Breast Imaging Findings Research Articles

The Utility of Second-Look US to Evaluate Abnormal Molecular Breast Imaging Findings: A Retrospective Study.

The purpose of this study was to evaluate the utility of US for identifying and characterizing lesions detected on molecular breast imaging (MBI). A retrospective single-institution review was performed of patients with MBI studies with subsequent US for abnormal MBI findings between January 1, 2015, and September 30, 2021. Medical records, imaging, and histopathology were reviewed. The reference standard was histopathology and/or imaging follow-up. Associations among MBI findings, the presence of an US correlate, and histopathology were evaluated by Fisher exact tests. The 32 lesions detected on MBI in 25 patients were evaluated by US, and 19 lesions had an US correlate (19/32, 59%). Mass uptake was more likely to have an US correlate (11/13, 85%; P = .02) than nonmass uptake (7/19, 37%), and mass uptake was more likely to be malignant (5/13, 38%; P = .01). Of the 13 lesions without an US correlate, 5 were evaluated and subsequently biopsied by MRI (2 high-risk lesions and 3 benign lesions). Follow-up MBIs demonstrated stability/resolution for 5 lesions in 4 patients at 6 months or longer. Three patients had no further imaging. Mass lesions identified on MBI were more likely to have an US correlate and were more likely to be malignant than nonmass lesions.

Clinical Outcomes of Benign Concordant MRI-Guided Breast Biopsies

IntroductionMRI-guided biopsy is the standard of care for breast imaging findings seen only by MRI. Although a non-zero false-negative rate of MRI-guided breast biopsy has been reported by multiple studies, there are varied practice patterns for imaging follow-up after a benign concordant MRI guided biopsy. This study assessed the outcomes of benign concordant MRI-guided biopsies at a single institution. Patients and MethodsThis IRB-approved, retrospective study included patients with MRI-guided biopsies of breast lesions from November 1, 2014, to August 31, 2020. Only image-concordant breast lesions with benign histopathology and those follow up with MRI imaging or excision were included in the study. ResultsOut of 275 lesions in 216 patients that met the inclusion criteria, 274 lesions were followed with MRI (range, 5-79 months; average, 25.5 months) and showed benign or stable features upon follow-up. One out of 275 lesions (0.4%), a 6 mm focal nonmass enhancement, was ultimately found to represent malignancy after initial MRI-guided biopsy yielded fibrocystic changes. The lesion was stable at a 6-month follow-up MRI but increased in size at 18 months. Repeat biopsy by ultrasound guidance yielded invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). ConclusionBreast MRI-guided biopsy has a low false-negative rate. Our single malignancy from a total of 275 lesions gives a false negative rate of 0.4%. This data also supports a longer follow-up interval than the commonly performed 6-month follow-up, in order to assess for interval change.

Preoperative breast imaging and histopathological findings in chest contouring surgery on transmen

Chest contouring is the most common surgical procedure transmen receive. Only a few articles discuss the importance of preoperative imaging and postoperative histopathological analysis of excised breast tissue. We studied the findings of preoperative breast imaging and the results of postoperative histopathological analysis in a clinical setting. Data from 220 patients were collected retrospectively from 2005 to 2018. Preoperative imaging modalities and their findings were recorded and classified according to the American College of Radiology Breast Imaging Reporting and Data System. The histopathological findings in breast specimens were categorized based on the World Health Organization Classification of Breast Tumors (5th edition). Preoperative imaging was performed in 133 (60.5%) patients. Patients in the ultrasound-only group were younger (mean age 22.8) than the other groups (mammogram (MGR) 37 years and MGR+US 35.5 years). Preoperative imaging results were normal in 131 (98.5%) patients. Two patients needed further evaluation. Histopathological results were available on 206 (93.6%) patients. The most common histopathological findings were fibrosis (67.5%), atrophy (34.3%), and chronic mastopathy (14.5%). There were no high-risk or malignant findings. The need for further examinations based on routine preoperative imaging was low (1.5%). Therefore, more individualized patient selection for preoperative imaging is justified. There were no high-risk or malignant findings in histopathological analysis, and the occurrence of benign findings was similar to that reported in previous studies. Despite our findings, based on current knowledge, histopathological examination of excised breast tissue can still be recommended. Therefore, future studies are needed to define clear guidelines.

Imaging Features Following Breast Explant Surgery: A Pictorial Essay.

Breast implants can be removed with breast explantation surgery (BES) for various reasons, including patient dissatisfaction, capsular contracture, implant infection or rupture, breast implant-associated anaplastic large cell lymphoma, and a recently emerging phenomenon called breast implant illness. There is very limited data on the imaging appearance after BES. A retrospective chart review was performed for patients with BES findings on imaging reports for the period between October 2016 and October 2021. When assessing BES techniques, a key element is determining whether the implant's fibrous capsule requires removal. The second important question is if the patient requires an additional aesthetic procedure after BES. BES techniques include capsulotomy, and partial, total, or en bloc capsulectomy. Adjunctive aesthetic or reconstructive procedures after BES include fat grafting, mastopexy, augmentation, and reconstruction with flaps. The majority of post-BES breast imaging findings are related to the surgical scar/bed, thereby confirming that the type of explantation surgery is important. Imaging findings after BES include focal and global asymmetries, architectural distortions, calcifications, calcified and non-calcified fat necrosis, masses, hematomas, seromas, capsular calcifications, and silicone granulomas. Most importantly, since these patients have residual breast tissue, paying attention to imaging features that are suspicious for breast cancer is necessary.

Patient and System Factors Associated With Completed Follow-Up of Probably Benign (BI-RADS 3) Breast Imaging Findings

ObjectiveEvaluate patient factors and health system test ordering and scheduling processes associated with completed BI-RADS 3 breast imaging follow-up. MethodsRetrospective review of reports from January 1, 2021, to July 31, 2021, identified BI-RADS 3 findings corresponding to unique patient encounters (index examinations). The electronic health record was queried for patient, examination, and health system ordering or scheduling data including follow-up order status (order placed, performed; order placed, scheduled, but not performed; order placed, unscheduled; no order placed); ordering provider specialty and health system affiliation (primary care versus other, internal versus external to health system); and ordering department (radiology staff versus referring physician staff). Patient home addresses were categorized by area deprivation index (University of Wisconsin’s Neighborhood Atlas). Univariable and multivariable analysis identified patient, examination, and ordering or scheduling factors associated with completed follow-up imaging within 15 months of BI-RADS 3 assessment. ResultsThere were 3,104 unique BI-RADS 3 assessments, 2,561 (82.5%) with completed BI-RADS 3 follow-up within 15 months of study examination. In multivariable analysis, factors associated with incomplete follow-up included ultrasound (odds ratio [OR] 0.48; 95% confidence interval [95% CI] 0.38-0.60; P < .001) and MRI (OR 0.71; 95% CI 0.50-1.00; P = .049) versus mammogram; patients living in the highest disadvantaged neighborhoods (OR 0.70; 95% CI 0.50-0.98; P = .04); patients <40 years (OR 0.14; 95% CI 0.11-0.19; P < .001); Asian race (OR 0.55; 95% CI 0.37-0.81; P = .003); order placement >3 months (OR, 0.05; 95% CI 0.02-0.16; P < .001) after index examination or scheduling >6 months after order placement (OR, 0.35; 95% CI 0.14-0.87; P = .02); order placement by breast oncology or breast surgery departments (OR 0.35; 95% CI 0.17-0.73; P = .01) versus radiology department. DiscussionIncomplete BI-RADS 3 follow-up is associated with ultrasound or MRI, most socioeconomically disadvantaged patients, younger patients, Asian race, delayed order entry, and follow-up examination ordering and scheduling by non–radiology departments.

Predicting Malignancy of Breast Imaging Findings Using Quantitative Analysis of Contrast-Enhanced Mammography (CEM).

We sought to develop new quantitative approaches to characterize the spatial distribution of mammographic density and contrast enhancement of suspicious contrast-enhanced mammography (CEM) findings to improve malignant vs. benign classifications of breast lesions. We retrospectively analyzed all breast lesions that underwent CEM imaging and tissue sampling at our institution from 2014-2020 in this IRB-approved study. A penalized linear discriminant analysis was used to classify lesions based on the averaged histograms of radial distributions of mammographic density and contrast enhancement. T-tests were used to compare the classification accuracies of density, contrast, and concatenated density and contrast histograms. Logistic regression and AUC-ROC analyses were used to assess if adding demographic and clinical data improved the model accuracy. A total of 159 suspicious findings were evaluated. Density histograms were more accurate in classifying lesions as malignant or benign than a random classifier (62.37% vs. 48%; p < 0.001), but the concatenated density and contrast histograms demonstrated a higher accuracy (71.25%; p < 0.001) than the density histograms alone. Including the demographic and clinical data in our models led to a higher AUC-ROC than concatenated density and contrast images (0.81 vs. 0.70; p < 0.001). In the classification of invasive vs. non-invasive malignancy, the concatenated density and contrast histograms demonstrated no significant improvement in accuracy over the density histograms alone (77.63% vs. 78.59%; p = 0.504). Our findings suggest that quantitative differences in the radial distribution of mammographic density could be used to discriminate malignant from benign breast findings; however, classification accuracy was significantly improved with the addition of contrast-enhanced imaging data from CEM. Adding patient demographic and clinical information further improved the classification accuracy.

Concerns About Breast Pain: How Useful Is Imaging?

Background: Breast pain is one of the most common reasons for referral to breast imaging. Objectives: This study aimed to determine the diagnostic yield of mammography and sonomammography in women complaining of breast pain in a teaching hospital in Southeast Nigeria. Methods: This descriptive study analyzed the mammographic/sonomammographic images and records of 241 consecutive adult women aged 18 - 81 years with breast pain who presented to the radiology department over three years. A non-random sampling method was employed to select the participants. The extracted variables were patient’s age, positive clinical history of breast pain, laterality of breast pain, type of imaging, presence or absence of lesion, type, and laterality of lesions if present, and Breast Imaging Reporting and Data System (BI-RADS) assignment of imaging findings on mammography and sonomammography. The descriptive analysis of continuous variables and inferential statistics of ordinal data were performed with Microsoft Excel and chi-squared test, respectively. In this study, P &lt; 0.05 was set as the significance level. Results: Most women (20%) with a complaint of breast pain were in the 40 - 44-year age group. Moreover, 32.3%, 33.2%, and 34.4% of the participants had left-sided, right-sided, and bilateral breast pain, respectively. Among the participants, 118 and 123 women had mammography and sonomammography, respectively. Furthermore, 76.3% had normal findings on mammography or sonomammography, and only 23.7% had positive imaging findings on breast imaging. These lesions were mostly observed among the women in the age group of 45 - 49 years. Of those with lesions detected on imaging, 79.2% and 20.8% demonstrated benign and malignant attributes, respectively. Masses with definite benign attributes assigned BI-RADS II were mostly fibroadenomata and cysts. Inferential statistics indicated that unilateral mastalgia was more likely to be associated with a breast lesion, while bilateral mastalgia usually resulted in normal breast imaging findings. Conclusions: Women referring to the Radiology Department with a complaint of breast pain alone are unlikely to have any significant breast imaging finding; hence, imaging serves as a tool for assuaging the anxiety of these patients and reassuring the referring physician. Unilateral but not bilateral mastalgia is likely to yield positive imaging findings, which are largely benign.

A case report of breast cancer in breast augmentation surgery with injection of free liquid silicone

Breast augmentation surgery with an injection of free liquid silicone has been performed from the early 1960s but was abandoned by most practitioners because numerous complications have been reported, such as migration of silicone to other parts of the body, inflammation, discoloration, and the formation of granulomas, ulceration and fistulae, anaplastic large cell lymphoma, Silicone-Induced Granuloma, breast carcinoma. In this case report, we describe an invasive breast carcinoma, diagnosed via core needle biopsy, in breast augmentation by injecting free liquid silicone ten years ago, including breast imaging findings on mammography and MRI, macroscopic and microscopic features. The nipple-sparing mastectomy was performed for two breasts that were injected with liquid silicone. In the right breast with adenocarcinoma, surgical margins above nipple-areolar were assessed intra-operatively by frozen section before immediate breast reconstruction was carried out in the same operation. TRAM flap procedure reconstructed for right breast and implant breast reconstruction for the left breast. We received amazing post-operative results. Key words: breast cancer, liquid silicone injection, breast reconstruction

Effects of Gender-affirming Medical and Surgical Therapy on Breast Imaging Findings and Breast Cancer Risk: Practical Considerations

Effects of Gender-affirming Medical and Surgical Therapy on Breast Imaging Findings and Breast Cancer Risk: Practical Considerations

Abstract P3-03-23: Surveillance breast magnetic resonance findings in asymptomatic CDH1 variant carriers

Abstract Introduction: An estimated 20% of breast cancers are attributed to a germline mutation; BRCA1/2 gene variants are most well-known and account for almost 40% of hereditary breast cancers. Families that carry CDH1 germline pathogenic or likely pathogenic (P/LP) variants have increased risk of developing diffuse type gastric cancer and invasive lobular breast cancer (LBC). Specifically, the lifetime risk of developing breast cancer due to CDH1 is estimated to be 39-55%. LBC is characterized by an infiltrative growth pattern, which results in decreased detection sensitivity by mammography. Consensus guidelines recommend annual breast surveillance with magnetic resonance (MR) imaging alternating with mammography every six months between 30 and 50 years of age. However, this patient population is less studied, particularly regarding breast cancer surveillance. We sought to determine the incidence of abnormal breast MR findings in women with CDH1 P/LP variants, identify the median age that abnormalities were discovered, and evaluate for concordance with mammogram, ultrasound, and pathology. Methods: Patients with CDH1 P/LP variants were enrolled in a prospective study of hereditary gastric cancers at a single institution between January 2017 and May 2021. Patient demographics, breast imaging findings, breast pathology, and detailed family pedigree of breast and gastric cancers were analyzed. Results: 283 patients with CDH1 P/LP variants were enrolled, of whom 154 were women. Thirty-one (31/154) women were diagnosed with breast cancer prior to enrollment and 30 were outside the recommended breast MR surveillance window (&amp;lt;30 or &amp;gt;50 years). Data were available on 64 women who underwent at least one surveillance breast MR. The majority (58/64, 91%) were Caucasian, 48 (75%) had family history of breast cancer and 48 (75%) had a family history of gastric cancer. The median age of first surveillance MR was 44 (range 25-73) with a median age of 45 at CDH1 diagnosis. Of the 64 women who underwent surveillance breast MR, a total of 106 scans were performed; 32 patients (48%) had one MR, 14 (1%) had two, and 18 (28%) had ≥3. Most women (34/64, 53%) demonstrated benign or normal findings (BIRADS 1 or 2). Abnormal or incomplete imaging was found in 19 women (BIRADS 0, 3, 4, 5). Most women (18/19, 94%) with a breast abnormality were discovered during the first surveillance scan, whereas one woman had an abnormality on subsequent imaging. Four (4/19) women demonstrated multifocal lesions and four had bilateral enhancing lesions. The average size of contrast-enhancing lesion was 1.3cm (0.3-4.4cm). Further diagnostic workup was available on 15 women, of whom four had invasive disease resulting in an overall cancer detection rate of 6% (4/64) and a false positive rate of 73% (11/15). Of the four women ultimately diagnosed with LBC, three had an initial BIRADS 4 and one was BIRADS 0. Of the 11 women who did not have invasive disease, six initially had BIRADS 0 readings, two BIRADS 3, and three BIRADS 4. Conclusions: In a cohort of women with CDH1 P/LP variants the overall detection rate of abnormal lesions on surveillance MR was 29% and the cancer detection rate was 6%. When follow-up imaging and/or biopsy was available the concordance rate was 33%. The median age of first surveillance MR and first lesion discovered were the same, suggesting the recommendation for breast cancer surveillance starting at age 30 is appropriate. These data support the use of alternating breast MR with mammogram and highlight the need for prompt diagnosis of germline CDH1 variants in order to promote early breast cancer detection. Citation Format: Lauren A. Gamble, Martha Teke, Jeremy Fridling, Sarah G. Samaranayake, Bernadette Redd, Andrew Blakely, Jeremy L. Davis. Surveillance breast magnetic resonance findings in asymptomatic CDH1 variant carriers [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-03-23.

Perceptions of patients and medical oncologists toward biospecimen donation in the setting of abnormal breast imaging findings.

We sought to understand the attitudes of individuals with abnormal breast imaging findings prompting a diagnostic breast biopsy toward donation of blood, excised tissue, or percutaneous biospecimens for research, and to understand medical oncologists' attitudes toward research biospecimen collection in this population. We included individuals who presented to a single academic medical center for a clinically indicated, image-guided, percutaneous breast biopsy. We administered a survey prior to knowledge of biopsy results to assess willingness to consider, entirely for research purposes, donating blood or excess excised breast tissue, or having additional biospecimens (AB) obtained during a clinically indicated percutaneous biopsy. We also surveyed breast medical oncologists from National Cancer Institute-designated cancer centers to assess attitudes toward approaching patients for biospecimen research. Overall, 53/63 patients responded to the survey; 70% would consider donating blood, 85% would consider donating excess excised breast tissue, and 32% would consider having AB obtained during a clinically indicated biopsy. Main motivating factors for considering AB included contributing to scientific knowledge and return of study or biopsy results, whereas anxiety and the potential discomfort were the main dissuading factors. Among 191 medical oncologists, most were very comfortable (59.2%), or somewhat comfortable (32.5%) asking patients to have AB obtained during a clinically indicated breast biopsy. Medical oncologists reported hesitancy to refer a patient for AB due to potential pain/discomfort, and other procedure risks. Only one-third of individuals with breast imaging findings would consider consenting to AB during a diagnostic biopsy, whereas most were open to donating blood or excess excised breast tissue. Most medical oncologists would be comfortable asking patients to have AB obtained during the biopsy. Understanding patients' and oncologists' baseline attitudes may inform the design and approach to breast biospecimen-based research.

Breast Imaging Findings of Microcalcifications in Ductal Carcinoma in Situ and Their Correlations with Pathological and Biological Features

Background: Mammography (MMG) is the primary screening tool for breast cancer, as microcalcifications are the most common MMG finding in ductal carcinoma in situ (DCIS). The use of high-frequency transducers facilitates the visualization of calcifications on ultrasonography (USG), especially in patients with dense breasts and cancer symptoms. Although a correlation has been reported between the imaging features of DCIS and pathological features, few studies have focused on multiple imaging modalities. Objectives: To evaluate the correlation of DCIS microcalcifications in breast imaging with pathological and biological features. Patients and Methods: The MMG and USG findings of 125 lesions detected in 123 patients, diagnosed with pure DCIS, were retrospectively reviewed according to the breast imaging-reporting and data system (BI-RADS). The USG and comparable MMG findings of microcalcifications were divided into three groups: group 1 (MMG negative, USG negative), group 2 (MMG positive, USG negative), and group 3 (MMG positive, USG positive). The pathological findings (nuclear grade and comedo necrosis) and biological features [estrogen (ER) positive group, human epidermal growth factor receptor 2 (HER2) positive group, triple negative group, and Ki-67 index] were compared with the MMG and USG features using Chi-square test. Results: Microcalcifications were observed on MMG in 83 (66.4%) DCIS lesions. Positive microcalcifications on MMG were significantly associated with a high nuclear grade (P = 0.001) and comedo necrosis (P = 0.001). Positive microcalcifications on MMG were significantly associated with ER negativity (P = 0.023), HER2 positivity (P = 0.002), and increased Ki-67 index (P = 0.001). There were 62 lesions (49.6%) without microcalcifications on USG (group 1 and group 2), while there were 63 (50.4%) lesions with microcalcifications on USG (group 3). Positive microcalcifications on MMG were significantly associated with ER-negative group (P = 0.023), HER2-positive group (P = 0.002), and increased Ki 67 index (P = 0.001). Conclusion: Based on the present results, DCIS microcalcifications detected via imaging were significantly associated with poor prognostic pathological factors, such as a high nuclear grade and comedo necrosis, as well as poor prognostic biological factors, including ER negativity, HER2 positive group, and a high Ki-67 index.

Breast Computed Tomography: Diagnostic Performance of the Maximum Intensity Projection Reformations as a Stand-Alone Method for the Detection and Characterization of Breast Findings.

This study aimed to evaluate the diagnostic performance of the maximum intensity projection (MIP) reformations of breast computed tomography (B-CT) images as a stand-alone method for the detection and characterization of breast imaging findings. A total of 160 women undergoing B-CT between August 2018 and December 2020 were retrospectively included; 80 patients with known breast imaging findings were matched with 80 patients without imaging findings according to age and amount of fibroglandular tissue (FGT). A total of 71 benign and 9 malignant lesions were included. Images were evaluated using 15-mm MIP in 3 planes by 2 radiologists with experience in B-CT. The presence of lesions and FGT were evaluated, using the BI-RADS classification. Interreader agreement and descriptive statistics were calculated. The interreader agreement of the 2 readers for finding a lesion (benign or malignant) was 0.86 and for rating according to BI-RADS classification was 0.82. One of 9 cancers (11.1%) was missed by both readers due to dense breast tissue. BI-RADS 1 was correctly applied to 73 of 80 patients (91.3%) by reader 1 and to 74 of 80 patients (92.5%) by reader 2 without recognizable lesions. BI-RADS 2 or higher with a lesion in at least one of the breasts was correctly applied in 69 of 80 patients (86.3%) by both readers. For finding a malignant lesion, sensitivity was 88.9% (95% confidence interval [CI], 51.75%-99.72%) for both readers, and specificity was 99.3% (95% CI, 96.4%-100%) for reader 1 and 100% (95% CI, 97.20%-100.00%) for reader 2. Evaluation of B-CT images using the MIP reformations may help to reduce the reading time with high diagnostic performance and confidence.

Palpable Nodules After Autologous Fat Grafting in Breast Cancer Patients: Incidence and Impact on Follow-up.

Autologous fat grafting (AFG) is a promising breast reconstruction technique, following surgery. However, fat necrosis after AFG can cause palpable nodules, inducing anxiety and prompting additional investigations. We aimed to determine the occurrence rate and to identify the risk factors of palpable nodules in breast cancer patients prompting complementary explorations. We retrospectively reviewed the computerized files of consecutive breast cancer patients who underwent AFG after mastectomy or breast conservative treatment (BCT) at our center from January 2013 to December 2016. We collected data regarding palpable nodule incidences and suspicious breast imaging findings that led to additional explorations. Of the 252 patients reviewed, 222 (88%) underwent AFG for breast reconstruction, while 30 (12%) underwent AFG for correction of defects after BCT. The follow-up period ranged from 0 to 74 months (median: 27 months), and 201 patients had follow-ups beyond 1year. Of the 252 patients, 66 (26.2%) underwent at least one control imaging and 24 (10%) underwent a biopsy, including 6 (2.4%) locoregional recurrence. Sixty patients (24%) were diagnosed with nodules during follow-ups. Among them, 52 (87%) patients had additional imaging, and 17 patients (28%) had a biopsy, including 82% benign histology. Patients with BCT had significantly more palpable nodules at 1year than patients who underwent total mastectomy (odds ratio = 2.50, 95% confidence interval: 1.04. 6.03, p = 0.04). This study underlines the importance of preoperative patient information. This intervention and its follow-up should be reserved for experienced teams to limit unnecessary additional explorations. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Breast cancer in young women: Imaging and clinical course.

The purpose of this study was to characterize presenting imaging findings in women younger than 40 diagnosed with invasive breast cancer in the context of pathology and clinical course. Retrospective chart and imaging reviews were performed in patients under 40 diagnosed with breast cancer between July 1, 2004, and December 31, 2013. Patient demographic, imaging, pathology, and clinical data were collected. Overall and recurrence-free survival were estimated using the Kaplan-Meier method. Univariate Cox proportional hazards models were performed to identify factors associated with recurrence-free survival. Our study cohort consisted of 110 patients with invasive mammary carcinoma. One hundred one (91.8%) presented with a palpable mass. The mean size of all lesions on imaging was 3.5cm±2.9cm. Malignant calcifications were present in 54 (49.1%) cases. Imaging demonstrated multifocal or multicentric disease in 45 (40.9%) cases. Seventy four (67.3%) cancers were high grade. Luminal genomic subtypes were the most common (n=61, 55.5%). At presentation, 4 (3.6%) patients had bilateral malignancy and 8 (7.3%) patients had distant metastatic disease. Ninety seven (88.2%) underwent neoadjuvant chemotherapy and 67 (60.9%) underwent radiation therapy. Seventy five (68.2%) of the patients underwent mastectomy. The restricted mean time to recurrence was 9.01years (standard error 3.162months). ER positivity was associated with compromised recurrence-free survival. The overall survival rate was 0.962 at 10years. Young patients diagnosed with breast cancer typically present with advanced breast imaging findings and undergo aggressive treatment. Recurrence often occurs >5years from diagnosis, and ER positive subtypes are at increased risk for recurrence.

A New Imaging Workup of The Male Breast: Single-View Mammography and Ultrasonography

Background: There is no generally accepted standard radiological approach to male breast diseases. Ultrasonography and mammography are the most preferred methods for imaging. The purpose of this study is to investigate the diagnostic performances of only single-view (mediolateral oblique) mammography and routine two-view mammography in the male breast diseases and also to evaluate the contribution of ultrasonography to the diagnosis and the management of the disease.Methods: Three hundred-twenty male patients’ breast imaging findings were evaluated retrospectively. Only mediolateral oblique and routine two-view mammograms were re-evaluated four months apart by two breast radiologists. The kappa value was calculated to measure consistency between two groups. The sensitivity, specificity, positive and negative predictive value, and detection accuracy of malignancy were calculated for both mammographic examinations and ultrasonography.Results: The accuracy of detection of malignant breast masses according to mediolateral oblique and two-view mammograms, and ultrasonography were 96.3 %, 97.5 %, and 99.5 %, respectively. Consistency between single-view and two-view mammograms was excellent (? = 0.967) and statistically significant (p=0.000). Two-view mammograms did not make any contribution to single-view mammograms.Conclusion: Only mediolateral oblique mammogram is sufficient in terms of characterization, spread and localization of the lesion, as long as mastectomy is preferred and the findings are supported by ultrasonography. Since there is no diagnostic performance difference, only mediolateral oblique view would protect from the potential adverse effects of extra radiation exposure and this is an important advantage.

Palpable Breast Findings in High-risk Patients: Are Self- and Clinical Breast Exams Worthwhile?

To assess breast imaging findings, biopsy rates, and malignancy rates in areas of palpable concern in women at high risk for breast cancer. An IRB-approved retrospective review of a tertiary cancer center's breast imaging database was performed. Breast imaging and electronic medical records of high-risk women with palpable findings detected on self- or clinical breast examination from January 1, 2010, to January 1, 2016, were reviewed. Descriptive statistical analyses were conducted. Imaging correlates for 322 palpable findings in 238 high-risk women included 55/203 (27.1%) on mammography, 183/302 (60.6%) on US, and 20/47 (42.6%) on MRI. Biopsies were performed for 104/322 (32.3%) palpable findings: 95/104 (91.3%) under imaging guidance and 9/104 (8.7%) under palpation after negative imaging. Of 322 palpable findings, 16 (5.0%) were malignant in 16/238 (6.7%) women, yielding a positive predictive value of biopsy of 16.8% (95% CI: 9.2%-24%). Women diagnosed with cancer had 16/16 (100%) sonographic, 9/14 (64.3%) mammographic, and 7/7 (100%) MRI correlates. Cancer histopathology included 12 invasive ductal carcinomas, 1 ductal carcinoma in situ, 1 invasive lobular carcinoma, 1 malignant phyllodes tumor, and 1 metastatic carcinoid tumor. Over two years of follow-up imaging in 183/238 (76.9%) women were reviewed; 7/183 (3.8%) were diagnosed with breast cancer at least one year after presenting with a palpable concern in a different location. High-risk women with palpable findings exhibit a 6.7% malignancy rate, indicating the value of imaging workup in this population. In our cohort, imaging demonstrated a high negative predictive value.

Breast Imaging Findings among Asymptomatic Women who Underwent Screening Mammographic Examination in Port Harcourt, South-South, Nigeria

cancer-related morbidity and mortality through early detection and treatment. Breast cancer death is rising in Nigeria and over 70% of breast cancer patients present with advanced stages when no known remedy can annul disease advancement. This study was designed to document the findings of screening mammography of asymptomatic women to emphasize the role of screening mammography in early detection of breast cancer so as to encourage our women to embrace preventive care.

Zuska's breast disease: Breast imaging findings and histopathologic overview

Zuska's disease describes the clinical condition of recurrent central or periareolar nonpuerperal abscesses associated with lactiferous fistulas. Pathogenesis involves the occlusion of an abnormal duct through an epithelial desquamation process that causes ductal dilatation, stasis of secretions, and periductal inflammation. Patients with Zuska's disease may develop chronic draining sinuses near the areola from lactiferous ducts fistula; therefore, the underlying abnormal duct system must be located and excised for proper treatment. Zuska's disease is often misdiagnosed and mistreated and is associated with significant morbidity, including the recurrence of abscess and cutaneous fistula formation. This case series aimed to help clinicians investigate and manage this disorder. The clinical and imaging findings, histopathologic correlation, and treatment of Zuska's disease are discussed.

Diagnostic performance of machine learning applied to texture analysis-derived features for breast lesion characterisation at automated breast ultrasound: a pilot study

BackgroundOur aims were to determine if features derived from texture analysis (TA) can distinguish normal, benign, and malignant tissue on automated breast ultrasound (ABUS); to evaluate whether machine learning (ML) applied to TA can categorise ABUS findings; and to compare ML to the analysis of single texture features for lesion classification.MethodsThis ethically approved retrospective pilot study included 54 women with benign (n = 38) and malignant (n = 32) solid breast lesions who underwent ABUS. After manual region of interest placement along the lesions’ margin as well as the surrounding fat and glandular breast tissue, 47 texture features (TFs) were calculated for each category. Statistical analysis (ANOVA) and a support vector machine (SVM) algorithm were applied to the texture feature to evaluate the accuracy in distinguishing (i) lesions versus normal tissue and (ii) benign versus malignant lesions.ResultsSkewness and kurtosis were the only TF significantly different among all the four categories (p < 0.000001). In subsets (i) and (ii), a maximum area under the curve of 0.86 (95% confidence interval [CI] 0.82–0.88) for energy and 0.86 (95% CI 0.82–0.89) for entropy were obtained. Using the SVM algorithm, a maximum area under the curve of 0.98 for both subsets was obtained with a maximum accuracy of 94.4% in subset (i) and 90.7% in subset (ii).ConclusionsTA in combination with ML might represent a useful diagnostic tool in the evaluation of breast imaging findings in ABUS. Applying ML techniques to TFs might be superior compared to the analysis of single TF.