American College Of Radiology Breast Imaging Reporting And Data System Research Articles

Ultrasonography in Solid benign lesions of breast: An Institutional experience

Introduction: Benign breast lesions create a heterogeneous group of pathologies arising from the mammary epithelium or other mammary tissues. Most lesions diagnosed in symptomatic women are benign. Although, the most reliable method for diagnosis of a breast lesion is histological evaluation, the initial investigation method recommended in young females is Sono-mammogram due to its precision in diagnosis in dense fibro-glandular tissue. However, with better imaging proficiency there is also considerable risk of detecting false positive benign lesions. In present study we have assessed the prevalence of various solid benign lesions on high resolution ultrasound along with their utrasonographic features. Materials & Methods- This retrospective descriptive cross sectional study was conducted on 478 women (age range 22-81 years) with breast lumps. The ultrasound examination was performed with AI Xplorer Supersonic Ultrasound machine, using a range of 2-18 MHz linear array transducers. The lesions were classified using American College of Radiology- Breast Imaging-Reporting and Data System (ACR-BI-RADS). BIRADS 2, 3 and biopsy confirmed 4 lesions were included and their imaging features were studied. Results- A total of 478 women with 790 breasts were analysed. Among these, 112 lesions were diagnosed and confirmed as benign. Fibroadenoma was the most common benign lesion followed by Intramammary lymph node. Other entities included Phyllodes, lipoma, intracystic or intraductal papilloma, Lipnecrosis, Fibroadenosis, PASH, Hamartoma, Neurofibroma and Granulomatous. Conclusion- The benign breast lesions form an extremely heterogeneous group of breast diseases. Some lesions are easily diagnosed due to their characteristic appearance; other lesions present with varying and overlapping imaging features during different stages of their evolution. However, USG is very helpful in lesion characterization & thus guiding further management.

The implications of increased mammographic breast density for breast screening in Jordan.

IntroductionMammographic breast density is associated with a four to six times increased risk for breast cancer. Mammographic breast density varies by ethnicity, geographical region and age. The aim of this study was to document for the first time the mammographic breast density of Jordanian women and to explore its relationship with age.MethodsMammograms completed at King Abdullah University Hospital (Irbid, Jordan) between January 2016 and August 2018 were retrospectively reviewed and classified for breast density using the American College of Radiology (ACR) Breast Imaging‐Reporting and Data System (BI‐RADS). Descriptive analyses and Kurskal–Wallis test were used to examine the association between age and mammographic breast density.ResultsA total of 659 mammograms were reviewed. A significant inverse relationship was observed between age and breast density (P < 0.001). In women aged 40–49 years, 83.2% had dense breasts (ACR BI‐RADS (c) and (d)). This percentage decreased to 59.8% of women aged 50–59 years; 38.4% of women in their 60s and 37.9% of women aged 70 years or older (ACR BI‐RADS (c) only).ConclusionThe mammographic breast density of Jordanian women has been shown to be high across all age groups. Increased mammographic breast density is associated with increased breast cancer risk and renders mammography a less effective technique for the early detection of breast cancer. Breast cancer screening of Jordanian women should be individualised to develop screening protocols and include additional adjunct imaging to best manage women at high risk.

Mammographic Breast Density Profile of Jordanian Women With Normal and Breast Cancer Findings.

Purpose:To document the mammographic breast density (MBD) distribution of Jordanian women and the relationship with MBD with age. Correlation between breast cancer diagnosis and density was also explored.Methods:A retrospective review of 660 screening mammograms from King Abdullah University Hospital was conducted. Mammograms were classified into 2 groups: normal (return to routine screening) and breast cancer and rated using the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) 5th edition for MBD. The association between MBD and age was assessed by descriptive analyses and Kruskal-Wallis test. To compare between normal and breast cancer groups, chi-square post hoc tests with Bonferroni adjustment was used.Results:Groups consisted of 73.9% (n = 488) normal group and 26.1% (n = 172) breast cancer group. A significant inverse relationship was demonstrated between age and MBD among the normal (r = −.319, P < .01) and breast cancer group (r = −.569, P < .01). In total, 69% (n = 336) of women in the normal group and 71% (n = 122) in the breast cancer group and 79.1% (n = 159) of the normal group and 100% (n = 48) of the breast cancer group aged 40 to 49 years reported high MBD (ACR BI-RADS c or d).Conclusions:Most of women in both the normal and breast cancer groups evidenced increased MBD. Increased MBD was inversely proportional to age. As MBD has a known link to increased breast cancer risk and the decreased sensitivity of mammography and it is vital that future screening guidelines for Jordanian women consider the unique breast density distribution of this population.

How I report breast magnetic resonance imaging studies for breast cancer staging and screening.

Magnetic resonance imaging (MRI) of the breast is the most sensitive imaging technique for the diagnosis and local staging of primary breast cancer and yet, despite the fact that it has been in use for 20 years, there is little evidence that its widespread uncritical adoption has had a positive impact on patient-related outcomes.This has been attributed previously to the low specificity that might be expected with such a sensitive modality, but with modern techniques and protocols, the specificity and positive predictive value for malignancy can exceed that of breast ultrasound and mammography. A more likely explanation is that historically, clinicians have acted on MRI findings and altered surgical plans without prior histological confirmation. Furthermore, modern adjuvant therapy for breast cancer has improved so much that it has become a very tall order to show a an improvement in outcomes such as local recurrence rates.In order to obtain clinically useful information, it is necessary to understand the strengths and weaknesses of the technique and the physiological processes reflected in breast MRI. An appropriate indication for the scan, proper patient preparation and good scan technique, with rigorous quality assurance, are all essential prerequisites for a diagnostically relevant study.The use of recognised descriptors from a standardised lexicon is helpful, since assessment can then dictate subsequent recommendations for management, as in the American College of Radiology BI-RADS (Breast Imaging Reporting and Data System) lexicon (Morris et al., ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System, 2013). It also enables audit of the service. However, perhaps the most critical factor in the generation of a meaningful report is for the reporting radiologist to have a thorough understanding of the clinical question and of the findings that will influence management. This has never been more important than at present, when we are in the throes of a remarkable paradigm shift in the treatment of both early stage and locally advanced breast cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/s40644-016-0078-0) contains supplementary material, which is available to authorized users.

Introducing Digital Mammography in a Resource Constrained Setting: Spectrum of Imaging Findings and Diagnostic Value in Ado-Ekiti, South Western Nigeria

Early diagnosis and treatment achieved through Mammographic screening plays a key role in the reduction of breast related morbidities and mortalities in middle and low income countries. This study highlights the spectrum of digital mammography findings in a tertiary health institution in Ado-Ekiti, South western Nigeria. A cross-sectional descriptive study of clients who presented for digital mammography at a newly equipped hospital was conducted within a year. The mammograms were reviewed by two radiologists and overall imaging findings were classified using the American College of Radiology Breast Imaging Reporting and Data System (ACR-BIRADS). Data analysis was done using SPSS version 20.0. A total of 154 clients with age range of 37 to 85 years (mean age of 51± 9.6years) underwent mammography during the study period. There was one male and 153 females out of which 69(45.1%) were postmenopausal while 84(54.9%) were premenopausal. Major clinical indications for mammography included routine breast cancer screening (N= 59, 38.3%), breast lump (N= 43, 27.9%) and breast pain (N=34, 22.1%). Mammograms were normal in 37(24.0%), inconclusive in 51(33.1%) and abnormal in 66(42.9%) clients. Abnormal mammographic findings included various forms of calcifications (N=56, 36.4%), breast opacities/masses (N=42, 27.3%), axillary lymphadenopathy (N=14, 9.0%), focal glandular asymmetry (N=10, 6.5%) and architectural distortion (N=6, 3.9%). About 55(35.7%) patients underwent additional imaging with ultrasonography, out of which 32(58.2%) had positive sonographic findings. The use of ultrasonography for additional imaging in cases of inconclusive mammograms improves the diagnostic yield. A greater proportion of the clients had mammography done for diagnostic reasons rather than screening purposes. Hence there is the need for increased awareness of screening mammography among the women in resource constrained settings.

Mammographic calcifications in women in Ibadan, South-West Nigeria: A seven years review

Background/Aims: The purpose of this paper is to present the various types of calcifications seen on mammograms in Nigerian women in Ibadan. The study was to describe calcifications using the American College of Radiology Breast Imaging Reporting and Data System (ACR-BIRADS) classification, document the incidence of the various types of calcifications in a Nigerian population and also report on any association between these calcifications and the demographic variables. Materials and Methods: A prospective study of 894 mammograms done in the Radiology Department of the University College Hospital, Ibadan over a seven year period (2006–2013). The mammographic evaluation was carried out by two radiologists. Calcifications were described and classified using the ACR-BIRADS system. Patients' demographic data were obtained using the departmental breast imaging questionnaire. Results: Of the 894 women (with an age range of 30–82 years), 213 (23.8%) had calcifications on their mammograms. Macro-calcifications (81.2%) were more common than micro-calcifications (18.8%). The most common distribution of these calcifications was the clustered type. Vascular calcifications (31.2%) were the common morphologic type of macro-calcifications while the punctate calcifications (15.5%) were the common morphologic type of micro-calcifications. About 12.3% of the women had associated masses, 3.3% had associated asymmetric density and 1.9% had associated architectural distortion. A quarter of micro-calcifications fell under 'higher probability of malignancy' (BIRADS 3) and 39% fell under 'intermediate concern of malignancy' (BIRADS 2). 18.4% of the women were asked to undergo further imaging studies. Conclusion: We have reported the various types, distributions and morphology of calcifications seen in an African population, similar to those seen in developed countries.

Distribution of Breast Density in Iranian Women and its Association with Breast Cancer Risk Factors

Background:Breast cancer is one of the most common cancers and the first-leading cause of cancer deaths among women in the world. Indeed, breast cancer is ranked as the first malignancy among Iranian women. Breast density, defined as the percentage of fibro glandular breast tissue in mammographic images, is one of the known risk factors for breast cancer. According to American college of radiology-Breast Imaging Reporting and Data System (ACR-BIRADS), mammographic density is divided into four categories. Studies have shown that increased breast density is associated with significant increase in breast cancer risk. Therefore, it is assumed that breast density should be associated with other breast cancer risk factors.Objectives:The aim of this study was to assess the epidemiologic distribution of breast density of the patients in a referral center in Iran, and to evaluate the association of high breast density and breast cancer risk factors and other factors that may possibly affect the mammographic density according to previous studies.Patients and Methods:In an analytical cross-sectional study, 728 of those who had referred to Imam Khomeini Imaging Center either for diagnostic or screening purposes, participated in the study, after filling out the informed consent form, the survey questionnaire based survey assessing breast cancer risk factors affecting the breast density and related demographic features, was conducted. SPSS 11.5 software and chi-square, t-test and logistic regression tests were used to analyze the data.Results:Most of patients (75%) in categories 2 and 3 of mammographic density had a breast density of 51.9%, however, this amount was less (49.2%) in screening mammograms, while in diagnosing group it was more (51.6%). The Findings showed an increase in age, body mass index (BMI), duration of breast feeding, and also to be menopause e, unemployed and married, younger than 29 years old at first delivery, having children up to 8 and smoking are associated with less breast density. Diagnostic mammograms and symptomatic patients showed denser breasts. But density had no association with oral contraceptives pill (OCP) consumption or hormone replacement therapy or calcium and/or vitamin D consumption, age at menarche and menopause, menstruation cycle phase and family history of breast cancer. Age at the first delivery, menopausal status and parity were independently associated with breast density.Conclusions:Density distribution and risk factors prevalence is different among symptomatic patients and the diagnostic mammograms of the screened persons, hence such information should be considered in the patient managements. In order to consider the effect of marriage and parity on decreasing the breast density, basic consultations should be performed. Smokers and obese women may falsely show low breast density while they may be in high-risk group. In this study no specific phase of menstrual cycle is suggested for mammographic examinations.

Who Should Have Breast Magnetic Resonance Imaging Evaluation?

During the last two decades, tremendous advances have been made in the performance and interpretation of breast magnetic resonance imaging (MRI) examinations. Technical requirements for optimal breast imaging including the requirement for a breast MRI biopsy system are now being defined as part of a voluntary American College of Radiology (ACR) breast MRI accreditation program. The ACR BI-RADS (Breast Imaging Reporting and Data System) lexicon for breast MRI has brought uniformity to the interpretation of breast MRI examinations. With these advances in imaging technique, interpretation guidelines, and increasing availability of MR-compatible breast biopsy systems, MRI of the breast is rapidly gaining popularity in clinical practice in both the diagnostic setting and, more recently, in the screening setting. The clinical indications for breast MRI, however, remain to be defined. There are clinical indications that have emerged where MRI, as an adjunct to mammography, seems to be the imaging study of choice. There are other indications, specifically breast cancer staging, in which MRI is being utilized with increasing frequency, but in which controversy persists.

Classificação BI-RADS™: categorização de 4.968 mamografias

Seguindo o modelo adotado pelo Colégio Americano de Radiologia, utilizamos o método BI-RADS™ (Breast Imaging Reporting and Data System) numa análise regional retrospectiva de 4.968 mamogramas, para categorizar e avaliar a freqüência dos achados mamográficos, distribuindo-os nos diferentes grupos desta classificação. Das 4.968 mamografias foram laudadas 44,4% (n = 2.208) como negativas, 46,3% (n = 2.305) como achados mamográficos benignos, 7,5% (n = 374) como achados mamográficos provavelmente benignos, 0,98% (n = 49) como achados mamográficos suspeitos e 0,72% (n = 36) como achados mamográficos altamente suspeitos. O estudo também demonstra a importância da uniformização do laudo mamográfico, através da aplicação da classificação BI-RADS™, sobretudo como preditor de malignidade, bem como na avaliação da conduta a ser seguida.

Use of the American College of Radiology BI-RADS to report on the mammographic evaluation of women with signs and symptoms of breast disease.

To examine whether mammographic assessments and recommendations are linked as expected, based on the Breast Imaging Reporting and Data System (BI-RADS), for the evaluation of women with signs and symptoms of breast disease. Eight mammography registries from the Breast Cancer Surveillance Consortium contributed mammographic data from 1996 through 1997 for women 25 years of age or older, with signs or symptoms of breast cancer. The association of assessments and recommendations and the relationship of self-reported symptoms to assessments are described. A total of 51,673 diagnostic mammograms were included in the analyses and the expected management recommendation was provided 85%-90% of the time for mammograms classified as assessment categories 1, 2, 4, or 5. Category 3 ("probably benign finding") had the most variability in associated management recommendations, with only 40% (2,998 of 7,423) of cases associated with the recommendation for short interval follow-up. Of the 1,648 category 0 mammograms ("needs additional imaging") that did not have a final assessment, 64% were recommended for additional imaging, while another 20% of the cases were recommended for either a consultation or biopsy. The number of women who reported a lump as a symptom decreased with age but was associated with higher BI-RADS assessments. BI-RADS assessment categories were generally used as intended for all categories but 0 and 3. Additional education about the use of these categories may be warranted. The inconsistencies between assessment category and management recommendations may present difficulties in conducting outcome audits.