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.
Tuesday, 21 September 2010
Thursday, 26 August 2010
Breast MRI After Conservation Therapy: Usual Findings in Routine Follow-Up Examinations
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
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
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
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
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.
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.
Thursday, 22 July 2010
Breast MRI Screening of Women With a Personal History of Breast Cancer
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%)
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
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
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
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
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
Monday, 21 June 2010
Accuracy of MRI in Prediction of Pathologic Complete Remission in Breast Cancer After Preoperative Therapy: A Meta-Analysis
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
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
Thursday, 20 May 2010
The Future of Mammography: Radiology Residents' Experiences, Attitudes, and Opinions
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
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
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
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
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
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
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
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
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
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
Wednesday, 21 April 2010
The Positive Predictive Value of BI-RADS Microcalcification Descriptors and Final Assessment Categories
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
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
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)
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
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
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
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
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
Monday, 22 March 2010
Multimodality Imaging of Triple Receptor-Negative Tumors With Mammography, Ultrasound, and MRI
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
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?
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
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
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
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
Thursday, 21 January 2010
Factors That Impact the Duration of MRI-Guided Core Needle Biopsy
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
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
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
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
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
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
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
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
Subscribe to:
Comments (Atom)
