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

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

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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

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

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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

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;192:216-22

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

Interpretation and Clinical Applications of Breast MRI: Self-Assessment Module

Interpretation and Clinical Applications of Breast MRI: Self-Assessment Module
Linda Moy and Cecilia L. Mercado
AJR 2008;191:60-67

Link to module

Molecular Breast Imaging: Use of a Dual-Head Dedicated Gamma Camera to Detect Small Breast Tumors

Molecular Breast Imaging: Use of a Dual-Head Dedicated Gamma Camera to Detect Small Breast Tumors
Carrie B. Hruska, Stephen W. Phillips, Dana H. Whaley, Deborah J. Rhodes, and Michael K. O'Connor
AJR 2008;191:1805-1815

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Gains in sensitivity with the dual-head system molecular breast imaging are partially due to increased confidence in lesion detection. Molecular breast imaging can reliably detect breast lesions < 2 cm and dual-head molecular breast imaging can significantly increase sensitivity for subcentimeter lesions

Outcome of MRI-Guided Breast Biopsy

Outcome of MRI-Guided Breast Biopsy
Boo-Kyung Han, Mitchell D. Schnall, Susan G. Orel, and Mark Rosen
AJR 2008;191:1798-1804

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The cancer rate in our cohort of women who underwent MRI-guided breast biopsy was 29%. It varied according to the indication for the original MRI examination, but not according to the MRI features of the lesions

Automated Classification of Breast Parenchymal Density: Topologic Analysis of X-Ray Attenuation Patterns Depicted with Digital Mammography

Automated Classification of Breast Parenchymal Density: Topologic Analysis of X-Ray Attenuation Patterns Depicted with Digital Mammography
Holger F. Boehm, Tanja Schneider, Sonja M. Buhmann-Kirchhoff, Thomas Schlossbauer, Dorothea Rjosk-Dendorfer, Stefanie Britsch, and Maximilian Reiser
AJR 2008;191:275-282

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Topologic analysis of x-ray attenuation patterns on digital mammograms obtained with Minkowski functionals is simple and robust, and the results agree with radiologists' ratings. Because correct classification is significantly higher than with use of density features, our technique may be an objective and quantitative alternative in the evaluation of the parenchymal structure of the breast

Primary Breast Cancer in Men: Clinical, Imaging, and Pathologic Findings in 57 Patients

Primary Breast Cancer in Men: Clinical, Imaging, and Pathologic Findings in 57 Patients
Jean Mathew, George H. Perkins, Tanya Stephens, Lavinia P. Middleton, and Wei-Tse Yang
AJR 2008;191:1631-1639

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Breast cancer in men characteristically presents as an irregular subareolar mass with spiculated or indistinct margins on mammography and can be associated with calcifications and gynecomastia. Sonography has a role in regional staging of lymph nodes

Malignant-Appearing Microcalcifications at the Lumpectomy Site with the Use of FloSeal Hemostatic Sealant

Malignant-Appearing Microcalcifications at the Lumpectomy Site with the Use of FloSeal Hemostatic Sealant
Amy Henkel, Richard A. Cooper, Kathleen A. Ward, Davide Bova, and Katharine Yao
AJR 2008;191:1371-1373

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Application of FloSeal hemostatic sealant in the lumpectomy cavity results in benign mammographic microcalcifications that could be misinterpreted as malignant

Underestimation of Atypical Ductal Hyperplasia at Sonographically Guided Core Biopsy of the Breast

Underestimation of Atypical Ductal Hyperplasia at Sonographically Guided Core Biopsy of the Breast
Mijung Jang, Nariya Cho, Woo Kyung Moon, Jeong Seon Park, Min Hyun Seong, and In Ae Park
AJR 2008;191:1347-135

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For sonographically guided core biopsy of the breast, the rate of underestimation of ADH was 48%. This rate was lower for lesions evaluated with 11-gauge vacuum-assisted biopsy (22%) than for those evaluated with 14-gauge automated gun biopsy (65%). This finding was particularly true of smaller lesions (≤ 2.0 cm) and for lesions of the mass-only type

Radiofrequency Identification Tags for Preoperative Tumor Localization: Proof of Concept

Radiofrequency Identification Tags for Preoperative Tumor Localization: Proof of Concept
Joshua J. Reicher, Murray A. Reicher, Mariam Thomas, and Robert Petcavich
AJR 2008;191:1359-1365

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This is an interesting proof of concept study from UCLA showing how you could potentially use everyday tracker devices used for stock inventopry to identify and mark lesions in the breast. The combination of RFID tags and a new handheld RFID detector shows promise for preoperative imaging-guided tumor localization

Variable Appearances of Fat Necrosis on Breast MRI

Variable Appearances of Fat Necrosis on Breast MRI
Caroline P. Daly, Barbara Jaeger, and David S. Sill
AJR 2008;191:1374-1380

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Fat necrosis may mimic malignancy with varying appearances on MRI. Suspicious morphologic and kinetic features may be present, necessitating biopsy to exclude new or recurrent breast cancer

Contrast-Enhanced MR Mammography: Improved Lesion Detection and Differentiation with Gadobenate Dimeglumine

Contrast-Enhanced MR Mammography: Improved Lesion Detection and Differentiation with Gadobenate Dimeglumine
Federica Pediconi, Carlo Catalano, Simona Padula, Antonella Roselli, Valeria Dominelli, Sabrina Cagioli, Miles A. Kirchin, Gianpaolo Pirovano, and Roberto Passariello
AJR 2008;191:1339-1346

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Lesion detection and malignant–benign differentiation is significantly better with 0.1 mmol/kg gadobenate dimeglumine than 0.1 mmol/kg gadopentetate dimeglumine

Dynamic Contrast-Enhanced MRI for Prediction of Breast Cancer Response to Neoadjuvant Chemotherapy: Initial Results

Dynamic Contrast-Enhanced MRI for Prediction of Breast Cancer Response to Neoadjuvant Chemotherapy: Initial Results
Claudette E. Loo, H. Jelle Teertstra, Sjoerd Rodenhuis, Marc J. van de Vijver, Juliane Hannemann, Saar H. Muller, Marie-Jeanne Vrancken Peeters, and Kenneth G. A. Gilhuijs
AJR 2008;191:1331-1338

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Reduction of less than 25% in largest diameter of late enhancement during neoadjuvant chemotherapy shows the potential to predict residual tumor after therapy with high specificity.
This paper however continues the trend to measure anatomical dimensions, which are late responses to chemotherapy, and do not give the early feedback about neoadjuvant response

Dual-Time-Point 18F-FDG PET/CT Versus Dynamic Breast MRI of Suspicious Breast Lesions

Dual-Time-Point 18F-FDG PET/CT Versus Dynamic Breast MRI of Suspicious Breast Lesions
Massimo Imbriaco, Maria Grazia Caprio, Gennaro Limite, Leonardo Pace, Teresa De Falco, Ermanno Capuano, and Marco Salvatore
AJR 2008;191:1323-1330

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A dual time point improves PET/CT accuracy in patients with a suspected breast malignancy over single-time-point PET/CT. On PET/CT, FDG is increasingly taken up over time in breast tumors; conversely, benign lesions show a decrease in FDG uptake over time. These changes in SUV might represent a reliable parameter that can be used to differentiate benign from malignant lesions of the breast on PET/CT examination

Staging MR Lymphangiography of the Axilla for Early Breast Cancer: Cost-Effectiveness Analysis

Staging MR Lymphangiography of the Axilla for Early Breast Cancer: Cost-Effectiveness Analysis
Pari V. Pandharipande, Mukesh G. Harisinghani, Elissa M. Ozanne, Michelle C. Specht, Chin Hur, Janie M. Lee, and G. Scott Gazelle
AJR 2008;191:1308-1319

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From a cost-effectiveness perspective, MR lymphangiography strategies for axillary staging of early breast cancer are preferred over SLN biopsy alone. The sensitivity of MR lymphangiography is a critical determinant of the cost-effectiveness of MR lymphangiography strategies and merits further investigation in the care of patients with early breast cancer

Sonographically Guided Marker Placement for Confirmation of Removal of Mammographically Occult Lesions After Localization

Sonographically Guided Marker Placement for Confirmation of Removal of Mammographically Occult Lesions After Localization
Cecilia L. Mercado, Amber A. Guth, Hildegard K. Toth, Linda Moy, Deborah Axelrod, and Joan Cangiarella
AJR 2008;191:1216-1219

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At needle localization of breast lesions, marker placement under sonographic guidance is beneficial because it enables immediate confirmation of accurate surgical removal of the localized lesion at surgical excision. Use of marker placement, however, does not reduce the percentage of cases with close margins necessitating reexcision

Preliminary In Vivo Validation of a Dedicated Breast MRI and Sonographic Coregistration Imaging System

Preliminary In Vivo Validation of a Dedicated Breast MRI and Sonographic Coregistration Imaging System
Petrina A. Causer, Cameron A. Piron, Roberta A. Jong, and Donald B. Plewes
AJR 2008;191:1203-1207

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In 10 patients with 13 lesions, the system was found to be an accurate means for targeting sonography to MRI of the same breast lesions

Complete Excision of the MRI Target Lesion at MRI-Guided Vacuum-Assisted Biopsy of Breast Cancer

Complete Excision of the MRI Target Lesion at MRI-Guided Vacuum-Assisted Biopsy of Breast Cancer
Jung-Min Lee, Jennifer B. Kaplan, Melissa P. Murray, and Laura Liberman
AJR 2008;191:1198-1202

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Complete excision of the MRI target occurred in 30% of breast cancers diagnosed at MRI-guided vacuum-assisted biopsy. Among cancers in which the MRI target was percutaneously excised, surgery yielded residual cancer in 64%. Complete removal of the MRI target does not ensure complete histologic excision of the cancer.

Anticoagulation and Bleeding Risk After Core Needle Biopsy

Anticoagulation and Bleeding Risk After Core Needle Biopsy
Patricia Somerville, Posy J. Seifert, Stamatia V. Destounis, Philip F. Murphy, and Wende Young
AJR 2008;191:1220-1232

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The results of this study confirm that performing core needle biopsy in patients on anticoagulation therapy is safe.

Spectrum of Papillary Lesions of the Breast: Clinical, Imaging, and Pathologic Correlation

Spectrum of Papillary Lesions of the Breast: Clinical, Imaging, and Pathologic Correlation
Malai Muttarak, Pailin Lerttumnongtum, Benjaporn Chaiwun, and Wilfred C. G. Peh
AJR 2008;191:700-707

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Papillary lesions of the breast are a heterogeneous group of lesions that are difficult to diagnose as benign or malignant. The purpose of this article is to review clinical presentation, imaging features, and pathologic correlation of papillary lesions of the breast and to discuss the prognosis and management of these lesions.

Recognition of the variety of benign and malignant papillary lesions of the breast will facilitate diagnosis and proper management.

Pure Ductal Carcinoma in Situ: A Range of MRI Features

Pure Ductal Carcinoma in Situ: A Range of MRI Features
Sughra Raza, Monica Vallejo, Sona A. Chikarmane, and Robyn L. Birdwell
AJR 2008;191:689-699

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Breast MRI plays an important role in the detection of DCIS, which most often appears as non-mass clumped enhancement, in a ductal or segmental distribution, with variable enhancement kinetics.

Evaluation of MRI Findings After Polyacrylamide Gel Injection for Breast Augmentation

Evaluation of MRI Findings After Polyacrylamide Gel Injection for Breast Augmentation
Chun Ying Lui, Chiu Ming Ho, Po Ping Iu, Wing Yung Cheung, Hon Shing Lam, Ming Shiaw Cheng, and Hin Lun Lawrence Liu
AJR 2008;191:677-688

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Because poly acrylamide gel has a high water content, sagittal and axial T2-weighted are the best sequences to use to detect complications.

MDCT in the Preoperative Planning of Abdominal Perforator Surgery for Postmastectomy Breast Reconstruction

MDCT in the Preoperative Planning of Abdominal Perforator Surgery for Postmastectomy Breast Reconstruction
Juan A. Clavero, Jaume Masia, Jose Larranaga, Josep M. Monill, Gemma Pons, Sahyly Siurana, and Xavier Alomar
AJR 2008;191:670-676

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MDCT provides valuable information before surgery about the arterial anatomy of the inferior abdominal wall. It enables accurate identification of the most suitable dominant perforator vessel and makes surgical perforator flap procedures for breast reconstruction faster and safer.

Role of Breast Sonography in Imaging of Adolescents with Palpable Solid Breast Masses

Role of Breast Sonography in Imaging of Adolescents with Palpable Solid Breast Masses
Aruna Vade, Vaishali S. Lafita, Kathleen A. Ward, Jennifer E. Lim-Dunham, and Davide Bova
AJR 2008;191:659-663

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OBJECTIVE.
The purpose of this study was to assess the role of sonography in the diagnosis and management of palpable solid breast masses in adolescents and to correlate the sonographic findings with the histopathologic findings and clinical outcome.

CONCLUSION.
Sonography was not useful for predicting the histologic diagnosis of all solid benign breast masses in adolescent patients. The Stavros sonographic criteria, however, were useful for predicting benignity in 65% of the breast masses on which histopathologic examination was performed. Tissue biopsy may be performed on solid breast masses that do not meet the criteria for benign masses according to the Stavros sonographic criteria.

Application of Sonographic BI-RADS to Synchronous Breast Nodules Detected in Patients with Breast Cancer

Application of Sonographic BI-RADS to Synchronous Breast Nodules Detected in Patients with Breast Cancer
Suk Jung Kim, Eun Young Ko, Jung Hee Shin, Seok Seon Kang, Sung Hee Mun, Boo-Kyung Han, and Eun Yoon Cho
AJR 2008;191:653-658

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OBJECTIVE.
The purpose of this study was to evaluate the applicability of the current BI-RADS for sonography to the assessment of synchronous breast nodules other than the primary malignant tumor in patients with breast cancer.

CONCLUSION.
For assessment of synchronous nodules in breast cancer patients, application of conventional screening sonographic BI-RADS categories may not account for possible increased risk of malignancy in synchronous nodules, especially those in the same quadrant of the breast as the index malignant tumor.

Cortical Morphologic Features of Axillary Lymph Nodes as a Predictor of Metastasis in Breast Cancer: In Vitro Sonographic Study

Cortical Morphologic Features of Axillary Lymph Nodes as a Predictor of Metastasis in Breast Cancer: In Vitro Sonographic Study
Deepak G. Bedi, Rajesh Krishnamurthy, Savitri Krishnamurthy, Beth S. Edeiken, Huong Le-Petross, Bruno D. Fornage, Roland L. Bassett, Jr., and Kelly K. Hunt
AJR 2008;191:646-652

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CONCLUSION.
In breast cancer, axillary lymph nodes can be classified according to cortical morphologic features. Predominantly hyperechoic nodes (types 1–3) can be considered benign. Generalized cortical lobulation (type 4) is uncommonly a false-negative finding, but metastasis, if present, is invariably detected at sentinel node mapping.

The presence of asymmetric focal hypoechoic cortical lobulation (type 5) or a completely hypoechoic node (type 6) should serve as a guideline for universal performance of fine-needle aspiration for preoperative staging of breast cancer. This classification, when verified with larger samples, may serve as a useful clinical guideline if proven with results of in vivo studies.

One of my criticisms of this paper is the absence of mention of the Nottingham Criteria for abnormal lymph nodes requiring biopsy. The original paper was published in 2003 in the British Journal of Cancer, and did not get the publicity it deserved.

Axillary ultrasound is now a routine procedure for patients with cancer, especially important in patients entering neo-adjuvant treatment or trials (such as I-SPY), where the pre-chemo demonstration of positive nodes may be the only evidence of stage 3 disease.

Radiologic Features of Polyacrylamide Gel Mammoplasty

Radiologic Features of Polyacrylamide Gel Mammoplasty
Sze Yiun Teo and Shih-chang Wang
AJR 2008;191:89-95

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Although polyacrylamide gel implants may mimic conventional implants on both sonography and MRI in women who do not have complications from mammoplasty, polyacrylamide gel implants have some distinguishing features.

The imaging appearance of polyacrylamide gel implants is related to the technique of injection and whether there are any associated complications. The implants are usually in a retroglandular location. Mammography, sonography, and MRI can be used to evaluate short-term complications, although MRI appears to be the most sensitive. Common short-term complications include extravasation of polyacrylamide gel and secondary infection, which may be related to lactation.

The long-term complications of polyacrylamide gel mammoplasty are unknown. Knowledge of the appearances of polyacrylamide gel implants in women with and those without complications from mammoplasty is useful in the radiologic evaluation of such patients.

Image Quality of Digital Direct Flat-Panel Mammography Versus an Analog Screen-Film Technique Using a Low-Contrast Phantom

Image Quality of Digital Direct Flat-Panel Mammography Versus an Analog Screen-Film Technique Using a Low-Contrast Phantom
Kathrin Barbara Krug, Hartmut Stutzer, Rene Schroder, Julia Boecker, Jorg Poggenborg, and Klaus Lackner
AJR 2008;191:80-88

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RESULTS. The digital monitor technique generally scored better than digital film viewing and analog readings. The McNemar test for multiple paired comparisons mostly yielded a p value of <>

CONCLUSION. Digital flat-panel mammography is superior to the analog screen-film method for the detection of simulated opacities.

Breast Carcinoma with Basal Phenotype: Mammographic Findings

Breast Carcinoma with Basal Phenotype: Mammographic Findings
Angela A. Luck, Andrew J. Evans, Jonathan J. James, Emad A. Rakha, E. Claire Paish, Andrew R. Green, and Ian O. Ellis
AJR 2008;191:346-351

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Forty-one (12%) of the screening-detected tumors had basal phenotypic expression, and these were compared with 309 (88%) nonbasal tumors. Basal-phenotype tumors were significantly more likely to manifest as an ill-defined mass (basal phenotype, 25 [61%] of 41 tumors; nonbasal phenotype, 75 [24%] of 309 tumors; p < p =" 0.019).">

Screening-detected breast tumors with a basal phenotype have a mammographic appearance different from that of nonbasal tumors. This finding may explain the good prognostic value of mammographic spiculation reported in previous studies.

Analysis of the Mammographic and Sonographic Features of Pseudoangiomatous Stromal Hyperplasia

Analysis of the Mammographic and Sonographic Features of Pseudoangiomatous Stromal Hyperplasia
Gormlaith C. Hargaden, Eren D. Yeh, Dianne Georgian-Smith, Richard H. Moore, Elizabeth A. Rafferty, Elkan F. Halpern, and Grace T. McKee
AJR 2008;191:359-363

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The purpose of this study was to describe the imaging findings in 149 patients with pseudoangiomatous stromal hyperplasia (PASH) who had undergone at least 4 years of clinical follow-up for detection of subsequent malignancy

PASH is a common entity that presents with benign imaging features without evidence of subsequent malignant potential. At our institution, in the absence of suspicious features a diagnosis of PASH at core biopsy is considered sufficient, and surgical excision has been obviated.

Patient Retention and Attrition Factors in a Screening Mammography Practice: University Versus Community Sites

Patient Retention and Attrition Factors in a Screening Mammography Practice: University Versus Community Sites
Mary Catherine Mahoney
AJR 2008;191:371-375

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Although both stayers and leavers reported satisfaction with overall
quality of service and care received at the university­ based locations, stayers gave higher marks than leavers.

National Trends and Practices in Breast MRI

National Trends and Practices in Breast MRI
Lawrence W. Bassett, Sonia G. Dhaliwal, Jilbert Eradat, Omer Khan, Dionne F. Farria, R. James Brenner, and James W. Sayre
AJR 2008;191:332-339

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Radiologists qualified under the Mammography Quality Standards Act supervised the performance of and interpreted breast MRI in the majority of facilities. Of 552 respondents, breast MRI was interpreted as soft copy with computer-aided detection (CAD) in 280 practices (50.7%), as soft copy without CAD in 261 (47.3%), and as hard copy in 11 (2.0%). Of 551 respondents, 256 (46.5%) never and 207 (37.6%) rarely interpreted breast MRI without correlating mammography or sonography findings. The majority of respondents never (269/561, 48.0%) or rarely (165/561, 29.4%) interpreted breast MRI performed at an outside facility. Screening breast MRI was offered at 359 of 561 (64.0%) practices. Of the practices performing contrast-enhanced examinations, 173 of 557 (31.1%) did not perform MRI-guided interventional procedures.

Contrast-enhanced breast MRI is now widely used in the United States. The information gained from this survey should provide reasonable approaches for the development of professional practice guidelines

Breast MRI in the Evaluation of Eligibility for Accelerated Partial Breast Irradiation

Breast MRI in the Evaluation of Eligibility for Accelerated Partial Breast Irradiation
Juan Godinez, Eva C. Gombos, Sona A. Chikarmane, Gabriel K. Griffin, and Robyn L. Birdwell
AJR 2008;191:272-277

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The treatment effect of whole-breast irradiation on microscopic tumor cells and on additional occult foci in other quadrants of the breast is lost with partial breast irradiation. Our results suggest that MRI before accelerated partial breast irradiation may be of benefit to patients to ensure they do not have multifocal or multicentric disease, remote from the lumpectomy bed

Sonographic and Mammographic Appearances of Breast Hemangioma

Sonographic and Mammographic Appearances of Breast Hemangioma
Benoit Mesurolle, Vitaly Sygal, Lucie Lalonde, Andre Lisbona, Michel-Pierre Dufresne, Jean H. Gagnon, and Ellen Kao
AJR 2008;191:17-22

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A mass displaying an oval or lobular shape with well-circumscribed or microlobulated margins on mammography and sonography, and in a superficial location, should alert the radiologist to the possible diagnosis of hemangioma. Imaging-guided biopsy appears sufficiently reliable to rule out any malignant or premalignant component and to avoid a surgical excision if doing so is clinically appropriate

MDCT of the Breast

Anna Perrone, Luigi Lo Mele, Simona Sassi, Marina Marini, Lorenzo Testaverde, Luciano Izzo, and Mario Marini
AJR 2008;190:1644-1651

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The purpose of this study was to evaluate retrospectively the accuracy of low-dose MDCT in the differentiation of breast lesions suspected on mammography and sonography. Forty-seven of 61 patients underwent surgery, and the pathologic findings revealed 27 malignant and 20 benign lesions. With CT 25 of 27 malignant lesions and all 20 benign lesions were diagnosed correctly. CT had a sensitivity of 92.6%, specificity of 100%, positive predictive value of 100%, negative predictive value of 90.9%, and accuracy of 95.74%. The cutoff attenuation value, which had the best validity for differentiating malignant and benign lesions, was calculated to be 90 H on the 1-minute images.
Our results confirm and strengthen the importance of all imaging parameters and not one in particular. Dynamic MDCT can be used in the evaluation of selected patients with suspected breast tumors

Breast Stromal Enhancement on MRI Is Associated with Response to Neoadjuvant Chemotherapy

Jona Hattangadi, Catherine Park, James Rembert, Catherine Klifa, Jimmy Hwang, Jessica Gibbs, and Nola Hylton
AJR 2008;190:1630-1636

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From my own group at UCSF - Breast stroma tissue outside the incident tumor can be quantified using signal enhancement ratio analysis on dynamic contrast-enhanced MRI. Stromal signal enhancement ratio is a potential indicator for response to treatment and for overall outcome in patients with breast cancer; however, these results should be validated in a prospective study.

Clinical Application of the BI-RADS Final Assessment to Breast Sonography in Conjunction with Mammography

Eun-Kyung Kim, Kyung Hee Ko, Ki Keun Oh, Jin Young Kwak, Jai Kyung You, Min Jung Kim, and Byoung-Woo Park
AJR 2008;190:1209-1215

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As with mammography, placing sonographic lesions into BI-RADS categories is useful for predicting the presence of malignancy

Accuracy of Short-Interval Follow-Up Mammograms by Patient and Radiologist Characteristics

Erin J. Aiello Bowles, Diana L. Miglioretti, Edward A. Sickles, Linn Abraham, Patricia A. Carney, Bonnie C. Yankaskas, and Joann G. Elmore
AJR 2008;190:1200-1208

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Initial short-interval follow-up mammography examinations had a lower sensitivity for detecting breast cancer within 12 months than other diagnostic mammograms (61% for short-interval follow-up vs 80% for diagnostic mammograms reported in the literature). However, sensitivity within the 6-month interval that is usually recommended for subsequent follow-up was 83%. Accuracy of short-interval follow-up mammograms was influenced by few patient and radiologist characteristics.

Radiologic-Pathologic Conferences of the Nagoya University Hospital: Centrally Necrotizing Carcinoma of the Breast

Koji Oda, Hiroko Satake, Akiko Nishio, Shu Ichihara, Yoshie Shimoyama, Tsuneo Imai, and Masato Nagino
AJR 2008;190:237-239

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A representative case is presented, in which the characteristic clinical and radiologic features led to a preoperative diagnosis of centrally necrotizing carcinoma of the breast. The preoperative diagnosis of centrally necrotizing carcinoma of the breast is important for breast surgeons and radiologists in performing aspiration cytology or core needle biopsy because of the vascular nature of the lesion. Thorough hemostasis is necessary after careful percutaneous sampling because of the risk of hemorrhage.

Digital Breast Tomosynthesis: A Pilot Observer Study

Walter F. Good, Gordon S. Abrams, Victor J. Catullo, Denise M. Chough, Marie A. Ganott, Christiane M. Hakim, and David Gur
AJR 2008;190:865-869

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The objective of our study was to assess ergonomic and diagnostic performance–related issues associated with the interpretation of digital breast tomosynthesis–generated examinations.
Observer performance measures were not statistically significant (p > 0.05) primarily because of the small sample size in this pilot study, suggesting that showing significant improvements in diagnosis, if any, will require a larger study. Several radiologists did perceive the digital breast tomosynthesis image set and the projection series to be better than FFDM (p <>

Tomosynthesis-based breast imaging may have great potential, but much work is needed before its optimal role in the clinical environment is known.

Comparison of Computer-Aided Detection to Double Reading of Screening Mammograms: Review of 231,221 Mammograms

Matthew Gromet
AJR 2008;190:854-859

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This study compares the efficacy of single reading with computer-aided detection (CAD) to double reading and also to the first reader (without CAD) in a double-reading program.

For double reading, the first reader's recall rate was 10.2%; sensitivity, 81.4%; positive predictive value, as a percentage of positive screening mammograms resulting in a tissue diagnosis of cancer within 1 year (PPV1), 4.1%; and cancer detection rate, 4.12 per 1,000. After the double-reading process, the final recall rate was 11.9%; sensitivity, 88.0%; PPV1, 3.7%; and cancer detection rate, 4.46 per 1,000. For single-reading with CAD, the recall rate was 10.6%; sensitivity, 90.4%; PPV1, 3.9%; and cancer detection rate, 4.20 per 1,000. Statistically significant results included a lower recall rate with CAD compared with double reading (10.6% vs 11.9%, respectively; p <>

Double reading increased sensitivity with a modest increase in the recall rate compared with single reading. Single reading with CAD, compared with double reading, resulted in a small, but not statistically significant, increase in sensitivity with a lower recall rate. Our results indicate that CAD enhances performance of a single reader, yielding increased sensitivity with only a small increase in recall rate.

Microcalcifications of Breast Tissue: Appearance on Synchrotron Radiation Imaging with 6-µm Resolution

Keiko Imamura, Norishige Ehara, Yoichi Inada, Yoshihide Kanemaki, Joji Okamoto, Ichiro Maeda, Keiko Miyamoto, Haruki Ogata, Hisanori Kawamoto, Yasuo Nakajima, Mamoru Fukuda, Keiji Umetani, and Kentarou Uesugi
AJR 2008;190:234-236

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The purpose of this study was to use synchrotron radiation imaging with 6-µm resolution to evaluate amorphous and pleomorphic breast tissue microcalcifications. Synchrotron radiation imaging depicted microcalcifications as small as 24 µm. Imaging with this technique revealed that most amorphous and pleomorphic calcifications on conventional mammograms are clusters of fine specks and that in addition to the shape or density of a speck, the distribution density of clustered specks is a factor determining the apparent shape.

Lobular Neoplasia at Percutaneous Breast Biopsy: Variables Associated with Carcinoma at Surgical Excision

Rachel F. Brem, Mary C. Lechner, Roger J. Jackman, Jocelyn A. Rapelyea, W. Phil Evans, Liane E. Philpotts, Jonathan Hargreaves, and Shane Wasden
AJR 2008;190:637-641

Link

Significant sampling error occurs regardless of the type of core biopsy device, number of specimens obtained, histologic–radiographic concordance, mammographic appearance, and complete excision of the lesion as determined by imaging. For this reason, all patients with lobular neoplasia at core or vacuum-assisted biopsy should undergo surgical excision until further differentiating criteria can be determined.

Papillary Lesions of the Breast Diagnosed at Percutaneous Sonographically Guided Biopsy

Papillary Lesions of the Breast Diagnosed at Percutaneous Sonographically Guided Biopsy: Comparison of Sonographic Features and Biopsy Methods
Hee Jung Shin, Hak Hee Kim, Sun Mi Kim, Hye Rin Yang, Jeong-Hee Sohn, Gui Young Kwon, and Gyungyub Gong
AJR 2008;190:630-636

Link

Vacuum-assisted biopsy was more accurate than core needle biopsy in diagnosing papillary lesions, and both sonographic features and core needle biopsy were not sufficiently accurate. Therefore, surgical excision should be performed for the accurate diagnosis of papillary lesions.

Intraoperative Loss of Core Biopsy Clips: Clinical Implications

Kristine Calhoun, Armando Giuliano, and R. James Brenner
AJR 2008;190:196-200
Link

Intraoperative loss of metallic clips placed at the conclusion of image-guided breast biopsy is unusual but can occur during subsequent surgical excision.

Repeated inability to locate the clip on specimen radiographs after accurate preoperative localization should raise the suspicion that the target clip has been lost, not missed, during surgery, likely because of inadvertent removal of the clip with the suction device

Angiosarcoma of the Breast - Pictorial Essay

Katrina N. Glazebrook, Maureen J. Magut, and Carol Reynolds
AJR 2008;190:533-538
http://www.ajronline.org/cgi/content/abstract/190/2/533

With the increasing use of breast conservation therapy for breast cancer, reports of postirradiation angiosarcoma have increased. Both primary and secondary angiosarcomas may present with bruiselike skin discoloration, which may delay the diagnosis. Imaging findings are nonspecific. MRI may be used to determine lesion extent by showing rapid enhancement and washout in high-grade tumors

Physician Workload in Mammography

Rebecca Smith-Bindman, Diana L. Miglioretti, Robert Rosenberg, Robert J. Reid, Stephen H. Taplin, Berta M. Geller, Karla Kerlikowske - the National Institutes of Health Breast Cancer Surveillance Consortium
AJR 2008;190:526-532
http://www.ajronline.org/cgi/content/abstract/190/2/526

Doubling physician annual volume requirements would result in a small impact on overall mammography capacity. Increasing volume requirements to 2,000 mammography examinations annually would require a dramatic increase in the number of mammography examinations interpreted by the higher volume radiologists. Unless previously low-volume radiologists increased their volumes, raising requirements to 2,000 examinations could curtail access to mammography, particularly in rural areas

Screening-Detected and Symptomatic Ductal Carcinoma in Situ: Differences in the Sonographic and Pathologic Features

Hee Jung Shin, Hak Hee Kim, Sun Mi Kim, Gui Young Kwon, Gyungyub Gong, and On Koo Cho
AJR 2008;190:516-525
http://www.ajronline.org/cgi/content/abstract/190/2/516

Our results showed that differences exist in the sonographic features of screening-detected and symptomatic DCIS. Recognition of the many and varied sonographic appearances of DCIS might be helpful to decrease the false-negative rate of bilateral whole-breast sonography and to detect symptomatic mammographically occult DCIS when we use sonography to supplement mammography

Lesion and Patient Characteristics Associated with Malignancy After a Probably Benign Finding on Community Practice Mammography

Constance D. Lehman, Carolyn M. Rutter, Peter R. Eby, Emily White, Diana S. M. Buist, and Stephen H. Taplin
AJR 2008;190:511-515
http://www.ajronline.org/cgi/content/abstract/190/2/511

In community practice, patient and lesion mammographic characteristics can be predictive of the likelihood of a subsequent cancer diagnosis of mammographic lesions designated as probably benign. Careful evaluation of mass margins and of the morphologic features of calcifications can help distinguish a malignant lesion from a probably benign finding

Proton MR Spectroscopy in Normal Breasts Between Pre- and Postmenopausal Women: A Preliminary Study

Jane Wang, Pao-Ling Torng, Tsang-Pai Liu, Kuan-Lin Chen, and Tiffany Ting-Fang Shih
AJR 2008;190:505-510
http://www.ajronline.org/cgi/content/abstract/190/2/505

Breast ¹H-MRS shows the differences of water and lipid compositions between pre- and postmenopausal women. Lipids containing methylene and allylic methylene protons had different implications in normal breasts

Correlation of Whole-Breast Vascularity with Ipsilateral Breast Cancers Using Contrast-Enhanced MDCT

Doo Kyoung Kang, Eun Jin Kim, Ho Sung Kim, Joo Sung Sun, and Yong Sik Jung
AJR 2008;190:496-504
http://www.ajronline.org/cgi/content/abstract/190/2/496

Breast cancers were found to be associated with ipsilateral increased whole-breast vascularity in a significant percentage of patients. Increased whole-breast vascularity indicated the growth and metastatic potential of a breast cancer

Role of Sonography in 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 2008;190:476-480
http://www.ajronline.org/cgi/content/abstract/190/2/476

Sonography alone detected 14% of metachronous contralateral breast cancers. The results of this study suggest that annual additional sonography with mammography contributes to the early detection of metachronous cancers. However, sonography every 6 months is unlikely to be helpful for the early detection of metachronous cancer