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
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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
Thursday, 20 May 2010
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
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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
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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
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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
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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
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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
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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
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