Time-dependent diffusion MRI for non-invasive differentiation of benign and malignant breast lesions and evaluation of proliferation index biomarkers.

Breast cancer remains a major global health challenge, and conventional B-mode ultrasound frequently encounters limitations in reliably distinguishing benign from malignant lesions, particularly within intermediate Breast Imaging-Reporting and Data System (BI-RADS) categories. These uncertainties often contribute to unnecessary biopsies. Shear wave elastography (SWE), a quantitative method for assessing tissue stiffness, may improve diagnostic confidence by providing objective elasticity thresholds. This study aimed to evaluate the diagnostic accuracy of SWE in routine clinical practice and to determine optimal stiffness cut-off values for differentiating benign from malignant breast lesions. In this prospective single-center study, 73 women (mean age 48.6 ± 15.6 years) with BI-RADS 3-5 breast lesions underwent SWE examination prior to biopsy. Stiffness measurements (kPa and m/s) were obtained for each lesion. Histopathology served as the reference standard. Diagnostic performance was assessed, and optimal thresholds were determined using receiver-operating characteristic (ROC) analysis. Intra- and interobserver reproducibility were evaluated. Malignant lesions demonstrated significantly higher stiffness values (mean 56.7 kPa) compared with benign lesions (mean 18.7 kPa). SWE exhibited excellent diagnostic accuracy with an AUC of 0.932. The optimal cut-off value for distinguishing malignant from benign lesions was 40.03 kPa (sensitivity 88%, specificity 95%), corresponding to 3.6 m/s. Stiffness measurements showed high reproducibility across observers. SWE accurately differentiates benign from malignant breast lesions, improving specificity, and potentially reducing unnecessary biopsies. Standardization is needed to support widespread clinical adoption.

A novel and general spatiotemporal diagnostic model: Intratumoral outflow and peritumoral inflow for the differentiation and stratification of breast tumor.

Granular cell tumor (GCT) of the breast is a rare, typically benign neoplasm of Schwann cell origin, which frequently presents a significant diagnostic challenge due to its ability to clinically and radiologically mimic invasive breast carcinoma. We present the case of a 45-year-old female who presented with a palpable, firm, non-mobile mass in the right upper inner quadrant of her breast. Diagnostic imaging was highly suspicious for malignancy, with mammography revealing a high-density, spiculated, irregular mass with architectural distortion (BI-RADS 5), and ultrasound demonstrating an irregular, hypoechoic mass with severe posterior acoustic shadowing and a "taller-than-wide" orientation. Core needle biopsy was performed due to the high suspicion of malignancy. Histopathological examination revealed nests and sheets of large, polygonal cells with abundant granular, eosinophilic cytoplasm. Immunohistochemistry (IHC) studies were critical for definitive diagnosis, showing strong positivity for S100 protein and SOX10, and granular positivity for CD68, while being negative for cytokeratin markers (AE1/AE3, CAM 5.2). This immunoprofiling confirmed the diagnosis of benign GCT. The patient was successfully treated with complete surgical excision (R0 resection) and has remained free of local recurrence at three years of follow-up. This case underscores the critical role of tissue diagnosis and characteristic IHC in differentiating this rare benign entity from malignant breast lesions, thereby preventing unnecessary aggressive treatment.

Breast cancer remains a major challenge in women's health globally. Early screening and personalized treatment can improve outcomes. This study aimed to evaluate ultrasound viscosity imaging (UVI) for distinguishing benign from malignant breast lesions and noninvasively assessing human epidermal growth factor receptor 2 (HER2) status. We conducted a retrospective analysis of 274 breast lesions, randomly divided into a derivation cohort and a validation cohort (VC) at a 7:3 ratio. Breast Imaging Reporting and Data System (BI-RADS) scores and UVI parameters were collected, with histopathology as the reference standard. The Boruta algorithm was used to identify the optimal viscous parameter (VP). A logistic regression model assessed the diagnostic performance of BI-RADS alone and in combination with VP. Associations between viscous parameters (VPs) and HER2 status were also examined. Among 40 VPs, V2.max (maximum viscosity from the Voigt model within a perilesional 2-mm rim) was identified as the optimal marker. When combined with BI-RADS, V2.max enhanced the differentiation between benign and malignant lesions (p<0.001), increasing the area under the curve (AUC) from 0.91 (95% CI: 0.87-0.95) to 0.96 (95% CI: 0.94-0.98). The combined model also demonstrated superior calibration, which was revalidated in the VC. Subgroup analyses confirmed its effectiveness in younger patients and those with larger lesions. Furthermore, we identified four Voigt-model-derived VPs, including V2.max, that correlated with HER2 positivity, and explored their potential histological basis. UVI-derived VPs enhance BI-RADS diagnostic performance for breast lesions and are associated with HER2 status.

Background/Objectives: Estrogen receptor (ER) expression is a key biomarker in breast cancer (BC) and guides endocrine therapy selection. Estrogen receptor-targeted imaging with 16ɑ-[18F]-fluoro-17β-estradiol (18F-FES) PET is recommended in several clinical guidelines for noninvasive assessment of ER status. In clinical practice, 18F-FES PET may also identify ER-negative malignancies or benign breast lesions with variable uptake patterns. This study aimed to systematically characterize 18F-FES PET/MRI uptake patterns in benign breast lesions and across breast cancer subtypes defined by receptor status, histology, and molecular phenotype. Methods: This retrospective single-center study included 41 women with 50 breast lesions who underwent simultaneous 18F-FES PET/MRI prior to any treatment. Histopathology or long-term follow-up served as the standard of reference. Maximum and mean standardized uptake values (SUVmax and SUVmean) were derived using MRI-based lesion delineation. Results: Both benign and malignant breast lesions measuring < 10 mm demonstrated low 18F-FES uptake (SUVmax < 1.00). 18F-FES uptake among benign breast lesions was variable, with SUVmax ranging from 0.44 to 1.57. In contrast, ER-positive lesions ≥ 10 mm exhibited substantially higher 18F-FES uptake (median SUVmax 2.76; range 1.23-9.74) compared with ER-negative tumors of similar size (SUVmax 0.30-0.94). 18F-FES uptake was consistent across histologic BC subtypes and did not differ significantly among ER-positive molecular subtypes. No significant associations were observed with HER2 status or tumor grade. Conclusions: Awareness of the heterogeneous 18F-FES uptake patterns in benign breast lesions, as well as the limited sensitivity for detecting ER-positive tumors < 10 mm, is essential for accurate image interpretation. 18F-FES PET/MRI enables reliable assessment of ER expression in BC lesions ≥ 10 mm, with uptake patterns remaining consistent across molecular and histologic subtypes.

Abstract Background: In the last decades, the proportion of breast cancer patients receiving breast-conserving surgery has increased, reaching 70-80% in developed countries. In case of non-palpable lesions, surgical excision requires some form of breast localization. While wire-guided localization has long been considered gold standard, it carries several limitations, including logistical difficulties, the potential for displacement and patient discomfort, and re-excision rates reaching 21%. Other techniques (radioactive seed or radio-occult lesion localization, intraoperative ultrasound, magnetic, radiofrequency and radar localization) have been developed with the aim of overcoming these disadvantages. However, comparative data on the rates of successful lesion removal, negative margins and re-operations are limited. In the majority of studies, the patient’s perspective with regard to discomfort and pain level has not been evaluated. The aim of MELODY (MEthods for LOcalization of Different types of breast lesions) is to evaluate different imaging-guided localization methods with regard to oncological safety, patient-reported outcomes, and surgeon and radiologist satisfaction. Methods: The EUBREAST and the iBRA-NET have initiated the MELODY study to assess breast localization techniques and devices from several perspectives (NCT05559411, http://eubreast.org/melody). MELODY is a prospective intergroup cohort study which enrolls female and male pts. requiring breast-conserving surgery and imaging-guided localization for invasive breast cancer or DCIS. Multiple or bilateral lesions and neoadjuvant chemotherapy are allowed. Primary outcomes are: 1) Intended target lesion and/or marker removal, independent of margin status on final histopathology, and 2) Negative resection margin rates at first surgery. Secondary outcomes are, among others: rates of second surgery and secondary mastectomy, Resection Ratio (defined as actual resection volume divided by the calculated optimum specimen volume), duration of surgery, marker dislocation rates, rates of marker placement or localization failure, comparison of patient-reported outcomes, rates of “lost markers” and diagnostician/radiologist’s and surgeon’s satisfaction as well as the health economic evaluation of the different techniques. Target accrual: 7,416 patients. Enrollment started in January 2023. The study will be conducted in 30 countries and is supported by the Oncoplastic Breast Consortium (OPBC), AWOgyn, AGO-B and SENATURK. Financial support was provided by Endomag, Merit Medical, Sirius Medical and Hologic. Citation Format: J. Ryu, T. Kühn, N. Ditsch, J. Harvey, S. Hartmann, N. Cabioglu, N. Canturk, A. Karakatsanis, J. de Boniface, T. Filtenborg Tvedskov, L. Pankratjevaite, M. Gasparri, S. Alran, E. Schlichting, A. Lowery, A. Esgueva, R. Di Micco, D. Murawa, M. Kontos, M. Muneer Khan, Y. Masannat, V. Fabiano, K. Abdelwahab, L. Rebaza, F. Peintinger, M. Correia, E. Giblin, G. Dindelegan, S. Nietz, F. Malherbe, A. Kothari, R. Dave, O. Gentilini, B. Güllüoglu, M. Hahn, G. Karadeniz Cakmak, M. Lux, S. Potter, I. Rubio, M. Smidt, W. Weber, N. Krawczyk, K. Jursik, A. Kaiser, A. Körner, M. Köpke, N. Tauber, S. Lukac, M. Banys-Paluchowski, MELODY study group. Melody: A prospective non-interventional multicenter cohort study to evaluate different imaging-guided methods for localization of malignant breast lesions (Eubreast-4 / iBra-net, Nct 05559411) [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-08-17.

To determine the incremental diagnostic value of multiparametric quantitative ultrasound-integrating B-mode, Color Doppler, Strain, and Shear Wave Elastography (SWE)-in differentiating benign and malignant breast lesions, using histopathology/FNAC as the gold standard. Seventy patients with 87 breast lesions underwent comprehensive ultrasound by a resident and a consultant radiologist (> 20years' experience) with consensus reporting. Each lesion was evaluated using B-mode (BI-RADS), Color Doppler (vascularity, resistive and pulsatility indices), Strain elastography (strain ratio), and SWE (stiffness in kPa). Pathological correlation was available for all lesions. Diagnostic performance of individual and combined parameters was assessed using sensitivity, specificity, PPV, NPV, accuracy, and ROC analysis. Multivariate logistic regression evaluated incremental value of multiparametric combinations. B-mode had the highest sensitivity (88.37%) and accuracy (82.76%), Color Doppler the highest specificity (95.45%) but low sensitivity (55.81%), while Strain and SWE showed balanced performance, with SWE achieving the highest accuracy (85.06%) and AUC (0.85). Adding Color Doppler or Strain to B-mode provided no additional benefit. Incorporating SWE improved specificity (88.64%) and accuracy (85.06%). B-mode + Strain + Color Doppler achieved 83.91% accuracy, whereas B-mode + SWE + Color Doppler provided the highest overall performance (sensitivity 86.05%, specificity 86.36%, accuracy 86.21%, AUC 0.86). The four-parameter model (B-mode + Color Doppler + Strain + SWE) showed 83.72% sensitivity, 86.36% specificity, AUC 0.85, and 85.06% accuracy, performing comparably but marginally inferior to the best triple combination (B-mode + Color Doppler + SWE), likely due to redundancy and threshold effects, indicating that adding Strain did not improve performance. Multiparametric ultrasound enhances lesion differentiation. B-mode ensures sensitivity, Color Doppler confirms benign vascular patterns, and SWE provides quantitative stiffness assessment. Combining morphology, vascularity, and stiffness-particularly B-mode + SWE + Color Doppler-yields the highest diagnostic accuracy.

Retraction Note: Diagnostic utility of strain and shear wave ultrasound elastography in differentiation of benign and malignant solid breast lesions

Introduction The round block technique (RBT) is an established oncoplastic approach that enables wide local excision through a periareolar incision while preserving breast contour and minimizing visible scarring. Its growing use in benign and early malignant breast lesions warrants further evaluation. This study assessed the safety, operative efficiency, postoperative recovery, and cosmetic outcomes of RBT in breast-conserving surgery. Methods A prospective observational study was conducted at a tertiary care centre from November 2022 to July 2025. Thirty-six patients with benign breast disease or early breast carcinoma meeting predefined eligibility criteria underwent lumpectomy using the RBT. Clinical characteristics, operative parameters, complications, recovery and cosmetic outcomes were recorded. Data were analysed using descriptive and inferential statistics, with p&lt;0.05 considered significant. Results Fibroadenomas and multiple fibroadenomas constituted the most common diagnoses, followed by gynaecomastia and phyllodes tumours. Most lesions measured 3–6 cm and frequently involved multiple quadrants. Intraoperative dissection was generally uncomplicated, with minimal blood loss and a low complication rate. Seroma and hematoma were the most frequent postoperative events, while serious complications were rare. Hospital stay and recovery time were shortest for fibroadenomas and longest for early breast cancer. Cosmetic outcomes were favourable, with over 80% rated excellent or good. Re-interventions were infrequent and limited to seroma aspiration or minor wound correction. Conclusion The round block technique is a safe and effective breast-conserving approach for benign and selected early malignant lesions, offering rapid recovery, low morbidity, and consistently high cosmetic satisfaction. Larger, long-term studies with patient-reported outcomes are recommended.

Dynamic contrast enhancement-magnetic resonance imaging (DCE-MRI) is becoming increasingly significant for identifying and characterizing breast lesions. It can also provide insight into functional parameters, such as enhancement kinetics and tissue perfusion parameters, including Ktrans, Ve, and Kep. This study explores the role of both qualitative and quantitative analyses of DCE-MRI in enhancing diagnostic accuracy for distin-guishing between benign and malignant breast lesions, contributing to more precise breast cancer diagnosis and management. This single-center cross-sectional study was performed on 47 patients with breast lesions. MRI Breast was performed on a closed 3T MRI scanner equipped with a dedicated 18-channel breast coil. MRI study protocol included conventional Breast MRI and DCE sequences. Statistical analysis was performed using the SPSS statistics software package version 28.0. A total of 47 patients, with an age range of 17 to 70 years old, were included in the study. The sensitivity of kinetic curve analysis was 94.74 %, specificity of 75%, positive predictive value of 72 %, and negative predictive value of 95.45 % to distinguish benign and mali-gnant breast lesions. The mean Ktrans value of benign breast lesions was 0.447+1.55/min and 0.496+1.08 / min (p-value <0.04) for malignant lesions. The mean Kep value of benign breast lesions was 2.984+8.27/ min, and for malignant lesions was 3.424+8.70/ min (p-value <0.008). The mean Ve value did not show a significant value in distinguishing benign and malignant breast lesions (p-value <0.386). Kep cut-off value at 0.279 and Ktrans cut-off value at 0.73 depicted the highest area under the curve (AUC). Integrating qualitative and quantitative data provides a more comprehensive understanding of breast lesions, ultimately leading to more accurate diagnoses and tailored treatment strategies.

Utility of ultrafast kinetic parameters in differentiation of suspicious breast lesions referred for MRI-guided biopsies.

Breast cancer is the most common malignancy among women worldwide and a leading cause of cancer-related mortality in Pakistan. Accurate differentiation between benign and malignant solid breast lesions is essential for appropriate management. Conventional B-mode ultrasonography is widely used but is limited by operator dependence. Shear wave elastography (SWE) provides an objective, quantitative assessment of tissue stiffness and may improve diagnostic accuracy. Objectives: To evaluate the diagnostic accuracy of shear wave elastography in differentiating benign and malignant solid breast lesions using histopathology as the reference standard. Methods: This descriptive cross-sectional study was conducted at the Department of Radiology, Bahawal Victoria Hospital, Bahawalpur, from March to September 2023. A total of 232 patients with solid breast lesions detected on ultrasound underwent SWE followed by core needle biopsy or surgical excision. Mean elasticity (Emean), maximum elasticity (Emax), and lesion-to-parenchyma elasticity ratio were recorded. Diagnostic performance was assessed using receiver operating characteristic analysis. Results: Among 232 lesions, 153 (65.9%) were benign and 79 (34.1%) were malignant. Malignant lesions showed significantly higher SWE values (p&lt;0.001). AUCs were 0.974 for Emean, 0.986 for Emax, and 0.980 for the elasticity ratio. Emax demonstrated the highest accuracy, with 96% sensitivity and 92% specificity at a cutoff of 130–135 kPa. Conclusions: Shear wave elastography shows excellent accuracy for differentiating solid breast lesions, with Emax being the most reliable parameter.

To evaluate if co-registering Diffusion-Weighted Imaging (DWI) before generating Apparent Diffusion Coefficient (ADC) maps can improve differentiating benign and malignant breast lesions in MRI based on the A6702 thresholds. This IRB-approved study involved an in-house dataset and the publicly available ACRIN-6698 dataset, both including multi b-value DWI. In phase one, 16 ANTs library-based co-registration methods were evaluated on a subset of n = 138 cases from our in-house cohort. The quantitative assessment included mean ADC values of manually segmented lesions (diagnostic metrics using individual and A6702-defined thresholds) and coefficient of Variation. In the second phase, the best-performing methods were tested for generalizability on an unseen set of 40 cases (20 from in-house and 20 from external dataset). Three blinded readers segmented lesions on co-registered and non-co-registered ADC maps. Agreement and consistency were evaluated via Bland-Altman, segmentation distance, and intraclass correlation coefficient. Rigid co-registration using DWI at b = 750s/mm2 as reference (b750-Rigid) improved accuracy of both optimal/conservative A6702 trial thresholds with sensitivity/specificity increasing from 93%/10% to 97%/30% and 100%/30% respectively. Mean ADC values were not significantly different after co-registration (p > 0.05). Co-registration of DWI images before ADC map generation, particularly using b750-Rigid registration, seems promising for improving lesion classification in breast MRI. Further validation is warranted.

A combined model of ultrasound viscoelasticity and inflammatory indices for differentiating benign and malignant breast lesions.

Spectral computed tomography (CT) in breast lesion evaluation: clinical utility and imaging spectrum-a pictorial review.

Differentiation of benign and malignant complex cystic lesions of the breast: The diagnostic value of MRI.

Abstract Background: Argyrophilic nucleolar organizer region (AgNOR) staining is a rapid and cost-effective marker of cellular proliferation, useful in differentiating benign from malignant breast lesions. This study evaluated the mean AgNOR count and the subjective AgNOR pattern assessment (SAPA) score in fine needle aspiration cytology (FNAC) samples of breast neoplasms. Materials and Methods: This prospective study included 100 women with palpable breast lumps who underwent FNAC at a tertiary care teaching hospital over 2 years. Smears were stained with hematoxylin and eosin (H and E) for cytology and silver stain for AgNOR analysis. Mean AgNOR count (mAgNOR) and SAPA score were evaluated in 100 neoplastic cells per case. Histopathology was available for 61 cases for correlation. Data were analyzed using SPSS 20.0; descriptive statistics and Chi-square tests were applied, with P &lt; 0.05 considered statistically significant. Results: Among 100 breast lesions, FNAC classified 53% as benign, 36% as malignant, and 11% as premalignant, with fibroadenoma and ductal carcinoma being the most common benign and malignant lesions, respectively. Histopathological follow-up was available for 61 cases. Mean AgNOR counts rose progressively from benign (3.62 ± 0.91) to premalignant (4.92 ± 1.52) and malignant lesions (6.79 ± 2.11; P &lt; 0.001), paralleling histopathology. SAPA scores similarly distinguished benign (6.92 ± 1.49), premalignant (10.27 ± 1.95), and malignant lesions (12.42 ± 2.43; P &lt; 0.001). FNAC-histopathology concordance was high, with all malignant cases confirmed and 75% of premalignant cases upgraded to malignancy. Conclusion: These findings suggest that both AgNOR count and SAPA score are reliable indicators of proliferative activity and can effectively differentiate malignant from benign breast lesions in FNAC smears.

Platelets possess an important biological role at several stages of various malignant diseases. Platelet activation, as manifested by platelet indices, could help establish them as a diagnostic non-invasive biomarker for use in distinguishing benign and malignant breast lumps. To compare various platelet indices in patients with different categories of breast lesions and among different cytological or histological grades of breast carcinoma. This was a prospective cross-sectional analytical study conducted in the Department of Pathology at Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. It included 93 cytologically and histopathologically proven cases of breast lesions over a period of 9 months from September 2024 to May 2025. Blood samples from all 93 patients and 31 healthy controls were assessed for various parameters. The ANOVA test was used to compare different platelet indices across different categories and grades of breast lesions. Statistically significant differences in platelet counts, mean platelet volume, platelet-large cell ratio and platelet-lymphocyte ratio were observed when comparing the control group with the malignant group (p<0.001 in all indices), the non-neoplastic group with the malignant group (p<0.001 in all indices), and the benign group with the malignant group (p<0.001 in all indices). Platelet distribution width additionally showed significant differences between non-neoplastic group and benign group (p value 0.008). Amongst the various grades within malignant group, differences in platelet indices were not significant. Malignant breast tumors are associated with higher levels of platelet activation and systemic inflammatory response, which are reflected in altered platelet parameters. Platelet indices may assist in distinguishing between malignant and non-malignant lesions, but are less reliable in grading the malignancy.

Diagnostic performance of contrast-enhanced spectral mammography compared to conventional mammography across varying breast densities.