Wednesday, 2 April 2008

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.