Mammographic Findings Research Articles

Synthetic Mammography: Review of Benefits and Drawbacks in Clinical Use.

Digital breast tomosynthesis (DBT) has been widely adopted as a breast cancer screening tool, demonstrating decreased recall rates and other improved screening performance metrics when compared to digital mammography (DM) alone. Drawbacks of DBT when added to 2D DM include the increased radiation dose and longer examination time. Synthetic mammography (SM), a 2D reconstruction from the tomosynthesis slices, has been introduced to eliminate the need for a separate acquisition of 2D DM. Data show that the replacement of 2D DM by SM, when used with DBT, maintains the benefits of DBT, such as decreased recall rates, improved cancer detection rates, and similar positive predictive values. Key differences between SM and 2D DM include how the image is acquired, assessment of breast density, and visualization of mammographic findings, such as calcifications. Although SM is approved by the Food and Drug Administration and has been shown to be non-inferior when used with DBT, concerns surrounding SM include image quality and artifacts. The purpose of this review article is to review the benefits, drawbacks, and screening performance metrics of SM versus DBT.

Fibromatosis of the Breast: Report of a Case with Cytohistological Correlation

Background: Breast fibromatosis is a very rare, locally infiltrative lesion, without metastatic potential that arises from either stromal fibroblasts or myofibroblasts of the breast or from the pectoral fascia, extending into the breast, with its cytological and histological features only rarely being described. Case Presentation: A 58-year-old woman, with no past medical/surgical or family history, was diagnosed on regular mammographic and ultrasound examination with a nodular tumor density, in the upper inner part of her right breast. There were no calcifications or apparent lymph nodes in the right axilla. The woman underwent FNA and US-guided biopsy and final resection biopsy under hook marking. We reviewed the cytological findings of fibromatosis of the breast, as they presented in FNAC aspirates of a non-palpable mammographic finding and the histological findings in both preoperative core-needle biopsy and excision specimen. The final diagnosis was of fibromatosis of the breast. No further actions were taken. The woman is well, without recurrence, more than four years afterwards. Conclusion: Our case can make the pathologists more acquainted with the cytological and pathologic features of a rare tumor entity and the clinicians with a rare breast lesion, which can mimic malignancy both clinically and radiologically. The diagnosis of fibromatosis of the breast is more reliable in excision specimens. Nevertheless, cytology can be an invaluable adjunct to histology, pre-operatively, as it can exclude cancer and help in the preoperative planning.

A Five-Year Review of the Outcomes of Breast Imaging Reporting and Data System 4 Lesions in Hospital Universiti Sains Malaysia.

Purpose: The Breast Imaging Reporting and Data System (BI-RADS) lexicon used in reporting breast imaging has several categories with specific positive predictive values for breast cancer. Among those, BI-RADS 4 is associated with a wider range of risk for breast cancer, which makes the decision for biopsy difficult. The study aim was to determine the malignancy rate and clinical outcomes of BI-RADS 4 lesions in Hospital Universiti Sains Malaysia (HUSM) for a period of five years.Methods: This was a retrospective study of patients diagnosed by mammographic or ultrasonographic findings with BI-RADS 4 breast lesions in HUSM, Kelantan from July 2015 to June 2020. Data were collected from the medical records and an electronic database. Patients with BI-RADS 4 lesions who underwent biopsy and had a known tissue diagnosis were included in this study. The data was used to calculate the malignancy rate and associated positive predictive factors for breast cancer associated with BI-RADS 4 lesions.Results: From the mammography and ultrasonography performed at HUSM from July 2015 to June 2020, a total of 256 lesions were categorized as BI-RADS 4. However, only 198 BI-RADS 4 lesions underwent biopsy and were included in the study. Of these 198 lesions, 26.8% were malignant on histopathological examination of the biopsy samples. Simple logistic regression analysis showed that age, diabetes mellitus, hypertension, number of parity, and certain mammogram findings were significantly associated with breast cancer. Invasive breast cancer was the most common type. Fibrocystic disease was the most common benign pathology, followed by fibroadenoma.Conclusion: The malignancy rate of BI-RADS 4 lesions in HUSM was similar to previously reported rates. A thorough evaluation of positive predictive factors and careful selection of patients for biopsy in BI-RADS 4 lesions will minimize unwanted biopsies and associated patient anxiety, in addition to reducing the health care burden.

359 Lynch syndrome and breast cancer: Our experience

Introduction and aims: of the study: Lynch Syndrome (LS), also known as Hereditary Non-Polyposis Colorectal cancer (HNPCC), is a hereditary cancer predisposition syndrome caused by autosomal dominant mutation in tumor suppressor genes, the DNA mismatch repair proteins (MMR). Alterations in four DNA MMR genes are related to LS: MLH1, MSH2, MSH6 and PMS2. LS is associated with a variety of cancers, mostly with colorectal and endometrial cancer. We present three cases of breast cancer associated with LS. Methods: Three different patients presented to our clinic with abnormal mammographic findings and were diagnosed with breast cancer and LS. The first patient who was 68 years old and had a personal history of thyroid, endometrial and breast cancer, presented with a newly diagnosed DCIS in the contralateral breast. The second one, a 60 year old woman had a personal history of endometrial cancer, while our third patient was 45 years old and had a family history of breast cancer (sister, 36 years old). Genetic testing revealed mutations in MSH6 gene in the first two patients and in PMS2 gene in the third one. Discussion: Approximately 5% of endometrial and 1% of ovarian cancer occur because of LS. LS patients have a life time risk of 5-14% for breast cancer, 4-12% for ovarian cancer, 30-70% for colon cancer and 30-60% for endometrial cancer. According to the literature breast cancer in LS patients seems to be related more often with MSH6 mutations. Risk management guidelines for these patients are available, recommending earlier and more frequent gastrointestinal and gynecologic screening. Breast cancer screening is based upon the individual risk resulting from personal and family history. In some cases apart from hysterectomy with bilateral salpingo-oophorectomy, bilateral mastectomy appears to be necessary. Conclusions: It is significant to offer genetic consultation and testing in patients with breast cancer and personal or family history of colorectal, ovarian, endometrial and breast cancer.

Breast adenomyoepithelioma from a radiologic perspective

Adenomyoepithelioma of the breast (AB) is an uncommon tumor that is characterized by the biphasic proliferation of epithelial and myoepithelial cells. The radiologic findings for AB have been scantly reported. This paper aims to analyze the characteristic findings for AB on ultrasonography (US) and mammography. This retrospective descriptive study used the Breast Imaging-Reporting and Data System (BI-RADS) to analyze the US and mammography findings for histologically confirmed AB in patients attended at our institution between 2007 and 2019. We identified a total of 13 AB in 13 women. All patients underwent US. On US, 12 lesions were seen as oval nodules, and the remaining lesion was irregular-shaped; 8 lesions had circumscribed margins, 3 had angled margins, and 2 had microlobulated margins. Regarding the echo pattern, 8 lesions were hypoechoic and 5 were complex (solid-cystic). On color Doppler, 11 lesions were vascularized nodules and 2 were avascular nodules. In conclusion, we present the imaging characteristics for a series of cases of AB. It is unlikely that this lesion can be suspected solely on the basis of the imaging findings; nevertheless, it is important for radiologists to be familiar with AB to carry out a good radiopathologic correlation.

Cancer yield and imaging features of probably benign calcifications at digital magnification view.

To investigate the malignancy rate of probably benign calcifications assessed by digital magnification view and imaging and clinical features associated with malignancy. This retrospective study included consecutive women with digital magnification views assessed as probably benign for calcifications without other associated mammographic findings from March 2009 to January 2014. Initial studies rendering a probably benign assessment were analyzed, with biopsy or 4-year imaging follow-up. Fisher's exact test and univariable logistic regression were performed. Cancer yields were calculated. A total of 458 lesions in 422 patients were finally included. The overall cancer yield was 2.2% (10 of 458, invasive cancer [n = 4] and DCIS [n = 6]). Calcification distribution (OR = 23.80, p = .041), calcification morphology (OR = 10.84, p = .005), increased calcifications (OR = 29.40, p = .001), and having a concurrent newly diagnosed breast cancer or high-risk lesion (OR = 10.24, p = .001) were associated with malignancy. Cancer yields did not significantly differ between grouped punctate calcifications vs. calcifications with other features (1.2% [2 of 162] vs. 2.7% [8 of 296], p = .506). The cancer yield was 1.6% (7 of 437) in women without newly diagnosed breast cancer or high-risk lesions. The cancer yield of probably benign calcifications assessed by digital magnification view was below the 2% threshold for grouped punctate calcifications and for women without newly diagnosed breast cancer or high-risk lesions. Calcification distribution, morphology, increase in calcifications, and the presence of newly diagnosed breast cancer/high-risk lesion were associated with malignancy. • Among 458 probably benign calcifications assessed by digital magnification view, the overall cancer yield was 2.2% (10 of 458). • The cancer yield was below the 2% threshold for grouped punctate calcifications (1.2%, 2 of 162) and in women without newly diagnosed breast cancer or high-risk lesions (1.6%, 7 of 437). • Calcification distribution, morphology, increase in calcifications, and the presence of newly diagnosed breast cancer/high-risk lesion were associated with malignancy (all p < .05).

“I saw the sign”: Ace of Base (yes) inspires a column for Clinical Imaging promoting education, mentorship and sponsorship

“I saw the sign”: Ace of Base (yes) inspires a column for Clinical Imaging promoting education, mentorship and sponsorship

Retrospective Review of Missed Cancer Detection and Its Mammography Findings with Artificial-Intelligence-Based, Computer-Aided Diagnosis.

To investigate whether artificial-intelligence-based, computer-aided diagnosis (AI-CAD) could facilitate the detection of missed cancer on digital mammography, a total of 204 women diagnosed with breast cancer with diagnostic (present) and prior mammograms between 2018 and 2020 were included in this study. Two breast radiologists reviewed the mammographic features and classified them into true negative, minimal sign or missed cancer. They analyzed the AI-CAD results with an abnormality score and assessed whether the AI-CAD correctly localized the known cancer sites. Of the 204 cases, 137 were classified as true negative, 33 as minimal signs, and 34 as missed cancer. The sensitivity, specificity and diagnostic accuracy of AI-CAD were 84.7%, 91.5% and 86.3% on diagnostic mammogram and 67.2%, 91.2% and 83.38% on prior mammogram, respectively. The AI-CAD correctly localized 27 cases from 34 missed cancers on prior mammograms. The findings in the preceding mammography of AI-CAD-detected missed cancer were common in the order of calcifications, focal asymmetry and asymmetry. Asymmetry was the most common finding among the seven cases, which could not be detected by AI-CAD in the missed cases (5/7). The assistance of AI-CAD can be helpful in the early detection of breast cancer in mammography screenings.

Automated Deep Learning Empowered Breast Cancer Diagnosis Using Biomedical Mammogram Images

Biomedical image processing is a hot research topic which helps to majorly assist the disease diagnostic process. At the same time, breast cancer becomes the deadliest disease among women and can be detected by the use of different imaging techniques. Digital mammograms can be used for the earlier identification and diagnostic of breast cancer to minimize the death rate. But the proper identification of breast cancer has mainly relied on the mammography findings and results to increased false positives. For resolving the issues of false positives of breast cancer diagnosis, this paper presents an automated deep learning based breast cancer diagnosis (ADL-BCD) model using digital mammograms. The goal of the ADL-BCD technique is to properly detect the existence of breast lesions using digital mammograms. The proposed model involves Gaussian filter based pre-processing and Tsallis entropy based image segmentation. In addition, Deep Convolutional Neural Network based Residual Network (ResNet 34) is applied for feature extraction purposes. Specifically, a hyper parameter tuning process using chimp optimization algorithm (COA) is applied to tune the parameters involved in ResNet 34 model. The wavelet neural network (WNN) is used for the classification of digital mammograms for the detection of breast cancer. The ADL-BCD method is evaluated using a benchmark dataset and the results are analyzed under several performance measures. The simulation outcome indicated that the ADL-BCD model outperforms the state of art methods in terms of different measures.

Comparison of ultrasonographic and mammographic features of extremely rare papillary carcinoma and invasive ductal carcinoma

This study aimed to investigate and compare ultrasonographic and mammographic findings of papillary breast carcinoma and invasive ductal carcinoma in breast masses that were diagnosed as pathological. This retrospective study included 88 patients with breast lesions, who underwent ultrasonography, mediolateral oblique-craniocaudal, and tomosynthesis imaging in the Picture Archiving and Communication System between January 2010 and March 2019. 44 histopathologically diagnosed papillary carcinoma patients and 44 invasive ductal carcinoma patients were divided into groups according to contour, shape, internal structure, calcific-cystic component, echogenicity, posterior acoustic change, skin orientation, and environmental echogenic halo. There was a statistically significant difference between the groups in mammography contour, U/S contour, U/S shape, U/S posterior acoustics, and U/S internal structure. Logistic regression analysis showed that the presence of homogenous appearance (p < 0.001) and absence of shading in the posterior acoustic U/S (p = 0.001) were the most pertinent findings for determining papillary carcinoma. In the U/S, the likelihood of a homogenous tumour being a papillary carcinoma was 16.869 times higher than that of invasive ductal carcinoma, whereas the same probability was 0.1101 times less for a tumour with posterior acoustic shadowing. It is challenging to differentiate between invasive ductal carcinoma and papillary carcinoma of the breast without histopathological diagnosis both on ultrasound and mammography. The results of our study demonstrated that the ultrasonographic and mammographic findings of invasive ductal carcinoma and papillary carcinoma were like each other. Therefore, it is still not possible to distinguish between these 2 types of cancer only in accordance with these 2 criteria.

Unusual presentation of dermal microcalcifications on mammography images: A case report

Introduction. Calcifications and microcalcifications are mineral deposits in the breast tissue. Breast calcifications are a common mammographic finding, present on over 80% of images, and they are usually benign. Characteristics such as size, shape, number, distribution pattern, location, density, and other findings help determine the pathology. Dermal calcifications of the breast are superficial and benign calcifications that are usually found on the sebaceous glands of the skin. In some cases, calcifications can be the first marker of underlying cancer development. They may be associated with the presence of ductal carcinoma in situ or even invasive ductal carcinoma that has spread to the surrounding breast tissue. By correct identification of benign calcifications as such, unnecessary interventions and use of limited resources can be avoided. Case Report. A 66-year-old female patient presented for a regular mammography check-up. On the previous mammographic examination, she was categorized as bilateral breast imaging reporting and data system 1. The new mammography images showed numerous newly formed grouped microcalcifications at the junction of the lower quadrants of the right breast, and a stereotactic vacuum-assisted biopsy was indicated. During the biopsy attempt, the image guided biopsy program did not detect any calcifications in the parenchyma or in any projection and therefore it did not allow the biopsy procedure to continue after several attempts. Examination of the right breast skin revealed lesions treated by the patient for a few weeks; a repeat mammogram was performed and it was observed that the calcifications were of dermal origin. Conclusion. Dermal calcifications are mostly tiny, about the size of skin pores, single or clustered, and often have a calcified rim surrounding a lucent center. However, dermal calcifications deserve a special attention, because they sometimes lack a lucent center and simulate grouped intraparenchymal calcifications that require careful monitoring or biopsy.

Imaging and pathologic features of non-calcified ductal carcinoma in situ: can sonography predict upgrade?

The purpose of this study was to evaluate the imaging and pathologic features and upgrade rate of non-calcified ductal carcinoma in situ (NCDCIS). The study tested the hypothesis that lesions with sonographic findings have higher upgrade rate compared to lesions seen on mammography or MRI only. This retrospective study included patients with ductal carcinoma in situ (DCIS) diagnosed by image-guided core breast biopsy from December 2009 to April 2018. Patients with microcalcifications on mammography or concurrent ipsilateral cancer on core biopsy were excluded. An upgrade was defined as surgical pathology showing microinvasive or invasive cancer. A total of 71 lesions constituted the study cohort. 62% of cases (44/71) had a mammographic finding, and 38% (27/71) of mammographically occult lesions had findings on either ultrasound, MRI, or both. Of the 67 cases that underwent sonography, a mass was noted in 56/67 (83.6%) cases and no sonographic correlate was identified in 11/67 (16.4%) cases. 21% (15/71) of lesions were upgraded on final surgical pathology. The upgrade rate of patients with sonographic correlate was 27% (15/56) vs with mammographic findings only was 0% (0/11). DCIS should be considered in the differential diagnosis of architectural distortion, asymmetries, focal asymmetries, and masses, even in the absence of microcalcifications. NCDCIS diagnosed by ultrasound may be an independent risk factor for upgrade. Radiologists must be aware of imaging features of DCIS and consider increased upgrade rate when NCDCIS is diagnosed by ultrasound.

Construction of mammographic findings simulators to study the interference of silicone implants in the diagnosis of breast cancer

Introduction: Breast cancer is the most prevalent malignant neoplasm among women, presenting itself, in 99% of cases, in females. Augmentation mammoplasty is the most performed aesthetic surgical intervention in the world. Objective: This study aims to improve the search for biomaterials compatible with mammographic findings suggestive of malignancy, to further study the interference of silicone implants in mammography exams. Methods: To make the simulators of mammographic findings, a bibliographic study of possible biomaterials that presented compatibility with the breast tissue and with possible neoplastic findings was carried out. The validation process of the simulators made in this work was carried out in two stages. Results: The result found was a density variation between 2.54 and 2.57 (dimensionless unit). For the second plate, the individual optical density of each material was analyzed. The results found for fiberglass ranged between 1.95 and 2.63. For chicken eggshells between 0.59 and 0.80. For the glycerin suppository, values between 1.43 and 2.29 were found. And for plastic PVC film 1.78 to 2.53. Conclusion: Given the above, it is observed that the first plate as a whole is compatible with mammographic studies. However, on the second plate, when the materials were analyzed separately, it was observed that fiberglass and plastic PVC film were the closest to compatibility with the commercial phantom, being compatible materials to simulate breast neoplasms in possible further studies.

Best Practice Guideline - DEGUM Recommendations on Breast Ultrasound.

For many years, breast ultrasound has been used in addition to mammography as an important method for clarifying breast findings. However, differences in the interpretation of findings continue to be problematic 1 2. These differences decrease the diagnostic accuracy of ultrasound after detection of a finding and complicate interdisciplinary communication and the comparison of scientific studies 3. In 1999, the American College of Radiology (ACR) created a working group (International Expert Working Group) that developed a classification system for ultrasound examinations based on the established BI-RADS classification of mammographic findings under consideration of literature data 4. Due to differences in content, the German Society for Ultrasound in Medicine (DEGUM) published its own BI-RADS-analogue criteria catalog in 2006 3. In addition to the persistence of differences in content, there is also an issue with formal licensing with the current 5th edition of the ACR BI-RADS catalog, even though the content is recognized by the DEGUM as another system for describing and documenting findings. The goal of the Best Practice Guideline of the Breast Ultrasound Working Group of the DEGUM is to provide colleagues specialized in senology with a current catalog of ultrasound criteria and assessment categories as well as best practice recommendations for the various ultrasound modalities.

Attentive Evaluation of Trace Elements in Patients with Breast Cancer-A Cross Sectional Study of Nawabshah, Sindh, Pakistan

Background: Breast cancer has recently become one of the most obsessing and life threatening issues in the world. Globally, females suffered mostly by breast cancer. Breast cancer is multifactorial etiological disorder. Trace elements are acts as cofactors and biological catalyst. They play a very essential role in the metabolic pathways.&#x0D; Methods: A cross sectional study with two hundred (200) subjects and divided into two groups. 50 females were normal healthy as a control while 150 females were patient with breast cancer. Blood was collected from all participant after taking history, clinical data, mammographic and histopathological findings. Consent and predesign porforma were filled by all participants of study. The trace elements (Na, K, Zn, Fe, Ca) were determined through atomic absorption spectrophotometer (ASS) and other biochemical analysis such as Total Protein, serum albumin and Total cholesterol were analyzed on Micro Lab.300. Data was entered on SPSS 22.0 version, and applied student t-test for continuous variables. Results were analyzed as Mean and standard deviation.&#x0D; Results: The results of serum Na+, K+, Ca++, Zn++, Cu++ and Fe in breast cancer patient were observed and found significantly fluctuated in breast cancer patients as compared to normal healthy subjects. Serum Total Protein significantly increased whereas serum Albumin decreased in patient with breast cancer.&#x0D; Conclusions: in Present study we found significantly abnormal concentration of Na+, K+, Ca++, Zn++, Cu++ and Fe in breast cancer these elements may contribute in early diagnosis of breast cancer. Increased body weight and total cholesterol are also risk factors of Ca breast.

Women with Abnormal Mammographic Findings and High Neutrophil-to-Lymphocyte Ratio have the Worst Dietary Carbohydrate Quality Index

Introduction: There are gaps in knowledge in breast cancer prevention studies focusing on interactions among mammographic findings, inflammation, and diet, especially those related to carbohydrates. Objective: We aimed to verify the association among mammographic findings, inflammatory markers, and carbohydrate quality index (CQI) in women. Methodology: This was a cross-sectional study of 532 women assisted in a healthcare service. The enrolled women were divided into two groups according to their mammographic findings: those without and those with abnormal mammographic findings. Two 24-hour dietary reminders were applied, and CQI was determined based on four components: fibers, glycemic index, ratio between whole and total grains, and ratio between solid and total carbohydrates. The neutrophil-to-lymphocyte ratio (NLR) was calculated as an inflammatory marker. Results: There were 178 (33.5%) women with abnormal mammographic findings, and 20 (3.8%) had NLR. There was no association between CQI and mammographic findings and NLR. Women with abnormal mammographic findings and high NLR had lower CQI (p = 0.039) and lower whole total ratio (p = 0.024). Conclusion: Women with abnormal findings and high NLR had worse CQI and worse overall total grain ratio.

Invasive ductal carcinoma mammographic findings: Correlation with age, breast composition and tumor size.

The aim of this study was to identify the mammographic findings associated with malignancy in different age groups, taking into account breast composition (BC) and lesion size. Preoperative mammograms of 1023 invasive ductal carcinomas were retrospectively evaluated. According to the American College of Radiology Breast Imaging Reporting and Data System, cancer mammographic findings were classified as mass, calcifications, architectural distortion and asymmetry, and breasts were assessed as non-dense (A or BBC) and dense (C or DBC). Patient cohort was subdivided into three age groups (group 1: <50 years of age; group 2: between 50 and 69; group 3: ≥70 years of age). Significant results of multinomial logistic regression were the association between mass and non-dense breast (p <0.0001) and the association between mass and tumor size larger than 15mm (p =0.0049). Mass finding of invasive ductal breast carcinoma is associated with breast composition and tumor size.

Pre-treatment MRI tumor features and post-treatment mammographic findings: may they contribute to refining the prediction of pathologic complete response in post-neoadjuvant breast cancer patients with radiologic complete response on MRI?

Radiologic complete response (rCR) in breast cancer patients after neoadjuvant chemotherapy (NAC) does not necessarily correlate with pathologic complete response (pCR), a marker traditionally associated with better outcomes. We sought to verify if data extracted from two important steps of the imaging workup (tumor features at pre-treatment MRI and post-treatment mammographic findings) might assist in refining the prediction of pCR in post-NAC patients showing rCR. A total of 115 post-NAC women with rCR on MRI (2010-2016) were retrospectively assessed. Pre-treatment MRI (lesion morphology, size, and distribution) and post-treatment mammographic findings (calcification, asymmetry, mass, architectural distortion) were assessed, as well as clinical and molecular variables. Bivariate and multivariate analyses evaluated correlation between such variables and pCR. Post-NAC mammographic findings and their correlation with ductal in situ carcinoma (DCIS) were evaluated using Pearson's correlation. Tumor distribution at pre-treatment MRI was the only significant predictive imaging feature on multivariate analysis, with multicentric lesions having lower odds of pCR (p = 0.035). There was no significant association between tumor size and morphology with pCR. Mammographic residual calcifications were associated with DCIS (p = 0.009). The receptor subtype remained as a significant predictor, with HR-HER2 + and triple-negative status demonstrating higher odds of pCR on multivariate analyses. Multicentric lesions on pre-NAC MRI were associated with a lower chance of pCR in post-NAC rCR patients. The receptor subtype remained a reliable predictor of pCR. Residual mammographic calcifications correlated with higher odds of malignancy, making the correlation between mammography and MRI essential for surgical planning. Key Points • The presence of a multicentric lesion on pre-NAC MRI, even though the patient reaches a radiologic complete response on MRI, is associated with a lower chance of pCR. • Molecular status of the tumor remained the only significant predictor of pathologic complete response in such patients in the present study. • Post-neoadjuvant residual calcifications found on mammography were related to higher odds of residual malignancy, making the correlation between mammography and MRI essential for surgical planning.

Can Ultrasound Elastography Help Better Manage Mammographic BI-RADS Category 4 Breast Lesions?

BackgroundTo assess the performance of conventional ultrasound (US) combined with strain elastography (SE) in the Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions on mammography. Materials and MethodsWomen with breast lesions identified as having mammography BI-RADS 4 lesions and underwent US examination were included in China. US features and US BI-RADS assessment were recorded in real-time and prospectively reported. The pathological result was referred to as the gold standard. The performance of US in the mammographic BI-RADS category 4 lesions was evaluated. Diagnostic performances of US BI-RADS, SE and combined both were compared. ResultsA total of 751 women with 751 breast lesions classified as mammographic BI-RADS category 4 were included. For mammographic findings, 530 (70.6%) were true positive and 221 (29.4%) were false positive. Conventional US achieved higher positive predictive value (PPV) than mammography (78.5% vs. 70.6%, P=.001). The specificity increased from 34.4% to 47.1% (P< .001) without any loss in sensitivity and the PPV increased to 81.9% (P = .122) when conventional US was used in combination with SE. For conventional US combined with SE, it led to a correct diagnosis of no breast cancer in 104 of the 221 false-positive findings (47.1%) and achieved higher PPV than mammography regardless of patient age and lesion size. ConclusionConventional US combined with SE is a helpful tool for the noninvasive examination of breast lesions classified as BI-RADS category 4 on mammography. It helped increase the PPV and had the potential to avoid unnecessary biopsies of BI-RADS category 4 lesions detected on mammography.

Could Breast Tomosynthesis With Synthetic View Mammography Aid Standard Two-Dimensional Mammography in Evaluation at Symptomatic Triple Assessment Breast Clinics?

BackgroundThis study aimed to determine whether breast tomosynthesis and synthetic view mammography (SM) can aid standard two-dimensional mammography (S2DM) in the evaluation of symptomatic women at triple assessment clinics (TACs).MethodologyDigital breast tomosynthesis (DBT), SM, and S2DM were performed on 400 patients at symptomatic breast TACs between September 2020 and November 2020. Diagnostic findings on mammography and ultrasound were retrospectively recorded and analyzed by a breast-trained radiologist with 13 years of clinical experience. Pathology results for all biopsies were recorded and correlated with the mammographic and ultrasound findings.ResultsThe combination of DBT and SM was superior to S2DM in the following settings: calcifications were more conspicuous on SM than S2DM in 44% of patients with calcifications. Mass margins were better defined on DBT than S2DM in 71% of patients with masses. Distortion was more easily detectable in 11% of patients with distortion on SM and in 44% of patients with distortion on DBT compared with S2DM. All malignant lesions were identified on all modalities.ConclusionsCombined DBT and SM demonstrated several advantages over S2DM alone. SM can provide equal and sometimes superior diagnostic performance with the added benefit of requiring no additional radiation exposure when synthesized from DBT data. We conclude that adding DBT and SM to S2DM aids in the assessment of symptomatic women, and omitting S2DM results in no loss of clinically relevant information for women presenting to symptomatic breast clinics.