Journal of Breast Imaging最新文献

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.

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.

The BI-RADS 5th Edition recommends that a solitary dilated duct should be assessed as a BI-RADS category 4 lesion and recommended for biopsy. More recently, 3 studies published after the fifth edition of BI-RADS have reported lower rates of malignancy associated with solitary dilated ducts ranging from 0% to 3.4%. According to these studies, clinical considerations and additional imaging characteristics can help determine which solitary ducts should be managed conservatively and which should undergo tissue biopsy. This review examines the latest research on solitary dilated ducts and proposes an updated management approach.

Breast image-guided procedures play a critical role in the diagnosis and management of breast cancer, serving as the gold standard for tissue sampling and preoperative localization. These minimally invasive procedures carry a very low risk of complications, with postprocedural infections occurring in fewer than 0.2% of cases. However, given the high volume of breast interventions performed annually, the potential impact of infections remains significant. Despite this, published guidelines addressing procedural cleanliness techniques in breast imaging are sparse and often provide conflicting recommendations, leading to variability in clinical practice and resource utilization. The lack of clear and specific guidance creates challenges for radiologists navigating institutional policies and best practice implementation. This review synthesizes existing standards and guidelines, evaluating the supporting evidence to propose an evidence-based best practice approach for maintaining clean techniques in breast image-guided procedures. By standardizing cleanliness protocols, we aim to enhance patient care, optimize procedural success, and promote consistency across breast imaging practices.