Journal of Breast Imaging最新文献

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.

Solid organ transplantation volumes in the United States have been steadily increasing over the past decade. Rigorous evaluation of potential transplant recipients must be performed to ensure appropriate allocation of solid organs for transplant. Because active malignancy is a contraindication for most solid organ transplantations, appropriate cancer screening should be included as part of the pretransplant assessment for both potential transplant recipients and donors. This article provides a summary of the current state of solid organ transplant-related breast cancer screening in the United States.

Objective: Online patient education materials (OPEMs) provide valuable information on breast-related conditions and treatment options. We evaluated commonly accessed OPEMs related to breast cryoablation to assess the readability, understandability, and actionability metrics of educational materials available to patients.

Methods: Using Google, the terms "breast cryoablation," "breast cryosurgery," and "breast cryotherapy" were queried. The top 50 websites providing OPEMs for the general public were identified by search ranking. A virtual private network was used, and location tracking, cookies, and user account information were disabled before querying. Sponsored content and research journal articles were excluded. Websites were categorized as academic/hospital, commercial, or nonprofit based on the hosting organization. Online patient education materials from the top 50 sites were downloaded and assessed for readability, understandability, and actionability. Mixed modeling, with sources nested within readability scores (automated readability, Coleman-Liau, Flesch-Kincaid, Gunning Fog, and Simple Measure of Gobbledygook), was used to evaluate these metrics.

Results: Among 52 websites, the overall mean grade-level readability was 12.3 (95% CI, 11.1-13.6). Academic/hospital sites had the lowest readability at 11.8, followed by nonprofit at 12.4 and commercial at 12.7 (P = .03). The mean understandability score was 71%, with academic/hospital sites at 81%, commercial at 73%, and nonprofit at 25%. Only 2 websites-Serenity Surgery and Cleveland Clinic-demonstrated actionability. Overall actionability was 18.5% (95% CI, 7.5%-38.9%), with 24 websites scoring 0% for actionability.

Conclusion: Current OPEMs concerning breast cryoablation fall short of the American Medical Association's recommendations for health literacy, averaging twice that level. Additionally, there is significant variability in the materials' understandability and actionability.

Objective: To assess the performance and cost implications of contrast-enhanced mammography-guided biopsy (CEM Bx).

Methods: This is a prospective study from May 5, 2021, to April 18, 2022, across 2 U.S. academic centers, evaluating technical success, patient/radiologist feedback, and operational factors of CEM Bx. Inclusion criteria included that patients be 40 years or older and recommended for biopsy with suspicious findings on contrast-enhanced mammography (CEM). Descriptive statistics are reported for clinical outcomes, length of procedure, and user and participant feedback. An estimate of cost was made by comparing general Medicare costs that are being billed for CEM Bx and post-clip mammogram ($475.48) to the Medicare costs of MRI-guided biopsy (MRI Bx) and post-clip placement mammogram ($845.94).

Results: Eighty-two participants enrolled. Twenty-two were excluded at the time of CEM Bx (22/82, 27%). Sixty participants were included (mean age 57 years, range 33 to 81 years) with 63 suspicious CEM lesions. The malignancy rate was 22% (14/63). A technical success rate of 100% was achieved. Average CEM Bx time was 29% to 33% the average reported MRI-guided breast biopsy times (CEM Bx = 11 minutes; MRI Bx = 33 to 38 minutes), indicating operational efficiencies. A positive opinion of CEM Bx was reported by 78% of radiologists, 93% of technologists, and 98% of patients. The estimated cost for each CEM Bx was ~ 45% lower than MRI Bx.

Conclusion: CEM Bx demonstrates high success rates and satisfaction scores. CEM Bx resulted in shorter procedure times, enhanced operational efficiency, and ~45% reduction in costs compared with MRI Bx. As advancements continue, we anticipate CEM Bx will offer a cost-efficient and timely option for breast biopsy.

Objective: To determine whether menopausal status and race affect the imaging features of triple-negative breast cancer (TNBC).

Methods: This institutional review board-approved retrospective study reviewed the clinicopathologic data and imaging features of patients diagnosed with invasive ductal TNBC from January 1, 2014, to March 30, 2023. There were 199 patients, of whom 67 (33.7%) were pre- and perimenopausal and 132 (66.3%) were postmenopausal. Data analysis was performed using Chi-squared or Fisher's exact test, and a P-value <.05 was considered significant. Subgroup analysis of Black and White patients was also performed.

Results: Sixty-six percent (44/67) of the TNBCs in the premenopausal group were a round- or oval-shaped mass, while an irregular-shaped mass made up 50.5% (65/129) in the postmenopausal group (P = .041). Three (2.3%) TNBCs were out of the mammographic field of view. Forty-two percent (28/67) of the TNBCs in the premenopausal group had indistinct margins, whereas 51.2% (66/129) of the postmenopausal group had spiculated margins (P = .011). Associated calcifications were present in 29.5% (20/67) of the TNBCs in the premenopausal group vs 24.8% (32/129) (P = .395). In subgroup analysis, a round/oval-shaped TNBC was more common in both premenopausal and postmenopausal Black patients-76.9% (20/26) and 54.5% (24/45), respectively (P = .061). However, 57.1% (44/79) of TNBCs in postmenopausal White women were irregular, and 61.0% (47/79) had spiculated margins (P <.009).

Conclusion: Menopausal status and race should be considered in the imaging features of TNBC. These data may further assist in the understanding of the biology of TNBC and lesion characteristics by race.

Objective: Mammographic breast cancer detection depends on high-quality positioning, which is traditionally assessed and monitored subjectively. This study used artificial intelligence (AI) to evaluate mammography positioning on digital screening mammograms to identify and quantify unmet mammography positioning quality (MPQ).

Methods: Data were collected within an IRB-approved collaboration. In total, 126 367 digital mammography studies (553 339 images) were processed. Unmet MPQ criteria, including exaggeration, portion cutoff, posterior tissue missing, nipple not in profile, too high on image receptor, inadequate pectoralis length, sagging, and posterior nipple line (PNL) length difference, were evaluated using MPQ AI algorithms. The similarity of unmet MPQ occurrence and rank order was compared for each health system.

Results: Altogether, 163 759 and 219 785 unmet MPQ criteria were identified, respectively, at the health systems. The rank order and the probability distribution of the unmet MPQ criteria were not statistically significantly different between health systems (P = .844 and P = .92, respectively). The 3 most-common unmet MPQ criteria were: short PNL length on the craniocaudal (CC) view, inadequate pectoralis muscle, and excessive exaggeration on the CC view. The percentages of unmet positioning criteria out of the total potential unmet positioning criteria at health system 1 and health system 2 were 8.4% (163 759/1 949 922) and 7.3% (219 785/3 030 129), respectively.

Conclusion: Artificial intelligence identified a similar distribution of unmet MPQ criteria in 2 health systems' daily work. Knowledge of current commonly unmet MPQ criteria can facilitate the improvement of mammography quality through tailored education strategies.

To assess breast imaging fellowship program directors' perspectives of the outcomes of the first-ever virtual interview season. A 19-question survey was constructed by members of the Fellowship Match Committee of the Society of Breast Imaging and distributed via email to 103 program directors. An initial email with a link to the survey was distributed on May 17, 2023, with 2 reminder emails sent on May 31, 2023, and June 20, 2023. The survey was closed on June 26, 2023. Results were compiled, and a descriptive statistical analysis was performed using Excel. There were 36 total responses yielding a response rate of 35% (36/103). The majority of programs, 61% (22/36), did not fill positions with any internal candidates. Overall, 72% answered that the perception of their fellow's performance was equal to or higher than those in prior years. Despite the effects of the pandemic on clinical exposure for this cohort, 73% of programs stated that the fellow's foundational knowledge was equivalent or better. Remarkably, 81% of respondents stated that procedural skills were equivalent or better, and 78% stated that communication skills were equivalent or better. This is the first study to investigate the outcomes of the unexpected pivot to virtual interviews. Despite the lack of preparation for this operational shift, it does not appear to have negatively impacted the program directors' impressions of their matched fellows.