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
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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
Thursday, 26 August 2010
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
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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
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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.
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