Journal of Breast Imaging最新文献

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.

As genetic testing expands, radiologists increasingly care for carriers of pathogenic variants associated with inherited breast cancer. Across the literature and current guidelines, 3 themes emerge. First, gene-specific screening is essential. High-penetrance variants (BRCA1/2, TP53, PALB2, PTEN) warrant intensified surveillance, with annual MRI as the cornerstone and mammography tailored by gene and age. For moderate-penetrance variants (eg, ATM, CHEK2), risk-adapted strategies are recommended, with MRI considered when lifetime risk is ≥20% or when additional risk factors are present. Second, MRI provides the greatest incremental cancer detection in patients who are high risk; contrast-enhanced mammography and US may be reasonable alternatives when MRI is unavailable or contraindicated. Third, mutation-associated cancers show patterns that can reduce missed and interval cancers when radiologists stay alert to gene-specific presentations and background parenchymal enhancement on MRI. Radiologists play a central role in longitudinal surveillance and in counseling about risk-reducing options in coordination with genetics and surgery. These points translate the evidence into practical, gene-informed imaging care for patients with inherited breast cancer risk.

Objective: To evaluate the risk of symptomatic hematomas in patients receiving epinephrine-containing lidocaine compared with lidocaine alone after core-needle breast biopsies (CNBBs). The efficacy of epinephrine-containing lidocaine in reducing hematoma risk following image-guided CNBB remains unclear.

Methods: A single-institution, retrospective review of all CNBBs performed during a 6-month period using lidocaine alone (September 1, 2022, to March 15, 2023) due to a national shortage of epinephrine-containing lidocaine and a 6-month period using epinephrine-containing lidocaine (April 1, 2023, to October 1, 2023). A nurse navigator contacted all patients postbiopsy to assess postprocedural complications, including symptomatic hematomas. Postprocedure mammograms were reviewed for detectable hematomas after 9-gauge and 12- to 14-gauge CNBBs. Logistic regression models evaluated the associations between epinephrine-containing lidocaine use and symptomatic and mammographically evident hematomas.

Results: A total of 1157 CNBBs were performed in 967 patients; 619 received epinephrine-containing lidocaine and 538 received lidocaine alone. There were 11 (1.0%; 11/1157) symptomatic hematomas, 10 of which occurred following 9-gauge CNBBs (6 with stereotactic/tomosynthesis guidance and 4 with MRI guidance). There was no significant difference in the occurrence of symptomatic hematomas (P = .34) or mammographically evident hematomas (P = .53) after 12- to 14-gauge US-guided CNBBs performed with epinephrine-containing lidocaine vs lidocaine alone. Fewer symptomatic hematomas occurred after 9-gauge CNBBs in the epinephrine-containing lidocaine group (0.6%; 2/310) compared with the lidocaine alone (4.1%; 8/194) (P = .02). After 9-gauge CNBBs, mammographically evident hematomas were less frequent (16.1% vs 41.2%; P <.0001) with epinephrine-containing lidocaine compared with lidocaine alone.

Conclusion: Epinephrine-containing lidocaine reduced rates of symptomatic and mammographically detected hematomas after 9-gauge CNBBs. Local infiltration with epinephrine-containing lidocaine could be considered in 9-gauge CNBBs to reduce hematoma risk.

Objective: To determine reader preference for image order and thus, by inference, image timing after contrast administration that maximizes cancer visualization on contrast-enhanced mammography (CEM).

Methods: This IRB-approved reader study includes consecutive CEMs performed for research or clinical care in patients before a diagnosis of unifocal breast cancer, where the cancer was seen on both craniocaudal (CC) and mediolateral oblique (MLO) recombined images. All CEMs started with the side containing cancer and alternated with the nonaffected side of the same projection. From 2016 to 2018, CC projection was performed first (group 1), and from 2019 to 2020, the MLO projection was performed first (group 2). Five readers evaluated cases for background parenchymal enhancement (BPE) and lesion type. Readers assessed cancer visibility, confidence in margins, and cancer conspicuity using a 5-point Likert scale. Contrast-to-noise (CNR) measurements were also taken.

Results: Seventy-eight female patients were included. Group 1 (CC-first) included 40 patients (51%) and group 2 (MLO-first) included 38 patients (49%). Mean age differed between groups by 5 years (P = .031), otherwise there were no differences in group characteristics. There was an overall preference for earlier-obtained images for cancer visibility, confidence in margins, and lesion conspicuity against BPE (P < .001) and preference for CC projection for lesion conspicuity (P = .045). In 35 instances (35/390, 9%), an individual reader reported a different lesion type on images obtained later, with a majority (28/35, 80%) reporting a less discernible lesion on later-obtained imaging (eg, mass changed to nonmass enhancement).

Conclusion: Our study shows significant reader preference for cancer characteristic evaluation of CEM performed at earlier time points.

Contrast-enhanced mammography (CEM) is a widely accepted functional breast imaging modality. With the inclusion of this modality in the BI-RADS Atlas, this article provides a pictorial review of the newly adopted lexicon, along with the appropriate application of assessment categories and recommendations. By the end of the pictorial review, readers should be able to recognize common CEM findings and accurately use the BI-RADS lexicon.