Journal of Breast Imaging最新文献

Objective: To determine the contrast-enhanced mammography-guided biopsy (CEM-Bx) success rate for MRI-suspicious lesions lacking known tomosynthetic or sonographic correlate along with factors associated with biopsy success.

Methods: From June 2022 to August 2023, this prospective IRB-approved study enrolled women with breast MRI lesions rated BI-RADS ≥4A for CEM-Bx. Ipsilateral contrast-enhanced mammography (CEM) was performed in the biopsy suite and correlated with MRI. For visible lesions, CEM-Bx was performed immediately after prebiopsy CEM. Success criteria included enhancing correlate visualization and biopsy completion with accurate lesion sampling. An MRI-guided biopsy was recommended for failures. The success rate was evaluated with the Wilson score interval. MRI lesion and patient characteristics (size, type [mass, focus, or nonmass enhancement], kinetics, breast density, body mass index, background parenchymal enhancement [BPE], radiologist CEM experience, radiologist MRI experience, and histopathology) were collected. Multivariable logistic regression was performed with backward feature selection.

Results: Analysis included 152 women (mean age 53 ± 11 years) with 184 lesions. CEM-Bx was successful for 106/184 (57.6%; [95% CI, 50.0-65.0]) lesions with 24/106 (22.6%) malignant. Of 78 failures, 60 (76.9%) lacked enhancement on prebiopsy CEM, 14 (17.9%) were not visualized with the biopsy grid, and 4 (5.1%) were not accurately sampled; 14/78 (17.9%) failures proved malignant. Increasing lesion size (odds ratio [OR] = 1.03; [95% CI, 1.01-1.06]), more years of radiologist CEM experience (OR = 1.24; [95% CI, 1.01-1.49]), and lower BPE (OR = 0.68 [95% CI, 0.46-0.98]) were associated with success.

Conclusion: Contrast-enhanced mammography biopsy can be a successful alternative to MRI-guided biopsy for MRI-detected lesions. MRI-guided biopsy should be pursued if CEM-Bx fails.

Objective: To detail acute and delayed contrast reactions associated with contrast-enhanced mammography (CEM) in a prospective screening trial.

Methods: In an institutional review board-approved protocol from October 2019 through July 2024, women with personal history of breast cancer received up to 3 rounds of annual supplemental screening CEM. Intravenous iopamidol (370 mg/mL) was administered via automated injector. Adverse events within 1 week of contrast administration were recorded.

Results: A total of 1651 women (mean age at entry: 63.2 years) received 3873 contrast injections (1651, 1326, and 896 in years 1, 2, and 3, respectively). Among 3873 injections, we observed 38 (0.98%) contrast reactions in 35 unique participants, including 25/3873 (0.65%) allergic-like reactions (15/1651 [0.91%] in year 1, 7/1326 [0.53%] in year 2, and 3/896 [0.33%] in year 3), 9/3873 (0.23%) physiologic reactions, and 4/3873 (0.10%) other reactions. Of 25 allergic-like reactions, 20 (80%) were cutaneous (hives/rash). One participant had bronchospasm, 1 had scratchy throat, 1 had shortness of breath, 1 sneezed repeatedly, and 1 had watery eyes. Five allergic-like reactions were delayed, including hives in 4 (2 at 1 day, 1 at 2-3 days, and one 7 days later) and watery eyes in 1; 2 physiologic reactions were delayed. Two of 25 reactions were immediate, and imaging was not completed; medication was given to 15/25 (60%). Allergic-like reactions occurred in 14/3328 (0.42%) examinations in women with prior uneventful iodinated contrast exposure, 10/510 (1.96%) among those naïve to contrast (P <.001), and 1 woman with recurrent but initially unreported reaction in year 1. No allergic-like reactions were observed in 34 examinations (19 women) premedicated for prior allergic contrast reaction.

Conclusion: We observed a low rate and usually mild severity of adverse reactions to iodinated contrast in CEM with trained staff.

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.

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.

Breast cryoablation for the treatment of fibroadenoma and breast cancer is safe and effective, and breast cryoablation performed as an outpatient procedure with local anesthesia alone is well tolerated by patients. Because use of this procedure is increasing, radiologists and proceduralists must understand the postcryoablation breast imaging algorithms, including the rationale for imaging, the appropriate timing for imaging, and appropriate imaging modalities. Radiologists must also be able to differentiate benign, expected posttreatment findings at the ablation zone from findings suggestive of residual, progressing, or recurrent malignancy on mammography, digital breast tomosynthesis, US, MRI, and contrast-enhanced mammography. Finally, radiologists must report postcryoablation breast imaging findings using appropriate descriptors and standardized reporting lexicon. Accurate and standardized reporting of postcryoablation breast imaging findings is important to guide clinical management, facilitate research on imaging findings' associated risk for malignancy, and permit comparison of radiologist performance and patient outcomes across facilities worldwide.

Image-guided procedures are an essential part of the breast imaging continuum of care. As more procedures are performed in comprehensive breast imaging clinics, there are potentially more patients who may experience significant postprocedural bleeding. Most postprocedural bleeding can be managed with conservative measures such as compression. Occasionally, more invasive intravascular and surgical measures are required to stop hemorrhage. This article reviews preprocedural considerations, proper compression techniques, and methods to control superficial and deep bleeding. There is also a review of intraprocedural preventive measures that can be used to reduce the risk of significant postprocedural bleeding complications. Additionally, diagrams/step-by-step illustrations describing suture techniques and the Foley catheter method to decrease bleeding are presented. Because many breast procedures are performed in outpatient or satellite clinics without immediate access to surgeons, it is imperative that the entire breast imaging care team is familiar with effective methods to prevent and manage significant bleeding during percutaneous breast procedures.

Objective: Understand radiologists' opinions regarding remote breast imaging and determine whether having home workstations is associated with greater job satisfaction or less burnout.

Methods: A 43-question survey on remote breast imaging was distributed to Society of Breast Imaging members (July 6 to August 2, 2023). Questions regarding job satisfaction and burnout were included. Pearson's chi-squared tests compared demographic variables and responses. Multiple-variable logistic regression assessed associations between home workstations and job satisfaction or burnout.

Results: In total, 424 surveys were completed (response rate 13%, 424/3244). Among the third (31%, 132/424) of breast imaging radiologists with home workstations, top motivations included flexibility/work-life balance (67%; 88/132) and decreased commute time (51%, 67/132). Most felt that working from home improved their efficiency (65%, 86/132). Perceived drawbacks among all breast imaging radiologists included the inability to perform US or physical examination (71%, 300/424) and impaired patient contact (47%, 198/424). Most (57%, 240/424) wished for more breast imaging remote reading opportunities, and one-third (32%, 136/424) saw themselves in a 100% remote reading practice in the future. The majority (60%, 228/388) felt that remote reading would majorly or moderately improve radiologist wellness, but no significant association was found between having home workstations and job satisfaction (P = .301) or burnout (P = .140).

Conclusion: The majority of breast imaging radiologists want more opportunities to work remotely, perceiving that it improves work-life balance and efficiency, albeit at the expense of patient contact. However, those currently working from home did not have higher job satisfaction or lower burnout.

Randomized controlled trials (RCTs) have confirmed the mortality benefits of screening mammography and are the gold standard for evaluating new diagnostic tests and medical interventions. Reliable and rigorous execution of RCTs can be complex and require high levels of funding and prolonged time from technology implementation to trial completion. Breast radiology and artificial intelligence technologies are being developed and are receiving regulatory approval faster than RCTs may be effectively conducted. Regulatory approval can lead to societal recommendations, legislation, clinical availability, purchasing, and patient care, even in the absence of reliable evidence indicating increased efficacy. Marketing and patient demand and physician perceptions influence technology use. There is a wide chasm between using data provided by RCTs and site-specific care decisions. Can we find a middle ground? What types of data can influence guidelines in the absence of rigorous clinical trials? This article explores the benefits and drawbacks of RCTs and describes professional initiatives, such as widespread use of method of detection, that could allow the breast imaging community to more quickly evaluate and integrate new technologies in a reasoned and evidence-based fashion.

Objective: To assess the current perceptions of breast imaging staffing shortages and contributing factors among breast imaging radiologists.

Methods: A survey assessing current perception of breast radiologists regarding breast imaging-specific staffing shortages and contributing factors was developed by the Patient Care and Delivery Committee of the Society of Breast Imaging (SBI) and emailed to SBI active physician members. Bivariable analysis (chi-squared, t test) was performed between the survey demographics and survey response questions of interest.

Results: There were 309 responses (response rate of 15.7%). Most respondents perceived their practices to be short-staffed for breast radiologists (79%, 239/302), US technologists (74%, 216/290), mammography technologists (70%, 211/301), and support staff (66%, 201/302). Of the respondents who indicated they were short-staffed for breast imaging radiologists, 92% (226/246) believed it was due to insufficient number of radiologists, 67% (164/246) thought it was due to increase in volume, and 63% (154/246) attributed it to both increase in volume and insufficient number of breast imaging radiologists. Practices were more likely to be short-staffed if they had more practice sites (mean, 8.2 ± 7.1 vs 6.4 ± 8.4; P = .002), had fewer breast imaging radiologists (mean, 10.1 ± 9.6 vs 11.3 ± 11.5; P = .009), and were academic practices (35.1% vs 25.7%; P = .028).

Conclusions: Most breast imaging radiologists perceive their current breast imaging practices to be short-staffed for radiologists, mammography technologists, US technologists, and support staff. Understanding contributing factors is crucial to addressing root causes and mitigating impact on patient care and burnout across breast imaging team members.