Journal of Breast Imaging最新文献

Cardiovascular disease (CVD) remains the leading cause of death among women globally, with significant mortality and poorer outcomes compared with men. Traditional CVD risk assessment methods are less effective for women in part due to a lack of consideration for female-specific risk factors and the underrepresentation of women in research. Mammography, primarily used for breast cancer screening, also provides valuable data on breast arterial calcifications (BAC), which are associated with increased CVD risk. Despite its potential, BAC is not routinely reported or used in clinical practice due to variability in reporting practices and the absence of standardized reporting and clinical follow-up guidelines. Various qualitative and quantitative techniques for the classification of BAC and the role of artificial intelligence (AI) in automating BAC quantification have been suggested. Surveys reveal varying attitudes toward BAC reporting among patients, radiologists, and referring clinicians. Despite the potential benefits of BAC reporting for personalized cardiovascular risk assessment, challenges remain, including the need to assess the cost-effectiveness of long-term outcomes, standardized guidelines, and effective follow-up.

Objective: To assess whether diagnostic mammogram alone is sufficient to identify breast cancer in women with a palpable lump and almost entirely fatty breast density.

Methods: All 2D full-field diagnostic mammograms performed in a large health system were retrospectively identified for patients assigned "almost entirely fatty" breast density from January 2014 through December 2018 who presented with a palpable lump and had at least 2 years of follow-up. Women were excluded if they had a history of breast cancer, ipsilateral surgery, or clinical suspicion of abscess. Other exclusions included axillary lumps, lumps located in the retroareolar or posterior one-third of the breast, and lumps in which the lump marker was visible in only 1 view. The investigators performed image-only review of the diagnostic mammogram, with blinding of the image reports and any ensuing outcomes. Subsequently, the associated US was assessed. Cancer outcomes were ascertained via linkage with the regional tumor registry.

Results: A total of 1552 eligible women, mean age 58.7 years ± 13.4, with 1791 lumps, were identified. Of these, 1139 women (73%) had no mammographic correlate, and 86 women (6%) had cancers corresponding to their lump, with 1 cancer having no mammographic correlate. The risk of cancer with no mammographic correlate to the palpable lump was 0.1% (1/1139 ; 95% CI, 0.0-0.3).

Conclusion: Diagnostic mammography alone has very low risk of missed cancer and is sufficient for evaluation of palpable symptoms in most women with fatty breast density.

Breast imaging plays a unique role in radiology, serving as the gatekeeper for initial imaging evaluation and tissue diagnosis of breast cancers. However, the definitive treatment of nonmetastatic breast cancer remains surgical excision, with radiation and/or chemotherapy based on stage and tumor profile.1 The reemergence of breast cryotherapy, highlighted by the recent 5-year results of the ICE3 trial, has the potential to expand the scope of breast imaging radiologists into the treatment of breast cancers.2 There is also increasing interest in cryoablation for immune potentiation in triple-negative and metastatic breast cancers.3.

Metaplastic breast carcinoma (MBC) is a rare and aggressive malignancy pathologically defined by differentiation of the neoplastic epithelium to mesenchymal-like and/or squamous components. Metaplastic breast carcinoma is typically a triple receptor negative invasive breast cancer (TNBC). There are multiple subtypes of MBC, and imaging findings are nonspecific. Classically, MBC presents in postmenopausal women as an enlarging palpable mass. At presentation, MBC is often larger than non-MBC breast cancer, and distant metastases are more common. Axillary nodal involvement is, however, less frequent. Mammography commonly demonstrates a circumscribed oval, round, or lobulated mass with or without calcifications. Spiculated masses and architectural distortion are less common than in non-MBC breast cancer. US often demonstrates a round/oval solid mass with cystic spaces due to necrosis. A T2 hyperintense mass with rim enhancement is often demonstrated on MRI. Imaging findings of MBC can mimic benign tumors, such as phyllodes and non-MBC breast cancers, and radiologists should consider MBC in the differential diagnosis of a mass with these features, especially with a clinical history of a new or enlarging palpable finding. Pathologic diagnosis is important, but accurate diagnosis on core biopsy can be limited due to the heterogeneity of this entity and dependence on sampling the metaplastic component. Data suggest that MBC confers a worse long-term prognosis than non-MBC breast cancers, including other TNBCs.

Breast MRI has evolved over the past several decades into a cornerstone of breast imaging. Historically, dynamic contrast-enhanced (DCE) MRI has served as the foundation of breast MRI protocols for differentiation of benign and malignant lesions and was supplemented by additional sequences to refine diagnostic accuracy. More recently, advanced techniques, such as diffusion-weighted MRI, ultrafast DCE-MRI, and deep learning models, have further expanded capabilities of breast MRI. These innovations, however, have also contributed to substantial variability in breast MRI protocols across institutions. At the same time, the expanding indications for screening and diagnostic breast MRI are driving higher patient volumes, creating operational challenges for breast imaging centers tasked with balancing efficiency, accuracy, and limited resources. This review outlines the key elements and considerations of modern breast imaging protocols, discusses strategies for protocol optimization, and explores emerging technologies and future trends that are shaping the next generation of breast imaging.

Background: Ongoing active monitoring (AM) trials for women with ductal carcinoma in situ (DCIS) are investigating the safety and efficacy of monitoring DCIS lesions vs the current standard of care (surgical treatment). The frequency of upgrade in women undergoing AM for DCIS remains unknown.

Objective: To evaluate the frequency of upgrade of DCIS at core-needle biopsy to invasive carcinoma at surgical excision among women who meet eligibility criteria for AM trials.

Methods: A retrospective review between 2010 and 2023 was performed of women at an National Cancer Institute-designated comprehensive cancer center with a diagnosis of DCIS at core-needle biopsy who underwent subsequent surgical excision. Medical records were reviewed for clinical presentation, imaging findings, core biopsy, and final surgical pathology. Each patient was evaluated for AM trial eligibility based on published criteria for the LORD, LORIS, and COMET trials. Fisher's exact test compared proportions, with a P-value <.05 considered statistically significant.

Results: Of 264 women, 10/264 (3.8%) were eligible for the LORD trial, 24/264 (9.1%) for the LORIS trial, and 64/264 (24.2%) for the COMET trial. Invasive carcinoma was found at surgical excision in 1/10 (10%) patients eligible for the LORD trial, 2/24 (8.3%) for the LORIS trial, and 9/64 (14.1%) for the COMET trial. All occult invasive carcinomas detected at surgical excision in trial-eligible patients were node-negative, with a median size of invasive cancer measuring 3.5 mm (interquartile range, 1-7 mm).

Conclusion: A subset of women who meet eligibility criteria for DCIS AM trials are at risk for occult invasive carcinoma, with frequency of upgrade ranging from 8% to 14%.

Clinical impact: More precise criteria and predictive biomarkers are needed to better stratify DCIS lesions and exclude women harboring invasive carcinomas from AM regimens.

Screening aims to detect breast cancer before it becomes clinically apparent, enabling identification of tumors when they are smaller and have not yet spread and when treatment options are more effective, less invasive, and more affordable. However, screening mammography has known limitations, with breast density being a primary challenge. Denser breast tissue not only increases the likelihood of cancer but also makes tumors harder to detect due to overlapping tissue. Strong evidence now exists to support updating our previous guidelines to recommend supplemental screening beyond mammography for individuals with American College of Radiology category c or d breast density. Supplemental screening methods, such as MRI, contrast-enhanced mammography (CEM), or US (in that order of preference) can significantly improve cancer detection rates. We recognize that implementing these recommendations across Canada will present challenges. Nevertheless, a collaborative effort among radiologists, health care stakeholders, and policymakers is essential to drive gradual, meaningful improvements in breast cancer detection and outcomes.

Objective: To determine the outcome and malignancy rate of BI-RADS 3 masses during follow-up at 6, 12, and 24 months.

Methods: This retrospective cohort study identified female patients <35 years of age with an oval, parallel, circumscribed mass assigned a BI-RADS 3 assessment on US from January 2014 to December 2021. Inclusion criteria were average risk women with a 6-month follow-up US and either (1) ≥18 months of follow-up imaging or (2) surgical excision/biopsy. Initial US lesion characteristics; follow-up BI-RADS assessments at 6, 12, 18, and 24 months; and pathology results were recorded.

Results: There were 662 patients with a BI-RADS 3 mass on US, of whom 191 were patients (mean age 26.4 ± 6.0 years) with 228 lesions (mean size 1.6 ± 0.7 cm) who met inclusion criteria. Most lesions exhibited either 2-year stability (56%, 128/228) or decreased in size/resolved (8%, 18/228). In all, 31% (71/228) of lesions were biopsied, most commonly because of increasing size (93%, 66/71). Most enlarging lesions underwent biopsy at the 6-month follow-up (68%, 45/66). All 71 lesions recommended for biopsy were fibroadenomas with a positive predictive value and malignancy rate of 0%. No phyllodes tumors were detected.

Conclusion: There were no cancers among young female patients with probably benign (BI-RADS 3) masses on US. A single 6-month imaging follow-up and then ongoing clinical surveillance may be sufficient in assessing probably benign masses in young women aged <35 years.

US-guided cryoablation has emerged as a promising minimally invasive treatment modality for breast cancer. With the growing adoption and success of cryoablation as a breast cancer treatment, many of these patients are undergoing routine follow-up imaging. There is a growing body of evidence and literature regarding the expected imaging appearance of the postcryoablation breast. Although there are limited data to provide guidelines for imaging and BI-RADS assessment after cryoablation, radiologists are seeking guidance in this area as they encounter these patients in their practice. Our objective is to provide an overview of the expected imaging findings after breast cryoablation and propose an imaging follow-up algorithm and BI-RADS assessment scheme in this patient population. Based on a review of the literature and the authors' clinical experience, we propose that patients should have initial imaging at 3 to 6 months after cryoablation. Subsequent surveillance imaging after cryoablation can be performed at 6- or 12-month intervals. Modalities of mammography with or without a contrast-enhanced study (MRI, contrast-enhanced mammography) should be used for follow-up imaging. BI-RADS assessment should be given on these imaging studies to aid in patient tracking and guide future interventions and imaging follow-up. For patients in whom cryoablation is considered a successful and definitive treatment and follow-up imaging shows expected postablation findings with no suspicious abnormalities, BI-RADS 2 assessment is appropriate. For patients in whom cryoablation was considered palliative and/or incomplete, BI-RADS 6 assessment can be given.