasticity score ( = 0.28). Moderateagreement ( = 0.46) was seen with static elastography.

Elastography improves the specificity, positive predictivevalue, and accuracy of ultrasound. However, significant interobservervariability exists, with real-time elastographic performance showingfair agreement.

Management of Ultrasonographically Detected Benign Papillomas of the Breast at Core Needle Biopsy

2011-04-25T10:59:00.000-07:00

Management of Ultrasonographically Detected Benign Papillomas of the Breast at Core Needle Biopsy
Jung Min Chang, Woo Kyung Moon, Nariya Cho, Wonshik Han, Dong-Young Noh, In-Ae Park, and Eun-Jung Jung
AJR 2011; 196:723-729

Link to Journal

Surgical excision revealed the presence of benign papillomasin 43 cases, no residual lesion in 12 cases, atypical papillomasin seven cases, and papillary ductal carcinoma in situ in twocases. The upgrade rates to atypical papilloma and to malignancywere 10.9% (7/64; 95% CI, 4.51–21.3%) and 3.1% (2/64;95% CI, 0.38–10.8%), respectively. Mean lesion size wassignificantly larger for lesions that were upgraded to malignancies(1.4 cm vs 0.9 cm) (p = 0.04). Age, distance from the nipple,and ultrasound findings were not significantly associated with underestimationof atypical lesions or malignancies after excision (p > 0.05).

Our results show that the upgrade rate to malignancy determinedby surgery for ultrasound-detected benign papillomas at coreneedle biopsy was 3.1% (2/64). Accordingly, for the accuratediagnosis of ultrasound-detected benign papillomas at core needlebiopsy, surgical excision is recommended.

HOWEVER - the patient group was not subdivided by pre-operative diagnosis, including atypical cases, which skews the data.

For a fuller picture, check the breadth of opinion on the data for this subject

Accuracy of Diagnostic Mammography and Breast Ultrasound During Pregnancy and Lactation

2011-04-25T10:55:00.000-07:00

Accuracy of Diagnostic Mammography and Breast Ultrasound During Pregnancy and Lactation
Jessica Robbins, Deborah Jeffries, Marilyn Roubidoux, and Mark Helvie
AJR 2011; 196:716-722

Link to Journal

Of 134 lesions, 87 (65%) were in patients who presented duringlactation, 34 (25%) who presented during pregnancy, and 13 (10%)who presented postpartum. The presenting symptom for 86 lesions(64%) was a palpable mass. Biopsies were performed for 40 lesions.Of these lesions, four were malignant and 36 were benign. Mammogramswere dense or heterogeneously dense in 88% of patients. Allfour malignancies were BI-RADS category 4 or 5 according toboth mammography and ultrasound. For the 85 lesions evaluated withmammography, there was 100% sensitivity, 93% specificity, 40%positive predictive value, and 100% negative predictive value.For the 122 lesions evaluated with sonography, there was 100%sensitivity, 86% specificity, 19% positive predictive value,and 100% negative predictive value

Among lactating and pregnant women, both mammographyand sonography had a negative predictive value of 100% and accuratelyrevealed the few cancers that were present in our study group.

Spectrum of Disease in the Male Breast

2011-04-25T10:53:00.000-07:00

Spectrum of Disease in the Male Breast
Elaine Iuanow, Mark Kettler, and Priscilla J. Slanetz
AJR 2011; 196:247-259

Link to Journal

Understanding the anatomy of the male breast iscentral to developing a differential diagnosis and deliveringoptimal care in male patients presenting with breast complaints.Diseases in the male breast can affect the skin and subcutaneoustissues, stroma and glandular elements, and neurovascular andlymphatic structures.

Although the most commonly encountered diseaseentity is gynecomastia, men can develop many other benign and neoplasticdiseases, including primary breast cancer.

By incorporating clinicalpresentation with imaging findings on mammography and ultrasound,the breast imager can more effectively establish the correctdiagnosis in males.

Detection and Classification of Calcifications on Digital Breast Tomosynthesis and 2D Digital Mammography: A Comparison

2011-04-25T10:51:00.000-07:00

Detection and Classification of Calcifications on Digital Breast Tomosynthesis and 2D Digital Mammography: A Comparison
M. Lee Spangler, Margarita L. Zuley, Jules H. Sumkin, Gordan Abrams, Marie A. Ganott, Christiane Hakim, Ronald Perrin, Denise M. Chough, Ratan Shah, and David Gur
AJR 2011; 196:320-324

Link to Journal

In this small data set, FFDM appears to be slightlymore sensitive than digital breast tomosynthesis for the detectionof calcification. However, diagnostic performance as measuredby area under the curve using BI-RADS was not significantlydifferent. With improvements in processing algorithms and display,digital breast tomosynthesis could potentially be improved forthis purpose

Breast Imaging and Intervention in the Overweight and Obese Patient

2011-04-25T10:49:00.000-07:00

Breast Imaging and Intervention in the Overweight and Obese Patient
Stamatia Destounis, Mary Newell, and Renee Pinsky
AJR 2011; 196:296-302

Link to Journal

This article comments on the challenges and coping mechanismsfor evaluating overweight and obese patients with breast imaging anddiagnostic techniques. With the prevalence of obesity in society,the obstacles that arise regarding patients' adherence to screeningguidelines are important to address.

This article discusses social factors and physical limitationsthat influence these patients' desires and ability to seek health care,specifically breast care and the problems that arise duringimaging and interventional procedures

Preoperative Sentinel Node Identification With Ultrasound Using Microbubbles in Patients With Breast Cancer

2011-04-25T09:51:00.000-07:00

Preoperative Sentinel Node Identification With Ultrasound Using Microbubbles in Patients With Breast Cancer
Ali R. Sever, Philippa Mills, Susan E. Jones, Karina Cox, Jennifer Weeks, David Fish, and Peter A. Jones
AJR 2011; 196:251-256

Link to Journal

In 71 (89%) of the 80 patients, SLNs were identifiedand guidewires were inserted. In these patients, operative findingsusing conventional radioisotope and blue dye techniques confirmedthat the wired nodes were SLNs. Fourteen patients were foundto have metastases in SLNs. In these patients, the SLNs wereidentified correctly and were localized with guidewires beforesurgery.

SLNs may be identified and localized before surgery usingcontrast-enhanced sonography after injection of microbubbles.

Microbubble Contrast-Enhanced Ultrasound for Sentinel Lymph Node Detection: Ready for Prime Time?

2011-04-25T09:35:00.000-07:00

Microbubble Contrast-Enhanced Ultrasound for Sentinel Lymph Node Detection: Ready for Prime Time?
Wei Tse Yang and Barry B. Goldberg
AJR 2011; 196:249-250

Link to Journal

Editorial/commentary on ultrasound contrast in the breast

2011-04-25T09:33:00.000-07:00

United States Preventive Services Task Force Screening Mammography Recommendations: Science Ignored
R. Edward Hendrick and Mark A. Helvie
AJR 2011; 196:112-116

Link to Journal

Averaged over the six Cancer Intervention and SurveillanceModeling Network models of benefit, screening mammography shows greatestbenefit—a 39.6% mortality reduction—from annualscreening of women 40–84 years old. This screening regimensaves 71% more lives than the USPSTF-recommended regimen ofbiennial screening of women 50–74 years old, which hada 23.2% mortality reduction. For U.S. women currently 30–39years old, annual screening mammography from ages 40–84 yearswould save 99,829 more lives than USPSTF recommendations ifall women comply, and 64,889 more lives with the current 65%compliance rate. The potential harms of a screening examinationin women 40–49 years old, on average, consist of the riskof a recall for diagnostic workup every 12 years, a negativebiopsy every 149 years, a missed breast cancer every 1,000 years, anda fatal radiation-induced breast cancer every 76,000–97,000years. Evidence made available to the USPSTF strongly supportsthe mortality benefit of annual screening mammography beginningat age 40 years, whereas potential harms of screening with thisregimen are minor.

Sonographic Confirmation of a Mammographically Detected Breast Lesion

2011-04-25T09:31:00.000-07:00

Sonographic Confirmation of a Mammographically Detected Breast Lesion
Richard L. Ellis
AJR 2011; 196:225-226

Link to Journal

With the increase in mammographic detection of smaller nonpalpablelesions, it is sometimes challenging to confirm that the lesion identifiedwith subsequent sonography for additional lesion characterization isthe same lesion. When additional confirmation is necessary,instillation of radiopaque contrast material under sonographicguidance followed by repeat mammography examination can helpconfirm lesion correlation

Background Parenchymal Enhancement on Baseline Screening Breast MRI: Impact on Biopsy Rate and Short-Interval Follow-Up

2011-04-25T09:29:00.000-07:00

Background Parenchymal Enhancement on Baseline Screening Breast MRI: Impact on Biopsy Rate and Short-Interval Follow-Up
Niamh M. Hambly, Laura Liberman, D. David Dershaw, Sandra Brennan, and Elizabeth A. Morris
AJR 2011; 196:218-224

Link to Journal

Of the 250 MRI examinations, 24.8% showed minimal enhancement;34%, mild; 24%, moderate; and 17.2%, marked enhancement. Women withminimal enhancement had a significantly higher number of BI-RADS categories1 and 2 examinations (64.5%) than women with mild (38.8%), moderate (40%),or marked (25.6%) enhancement. The BI-RADS category 3 rate was43.6% overall and was significantly lower for women with minimalenhancement (27.4% vs 47.1% for women with mild, 45.0% for womenwith moderate, and 58.1% for women with marked enhancement).At follow-up, 86.2% of the BI-RADS 3 lesions were convertedto BI-RADS category 1 or 2 and 13.8% were converted to BI-RADS 4,with a malignancy rate of 0.9% for lesions undergoing short-interval follow-up.There was no significant difference in biopsy rate or cancer detectionrate among enhancement categories.

Mild, moderate, and marked background parenchymal enhancementis associated with a significantly lower rate of BI-RADS categories1 and 2 assessments and a significantly higher rate of BI-RADS category3 assessments than minimal enhancement. There was no significant differencein biopsy rate or cancer detection rate among the enhancement categories.

Contribution of Diffusion-Weighted Imaging to Dynamic Contrast-Enhanced MRI in the Characterization of Breast Tumors

2011-04-25T09:09:00.000-07:00

Contribution of Diffusion-Weighted Imaging to Dynamic Contrast-Enhanced MRI in the Characterization of Breast Tumors
Sibel Kul, Aysegul Cansu, Etem Alhan, Hasan Dinc, Gurbuz Gunes, and Abdulkadir Reis
AJR 2011; 196:210-217

Link to Journal

Median ADCs of the benign and malignant lesions were1.26 x 10^–3 mm²/s and 0.75 x 10^–3 mm²/s, respectively.Cutoff value of 0.92 x 10^–3 mm²/s for ADC provided 91.5% sensitivityand 86.5% specificity. DCE-MRI alone showed 97.9% sensitivityand 75.7% specificity. The combination of DCE-MRI with DWI provided95.7% sensitivity and 89.2% specificity. The specificity ofbreast MRI improved by 13.5% (p = 0.063) without a significantdecrease in the sensitivity (p = 1.000).

The combination of DWI and DCE-MRI has the potentialto increase the specificity of breast MRI

Predictive Value for Malignancy of Suspicious Breast Masses of BI-RADS Categories 4 and 5 Using Ultrasound Elastography and MR Diffusion-Weighted Imaging

2011-04-25T09:06:00.000-07:00

Predictive Value for Malignancy of Suspicious Breast Masses of BI-RADS Categories 4 and 5 Using Ultrasound Elastography and MR Diffusion-Weighted Imaging
Hiroko Satake, Akiko Nishio, Mitsuru Ikeda, Satoko Ishigaki, Kazuhiro Shimamoto, Maki Hirano, and Shinji Naganawa
AJR 2011; 196:202-209

Link to Journal

In the analysis of all 115 breast masses, the elasticity scorewas predictive of malignancy, whereas the ADC value was not independentlypredictive. In an analysis of the 52 masses assessed as BI-RADS category4, the elasticity score was found to be a significant predictorof malignancy, compared with the ADC value, which was a nonsignificantpredictor. In an analysis of the 63 masses assessed as BI-RADScategory 5, neither the elasticity score nor the ADC value wasa significant predictor of malignancy.

Our results show that elasticity imaging provides relativelyreliable predictions for malignancy, especially in BI-RADS category 4masses, compared with MR DWI.

High Cancer Yield and Positive Predictive Value: Outcomes at a Center Routinely Using Preoperative Breast MRI for Staging

2011-04-25T09:04:00.000-07:00

High Cancer Yield and Positive Predictive Value: Outcomes at a Center Routinely Using Preoperative Breast MRI for Staging
Robert L. Gutierrez, Wendy B. DeMartini, Janet J. Silbergeld, Peter R. Eby, Sue Peacock, Sara H. Javid, and Constance D. Lehman
AJR 2011; 196:93-99

Link to Journal

Biopsy was recommended and performed for 152 of 570(27%) patients found to have one or more suspicious lesionson MRI distinct from the index cancer. Sixty-seven of 152 womenwho underwent biopsy had additional cancers diagnosed, for aPPV of 44%. Overall, 12% (67/570) of women had otherwise occultcancers diagnosed by MRI, with 8% having additional sites or greaterextent of ipsilateral disease and 4% having unsuspected contralateral cancerdetected by MRI alone. No significant differences were foundin the probability of detecting an occult cancer on the basisof patient age, breast density, index tumor characteristics,or lymph node status

Breast MRI detects otherwise occult cancer withan overall added cancer yield of 12% and a high PPV of 44% whenapplied to a diverse population of patients with newly diagnosedbreast cancer

Targeted Ultrasound in Women Younger Than 30 Years With Focal Breast Signs or Symptoms: Outcomes Analyses and Management Implication

2011-04-25T09:02:00.000-07:00

Targeted Ultrasound in Women Younger Than 30 Years With Focal Breast Signs or Symptoms: Outcomes Analyses and Management Implications
Vilert A. Loving, Wendy B. DeMartini, Peter R. Eby, Robert L. Gutierrez, Sue Peacock, and Constance D. Lehman
AJR 2010; 195:1472-1477

Link to Journal

Among 830 study patients, lesions were assessed asBI-RADS category 1 or 2 in 526 (63.4%), BI-RADS category 3 in140 (16.9%), BI-RADS category 4 in 163 (19.6%), and BI-RADScategory 5 in one (0.1%) patient. Three malignancies were detected,for a cancer yield of 0.4%. No BI-RADS category 3 lesions, twoBI-RADS category 4 lesions, and the single BI-RADS category5 lesion were malignant. Ultrasound sensitivity was 100%, specificitywas 80.5%, NPV was 100%, PPV2 was 1.8%, and PPV3 was 1.9%.

Women younger than 30 years with focal breast signsor symptoms have a very low (0.4%) incidence of malignancy.The 100% sensitivity and NPV of targeted ultrasound in our studysubstantiates its use as an accurate primary imaging test inthis clinical setting. We found no malignancies in BI-RADS category3 lesions, supporting ultrasound surveillance over biopsy inthis patient population.

BI-RADS Descriptors for Mammographically Detected Microcalcifications Verified by Histopathology After Needle-Localized Open Breast Biopsy

2011-04-25T08:35:00.000-07:00

BI-RADS Descriptors for Mammographically Detected Microcalcifications Verified by Histopathology After Needle-Localized Open Breast Biopsy
Hee Jung Shin, Hak Hee Kim, Myung-su Ko, Hyun Ji Kim, Jin Hee Moon, Byung Ho Son, and Sei Hyun Ahn
AJR 2010; 195:1466-1471

Link to Journal

For combineddescriptors of morphology and distribution, the odds ratiosof malignancy regarding the higher probability of malignancyand ductal distribution were as follows: 0 for typically benignmorphology or scattered distribution, 93.00 for intermediateconcern and regional, 33.53 for intermediate concern and clustered,5.00 for intermediate concern and ductal, 24.00 for higher probabilityof malignancy and regional, and 1.13 for higher probabilityof malignancy and clustered.

Each descriptor and combined descriptors for microcalcificationsand the final assessment category could help to predict therisk of malignancy

Computer-Aided Analysis of Ultrasound Elasticity Images for Classification of Benign and Malignant Breast Masses

2011-04-25T08:34:00.000-07:00

Computer-Aided Analysis of Ultrasound Elasticity Images for Classification of Benign and Malignant Breast Masses
Woo Kyung Moon, Ji Won Choi, Nariya Cho, Sang Hee Park, Jung Min Chang, Mijung Jang, and Kwang Gi Kim
AJR 2010; 195:1460-1465

Link to Journal

Computer-aided analysis of ultrasound elasticityimages has the potential to aid in the classification of benignand malignant breast tumors

Axillary Ultrasound and Fine-Needle Aspiration in the Preoperative Evaluation of the Breast Cancer Patient: An Algorithm Based on Tumor Size and Lymph Node Appearance

2011-04-25T08:33:00.000-07:00

Axillary Ultrasound and Fine-Needle Aspiration in the Preoperative Evaluation of the Breast Cancer Patient: An Algorithm Based on Tumor Size and Lymph Node Appearance
Martha B. Mainiero, Christina M. Cinelli, Susan L. Koelliker, Theresa A. Graves, and Maureen A. Chung
AJR 2010; 195:1261-1267

Link to Journal

Ultrasound-guided FNA of the axillary lymph nodesis most useful in the preoperative assessment of patients withlarge tumors (> 2 cm) or lymph nodes that appear abnormal

Stereotactic Vacuum-Assisted Breast Biopsy Is Not a Therapeutic Procedure Even When All Mammographically Found Calcifications Are Removed: Analysis of 4,086 Procedures

2011-04-25T08:30:00.000-07:00

Stereotactic Vacuum-Assisted Breast Biopsy Is Not a Therapeutic Procedure Even When All Mammographically Found Calcifications Are Removed: Analysis of 4,086 Procedures
Silvia Penco, Stefania Rizzo, Anna Carla Bozzini, Antuono Latronico, Simona Menna, Enrico Cassano, and Massimo Bellomi
AJR 2010; 195:1255-1260

Link to Journal

VABB may not be considered a therapeutic procedure,even in the case of complete removal of microcalcifications.

However, a complete removal of microcalcifications may resultin low rates of underestimation of malignancy and may consequentlyincrease the diagnostic accuracy of the diagnostic procedure

Contrast-Enhanced MR Angiography of the Breast: Evaluation of Ipsilateral Increased Vascularity and Adjacent Vessel Sign in the Characterization of Breast Lesions

2011-04-25T08:28:00.000-07:00

Contrast-Enhanced MR Angiography of the Breast: Evaluation of Ipsilateral Increased Vascularity and Adjacent Vessel Sign in the Characterization of Breast Lesions
Sibel Kul, Aysegul Cansu, Etem Alhan, Hasan Dinc, Abdulkadir Reis, and Gamze Can
AJR 2010; 195:1250-1254

Link to Journal

Both ipsilateral increased vascularity and the adjacent vesselsign were found to be associated with breast cancer in a significant percentageof patients. The adjacent vessel sign is more practical and generallyapplicable. There is a borderline significance in favor of the higheraccuracy of the adjacent vessel sign in comparison with ipsilateral increasedvascularity (p = 0.043)

Vessel Analysis on Contrast-Enhanced MRI of the Breast: Global or Local Vascularity? Francesco Sardanelli

2011-04-25T08:26:00.000-07:00

Vessel Analysis on Contrast-Enhanced MRI of the Breast: Global or Local Vascularity?
Francesco Sardanelli
AJR 2010; 195:1246-1249

Link to Journal

As is often the case in MRI, what we initially see is only atip of the iceberg

Features of Prospectively Overlooked Computer-Aided Detection Marks on Prior Screening Digital Mammograms in Women With Breast Cancer

2011-04-25T08:25:00.000-07:00

Features of Prospectively Overlooked Computer-Aided Detection Marks on Prior Screening Digital Mammograms in Women With Breast Cancer
Nariya Cho, Seung Ja Kim, Hye Young Choi, Chae Yeon Lyou, and Woo Kyung Moon
AJR 2010; 195:1276-1282

Link to Journal

On prior screening digital mammograms, the CAD system hadcorrectly marked 74% (34/46) of visible findings and 90% (19/21)of actionable findings. The actionable findings showed significantlyhigher CAD sensitivity and were marked on both mammographicviews more often than the 'under threshold' findings were.

Pseudoangiomatous Stromal Hyperplasia: Imaging Findings With Pathologic and Clinical Correlation

2010-09-21T12:03:00.000-07:00

Pseudoangiomatous Stromal Hyperplasia: Imaging Findings With Pathologic and Clinical Correlation
Katie N. Jones, Katrina N. Glazebrook, and Carol Reynolds
AJR 2010;195:1036-1042

Link to Journal

The purpose of this article is to describe the imaging characteristics of pseudoangiomatous stromal hyperplasia, where the primary histologic component was pseudoangiomatous stromal hyperplasia. The tumoral form of pseudoangiomatous stromal hyperplasia is rare. The most common mammographic and sonographic finding is a circumscribed mass. Its appearance on MRI is nonspecific, but it may present as clumped nonmasslike persistent enhancement on contrast-enhanced imaging. Biopsy guided by MRI may be necessary to confirm the diagnosis.

Breast MRI After Conservation Therapy: Usual Findings in Routine Follow-Up Examinations

2010-08-26T20:58:00.001-07:00

Breast MRI After Conservation Therapy: Usual Findings in Routine Follow-Up Examinations
Jie Li, D. David Dershaw, Carol F. Lee, Sandra Joo, and Elizabeth A. Morris
AJR 2010;195:799-807

Link to Journal

The objective of this study was to define the usual alterations in the ipsilateral and contralateral breast on MRI of women who have undergone surgery and radiation for the treatment of primary breast cancer

Background enhancement and cystic alteration decreased bilaterally on MRI after completion of surgery and radiation. Edema, skin thickening, seroma, and enhancement at the lumpectomy site progressively decreased over time. These changes never resolved in some women, with edema present in 25.9% of women at 6 or more years after BCT and seroma present in 3.7%. Lumpectomy site enhancement was seen in 37% of studies obtained in the first 12 months after treatment and persisted in 15% of women at 5 or more years. Rim enhancement was seen in women with seromas, whereas focal enhancement was typically seen in those without seromas. The persistence of lumpectomy site enhancement was seen in 12 of 16 women with fat necrosis, indicated by fat signal in the seroma and was seen in only five of 19 patients without fat seen in the surgery cavity (p = 0.007)

CONCLUSION
After a patient has undergone BCT, MRI shows changes in both breasts. Although the changes in our study population were greatest in the treated breast, parenchymal enhancement and cystic alteration decrease bilaterally indicating a systemic influence. Edematous changes, seroma, focal enhancement, and skin thickening were seen only in the treated breast. All posttreatment MRI findings decrease progressively, and all may persist. Lumpectomy site enhancement is most persistent in women with fat necrosis

Frequency, Upgrade Rates, and Characteristics of High-Risk Lesions Initially Identified With Breast MRI

2010-08-26T20:57:00.001-07:00

Frequency, Upgrade Rates, and Characteristics of High-Risk Lesions Initially Identified With Breast MRI
Roberta M. Strigel, Peter R. Eby, Wendy B. DeMartini, Robert L. Gutierrez, Kimberly H. Allison, Sue Peacock, and Constance D. Lehman
AJR 2010;195:792-798

Link to Journal

The purpose of this article was to determine the frequency, outcomes, and imaging features of high-risk lesions initially detected by breast MRI, including atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar

Four hundred eighty-two MRI-detected suspicious lesions underwent needle biopsy. High-risk histopathologic abnormalities were present in 61 (12.7%) of 482 lesions: 51 (10.6%) atypical ductal hyperplasias, six (1.2%) atypical lobular hyperplasias, three (0.6%) lobular carcinomas in situ, and one (0.2%) radial scar. Correlation between the lesion site and pathology at surgical excision was confirmed for 39 of 61 lesions. Twelve (30.8%) of those 39 lesions were upgraded to malignancy (11 atypical ductal hyperplasias and one atypical lobular hyperplasia); five (41.7%) of the 12 malignancies were invasive cancer, and seven (58.3%) were ductal carcinomas in situ. No significant lesion features predictive of subsequent upgrade to malignancy were discovered.

CONCLUSION
There are no specific imaging features that predict upgrade for high-risk lesions when detected with MRI. Therefore, surgical excision is recommended because upgrade to invasive carcinoma or ductal carcinoma in situ can occur in up to 31% of cases, regardless of biopsy technique

Positive Predictive Value of Mammography: Comparison of Interpretations of Screening and Diagnostic Images by the Same Radiologist and by Different Radiologists

2010-08-26T20:53:00.000-07:00

Positive Predictive Value of Mammography: Comparison of Interpretations of Screening and Diagnostic Images by the Same Radiologist and by Different Radiologists
Jacqueline R. Halladay, Bonnie C. Yankaskas, J. Michael Bowling, and Camille Alexander
AJR 2010;195:782-785
Link to Journal

OBJECTIVE
The purpose of this study was to evaluate whether the positive predictive value (PPV) after a recommendation for biopsy differs when one as opposed to more than one radiologist performs the workup after abnormal findings are discovered at screening mammography.

MATERIALS AND METHODS
Using data in a mammography registry for the years 1996–2005, we identified 6,391 diagnostic examinations with a recommendation for biopsy that were performed on a day other than the day of the screening examination. The PPV after a recommendation for biopsy was calculated for two scenarios. In the first scenario, the radiologist interpreting the diagnostic images had interpreted the screening images. In the second scenario, the radiologist read diagnostic images after another radiologist had read the screening images. We used conditional logistic regression analysis to perform within-radiologist comparisons, controlling for covariates known to be associated with PPV after a recommendation for biopsy.

RESULTS
Of the screening examinations with positive findings, 2,335 (36.5%) were scenario 1, and 4,056 (63.5%) were scenario 2. We found no difference between the two scenarios with respect to PPV after a recommendation for biopsy when we controlled for age, breast density, family history of breast cancer, history of breast procedures, time since last mammogram, use of ultrasound at any point in the workup after abnormal results of screening mammography, and interval in days between the screening and diagnostic studies.

CONCLUSION
Who interprets the follow-up images after screening mammograms show abnormal findings does not appear to be an important factor influencing the wide variability in PPV among radiologists.

Breast MRI Screening of Women With a Personal History of Breast Cancer

2010-07-22T20:18:00.001-07:00

Breast MRI Screening of Women With a Personal History of Breast Cancer
Sandra Brennan, Laura Liberman, D. David Dershaw, and Elizabeth Morris
AJR 2010;195:510-516

Link to Journal

RESULTS:
Of 144 women, 44 (31% [95% CI, 15–29%]) underwent biopsies prompted by MRI examination. Biopsies revealed malignancies in 17 women (12% [95% CI, 7–18%]) and benign findings only in 27 women (19% [95% CI, 13–26%]). Of the 17 women in whom cancer was detected, seven also had benign biopsy results. In total, 18 malignancies were found. One woman had two metachronous cancers. MRI screening resulted in a total of 61 biopsies, with a positive predictive value (PPV) of 39% (95% CI, 27–53%). The malignancies found included 17 carcinomas and one myxoid liposarcoma. Of the 17 cancers, 12 (71%) were invasive, five (29%) were DCIS, and 10 (59%) were minimal breast cancers. Of 17 cancers, 10 were detected by MRI only. The 10 cancers detected by MRI only, versus seven cancers later found by other means, were more likely to be DCIS (4/10 [40%] vs 1/7 [14%]; p = 0.25) or minimal breast cancers (7/10 [70%] vs 3/7 [43%]; p = 0.26)

CONCLUSION:
We found that breast MRI screening of women with only a personal history of breast cancer was clinically valuable finding malignancies in 12%, with a reasonable biopsy rate (PPV, 39%)

Cone-Beam CT for Breast Imaging: Radiation Dose, Breast Coverage, and Image Quality

2010-07-22T20:14:00.001-07:00

Cone-Beam CT for Breast Imaging: Radiation Dose, Breast Coverage, and Image Quality
Avice O'Connell, David L. Conover, Yan Zhang, Posy Seifert, Wende Logan-Young, Chuen-Fu Linda Lin, Lawrence Sahler, and Ruola Ning
AJR 2010;195:496-509

Link to Journal

RESULTS:
For a conventional mammographic examination, the average glandular radiation dose ranged from 2.2 to 15 mGy (mean, 6.5 [SD, 2.9] mGy). For cone-beam breast CT, the average glandular dose ranged from 4 to 12.8 mGy (mean, 8.2 [SD, 1.4] mGy). The average glandular dose from cone-beam breast CT was generally within the range of that from conventional mammography. For heterogeneously dense and extremely dense breasts, the difference between the mean dose of conventional mammography and that of cone-beam breast CT was not statistically significant (7.0 vs 8.1 mGy, p = 0.06). Breast tissue coverage was statistically significantly better with cone-beam breast CT than with mammography in the lateral (p < 0.0001), medial (p < 0.0001), and posterior (p = 0.0002) aspects. Mammography had statistically significantly better coverage than cone-beam breast CT in the axilla and axillary tail (p < 0.0001). Overall, most calcifications and all masses detected with mammography were also detected with cone-beam breast CT. The interobserver agreement on cone-beam breast CT was 83.7% in the detectability of imaging findings. The overall interobserver agreement on type of findings, size of findings (<1, 1–4.99, and ≥ 5 mm), and location of findings was 77.2%, 84.8%, and 78.3%, respectively

CONCLUSION:
The results of this study show that cone-beam breast CT can be used to image the entire breast from chest wall to nipple with sufficient spatial and contrast resolution for detection of masses and calcifications at a radiation dose within the range of that of conventional mammography

Digital Breast Tomosynthesis in the Diagnostic Environment: A Subjective Side-by-Side Review

2010-07-22T20:12:00.000-07:00

Digital Breast Tomosynthesis in the Diagnostic Environment: A Subjective Side-by-Side Review
Christiane M. Hakim, Denise M. Chough, Marie A. Ganott, Jules H. Sumkin, Margarita L. Zuley, and David Gur
AJR 2010;195:172-176

Link to Journal

RESULTS:
FFDM and DBT (combined) were perceived to be better for diagnosis in 50% (50/100) of the ratings (25 cases x four readers = 100 ratings) compared with FFDM and additional diagnostic views. Over all readers, 92% of the ratings for verified cancer cases and 50% of the ratings for high-risk cases were rated as BI-RADS 4 or 5. In 12% (12/100) of the ratings, radiologists indicated that the availability of DBT would have eliminated the need for ultrasound as a part of the diagnostic process

CONCLUSION:
DBT may be an alternative to obtaining additional mammographic views in most but not all cases of patients with a lesion that is not solely calcifications. In a fraction of cases, the use of DBT may eliminate the need for ultrasound

Accuracy of MRI in Prediction of Pathologic Complete Remission in Breast Cancer After Preoperative Therapy: A Meta-Analysis

2010-06-21T20:41:00.001-07:00

Accuracy of MRI in Prediction of Pathologic Complete Remission in Breast Cancer After Preoperative Therapy: A Meta-Analysis
Ying Yuan, Xiao-Song Chen, Shi-Yuan Liu, and Kun-Wei Shen
AJR 2010; 195:260-268

Link to Journal

This meta-analysis indicates that MRI has high specificity and relatively lower sensitivity in predicting pathologic complete remission after preoperative therapy in patients with breast cancer. The pathologic complete remission rate may influence the performance of MRI accuracy in this setting, which deserves further investigation

The Future of Mammography: Radiology Residents' Experiences, Attitudes, and Opinions

2010-05-20T20:59:00.000-07:00

The Future of Mammography: Radiology Residents' Experiences, Attitudes, and Opinions
Shrujal S. Baxi, Jacqueline G. Snow, Laura Liberman, and Elena B. Elkin
AJR 2010;194:1680-1686

Link to Journal

RESULTS. Three hundred forty-four residents completed the survey (response rate, 62%). The length of time spent training in breast imaging varied from no dedicated time (37%) to 1–8 weeks (40%) to more than 9 weeks (23%). Most respondents (97%) agreed that mammography is important to women's health. More than 85% of residents believed that mammography should be interpreted by breast imaging specialists. Respondents shared negative views about mammography, agreeing with statements that the field was associated with a high risk of malpractice (99%), stress (94%), and low reimbursement (68%). Respondents endorsed several positive attributes of mammography, including job availability (97%), flexible work schedules (94%), and few calls or emergencies (93%). Most radiology residents (93%) said that they were likely to pursue subspecialty training, and 7% expressed interest in breast imaging fellowships.

CONCLUSION. Radiology residents' negative and positive views about mammography seem to be independent of time spent training in mammography and of future plans to pursue fellowship training in breast imaging. Systematic assessment of the plans and preferences of radiology residents can facilitate the development of strategies to attract trainees to careers in breast imaging

Breast Cancers Not Detected at MRI: Review of False-Negative Lesions

2010-05-20T20:57:00.001-07:00

Breast Cancers Not Detected at MRI: Review of False-Negative Lesions
Akiko Shimauchi, Sanaz A. Jansen, Hiroyuki Abe, Nora Jaskowiak, Robert A. Schmidt, and Gillian M. Newstead
AJR 2010;194:1674-1679

Link to Journal

RESULTS. Enhancement was observed in 213 (95.9%) of the 222 cancer lesions. Of the nine lesions without visible enhancement, two lesions were excluded because the entire tumor had been excised at percutaneous biopsy performed before the MRI examination and no residual tumor was noted on the final histology. The overall sensitivity of MRI for the known cancers was 96.8% (213/220); for invasive cancer, 98.3% (176/179); and for ductal carcinoma in situ, 90.2% (37/41).

CONCLUSION. In a population of 220 sequentially diagnosed breast cancer lesions, we found seven (3.2%) MRI-occult cancers, fewer than seen in other published studies. Small tumor size and diffuse parenchymal enhancement were the principal reasons for these false-negative results. Although the overall sensitivity of cancer detection was high (96.8%), it should be emphasized that a negative MRI should not influence the management of a lesion that appears to be of concern on physical examination or on other imaging techniques

Apparent Diffusion Coefficient Values for Discriminating Benign and Malignant Breast MRI Lesions: Effects of Lesion Type and Size

2010-05-20T20:56:00.000-07:00

Apparent Diffusion Coefficient Values for Discriminating Benign and Malignant Breast MRI Lesions: Effects of Lesion Type and Size
Savannah C. Partridge, Christiane D. Mullins, Brenda F. Kurland, Michael D. Allain, Wendy B. DeMartini, Peter R. Eby, and Constance D. Lehman
AJR 2010;194:1664-1673

Link to Journal

RESULTS. Sixteen of 71 masses and 13 of 45 lesions with nonmasslike enhancement were malignant. The mean ADC was significantly lower for malignant than for benign lesions for both masses (mean difference, 0.49 x 10–3 mm2/s; p < 0.001) and lesions with nonmasslike enhancement (mean difference, 0.20 x 10–3 mm2/s; p = 0.02). The area under the receiver operating characteristics curve (AUC) was greater for masses (AUC, 0.80) than for lesions with nonmasslike enhancement (AUC, 0.66). The mean ADC for malignant masses (1.25 x 10–3 mm2/s) was lower than that for malignant lesions with nonmasslike enhancement (1.41 x 10–3 mm2/s; p = 0.07). The median lesion size was 1.1 cm (range, 0.5–8.3 cm); 45 of 71 masses (63%) measured 1 cm or smaller, and 37 of 45 lesions with nonmasslike enhancement (82%) were larger than 1 cm. There was no relation (p > 0.05) between ADC value and lesion size for benign or malignant lesions, and there were no differences in AUC based on lesion size (p > 0.05).

CONCLUSION. Diffusion-weighted MRI shows promise in differentiation of benign and malignant masses and lesions with nonmasslike enhancement found at breast MRI and is not affected by lesion size. However, ADC measurements may be more useful for discriminating masses than for discriminating lesions with nonmasslike enhancement

False-Positive Findings at Contrast-Enhanced Breast MRI: A BI-RADS Descriptor Study

2010-05-20T20:53:00.000-07:00

False-Positive Findings at Contrast-Enhanced Breast MRI: A BI-RADS Descriptor Study
Pascal A. T. Baltzer, Matthias Benndorf, Matthias Dietzel, Mieczyslaw Gajda, Ingo B. Runnebaum, and Werner A. Kaiser
AJR 2010;194:1658-1663

Link to Journal

The ratio of mass to non-mass lesions differed significantly (p < 0.001) between benign (1.2:1) and malignant (7:1) findings. Seventeen mass and 14 nonmass lesions were false-positive, and 105 mass and 15 nonmass lesions were true-positive. Among mass lesions, it was possible to differentiate malignant and benign lesions on the basis of margin (smooth, irregular, or spiculated) and dynamic enhancement features (p < 0.05). Among nonmass lesions, only stippled enhancement had a significant difference between the subgroups (p < 0.05). Tumor diameter had no influence on the correct diagnosis of nonmass lesions (p = 0.301). Conversely, among mass lesions, false-positive lesions were smaller than true-positive lesions (p = 0.01).

CONCLUSION. Nonmass lesions were the major cause of false-positive breast MRI findings. BI-RADS descriptors are not sufficient for differentiating benign and malignant non-mass lesions

MRI-Guided Breast Biopsy: Influence of Choice of Vacuum Biopsy System on the Mode of Biopsy of MRI-Only Suspicious Breast Lesions

2010-05-20T20:50:00.000-07:00

MRI-Guided Breast Biopsy: Influence of Choice of Vacuum Biopsy System on the Mode of Biopsy of MRI-Only Suspicious Breast Lesions
Simone Schrading, Birgit Simon, Michael Braun, Eva Wardelmann, Hans H. Schild, and Christiane K. Kuhl
AJR 2010;194:1650-1657

Link to Journal

Because of the procedural advantages of use of the console-based system, smaller lesions were biopsied in less time and with higher operator confidence. This result translated into a major shift in the care of patients with MRI-only lesions away from lesion localization toward increased use of MRI-guided vacuum-assisted biopsy

The Positive Predictive Value of BI-RADS Microcalcification Descriptors and Final Assessment Categories

2010-04-21T13:26:00.001-07:00

The Positive Predictive Value of BI-RADS Microcalcification Descriptors and Final Assessment Categories
Chris K. Bent, Lawrence W. Bassett, Carl J. D'Orsi, and James W. Sayre
AJR 2010;194:1378-1383

Link to Journal

RESULTS. The overall positive predictive value of biopsies was 28.8%. The individual morphologic descriptors predicted the risk of malignancy as follows: fine linear/branching, 16 (70%) of 23 cases; fine pleomorphic, 14 (28%) of 50 cases; coarse heterogeneous, two (20%) of 10 cases; amorphous, 10 (20%) of 51 cases; and typically benign, zero (0%) of 12 cases. Fisher-Freeman-Halton exact testing showed statistical significance among morphology descriptors (p < 0.001) and distribution descriptors (p < 0.001). The positive predictive value for malignancy according to BI-RADS assessment categories were as follows: category 2, 0%; category 3, 0%; category 4A, 13%; category 4B, 36%; category 4C, 79%; and category 5, 100%.

CONCLUSION. BI-RADS morphology and distribution descriptors can aid in assessing the risk of malignancy of microcalcifications detected on full-field digital mammography. The positive predictive value increased in successive BI-RADS categories (4A, 4B, and 4C), verifying that subdivision provides an improved assessment of suspicious microcalcifications in terms of likelihood of malignancy

1H MR Spectroscopy of Invasive Ductal Carcinoma: Correlations With FDG PET and Histologic Prognostic Factors

2010-04-21T13:24:00.001-07:00

1H MR Spectroscopy of Invasive Ductal Carcinoma: Correlations With FDG PET and Histologic Prognostic Factors
Mitsuhiro Tozaki and Kazuei Hoshi
AJR 2010;194:1384-1390

Link to Journal

The choline levels obtained using 1H MR spectroscopy with a 1.5-T unit were well correlated with the standardized uptake value obtained using PET/CT and with the histologic prognostic parameters (nuclear grade, estrogen receptor status, and triple-negative lesion status)

Adenoid Cystic Carcinoma of the Breast

2010-04-21T13:21:00.001-07:00

Adenoid Cystic Carcinoma of the Breast
Katrina N. Glazebrook, Carol Reynolds, Robin L. Smith, Edgardo I. Gimenez, and Judy C. Boughey
AJR 2010;194:1391-1396

Link to Journal

Recognition of ACC is important to avoid delay in diagnosis because this tumor has a good prognosis with rare metastases to axillary lymph nodes. Axillary nodal sampling by fine-needle aspiration or core biopsy is rarely indicated

Atypical Papilloma Diagnosed by Sonographically Guided 14-Gauge Core Needle Biopsy of Breast Mass

2010-04-21T13:19:00.000-07:00

Atypical Papilloma Diagnosed by Sonographically Guided 14-Gauge Core Needle Biopsy of Breast Mass
Ji Hyun Youk, Eun-Kyung Kim, Jin Young Kwak, and Eun Ju Son
AJR 2010;194:1397-1402

Link to Journal

Atypical papilloma diagnosed by use of sonographically guided 14-gauge core needle biopsy showed a high upgrade rate after surgical excision. Although some sonographic features may be helpful to predict an upgrade to malignancy, atypical papilloma should be excised surgically in any case

Multimodality Imaging of Triple Receptor-Negative Tumors With Mammography, Ultrasound, and MRI

2010-03-22T12:31:00.000-07:00

Multimodality Imaging of Triple Receptor-Negative Tumors With Mammography, Ultrasound, and MRI
Basak E. Dogan, Ana Maria Gonzalez-Angulo, Michael Gilcrease, Mark J. Dryden, and Wei Tse Yang
AJR 2010;194:1160-1166

Link to Journal

Despite their large size at presentation, triple receptor–negative cancers may be occult on mammography or sonography and frequently have benign or indeterminate features.

MRI identified all triple receptor–negative cancers and showed features that had a high positive predictive value for malignancy

Recommendation for Short-Interval Follow-Up Examinations After a Probably Benign Assessment: Is Clinical Practice Consistent With BI-RADS Guidance?

2010-03-22T12:26:00.000-07:00

Recommendation for Short-Interval Follow-Up Examinations After a Probably Benign Assessment: Is Clinical Practice Consistent With BI-RADS Guidance?
Erin J. Aiello Bowles, Edward A. Sickles, Diana L. Miglioretti, Patricia A. Carney, and Joann G. Elmore
AJR 2010;194:1152-1159

Link to Journal

In contrast to older studies, the majority of probably benign assessments are now recommended for short-interval follow-up, but the probability of short-interval follow-up recommendations varies by patient and radiologist characteristics

Radial Scars Without Atypia Diagnosed at Imaging-Guided Needle Biopsy

2010-03-22T12:24:00.000-07:00

Radial Scars Without Atypia Diagnosed at Imaging-Guided Needle Biopsy: How Often Is Associated Malignancy Found at Subsequent Surgical Excision, and Do Mammography and Sonography Predict Which Lesions Are Malignant?
Anna Linda, Chiara Zuiani, Alessandro Furlan, Viviana Londero, Rossano Girometti, Piernicola Machin, and Massimo Bazzocchi
AJR 2010;194:1146-1151

Link to Journal

A percutaneous diagnosis of a radial scar does not exclude associated malignancy at surgical excision.

Mammographic and sonographic features of a lesion diagnosed as a radial scar at percutaneous imaging-guided biopsy do not predict which lesions will have associated malignancy at surgery.

Therefore, all patients with percutaneous diagnosis of a radial scar should undergo surgical excision regardless of mammographic and sonographic appearances, until further criteria can be determined

Factors That Impact the Duration of MRI-Guided Core Needle Biopsy

2010-01-21T13:41:00.001-08:00

Factors That Impact the Duration of MRI-Guided Core Needle Biopsy
Mitra Noroozian, Eva C. Gombos, Sona Chikarmane, Dianne Georgian-Smith, Sughra Raza, Christine M. Denison, Elisabeth P. Frost, and Robyn L. Birdwell
AJR 2010;194:150-157

Link to Journal

Variables that minimized procedure duration were number of image acquisitions, number of patient insertions or removals from the magnet, and assistance of a breast imaging fellow-in-training. No patient-related or target-related variables impacted procedure time

Comparison of Acquisition Parameters and Breast Dose in Digital Mammography and Screen-Film Mammography in the American College of Radiology Imaging N

2010-01-21T13:37:00.000-08:00

Comparison of Acquisition Parameters and Breast Dose in Digital Mammography and Screen-Film Mammography in the American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial
R. Edward Hendrick, Etta D. Pisano, Alice Averbukh, Catherine Moran, Eric A. Berns, Martin J. Yaffe, Benjamin Herman, Suddhasatta Acharyya, and Constantine Gatsonis
AJR 2010;194:362-369

Link to Journal

Differences between screen-film mammography and FFDM in compression force and indicated compressed breast thickness were small. On average, FFDM had 22% lower mean glandular dose than screen-film mammography per acquired view, with sizeable variations in average FFDM doses by manufacturer

MR-Directed ("Second-Look") Ultrasound Examination for Breast Lesions Detected Initially on MRI: MR and Sonographic Findings

2010-01-21T13:35:00.000-08:00

MR-Directed ("Second-Look") Ultrasound Examination for Breast Lesions Detected Initially on MRI: MR and Sonographic Findings
Hiroyuki Abe, Robert A. Schmidt, Rajshri N. Shah, Akiko Shimauchi, Kirti Kulkarni, Charlene A. Sennett, and Gillian M. Newstead
AJR 2010;194:370-377

Link to Journal

MR-directed ultrasound of MRI-detected lesions was useful for decision making as part of the diagnostic workup. Malignant lesions were likely to have an ultrasound correlate, especially when they presented as masses on MRI. However, the sonographic findings of these lesions were often subtle, and careful scanning technique was needed for successful MRI–ultrasound correlation

(Ed..) this validates studies from Korea and Italy, published in Europe which showed that an US correlate was strongly associated with subsequent outcome of malignancy

Solitary Dilated Duct Identified at Mammography: Outcomes Analysis

2010-01-21T13:32:00.000-08:00

Solitary Dilated Duct Identified at Mammography: Outcomes Analysis
C. Belinda Chang, Natalya M. Lvoff, Jessica W. Leung, R. James Brenner, Bonnie N. Joe, Hilda H. Tso, and Edward A. Sickles
AJR 2010;194:378-382
Link to Journal

UCSF PAPER:
Solitary dilated duct is a rare mammographic finding, this series being the largest reported to date. Although few cases are studied, solitary dilated duct appears to have a greater than 2% likelihood of malignancy, sufficiently high to suggest that a suspicious (BI-RADS 4a) assessment may be appropriate

Ed... currently this is in the BIRADS lexicon as a benign finding. Our data suggest otherwise, but we await validation in a follow up series

Lesion Size Inaccuracies in Digital Mammography

2009-12-22T11:43:00.000-08:00

Lesion Size Inaccuracies in Digital Mammography
Jean R. Paquelet and R. Edward Hendrick
AJR 2010;194:115-118

Link to Journal

We show that some combinations of digital mammography acquisition and display systems can lead to clinically significant over- or underestimation of lesion size in magnification mode. This phenomenon can occur even with acquisition and display systems from the same manufacturer. Thus, the accuracy of lesion size in each magnification mode should be a routine QC acceptance test performed on each digital mammography acquisition–display system combination

Optimal Timing of Breast MRI Examinations for Premenopausal Women Who Do Not Have a Normal Menstrual Cycle

2009-11-20T13:45:00.000-08:00

Optimal Timing of Breast MRI Examinations for Premenopausal Women Who Do Not Have a Normal Menstrual Cycle
Richard L. Ellis
AJR 2009;193:1738-1740
Link to Journal

Serum progesterone concentrations corresponding to the follicular phase of a normal menstrual cycle can aid in optimal scheduling of breast MRI examinations for premenopausal women who lack cyclical menses

Preoperative Sonographic Classification of Axillary Lymph Nodes in Patients With Breast Cancer: Node-to-Node Correlation With Surgical Histology and

2009-11-20T13:42:00.000-08:00

Preoperative Sonographic Classification of Axillary Lymph Nodes in Patients With Breast Cancer: Node-to-Node Correlation With Surgical Histology and Sentinel Node Biopsy Results
Nariya Cho, Woo Kyung Moon, Wonshik Han, In Ae Park, Jihyoung Cho, and Dong-Young Noh
AJR 2009;193:1731-1737
Link to Journal

Sonographic classification of axillary lymph nodes is effective for predicting the presence of metastases to avoid sentinel node biopsy or to reduce unsuccessful lymphatic mapping during sentinel node biopsy

Short-Term Follow-Up of Palpable Breast Lesions With Benign Imaging Features: Evaluation of 375 Lesions in 320 Women

2009-11-20T13:39:00.000-08:00

Short-Term Follow-Up of Palpable Breast Lesions With Benign Imaging Features: Evaluation of 375 Lesions in 320 Women
Jennifer A. Harvey, Brandi T. Nicholson, Alexander P. LoRusso, Michael A. Cohen, and Viktor E. Bovbjerg
AJR 2009;193:1723-1730
Link to Journal

Short-term follow-up is a reasonable alternative to biopsy of palpable breast lesions with benign imaging features, particularly for young women with probable fibroadenoma

Quantitative Diffusion-Weighted Imaging as an Adjunct to Conventional Breast MRI for Improved Positive Predictive Value

2009-11-20T13:36:00.001-08:00

Quantitative Diffusion-Weighted Imaging as an Adjunct to Conventional Breast MRI for Improved Positive Predictive Value
Savannah C. Partridge, Wendy B. DeMartini, Brenda F. Kurland, Peter R. Eby, Steven W. White, and Constance D. Lehman
AJR 2009;193:1716-1722
Link to Journal

DWI shows potential for improving the PPV of breast MRI for lesions of varied types and sizes. However, considerable overlap in ADC of benign and malignant le- sions necessitates validation of these findings in larger studies

Comparison of Digital Mammography and Screen-Film Mammography in Breast Cancer Screening: A Review in the Irish Breast Screening Program

2009-09-29T13:24:00.000-07:00

Comparison of Digital Mammography and Screen-Film Mammography in Breast Cancer Screening: A Review in the Irish Breast Screening Program
Niamh M. Hambly, Michelle M. McNicholas, Niall Phelan, Gormlaith C. Hargaden, Ann O'Doherty, and Fidelma L. Flanagan
AJR 2009;193:1010-1018
Link to Journal

FFDM resulted in significantly higher cancer detection and recall rates than screen-film mammography in women 50–64 years old. The PPVs of FFDM and screen-film mammography were comparable. The results of this study suggest that FFDM can be safely implemented in breast cancer screening programs

Radioguided Localization of Nonpalpable Breast Cancer Lesions: Randomized Comparison With Wire Localization in Patients Undergoing Conservative Surger

2009-09-29T13:23:00.000-07:00

Radioguided Localization of Nonpalpable Breast Cancer Lesions: Randomized Comparison With Wire Localization in Patients Undergoing Conservative Surgery and Sentinel Node Biopsy
Antonio Mariscal Martinez, Montse Sola, Anna Perez de Tudela, Juan Francisco Julian, Manuel Fraile, Sara Vizcaya, and Jaume Fernandez
AJR 2009;193:1001-1009
Link to Journal

The radioguided technique is as effective as the standard wire technique for localization and excision of nonpalpable breast cancer lesions and is somewhat faster and simpler to perform than wire localization

BI-RADS Lesion Characteristics Predict Likelihood of Malignancy in Breast MRI for Masses But Not for Nonmasslike Enhancement

2009-09-29T13:21:00.000-07:00

BI-RADS Lesion Characteristics Predict Likelihood of Malignancy in Breast MRI for Masses But Not for Non mass like Enhancement
Robert L. Gutierrez, Wendy B. DeMartini, Peter R. Eby, Brenda F. Kurland, Sue Peacock, and Constance D. Lehman
AJR 2009;193:994-1000
Link to Journal

Combinations of BI-RADS lesion descriptors can predict the probability of malignancy for breast MRI masses but not for NMLE.
If our model is validated, masses with a low probability of malignancy may be eligible for short-interval follow-up rather than biopsy.
Further research focused on predictive features of NMLE is needed

Targeted Ultrasound of the Breast in Women With Abnormal MRI Findings for Whom Biopsy Has Been Recommended

2009-09-29T13:18:00.000-07:00

Targeted Ultrasound of the Breast in Women With Abnormal MRI Findings for Whom Biopsy Has Been Recommended
Matthias Meissnitzer, D. David Dershaw, Carol H. Lee, and Elizabeth A.Morris
AJR 2009;193:1025-1029
Link to Journal

The MR characteristics of lesions most likely to be seen with an ultrasound correlate were mass versus non-mass, increasing size, and increased level of suspicion of the lesion. Clip placement and follow-up imaging after ultrasound-guided biopsy that yields benign concordant results should be performed to detect cases in which the presumed ultrasound correlate is inaccurate to detect unsuspected false-negative biopsies

Is Breast MRI Helpful in the Evaluation of Inconclusive Mammographic Findings?

2009-09-29T13:17:00.000-07:00

Is Breast MRI Helpful in the Evaluation of Inconclusive Mammographic Findings?
Linda Moy, Kristin Elias, Vashali Patel, Jiyon Lee, James S. Babb, Hildegard K. Toth, and Cecilia L. Mercado
AJR 2009;193:986-993
Link to Journal

We found breast MRI to be a useful adjunctive tool when findings at conventional imaging were equivocal. Strict patient selection criteria should be used because of the high frequency of incidental lesions seen on MR images

Dynamic Contrast-Enhanced MRI of the Breast: Quantitative Method for Kinetic Curve Type Assessment

2009-09-29T13:15:00.000-07:00

Dynamic Contrast-Enhanced MRI of the Breast: Quantitative Method for Kinetic Curve Type Assessment
Riham H. El Khouli, Katarzyna J. Macura, Michael A. Jacobs, Tarek H. Khalil, Ihab R. Kamel, Andrew Dwyer, and David A. Bluemke
AJR 2009;193:295-300
Link to Journal

Quantitative assessment of the type of contrast enhancement kinetic curve on breast DCE-MRI resulted in significantly higher diagnostic performance for establishing or excluding malignancy compared with assessment based on the standard qualitative method

Assessment of Breast Lesions With Diffusion-Weighted MRI: Comparing the Use of Different b Values

2009-09-29T13:13:00.000-07:00

Assessment of Breast Lesions With Diffusion-Weighted MRI: Comparing the Use of Different b Values
Fernanda Philadelpho Arantes Pereira, Gabriela Martins, Eduardo Figueiredo, Marisa Nassar Aidar Domingues, Romeu Cortes Domingues, Lea Mirian Barbosa da Fonseca, and Emerson Leandro Gasparetto
AJR 2009;193:1030-1035
Link to Journal
http://www.ajronline.org/cgi/content/abstract/193/4/1030

Diffusion-weighted imaging is a potential resource as a coadjutant of MRI in the differentiation between benign and malignant lesions. Such imaging can be performed without a significant increase in examination time, especially because it can be done with lower b values

Characteristics of Probably Benign Breast MRI Lesions

2009-08-21T08:13:00.000-07:00

Characteristics of Probably Benign Breast MRI Lesions
Peter R. Eby, Wendy B. DeMartini, Robert L. Gutierrez, Monica H. Saini, Sue Peacock, and Constance D. Lehman
AJR 2009;193:861-867

Indeterminate lesions on high risk screening MRI are the bane of the radiologists life. Some insurance carriers will not pay for 6 month MRI follow up scans of probably benign lesions, so a review and recommendations for management by Connie Lehman and her group in Washington is very welcome.

The characteristics of BI-RADS 3 lesions were highly variable in our population, and the risk of malignancy was low (0.85%).

Assigning foci with 100% persistent enhancement to the BI-RADS 2 category can decrease the frequency of BI-RADS 3 assessment and maintain a likelihood of malignancy in less than 2% of cases

Mammary Fibromatosis

2009-08-21T08:10:00.000-07:00

Mammary Fibromatosis
Katrina N. Glazebrook and Carol A. Reynolds
AJR 2009;193:856-860
Link to Journal

Mammary fibromatosis is a rare, benign, non-metastasizing stromal tumor. It presents clinically and radiologically as a palpable, spiculated, and locally invasive tumor that is suspicious for malignancy. MRI is ideal for evaluation of chest wall involvement. Although histologically benign, the tumor is locally aggressive and has significant recurrence rates. On occasion, recurrence may require radical surgery

MRI Follow-Up After Concordant, Histologically Benign Diagnosis of Breast Lesions Sampled by MRI-Guided Biopsy

2009-08-21T08:06:00.000-07:00

MRI Follow-Up After Concordant, Histologically Benign Diagnosis of Breast Lesions Sampled by MRI-Guided Biopsy
Jie Li, D. David Dershaw, Carol H. Lee, Jennifer Kaplan, and Elizabeth A. Morris
AJR 2009;193:850-855

Link to Journal

This paper pertains to benign findings at MRI Biopsy when there is disconcordance with imaging findings
Follow-up MRI did not detect missed cancers because of lesion enlargement before 6 months after biopsy; two of four missed cancers were stable. The localizing marker can deploy away from the target despite successful sampling

1H MR Spectroscopy and Diffusion-Weighted Imaging of the Breast: Are They Useful Tools for Characterizing Breast Lesions Before Biopsy?

2009-08-21T07:59:00.000-07:00

1H MR Spectroscopy and Diffusion-Weighted Imaging of the Breast: Are They Useful Tools for Characterizing Breast Lesions Before Biopsy?
Mitsuhiro Tozaki and Eisuke Fukuma
AJR 2009;193:840-849
Link to Journal

The results of an in-vivo study using a 1.5-T MRI unit suggested that careful referencing and optimizing post-acquisition data processing improved the spectral resolution, allowing the few false-positive cases (including lactating women and healthy volunteers) to be distinguished by resonance at 3.28 ppm

1H MRS was useful for characterizing breast lesions measuring 15 mm or larger, and diffusion-weighted imaging was useful for characterizing lesions of any size. However, these two techniques still have potential pitfalls in relation to the diagnosis of non-mass breast lesions

Kinetic Curves of Malignant Lesions Are Not Consistent Across MRI Systems

2009-08-21T07:55:00.000-07:00

Kinetic Curves of Malignant Lesions Are Not Consistent Across MRI Systems: Need for Improved Standardization of Breast Dynamic Contrast-Enhanced MRI Acquisition
Sanaz A. Jansen, Akiko Shimauchi, Lindsay Zak, Xiaobing Fan, Abbie M. Wood, Gregory S. Karczmar, and Gillian M. Newstead
AJR 2009;193:832-839
Link to Journal

This paper from Chicago demonstrates that the kinetic curve data on malignant lesions acquired with one system showed significantly lower initial contrast uptake and a different curve shape in comparison with data acquired with the other two systems. Differences in k-space sampling, T1 weighting, and magnetization transfer effects may be explanations for the difference.

Standardization of DCE-MRI is needed for direct comparison

MRI-Detected Suspicious Breast Lesions: Predictive Values of Kinetic Features Measured by Computer-Aided Evaluation

2009-08-21T07:50:00.000-07:00

MRI-Detected Suspicious Breast Lesions: Predictive Values of Kinetic Features Measured by Computer-Aided Evaluation
Lilian C. Wang, Wendy B. DeMartini, Savannah C. Partridge, Sue Peacock, and Constance D. Lehman
AJR 2009;193:826-831

Link to Journal

Of Computer Aided Enhancement (CAE) kinetics analyzed, only delayed enhancement categorized by most suspicious type was significantly different between benign and malignant lesions. This supports the American College of Radiology BI-RADS Breast MRI Lexicon recommendation to report the "worst looking" kinetic curve

Invasive Micropapillary Carcinoma of the Breast: Mammographic, Sonographic, and MRI Features

2009-06-19T19:29:00.000-07:00

Invasive Micropapillary Carcinoma of the Breast: Mammographic, Sonographic, and MRI Features
Beatriz Adrada, Elsa Arribas, Michael Gilcrease, and Wei Tse Yang
AJR 2009;193:58-63

Link to Journal

The imaging characteristics of invasive micropapillary carcinoma are highly suggestive of malignancy. The lesion is a high-density irregular mass with indistinct margins associated with microcalcifications on mammograms; a solid irregular hypoechoic mass with indistinct margins and frequent axillary nodal involvement on sonograms; and a multifocal mass on MR images. This tumor may necessitate aggressive management

breast, carcinoma, mammography, micropapillary, MRI, neoplasm, pathology, prognosis, sonography

Dermatofibrosarcoma Protuberans of the Breast: Imaging Features and Review of the Literature

2009-06-19T19:28:00.000-07:00

Dermatofibrosarcoma Protuberans of the Breast: Imaging Features and Review of the Literature
Su-Ju Lee, Mary C. Mahoney, and Elizabeth Shaughnessy
AJR 2009;193:64-69

Link to Journal

Dermatofibrosarcoma protuberans is an extremely rare malignancy of the breast, with few published reports. This is the largest collection of such cases in a single institution with analysis of the imaging features

Invasive Carcinoma of the Breast Accompanied by Coarse Calcification

2009-06-19T19:26:00.000-07:00

Invasive Carcinoma of the Breast Accompanied by Coarse Calcification
Kenichiro Tanaka, Futoshi Akiyama, Noriko Nishikawa, Kiyomi Kimura, Naoya Gomi, Koji Oda, and Takuji Iwase
AJR 2009;193:70-71

Link to Journal

Benign calcifications within a breast mass are not diagnostic of a benign process if the imaging characteristics of the mass are suspicious

Diffusion-Weighted Imaging of Mucinous Carcinoma of the Breast: Evaluation of Apparent Diffusion Coefficient and Signal Intensity

2009-06-19T19:00:00.000-07:00

Diffusion-Weighted Imaging of Mucinous Carcinoma of the Breast: Evaluation of Apparent Diffusion Coefficient and Signal Intensity in Correlation With Histologic Findings
Reiko Woodhams, Satoko Kakita, Hirofumi Hata, Keiichi Iwabuchi, Shigeaki Umeoka, Carolyn E. Mountford, and Hiroto Hatabu
AJR 2009;193:260-266

Link to Journal

Mucinous carcinoma can be clearly differentiated from other breast tumors on the basis of ADC. The low signal intensity of mucinous carcinoma on diffusion weighted images appears to reflect the presence of mucin and low cellularity. High signal intensity on diffusion-weighted images may reflect the presence of fibrovascular bundles, increased cell density, or a combination of these features

Role of Breast MRI in the Preoperative Evaluation of Patients with Newly Diagnosed Breast Cancer

2009-04-22T07:40:00.000-07:00

Role of Breast MRI in the Preoperative Evaluation of Patients with Newly Diagnosed Breast Cancer
Amy M. Schell, Kari Rosenkranz, and Petra J. Lewis
AJR 2009;192:1438-1444

Link to Journal

MRI detected additional suspicious previously unsuspected lesions in 74 patients (37%). Fifty-four of these lesions, in 38 patients (19%), were identified as malignant, of which 41 (76%) were invasive. Retrospective review of the MRI-identified ipsilateral malignant lesions resulted in hypothetical recommendations that would have altered the surgical treatment of 26 of the patients (13%), principally as mastectomy or wider excision.

For patients with a new diagnosis of breast cancer, breast MRI in a mid-sized regional hospital depicts unsuspected malignant lesions in both the ipsilateral and contralateral breasts in proportions consistent with the results of earlier studies at larger institutions. Whether clinical outcome is improved by changes in surgical management consequent to MRI detection of unsuspected malignant lesions remains unproven

Utility of Targeted Sonography for Breast Lesions That Were Suspicious on MRI

2009-03-30T08:18:00.000-07:00

Utility of Targeted Sonography for Breast Lesions That Were Suspicious on MRI
Wendy B. DeMartini, Peter R. Eby, Sue Peacock, and Constance D. Lehman
AJR 2009;192:1128-1134

Link to Journal

Targeted sonography detected nearly half (46%) of MRI lesions evaluated, with depiction being most frequent for masses. Sonographically occult lesions had a probability of malignancy (22%), which warrants biopsy despite lack of sonographic detection

Connie Lehman's paper reflects our own experience that we often only find 50% of suspicious masses on 2nd look ultrasound.

Increasing Accuracy of Detection of Breast Cancer with 3-T MRI

2009-03-30T08:15:00.000-07:00

Increasing Accuracy of Detection of Breast Cancer with 3-T MRI
Haitham Elsamaloty, Mohamed Salah Elzawawi, Shaden Mohammad, and Nabeel Herial
AJR 2009;192:1142-1148

Link to Journal

MRI at 3 T is more sensitive than mammography and sonography in the detection of breast cancer and the characterization of small lesions (reaching 4 mm) but has lower specificity. Compared with the results of 1-T and 1.5-T MRI in the literature, 3-T MRI has higher sensitivity in the detection of breast cancer with no significant difference in specificity

Patients' Perceptions of Breast MRI: A Single-Center Study

2009-03-30T08:14:00.000-07:00

Patients' Perceptions of Breast MRI: A Single-Center Study
Shaheen Zakaria, Kathleen R. Brandt, Amy C. Degnim, and Kristine M. Thomsen
AJR 2009;192:1149-1154

Link to Journal

Most women undergoing breast MRI for cancer staging and screening found it to be a comfortable test and perceived it to have a positive impact on their care. Breast cancer patients perceived the clinical impact of their breast MRI examination to be significantly more positive than when assessed objectively.

A Logistic Regression Model Based on the National Mammography Database Format to Aid Breast Cancer Diagnosis

2009-03-30T08:08:00.000-07:00

A Logistic Regression Model Based on the National Mammography Database Format to Aid Breast Cancer Diagnosis
Jagpreet Chhatwal, Oguzhan Alagoz, Mary J. Lindstrom, Charles E. Kahn, Jr., Katherine A. Shaffer, and Elizabeth S. Burnside
AJR 2009;192:1117-1127

Link to Journal

The authors claim that -
"Our logistic regression model can effectively discriminate between benign and malignant breast disease and can identify the most important features associated with breast cancer."

I cannot comment on this paper yet, as I need time to digest it and examine what it has to offer us as practicing mammographers

Atypical Ductal Hyperplasia Diagnosed at Sonographically Guided 14-Gauge Core Needle Biopsy of Breast Mass

2009-03-30T08:02:00.000-07:00

Atypical Ductal Hyperplasia Diagnosed at Sonographically Guided 14-Gauge Core Needle Biopsy of Breast Mass
Ji Hyun Youk, Eun-Kyung Kim, and Min Jung Kim
AJR 2009;192:1135-1141

Link to Journal

There conclusions are as follows - ADH diagnosed at sonographically guided 14-gauge core needle biopsy has a high underestimation rate with respect to the results of surgical excision. Surgical excision should be recommended when ADH is diagnosed at sonographically guided 14-gauge core needle biopsy of breast masses.

This paper adds to added value to what is the increasingly obvious problem of ADH, and the requirements for surgical biopsy if found at needle biopsy of whatever size. This paper adds validation for the same approach to be used with ultrasound findings as are used with stereotactic biopsy

Probably Benign Breast Masses Diagnosed by Sonography: Is There a Difference in the Cancer Rate According to Palpability?

2009-03-30T07:56:00.000-07:00

Probably Benign Breast Masses Diagnosed by Sonography: Is There a Difference in the Cancer Rate According to Palpability?
Jung Hee Shin, Boo-Kyung Han, Eun Young Ko, Yeon Hyeon Choe, and Seok-Jin Nam
AJR 2009;192:187-191

Link to Journal

This Korean paper extends the possible validation of US BIRADS 3 to patients with palpable lesions. These sorts of papers will be useful for the BIRADS committee to review when they produce the next (5th Edition) of BIRADS in the next couple of years

The Many Faces of Fat Necrosis in the Breast

2009-02-20T15:58:00.000-08:00

The Many Faces of Fat Necrosis in the Breast
Jorge L. Taboada, Tanya W. Stephens, Savitri Krishnamurthy, Kathleen R. Brandt, and Gary J. Whitman
AJR 2009;192:815-825

Link to journal

On imaging studies, the appearance of fat necrosis ranges from typically benign to worrisome for malignancy. Mammography is more specific than sonography, and emphasis should be placed on mammography in making the diagnosis of fat necrosis. In selected cases, MRI may be helpful in showing findings consistent with fat necrosis

Digital Mammography-Guided Skin Marking for Sonographically Guided Biopsy of Suspicious Microcalcifications

2009-02-20T15:51:00.000-08:00

Digital Mammography-Guided Skin Marking for Sonographically Guided Biopsy of Suspicious Microcalcifications
Nariya Cho and Woo Kyung Moon
AJR 2009;192:132-136

Link to journal

Digital mammography–guided skin marking can be applied to identify and localize suspicious microcalcifications at breast sonography. This technique has the potential to be an alternative to stereotactic guidance when the stereotactic biopsy is unavailable or unsuccessful

Mucinous Carcinoma of the Breast: MRI Features of Pure and Mixed Forms with Histopathologic Correlation

2009-02-20T15:44:00.000-08:00

Mucinous Carcinoma of the Breast: MRI Features of Pure and Mixed Forms with Histopathologic Correlation
Shuichi Monzawa, Masaki Yokokawa, Toshiko Sakuma, Shintaro Takao, Koichi Hirokaga, Keisuke Hanioka, and Shuji Adachi
AJR 2009;192:125-13

Link to Journal

Hypercellular pure mucinous tumors exhibit strong early enhancement and may be difficult to differentiate from mixed mucinous tumors. The distinction between the pure and mixed forms of mucinous carcinoma is important because mixed mucinous carcinoma more frequently undergoes lymph node metastasis and has a poorer prognosis than does pure mucinous carcinoma

Image Registration for Detection and Quantification of Change on Digital Tomosynthesis Mammographic Volumes

2009-02-15T11:55:00.000-08:00

Image Registration for Detection and Quantification of Change on Digital Tomosynthesis Mammographic Volumes
Sumedha P. Sinha, Ramkrishnan Narayanan, Bing Ma, Marilyn A. Roubidoux, He Liu, Paul L. Carson
AJR 2009; 192:384-387

Link to Journal

Registration of digital breast tomosynthesis mammographic volumes was achieved with an average error of 1.8 ± 1.4 mm
This will be important when trying to compare change between two studies

Invasive Lobular Carcinoma: Detection with Mammography, Sonography, MRI, and Breast Specific Gamma Imaging

2009-02-15T11:51:00.000-08:00

Invasive Lobular Carcinoma: Detection with Mammography, Sonography, MRI, and Breast Specific Gamma Imaging
Rachel F. Brem, Marina Ioffe, Jocelyn A. Rapelyea, Kristen G. Yost, Jean M. Weigert, Margaret L. Bertrand, Lillian H. Stern
AJR 2009; 192:379-383

Link to Journal

BSGI has the highest sensitivity for the detection of invasive lobular carcinoma with a sensitivity of 93%, whereas mammography, sonography, and MRI showed sensitivities of 79%, 68%, and 83%, respectively. BSGI is an effective technique that should be used to evaluate patients with suspected cancer and has a promising role in the diagnosis of invasive lobular carcinoma

NB: Small numbers in retrospective study. However, the technology shows promise

False-Negative Diagnoses at Stereotactic Vacuum-Assisted Needle Breast Biopsy: Long-Term Follow-Up of 1,280 Lesions and Review of the Literature

2009-02-15T11:43:00.000-08:00

False-Negative Diagnoses at Stereotactic Vacuum-Assisted Needle Breast Biopsy: Long-Term Follow-Up of 1,280 Lesions and Review of the Literature
Roger J. Jackman, Francis A. Marzoni, Jr., Jarrett Rosenberg
AJR 2009; 192:341–351

Link to Journal

The purpose of this study was to determine retrospectively the frequency and causes of false-negative diagnoses of lesions evaluated with percutaneous stereotactic biopsy performed with vacuum-assisted probes with the patient prone on a biopsy table.
False-negative findings at stereotactic biopsy were least common with 11-gauge probes and were similar in frequency for calcifications and masses

NB: Comparisons only made between 14G and 11G needles

Detection of Breast Cancer with Full-Field Digital Mammography and Computer-Aided Detection

2009-02-15T11:38:00.000-08:00

Detection of Breast Cancer with Full-Field Digital Mammography and Computer-Aided Detection
Juliette S. The, Kathy J. Schilling, Jeffrey W. Hoffmeister, Euvondia Friedmann, Ryan McGinni and Richard G. Holcomb
AJR 2009; 192:337–340

Link to Journal

CAD with FFDM showed a high sensitivity in identifying cancers manifesting as calcifications and masses. Sensitivity was maintained in cancers with lower mammographic sensitivity, including invasive lobular carcinomas and small neoplasms (1–20 mm). CAD with FFDM should be effective in assisting radiologists with earlier detection of breast cancer. Future studies are needed to assess CAD accuracy in larger populations

Original Research. Predictors of Radiologists' Perceived Risk of Malpractice Lawsuits in Breast Imaging

2009-02-15T11:34:00.000-08:00

Predictors of Radiologists' Perceived Risk of Malpractice Lawsuits in Breast Imaging
John F. Dick, III, Thomas H. Gallagher, R. James Brenner, Joyce P. Yi, Lisa M. Reisch, Linn Abraham, Diana L. Miglioretti, Patricia A. Carney, Gary R. Cutter, Joann G. Elmore
AJR 2009; 192:327–333

Link to Journal

Radiologists working in breast imaging substantially overestimate their risk of a future malpractice lawsuit. Radiologists with higher risk perceptions show more negative reactions to uncertainty in a clinical setting. Understanding that their actual risk of malpractice lawsuits may be substantially lower than anticipated may help reduce radiologists' fears and alleviate the manpower shortage in mammography. Programs to address the shortage of breast imagers could be targeted toward radiologists with heightened malpractice lawsuit concerns

Frequency and Upgrade Rates of Atypical Ductal Hyperplasia Diagnosed at Stereotactic Vacuum-Assisted Breast Biopsy: 9-Versus 11-Gauge

2009-02-15T11:23:00.000-08:00

Frequency and Upgrade Rates of Atypical Ductal Hyperplasia Diagnosed at Stereotactic Vacuum-Assisted Breast Biopsy: 9-Versus 11-Gauge
Peter R. Eby, Jennifer E. Ochsner, Wendy B. DeMartini, Kimberly H. Allison, Sue Peacock, and Constance D. Lehman
AJR 2009;192:229-234

Link to Journal

Compared with an 11-gauge vacuum-assisted breast biopsy device, the use of a larger 9-gauge vacuum-assisted breast biopsy needle does not decrease the upgrade rate of ADH. Our frequency of ADH at vacuum-assisted breast biopsy is higher than any previously reported and may reflect regional differences in the incidence of breast cancer or practice patterns of the pathologist

Sonographic Surveillance for the Detection of Contralateral Metachronous Breast Cancer in an Asian Population

2009-02-15T11:21:00.000-08:00

Sonographic Surveillance for the Detection of Contralateral Metachronous Breast Cancer in an Asian Population
Min Jung Kim, Eun-Kyung Kim, Jin Young Kwak, Byeong-Woo Park, Seung-Il Kim, Joohyuk Sohn, and Ki Keun Oh
AJR 2009;192:221-228

Link to Journal

With a false-negative rate of only 0.06% and a PPV of 41.0% for the biopsy recommendation rate, our results suggest that annual sonography could be a useful adjunctive tool to mammography for the detection of metachronous contralateral cancers

Timed Efficiency of Interpretation of Digital and Film-Screen Screening Mammograms

2009-02-15T11:18:00.000-08:00

Timed Efficiency of Interpretation of Digital and Film-Screen Screening Mammograms
Tamara Miner Haygood, Jihong Wang, E. Neely Atkinson, Deanna Lane, Tanya W. Stephens, Parul Patel, and Gary J. Whitman
AJR 2009;192:216-220

Link to Journal

In screening mammography interpretation, digital mammograms take longer to read than film-screen mammograms, independent of other variables. Exclusive use of digital comparison studies may not cause interpretation times to drop enough to approach the interpretation time required for film-screen mammograms