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

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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

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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

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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