Hyperechoic Lesions of the Breast: Not Always Benign

Hyperechoic Lesions of the Breast: Not Always Benign
Anna Linda, Chiara Zuiani, Michele Lorenzon, Alessandro Furlan, Rossano Girometti, Viviana Londero, and Massimo Bazzocchi
AJR 2011; 196:1219-1224

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Of all biopsied lesions, 25 (0.6%) were hyperechoic. Among the 1849 malignant lesions, nine (0.4%) were hyperechoic. The remaining 16 were benign. None of the hyperechoic malignancies was a "purely" sonographic lesion, because all were palpable, mammographically visible, or detectable on breast MRI. Malignant lesions were more likely than benign lesions to have noncircumscribed margins (9/9 vs 7/16; p = 0.008) and nonparallel orientation (6/9 vs 1/16; p = 0.003).

When encountering a hyperechoic nodule, malignant nature cannot be excluded. Suspicious sonographic signs and correlation with other imaging techniques may help avoid misdiagnosis.

Variation of Breast Vascular Maps on Dynamic Contrast-Enhanced MRI After Primary Chemotherapy of Locally Advanced Breast Cancer

Variation of Breast Vascular Maps on Dynamic Contrast-Enhanced MRI After Primary Chemotherapy of Locally Advanced Breast Cancer
Laura Martincich, Ilaria Bertotto, Filippo Montemurro, Riccardo Ponzone, Luca A. Carbonaro, Daniele Regge, and Francesco Sardanelli
AJR 2011; 196:1214-1218

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Before primary chemotherapy, DCE-MRI vascular maps were asymmetrically increased ipsilaterally to the LABC. After primary chemotherapy, vascular maps significantly changed only in the breast harboring the cancer, with significant differences between responders and nonresponders.

Application of MR Mammography Beyond Local Staging: Is There a Potential to Accurately Assess Axillary Lymph Nodes? Evaluation of an Extended Protocol in an Initial Prospective Study

Application of MR Mammography Beyond Local Staging: Is There a Potential to Accurately Assess Axillary Lymph Nodes? Evaluation of an Extended Protocol in an Initial Prospective Study
Pascal A. T. Baltzer, Matthias Dietzel, Hartmut P. Burmeister, Ramy Zoubi, Mieczyslaw Gajda, Oumar Camara, and Werner A. Kaiser
AJR 2011; 196:641-647

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Most significant predictors (p < 0.001) of present metastasis were "irregular margin" (diagnostic OR, 14.0), "inhomogeneous cortex" (diagnostic OR, 8.4), "perifocal edema" (positive likelihood ratio, 100) and "asymmetry" (diagnostic OR, 19.5). CHAID tree identified "asymmetry" and "irregular margin" as significant predictors (adjusted-p < 0.05) for present metastasis (PPV: 100%), whereas absence of "asymmetry" and "homogeneous internal structure" were highly predictive of absent metastasis (negative predictive value, 94.3%). Combination of significant descriptors using binary logistic regression revealed an area under the receiver operating characteristic curve of 0.93 (p < 0.001). Inter-rater agreement was "almost-perfect" ( = 0.95).

Combined T-staging and locoregional staging (N-staging) was possible within one imaging session using the proposed protocol. Despite a minimal increase in examination time, high diagnostic accuracy and excellent interrater reliability were achieved

Interpretation of Positron Emission Mammography and MRI by Experienced Breast Imaging Radiologists: Performance and Observer Reproducibility

Interpretation of Positron Emission Mammography and MRI by Experienced Breast Imaging Radiologists: Performance and Observer Reproducibility
Deepa Narayanan, Kathleen S. Madsen, Judith E. Kalinyak, and Wendie A. Berg
AJR 2011; 196:971-981

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Across 36 observers, mean sensitivity, specificity, and area under the curve (AUC) for PEM were 96% (range, 75–100%), 84% (range, 66–97%), and 0.95 (range, 0.82–1.0), respectively. Mean sensitivity, specificity, and AUC for the MRI task were 82% (range, 45–100%), 67% (range, 38–91%), and 0.80 (range, 0.48–0.96), respectively. Interobserver agreement for PEM findings ranged from moderate to substantial, with kappa values of 0.57 for lesion type and 0.63 for final assessments.

With minimal training, experienced breast imagers showed high performance in interpreting PEM images. Performance in MRI interpretation by the same observers validated expected clinical practice.

Interpretation of Positron Emission Mammography: Feature Analysis and Rates of Malignancy

Interpretation of Positron Emission Mammography: Feature Analysis and Rates of Malignancy
Deepa Narayanan, Kathleen S. Madsen, Judith E. Kalinyak, and Wendie A. Berg
AJR 2011; 196:956-970

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Use of standardized terminology to report PEM findings will facilitate effective communication of results and consistent management. A probably benign category 3 assessment carried a substantial rate of malignancy for lesions seen on PEM, and biopsy may be more appropriate than follow-up.

Breast MRI Using a High-Relaxivity Contrast Agent: An Overview

Breast MRI Using a High-Relaxivity Contrast Agent: An Overview
Luca A. Carbonaro, Federica Pediconi, Nicola Verardi, Rubina M. Trimboli, Massimo Calabrese, and Francesco Sardanelli
AJR 2011; 196:942-955

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Thanks to its high relaxivity, gadobenate dimeglumine offers valuable advantages in terms of lesion conspicuity, detection rate, and sensitivity for malignant breast lesions. However, a higher enhancement of benign lesions should be taken into account to avoid reduced specificity

Development of an Adjustable Model Breast for Mammographic Dosimetry Assessment in Taiwanese Women

Development of an Adjustable Model Breast for Mammographic Dosimetry Assessment in Taiwanese Women
Shang-Lung Dong, Tieh-Chi Chu, Gong-Yau Lan, Yung-Chien Lin, Yu-Hsiu Yeh, and Keh-Shih Chuang
AJR 2011; 196:476-481

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Compressed breast thickness is useful for quantifying dimensions and percentage glandular content of a model breast. The adjustable model breast developed in this study can offer greater flexibility in the determination of breast dimensions for mammographic dosimetry assessment of Taiwanese women

MRI Appearance of Tumor Recurrence in Myocutaneous Flap Reconstruction After Mastectomy

MRI Appearance of Tumor Recurrence in Myocutaneous Flap Reconstruction After Mastectomy
Chenjing Peng, C. Belinda Chang, Hilda H. Tso, Christopher I. Flowers, Nola M. Hylton, and Bonnie N. Joe
AJR 2011; 196:471-475

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A top article from a top institution (but then I am biased). This is a study based on our work at UCSF looking at patients with TRAMOGRAMS who have a local recurrence in the augmented breast, often found BEFORE it is palpable.


Work has previously been presented at ARRS by ourselves on the mammographic appearances.

The Augmented Breast: A Pictorial Review of the Abnormal and Unusual

The Augmented Breast: A Pictorial Review of the Abnormal and Unusual
Natalie Yang and Derek Muradali
AJR 2011; 196:451-460

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Indications for Breast MRI: Case-Based Review

Indications for Breast MRI: Case-Based Review
Amy Argus and Mary C. Mahoney
AJR 2011; 196:1-14

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ALSO a Self Assessment Module (SAM) on the same topic -


Indications for Breast MRI: Self-Assessment Module
Amy Argus and Mary C. Mahoney
AJR 2011; 196:29-33

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Interobserver Variability of Ultrasound Elastography: How It Affects the Diagnosis of Breast Lesions

Interobserver Variability of Ultrasound Elastography: How It Affects the Diagnosis of Breast Lesions
Jung Hyun Yoon, Myung Hyun Kim, Eun-Kyung Kim, Hee Jung Moon, Jin Young Kwak, and Min Jung Kim
AJR 2011; 196:730-736

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Of the 65 lesions, 43 (66.2%) were benign, and 22 (33.8%) were malignant. Specificity (20.2–33.3%), positive predictive value (38.7–45.1%), and accuracy (46.7–55.4%) were significantly improved in combined ultrasound and elastography (p < 0.001). Area under the curve (AUC) values for all three performers did not show significant differences in ultrasound (AUC, 0.959) and combined ultrasound and elastography (AUC, 0.957) (p = 0.92). Interobserver agreement was not improved with combined ultrasound and elastography ( = 0.25) in comparison to ultrasound only ( = 0.37). Interobserver agreement of real-time elastography was fair in both fat-to-lesion ratio (intraclass correlation coefficient score, 0.25) and elasticity score ( = 0.28). Moderate agreement ( = 0.46) was seen with static elastography.

Elastography improves the specificity, positive predictive value, and accuracy of ultrasound. However, significant interobserver variability exists, with real-time elastographic performance showing fair agreement.

Management of Ultrasonographically Detected Benign Papillomas of the Breast at Core Needle Biopsy

Management of Ultrasonographically Detected Benign Papillomas of the Breast at Core Needle Biopsy
Jung Min Chang, Woo Kyung Moon, Nariya Cho, Wonshik Han, Dong-Young Noh, In-Ae Park, and Eun-Jung Jung
AJR 2011; 196:723-729

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Surgical excision revealed the presence of benign papillomas in 43 cases, no residual lesion in 12 cases, atypical papillomas in seven cases, and papillary ductal carcinoma in situ in two cases. The upgrade rates to atypical papilloma and to malignancy were 10.9% (7/64; 95% CI, 4.51–21.3%) and 3.1% (2/64; 95% CI, 0.38–10.8%), respectively. Mean lesion size was significantly larger for lesions that were upgraded to malignancies (1.4 cm vs 0.9 cm) (p = 0.04). Age, distance from the nipple, and ultrasound findings were not significantly associated with underestimation of atypical lesions or malignancies after excision (p > 0.05).

Our results show that the upgrade rate to malignancy determined by surgery for ultrasound-detected benign papillomas at core needle biopsy was 3.1% (2/64). Accordingly, for the accurate diagnosis of ultrasound-detected benign papillomas at core needle biopsy, surgical excision is recommended.


HOWEVER - the patient group was not subdivided by pre-operative diagnosis, including atypical cases, which skews the data.

For a fuller picture, check the breadth of opinion on the data for this subject

Accuracy of Diagnostic Mammography and Breast Ultrasound During Pregnancy and Lactation

Accuracy of Diagnostic Mammography and Breast Ultrasound During Pregnancy and Lactation
Jessica Robbins, Deborah Jeffries, Marilyn Roubidoux, and Mark Helvie
AJR 2011; 196:716-722

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Of 134 lesions, 87 (65%) were in patients who presented during lactation, 34 (25%) who presented during pregnancy, and 13 (10%) who presented postpartum. The presenting symptom for 86 lesions (64%) was a palpable mass. Biopsies were performed for 40 lesions. Of these lesions, four were malignant and 36 were benign. Mammograms were dense or heterogeneously dense in 88% of patients. All four malignancies were BI-RADS category 4 or 5 according to both mammography and ultrasound. For the 85 lesions evaluated with mammography, there was 100% sensitivity, 93% specificity, 40% positive predictive value, and 100% negative predictive value. For the 122 lesions evaluated with sonography, there was 100% sensitivity, 86% specificity, 19% positive predictive value, and 100% negative predictive value

Among lactating and pregnant women, both mammography and sonography had a negative predictive value of 100% and accurately revealed the few cancers that were present in our study group.

Spectrum of Disease in the Male Breast

Spectrum of Disease in the Male Breast
Elaine Iuanow, Mark Kettler, and Priscilla J. Slanetz
AJR 2011; 196:247-259

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Understanding the anatomy of the male breast is central to developing a differential diagnosis and delivering optimal care in male patients presenting with breast complaints. Diseases in the male breast can affect the skin and subcutaneous tissues, stroma and glandular elements, and neurovascular and lymphatic structures. 

Although the most commonly encountered disease entity is gynecomastia, men can develop many other benign and neoplastic diseases, including primary breast cancer. 

By incorporating clinical presentation with imaging findings on mammography and ultrasound, the breast imager can more effectively establish the correct diagnosis in males.

Detection and Classification of Calcifications on Digital Breast Tomosynthesis and 2D Digital Mammography: A Comparison

Detection and Classification of Calcifications on Digital Breast Tomosynthesis and 2D Digital Mammography: A Comparison
M. Lee Spangler, Margarita L. Zuley, Jules H. Sumkin, Gordan Abrams, Marie A. Ganott, Christiane Hakim, Ronald Perrin, Denise M. Chough, Ratan Shah, and David Gur
AJR 2011; 196:320-324

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In this small data set, FFDM appears to be slightly more sensitive than digital breast tomosynthesis for the detection of calcification. However, diagnostic performance as measured by area under the curve using BI-RADS was not significantly different. With improvements in processing algorithms and display, digital breast tomosynthesis could potentially be improved for this purpose

Breast Imaging and Intervention in the Overweight and Obese Patient

Breast Imaging and Intervention in the Overweight and Obese Patient
Stamatia Destounis, Mary Newell, and Renee Pinsky
AJR 2011; 196:296-302

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This article comments on the challenges and coping mechanisms for evaluating overweight and obese patients with breast imaging and diagnostic techniques. With the prevalence of obesity in society, the obstacles that arise regarding patients' adherence to screening guidelines are important to address.

This article discusses social factors and physical limitations that influence these patients' desires and ability to seek health care, specifically breast care and the problems that arise during imaging and interventional procedures

Preoperative Sentinel Node Identification With Ultrasound Using Microbubbles in Patients With Breast Cancer

Preoperative Sentinel Node Identification With Ultrasound Using Microbubbles in Patients With Breast Cancer
Ali R. Sever, Philippa Mills, Susan E. Jones, Karina Cox, Jennifer Weeks, David Fish, and Peter A. Jones
AJR 2011; 196:251-256

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In 71 (89%) of the 80 patients, SLNs were identified and guidewires were inserted. In these patients, operative findings using conventional radioisotope and blue dye techniques confirmed that the wired nodes were SLNs. Fourteen patients were found to have metastases in SLNs. In these patients, the SLNs were identified correctly and were localized with guidewires before surgery.

SLNs may be identified and localized before surgery using contrast-enhanced sonography after injection of microbubbles.

Microbubble Contrast-Enhanced Ultrasound for Sentinel Lymph Node Detection: Ready for Prime Time?

Microbubble Contrast-Enhanced Ultrasound for Sentinel Lymph Node Detection: Ready for Prime Time?
Wei Tse Yang and Barry B. Goldberg
AJR 2011; 196:249-250

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Editorial/commentary on ultrasound contrast in the breast

United States Preventive Services Task Force Screening Mammography Recommendations: Science Ignored
R. Edward Hendrick and Mark A. Helvie
AJR 2011; 196:112-116

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Averaged over the six Cancer Intervention and Surveillance Modeling Network models of benefit, screening mammography shows greatest benefit—a 39.6% mortality reduction—from annual screening of women 40–84 years old. This screening regimen saves 71% more lives than the USPSTF-recommended regimen of biennial screening of women 50–74 years old, which had a 23.2% mortality reduction. For U.S. women currently 30–39 years old, annual screening mammography from ages 40–84 years would save 99,829 more lives than USPSTF recommendations if all women comply, and 64,889 more lives with the current 65% compliance rate. The potential harms of a screening examination in women 40–49 years old, on average, consist of the risk of a recall for diagnostic workup every 12 years, a negative biopsy every 149 years, a missed breast cancer every 1,000 years, and a fatal radiation-induced breast cancer every 76,000–97,000 years. Evidence made available to the USPSTF strongly supports the mortality benefit of annual screening mammography beginning at age 40 years, whereas potential harms of screening with this regimen are minor.

Sonographic Confirmation of a Mammographically Detected Breast Lesion

Sonographic Confirmation of a Mammographically Detected Breast Lesion
Richard L. Ellis
AJR 2011; 196:225-226

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With the increase in mammographic detection of smaller nonpalpable lesions, it is sometimes challenging to confirm that the lesion identified with subsequent sonography for additional lesion characterization is the same lesion. When additional confirmation is necessary, instillation of radiopaque contrast material under sonographic guidance followed by repeat mammography examination can help confirm lesion correlation

Background Parenchymal Enhancement on Baseline Screening Breast MRI: Impact on Biopsy Rate and Short-Interval Follow-Up

Background Parenchymal Enhancement on Baseline Screening Breast MRI: Impact on Biopsy Rate and Short-Interval Follow-Up
Niamh M. Hambly, Laura Liberman, D. David Dershaw, Sandra Brennan, and Elizabeth A. Morris
AJR 2011; 196:218-224

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Of the 250 MRI examinations, 24.8% showed minimal enhancement; 34%, mild; 24%, moderate; and 17.2%, marked enhancement. Women with minimal enhancement had a significantly higher number of BI-RADS categories 1 and 2 examinations (64.5%) than women with mild (38.8%), moderate (40%), or marked (25.6%) enhancement. The BI-RADS category 3 rate was 43.6% overall and was significantly lower for women with minimal enhancement (27.4% vs 47.1% for women with mild, 45.0% for women with moderate, and 58.1% for women with marked enhancement). At follow-up, 86.2% of the BI-RADS 3 lesions were converted to BI-RADS category 1 or 2 and 13.8% were converted to BI-RADS 4, with a malignancy rate of 0.9% for lesions undergoing short-interval follow-up. There was no significant difference in biopsy rate or cancer detection rate among enhancement categories.

Mild, moderate, and marked background parenchymal enhancement is associated with a significantly lower rate of BI-RADS categories 1 and 2 assessments and a significantly higher rate of BI-RADS category 3 assessments than minimal enhancement. There was no significant difference in biopsy rate or cancer detection rate among the enhancement categories.

Contribution of Diffusion-Weighted Imaging to Dynamic Contrast-Enhanced MRI in the Characterization of Breast Tumors

Contribution of Diffusion-Weighted Imaging to Dynamic Contrast-Enhanced MRI in the Characterization of Breast Tumors
Sibel Kul, Aysegul Cansu, Etem Alhan, Hasan Dinc, Gurbuz Gunes, and Abdulkadir Reis
AJR 2011; 196:210-217

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Median ADCs of the benign and malignant lesions were 1.26 x 10^–3 mm²/s and 0.75 x 10^–3 mm²/s, respectively. Cutoff value of 0.92 x 10^–3 mm²/s for ADC provided 91.5% sensitivity and 86.5% specificity. DCE-MRI alone showed 97.9% sensitivity and 75.7% specificity. The combination of DCE-MRI with DWI provided 95.7% sensitivity and 89.2% specificity. The specificity of breast MRI improved by 13.5% (p = 0.063) without a significant decrease in the sensitivity (p = 1.000).

The combination of DWI and DCE-MRI has the potential to increase the specificity of breast MRI

Predictive Value for Malignancy of Suspicious Breast Masses of BI-RADS Categories 4 and 5 Using Ultrasound Elastography and MR Diffusion-Weighted Imaging

Predictive Value for Malignancy of Suspicious Breast Masses of BI-RADS Categories 4 and 5 Using Ultrasound Elastography and MR Diffusion-Weighted Imaging
Hiroko Satake, Akiko Nishio, Mitsuru Ikeda, Satoko Ishigaki, Kazuhiro Shimamoto, Maki Hirano, and Shinji Naganawa
AJR 2011; 196:202-209

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In the analysis of all 115 breast masses, the elasticity score was predictive of malignancy, whereas the ADC value was not independently predictive. In an analysis of the 52 masses assessed as BI-RADS category 4, the elasticity score was found to be a significant predictor of malignancy, compared with the ADC value, which was a nonsignificant predictor. In an analysis of the 63 masses assessed as BI-RADS category 5, neither the elasticity score nor the ADC value was a significant predictor of malignancy.

Our results show that elasticity imaging provides relatively reliable predictions for malignancy, especially in BI-RADS category 4 masses, compared with MR DWI.

High Cancer Yield and Positive Predictive Value: Outcomes at a Center Routinely Using Preoperative Breast MRI for Staging

High Cancer Yield and Positive Predictive Value: Outcomes at a Center Routinely Using Preoperative Breast MRI for Staging
Robert L. Gutierrez, Wendy B. DeMartini, Janet J. Silbergeld, Peter R. Eby, Sue Peacock, Sara H. Javid, and Constance D. Lehman
AJR 2011; 196:93-99

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Biopsy was recommended and performed for 152 of 570 (27%) patients found to have one or more suspicious lesions on MRI distinct from the index cancer. Sixty-seven of 152 women who underwent biopsy had additional cancers diagnosed, for a PPV of 44%. Overall, 12% (67/570) of women had otherwise occult cancers diagnosed by MRI, with 8% having additional sites or greater extent of ipsilateral disease and 4% having unsuspected contralateral cancer detected by MRI alone. No significant differences were found in the probability of detecting an occult cancer on the basis of patient age, breast density, index tumor characteristics, or lymph node status

Breast MRI detects otherwise occult cancer with an overall added cancer yield of 12% and a high PPV of 44% when applied to a diverse population of patients with newly diagnosed breast cancer

Targeted Ultrasound in Women Younger Than 30 Years With Focal Breast Signs or Symptoms: Outcomes Analyses and Management Implication

Targeted Ultrasound in Women Younger Than 30 Years With Focal Breast Signs or Symptoms: Outcomes Analyses and Management Implications
Vilert A. Loving, Wendy B. DeMartini, Peter R. Eby, Robert L. Gutierrez, Sue Peacock, and Constance D. Lehman
AJR 2010; 195:1472-1477

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Among 830 study patients, lesions were assessed as BI-RADS category 1 or 2 in 526 (63.4%), BI-RADS category 3 in 140 (16.9%), BI-RADS category 4 in 163 (19.6%), and BI-RADS category 5 in one (0.1%) patient. Three malignancies were detected, for a cancer yield of 0.4%. No BI-RADS category 3 lesions, two BI-RADS category 4 lesions, and the single BI-RADS category 5 lesion were malignant. Ultrasound sensitivity was 100%, specificity was 80.5%, NPV was 100%, PPV2 was 1.8%, and PPV3 was 1.9%.

Women younger than 30 years with focal breast signs or symptoms have a very low (0.4%) incidence of malignancy. The 100% sensitivity and NPV of targeted ultrasound in our study substantiates its use as an accurate primary imaging test in this clinical setting. We found no malignancies in BI-RADS category 3 lesions, supporting ultrasound surveillance over biopsy in this patient population.

BI-RADS Descriptors for Mammographically Detected Microcalcifications Verified by Histopathology After Needle-Localized Open Breast Biopsy

BI-RADS Descriptors for Mammographically Detected Microcalcifications Verified by Histopathology After Needle-Localized Open Breast Biopsy
Hee Jung Shin, Hak Hee Kim, Myung-su Ko, Hyun Ji Kim, Jin Hee Moon, Byung Ho Son, and Sei Hyun Ahn
AJR 2010; 195:1466-1471

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For combined descriptors of morphology and distribution, the odds ratios of malignancy regarding the higher probability of malignancy and ductal distribution were as follows: 0 for typically benign morphology or scattered distribution, 93.00 for intermediate concern and regional, 33.53 for intermediate concern and clustered, 5.00 for intermediate concern and ductal, 24.00 for higher probability of malignancy and regional, and 1.13 for higher probability of malignancy and clustered.

Each descriptor and combined descriptors for microcalcifications and the final assessment category could help to predict the risk of malignancy

Computer-Aided Analysis of Ultrasound Elasticity Images for Classification of Benign and Malignant Breast Masses

Computer-Aided Analysis of Ultrasound Elasticity Images for Classification of Benign and Malignant Breast Masses
Woo Kyung Moon, Ji Won Choi, Nariya Cho, Sang Hee Park, Jung Min Chang, Mijung Jang, and Kwang Gi Kim
AJR 2010; 195:1460-1465

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Computer-aided analysis of ultrasound elasticity images has the potential to aid in the classification of benign and malignant breast tumors

Axillary Ultrasound and Fine-Needle Aspiration in the Preoperative Evaluation of the Breast Cancer Patient: An Algorithm Based on Tumor Size and Lymph Node Appearance

Axillary Ultrasound and Fine-Needle Aspiration in the Preoperative Evaluation of the Breast Cancer Patient: An Algorithm Based on Tumor Size and Lymph Node Appearance
Martha B. Mainiero, Christina M. Cinelli, Susan L. Koelliker, Theresa A. Graves, and Maureen A. Chung
AJR 2010; 195:1261-1267

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Ultrasound-guided FNA of the axillary lymph nodes is most useful in the preoperative assessment of patients with large tumors (> 2 cm) or lymph nodes that appear abnormal

Stereotactic Vacuum-Assisted Breast Biopsy Is Not a Therapeutic Procedure Even When All Mammographically Found Calcifications Are Removed: Analysis of 4,086 Procedures

Stereotactic Vacuum-Assisted Breast Biopsy Is Not a Therapeutic Procedure Even When All Mammographically Found Calcifications Are Removed: Analysis of 4,086 Procedures
Silvia Penco, Stefania Rizzo, Anna Carla Bozzini, Antuono Latronico, Simona Menna, Enrico Cassano, and Massimo Bellomi
AJR 2010; 195:1255-1260

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VABB may not be considered a therapeutic procedure, even in the case of complete removal of microcalcifications.  

However, a complete removal of microcalcifications may result in low rates of underestimation of malignancy and may consequently increase the diagnostic accuracy of the diagnostic procedure

Contrast-Enhanced MR Angiography of the Breast: Evaluation of Ipsilateral Increased Vascularity and Adjacent Vessel Sign in the Characterization of Breast Lesions

Contrast-Enhanced MR Angiography of the Breast: Evaluation of Ipsilateral Increased Vascularity and Adjacent Vessel Sign in the Characterization of Breast Lesions
Sibel Kul, Aysegul Cansu, Etem Alhan, Hasan Dinc, Abdulkadir Reis, and Gamze Can
AJR 2010; 195:1250-1254

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Both ipsilateral increased vascularity and the adjacent vessel sign were found to be associated with breast cancer in a significant percentage of patients. The adjacent vessel sign is more practical and generally applicable. There is a borderline significance in favor of the higher accuracy of the adjacent vessel sign in comparison with ipsilateral increased vascularity (p = 0.043)

Vessel Analysis on Contrast-Enhanced MRI of the Breast: Global or Local Vascularity? Francesco Sardanelli

Vessel Analysis on Contrast-Enhanced MRI of the Breast: Global or Local Vascularity?
Francesco Sardanelli
AJR 2010; 195:1246-1249

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As is often the case in MRI, what we initially see is only a tip of the iceberg

Features of Prospectively Overlooked Computer-Aided Detection Marks on Prior Screening Digital Mammograms in Women With Breast Cancer

Features of Prospectively Overlooked Computer-Aided Detection Marks on Prior Screening Digital Mammograms in Women With Breast Cancer
Nariya Cho, Seung Ja Kim, Hye Young Choi, Chae Yeon Lyou, and Woo Kyung Moon
AJR 2010; 195:1276-1282

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On prior screening digital mammograms, the CAD system had correctly marked 74% (34/46) of visible findings and 90% (19/21) of actionable findings. The actionable findings showed significantly higher CAD sensitivity and were marked on both mammographic views more often than the 'under threshold' findings were.