Journal of Breast Imaging最新文献

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.

Objective: To evaluate the diagnostic efficacy of 7G image-guided vacuum-assisted biopsy (VAB) in predicting pathological complete response (pCR) after neoadjuvant systemic therapy (NST) in HER2+ or triple-negative (TN) breast cancer (BC) showing complete response (CR) or almost-CR on MRI.

Methods: A prospective study was conducted from June 2018 to October 2022 on 25 HER2+ or TN operable BC patients who achieved CR or almost-CR on post-NST MRI. Presurgery, stereotactic or US-guided 7G VAB of the tumor bed was performed, and the pathological findings were compared with surgical results to evaluate the negative predictive value (NPV), accuracy, sensitivity, positive predictive value (PPV), and specificity in predicting residual disease.

Results: All tumors were invasive ductal carcinoma, with TN BC accounting for 52% (13/25) and HER2+ for 48% (12/25). MRI showed CR in 60% (15/25) of cases and almost-CR in 40% (10/25). Stereotactic VAB was performed in 84% (21/25) of cases and US-VAB in 16% (4/25), using 7G needles (average 10 samples) in all the cases. Posttreatment changes were demonstrated in all cases. Pathological CR was observed in 80% (20/25) of VAB cases and 84% (21/25) of surgical cases. Vacuum-assisted biopsy had a 100% NPV (95% CI, 83.2-100.0), 97.6% accuracy (95% CI, 92.9-100.0), 100% sensitivity (95% CI, 39.8-100.0), 80% PPV (95% CI, 28.4-99.5), and 95.2% specificity (95% CI, 76.2-99.9).

Conclusion: Image-guided VAB with 7G needles in HER2+ or TN BC with CR or almost-CR in post-NST MRI demonstrated a 100% NPV for detecting residual carcinoma when sample correlation and representativeness were ensured. Additional studies with larger patient cohorts are needed to confirm these promising results and to potentially omit surgery through image-guided VAB in selected TN BC and HER2+ BC cases.

Transgender and gender-diverse (TGD) individuals face unique challenges in accessing affirming, evidence-based breast imaging care because of longstanding disparities in provider education, institutional practices, and imaging guidelines. Gender-affirming hormone therapy and gender-affirming surgeries, such as chest masculinization or breast augmentation, impact breast tissue composition and cancer risk, necessitating individualized imaging approaches. Through multiple clinical vignettes, this article illustrates potential pitfalls and key considerations in breast imaging for TGD patients, including appropriate imaging recommendations, inclusive system-level changes, and navigating patient encounters. Education of breast imaging radiologists, technologists, and front-desk staff is critical to bridge the known knowledge gap and improve outcomes for this patient population. By adopting inclusive, culturally competent, and trauma-informed practices, breast imaging professionals can help reduce disparities and improve the experience and health outcomes of TGD patients.

Breast amyloidosis is a rare disease that can be secondary to systemic disease or localized to the breast. The imaging findings are variable with features suspicious for breast malignancy such as calcifications, focal asymmetry, and mass that prompt the recommendation for biopsy. US correlates are also variable, though when present, most are irregular hypoechoic masses. The imaging features overlap with those of primary breast malignancy. Therefore, biopsy and histopathologic correlation are needed to confirm a concordant diagnosis and for amyloid typing. Because approximately half of cases are associated with B-cell disorders, referral to hematology-oncology for evaluation is important. An additional 16% of patients have systemic autoimmune inflammatory disease such as Sjogren's syndrome, rheumatoid arthritis, systemic lupus erythematosus, and polymyalgia rheumatica. Very rare cases are associated with iatrogenic amyloid formation because of injection of synthetic insulin. The remaining approximate one-third of cases are localized to the breast and other limited sites. These cases most commonly occur in postmenopausal women and are often detected on screening mammography. After evaluation to exclude systemic disease, these patients do not require surgical excision or medical treatment.

The initial method of detection (MOD) refers to the first imaging examination, physical symptom, or clinical sign that prompts further investigation and ultimately leads to a new breast cancer diagnosis. The MOD is assigned at the patient level and falls into 1 of 3 categories: screening in asymptomatic patients, detection by patients or health care providers, or neither of the above. The MOD should be assigned prospectively by the radiologist when interpreting an examination with a final BI-RADS category of 4 or 5, before image-guided biopsy and breast cancer diagnosis. The MOD is not assigned to examinations classified as BI-RADS category 0, 1, 2, 3, or 6, nor is it assigned in the setting of an active breast cancer diagnosis. This Clinical Practice article addresses frequently asked questions and challenging clinical scenarios compiled by the American College of Radiology's Screening and Emerging Technology Committee to guide consistent MOD assignment. For example, if a patient presents with a lump but is ultimately found to have a suspicious finding requiring biopsy in the contralateral breast, the MOD should reflect the reason for presentation, the patient-detected symptom (Pat), even if the cancer itself is asymptomatic. By increasing awareness of MOD and standardizing MOD reporting practices, radiologists can contribute to improved data collection. While MOD is not currently tracked in U.S. cancer registries, its systematic collection may offer valuable insights into screening effectiveness, technology performance, and disparities in cancer detection. Standardized MOD reporting has the potential to strengthen early detection efforts and improve outcomes across diverse clinical settings.