Journal of Breast Imaging最新文献

Objective: Screening mammography false-negative rates (FNRs) measure interval cancers (ICs) that are confounded by asymptomatic false-negative (FN) cancers detected on supplemental screening (SS) examinations. The purpose of this study was to 1) evaluate the impact of SS on FNRs for patients at higher-than-average risk in a robust SS program and 2) compare patient and tumor characteristics of symptomatic ICs and asymptomatic FN cancers.

Methods: Screening mammogram audit metrics from an academic institution from July 1, 2018, to June 30, 2023, were retrospectively reviewed. A negative screening mammogram with a subsequent diagnosis of cancer within 12 months was considered an FN cancer. Patient risk, method of detection, SS utilization, and tumor characteristics were collected. Cochran-Mantel-Haenszel tests were used to analyze trends, and univariable tests were used to compare symptomatic and asymptomatic cases.

Results: Of 106 750 screening mammograms, 624 screening-detected cancers and 119 FN cancers were identified, with a cancer detection rate of 5.8/1000 and an FNR of 1.11/1000. There were 53 (45%) symptomatic ICs and 66 (55%) asymptomatic FNs, with a symptomatic FNR of 0.50/1000. Patients with symptomatic IC were more likely to have a personal history of breast cancer (P = .0289), and 74% (39/53) were higher-than-average risk. Symptomatic ICs were larger at diagnosis (mean size 2.3 cm vs 1.5 cm; P = .0293). MRI detected the majority (37/66, 60%) of asymptomatic FNs.

Conclusion: A robust SS program allows for the symptomatic FNR to fall below published national performance benchmarks from the Breast Cancer Surveillance Consortium. Most patients with symptomatic IC were at higher-than-average risk and underutilized SS MRI.

Objective: This study evaluated (1) the reproducibility of 5 visual scoring systems for breast arterial calcifications (BACs) on mammography and their correlation with coronary artery calcifications (CACs), (2) their diagnostic accuracies, and (3) clinical applicability.

Methods: In this retrospective study, 90 women (median aged 57 years, interquartile range [IQR] 15) who underwent both mammography and cardiac CT were included. Breast arterial calcification was scored using 5 visual systems: (1) dichotomous (present/absent), (2) 4-level vessel count, (3) 4-level severity, (4) combined 4-level (severity + vessel count), and (5) an advanced 3-level scale (incorporating vessel count, length, and density). Diagnostic performance was evaluated via sensitivity, specificity, and area under the curve (AUC). Interobserver agreement was assessed with Cohen's kappa; correlation with CAC (Agatston score) used Spearman's rho.

Results: Breast arterial calcification was present in 17.8% (16/90) and showed a trend toward correlation with CAC (P = .05). The 4-level vessel count scale showed the strongest correlation with CAC (rho = 0.373; P <.001). The highest AUC (0.604) was achieved by the 4-level severity scale (sensitivity 44%, specificity 77%). Interobserver agreement was highest for the combined 4-level scale (κ = 0.835), followed by the 4-level vessel count (κ = 0.833), severity-only (κ = 0.819), 3-level vessel count (κ = 0.833), and the dichotomous scale (κ = 0.740). The dichotomous scale required the least time (mean 19 s/patient); the 3-level scale required the most (mean 51 s). The vessel count scale balanced accuracy, reproducibility, and efficiency (mean 34 s).

Conclusion: Grading BACs is feasible, with consistently high interobserver agreement across scoring systems. The 4-level vessel count scale demonstrated a favorable balance of accuracy, reproducibility, and practicality, suggesting it may warrant further evaluation as a potential tool in mammography-based cardiovascular risk assessment.

Combining patient services into fewer clinical visits has been increasingly explored across medical specialties as more attention is given to patient-centered care, patient access, and care delivery efficiency from health enterprises. The typical breast imaging care model requires multiple clinical visits to achieve a final diagnosis and, therefore, might be optimized to perform 2 or more steps in the process in 1 patient clinical visit. Recent studies suggest that this model can mitigate patient disparities in timeliness of care, improve patient satisfaction, and even improve patient adherence. Despite the potential benefits, there is variability in the use of same-day services across breast imaging facilities because of various local/institutional level barriers, staffing limitations, and concerns about interpreting examinations in real time. In this review, we describe the various same-day models that have been reported in the breast imaging literature, discuss their impact, and present evidence that may support further adoption of these care models. We also explore the barriers and limitations to this model and future directions of same-day services.

Objective: Antithrombotic therapy (AT) is crucial for preventing life-threatening thromboembolic events (TEEs). However, concerns about bleeding events (BEs) often lead to AT discontinuation before image-guided breast biopsy (iBB). This systematic review and meta-analysis assess the necessity and safety of AT suspension prior to iBB.

Methods: A systematic review was conducted using Embase and PubMed/MEDLINE databases through July 2024. Studies evaluating BEs in patients who had AT and were undergoing iBB were included. Case reports, surveys, and nonretrievable full texts were excluded. Data analysis was performed using Review Manager v5.4. The risk-of-bias assessment was based on the Risk Of Bias in Non-randomized Studies of Interventions tool.

Results: Of the 216 studies screened, 8 met the inclusion criteria, which comprised 1154 patients undergoing AT and 10 370 controls. Bleeding events occurred in 203 (17.9%) patients with AT and 1110 (10.7%) controls, yielding a pooled odds ratio of 1.89 (Z = 5.23; P < 0.001). Heterogeneity was moderate (I² = 34%). Variability existed in AT drugs, iBB techniques, and definitions of "clinically relevant BE." Only 3 (0.23%) BEs were considered "clinically relevant" in 1 study.

Conclusion: Although current evidence is burdened by unstandardized reporting and data fragmentation, it supports the safety of performing iBB without suspending ongoing AT because local BEs, although slightly more frequent under AT, are predominantly minor and clinically irrelevant. Antithrombotic therapy continuation can improve diagnostic efficiency, minimize delays, limit patient anxiety, and reduce health care costs. Our quantitative findings support AT continuation in the context of iBB while providing a clinical rationale that addresses the TEE risks associated with AT interruption-an issue often underrepresented in prior literature.

Objective: To understand the perspective of patients undergoing breast imaging on the use of artificial intelligence (AI) in breast cancer screening.

Methods: A 36-item survey was administered to breast imaging patients at 6 academic and 2 private practice groups in the United States. The survey included questions regarding demographics, breast imaging history, and electronic health literacy. Respondents were asked Likert scale questions on the role of AI in breast cancer screening, the role of AI as an independent or complementary reader, and concerns regarding AI in breast imaging.

Results: The survey yielded 3532 responses, a response rate of 69.9% (3532/5053). The median age was 55.9 years (SD, 12.3 years), and most respondents were White (73.0%, 2679/3532). Respondents indicated support for the role of AI to identify suspicious findings (70.6%, 2492/3532), triage findings for review (69.5%, 2382/3532), calculate breast density (73.2%, 2588/3532), and estimate breast cancer risk (61.9%, 2186/3532). Significantly higher support was noted among patients who were White, had more education, and had greater health literacy (all P <.05). There was strong agreement that it was necessary for radiologists to also review each examination (67.3%, 376/3532). Respondents were uncertain about whether AI (41.2%, 1456/3532) or radiologists (31.8%, 1124/3532) were responsible for errors. There was concern that AI will limit communication between patients and radiologists (75.7%, 2673/3532).

Conclusion: Breast imaging patients have an overall favorable view of AI in breast cancer screening, with variable support by demographics. Education and outreach efforts should target perceived challenges to AI adoption to improve patient acceptance.

Background: Supine breast MRI reproduces the surgical position during breast-conserving surgery, with early studies reporting the benefit of decreased positive margin rates. However, acquiring an additional contrast-enhanced supine breast MRI after a prone breast MRI in a second imaging session is clinically and financially challenging. The aim of this study was to evaluate the tumor-to-fibroglandular tissue contrast ratios and the ability to visualize tumor margins in a double-bolus prone-to-supine breast MRI obtained in a single imaging session.

Methods: Thirty-nine patients with breast cancer had a standard prone breast MRI followed immediately by a second contrast injection in the supine position to obtain supine breast MRI (double-bolus prone-to-supine MRI protocol [P2S2]). A control group of 35 patients received a prone examination and an independent supine examination in 2 separate imaging sessions. Tumor-to-fibroglandular tissue contrast ratios (TFRs), a measure of tumor enhancement that informs the ability to visualize tumor margins, were statistically compared between cohorts. Two radiologists independently rated the ability to visualize tumor margins in the independent and double-bolus supine breast MRIs.

Results: No significant differences were found in the mean TFR between the independent and P2S2 supine examinations (P = .79). Excellent agreement occurred between both readers regarding the ability to visualize the tumor margins in the independent and P2S2 supine MRIs with κ scores of 1.00 and 0.95, respectively.

Conclusion: A supine breast MRI obtained in a single imaging session after a second contrast injection provided adequate tumor enhancement for tumor margin visualization and preoperative surgical guidance comparable with independent supine breast MRI.

Extranodal extension (ENE) is defined as the spread of tumor cells beyond the lymph node capsule. It is an independent prognostic factor in breast cancer associated with increased nodal disease burden, influencing subsequent treatment strategies. Extranodal extension has been reported in approximately 20% to 50% of patients with metastases to axillary lymph nodes. Despite its clinical relevance, ENE remains challenging to detect. Key imaging features indicative of ENE include irregular nodal contours, nodal matting, and perinodal edema on US and MRI. However, these findings are often not detected or are underreported. Pathologic evaluation confirms capsular permeation and perinodal soft tissue infiltration by tumor cells, which may be accompanied by a stromal response. Our case examples demonstrate the importance of integrating imaging and pathology for accurate ENE detection. Improved diagnostic accuracy with radiologic-pathologic correlation optimizes treatment planning and facilitates appropriate risk stratification for patients with breast cancer.

The practice of formally documenting radiologic and pathologic concordance after percutaneous breast biopsies was instituted more than 20 years ago. There are several ways in which this can be done, but in many practices the performing radiologist independently compares the imaging findings with the pathology report to determine concordance. However, some studies show that a multidisciplinary review of breast biopsy results can maximize cancer detection, identify discordant cases in a timely manner, decrease imaging follow-up, and avoid unnecessary surgical intervention. This article will propose a practical method to establish a formal radiology-pathology conference in which percutaneous breast biopsies are reviewed with multidisciplinary input to increase efficiency and improve patient care. With the wide implementation of digital radiologic imaging and digital pathology evaluation plus the recent adoption of virtual meeting platforms, a successful radiology-pathology conference can be implemented in nearly any practice setting. Case examples will be presented demonstrating the utility of such a conference.

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.