Journal of Breast Imaging最新文献

Objective: To assess the prevalence of the axillary arch (AA) variant and its impact on the sensitivity of US vs MRI for detecting axillary nodal metastases in patients with breast cancer.

Methods: The IRB waved informed consent for this retrospective study. Three hundred, eighty-two breast MRIs performed for the extent of disease of breast cancer between 2012 and 2023 were reviewed for the presence of AA. Pre-MRI axillary US was available in 322 of these cases. The presence of axillary adenopathy was documented and correlated with pathology. A paired sample comparison was used to calculate sensitivities of US and MRI for detection of the AA.

Results: The AA was detected on breast MRI in 6.8% (26/382) of patients. Of these, 30.8% (8/26) were bilateral, 50% (13/26) were unilateral left, and 19.2% (5/26) were unilateral right. All had lymph nodes both superficial and deep to the AA. Of the 26 patients with AA, 19 patients underwent pre-MRI axillary US. Biopsy-proven malignant adenopathy was detected on MRI but missed on US in 10.5% (2/19) of patients with AA but only 2.5% (7/279) of patients without AA. Sensitivity for detection of lymphadenopathy on MRI and US was 69.7% (82/122)% and 67.5% (77/114) for all patients (P = .17), 72.2% (78/108) and 68.5% (74/108) for patients without AA (P = .21), and 66.2% (4/6) and 50.0% (3/6) for patients with AA. The small sample size of patients with AA precluded statistical comparison.

Conclusion: The AA is a common variant detectable on breast MRI. Axillary nodal metastases may reduce US sensitivity for identifying nodal metastases. Further investigation is required to establish statistical significance.

Rosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytosis characterized by the accumulation of histiocytes, primarily in the lymph nodes but also in extranodal sites, including the breast. Rosai-Dorfman disease is infrequently found in the breast, and limited literature exists on its imaging presentation. About two-thirds of cases present as a palpable mass and one-third as a finding on screening mammography. On mammography, the majority are masses with oval shape and indistinct margins. Almost all US findings are masses, and the majority have an irregular shape and indistinct margins. Treatment of RDD involving the breast varies and is tailored to its presentation and extent of involvement. About two-thirds of cases are limited to the breast, and spontaneous resolution often occurs. Most are treated conservatively without medical or surgical intervention. Alternatively, cases with single-site or skin-only involvement of the breast may undergo surgical excision for definitive treatment. FDG PET/CT is typically used at initial diagnosis for staging and subsequently for disease surveillance. Disseminated disease may require chemotherapy, radiation therapy, and immunomodulatory therapy. Although it is rare, breast imaging radiologists should be familiar with the imaging presentation of RDD because initial diagnosis may be made with breast biopsy. Referral to hematology oncology or a multidisciplinary team is important for further management because treatments vary based on disease location and extent.

Black women in the United States are diagnosed with breast cancer at younger ages and more advanced stages compared with White women. Although breast cancer mortality has declined in recent decades due to widespread screening and improved therapies, there are notable outcomes disparities by race and ethnicity. Black women, in particular, face marked inequities related to screening, diagnosis, and treatment and face 40% higher breast cancer-specific mortality compared with White women. In this article, we review the epidemiology and biology of breast cancer in Black women and discuss the impact of structural racism and biases on screening access, timeliness, and quality as well as timely diagnosis. We discuss evidence-based strategies to overcome these race-associated disparities in screening and diagnosis. Finally, we highlight persistent barriers to achieving breast cancer equity for Black women and explore future initiatives that are necessary to overcoming disparities.

Objective: Quantitative changes in mammographic properties during pregnancy and lactation remain underexplored. Therefore, the purpose of this study was to quantify mammographic changes in the breast from prepregnancy through lactation to postweaning at the individual level.

Methods: Mammograms of 39 women at elevated risk (mean age 38.7 years) who underwent 3 sequential examinations spanning the lactation period were retrospectively analyzed. Volpara-derived mammographic properties, including breast volume, fibroglandular tissue volume, volumetric breast density, compression force, and radiation dose, were automatically extracted and were statistically compared between the periods.

Results: Significant longitudinal changes in breast tissue were observed. During lactation, breast volume increased by 45%, fibroglandular tissue volume increased by 138.5%, and volumetric breast density increased by 53.2% compared with prepregnancy levels (P <.001 for all). After weaning, these values decreased by 23.3%, 52.8%, and 27.3%, respectively, compared with lactation (P <.001 for all). Breast compression was decreased by 22.3% on average during lactation compared with prepregnancy (P <.001), while it was not different between lactation and postweaning (P = .11). The radiation dose during lactation increased by 20% compared with both prepregnancy (P = .004) and postweaning (P = .005).

Conclusion: The temporal changes in mammographic properties from prepregnancy to lactation include significant increases in breast volume, fibroglandular tissue volume, breast density, and radiation dose, along with a decrease in compression force. While these changes reverse from lactation to postweaning, they generally do not return to prepregnancy levels.

Objective: To analyze recent trends in U.S. breast cancer mortality rates by age group and race and ethnicity.

Methods: This retrospective analysis of female breast cancer mortality rates used National Center for Health Statistics data from 1990 to 2022 for all women, by age group, and by race or ethnicity. Joinpoint analysis assessed trends in breast cancer mortality rates.

Results: Breast cancer mortality rates for women 20 to 39 years old decreased 2.8% per year from 1999 to 2010 but showed no decline from 2010 to 2022 (annual percentage change [APC], -0.01; P = .98). For women of ages 40 to 74 years, breast cancer mortality rates decreased 1.7% to 3.9% per year from 1990 to 2022 (P <.001); a decline was found for all cohorts in this age group except Asian women. For women ≥75 years of age, breast cancer mortality rates declined significantly from 1993 to 2013 (APC, -1.26; P = .01) but showed no evidence of decline from 2013 to 2022 (APC, -0.2; P = .24). Across all ages, breast cancer mortality rates declined for White and Black women but not for Asian, Hispanic, and Native American women. Asian women ≥75 years of age had significantly increasing mortality rates (APC, 0.73; P <.001). For 2004 to 2022, breast cancer mortality rates were 39% higher in Black women than White women and varied strongly by age group: 104% for ages 20 to 39 years, 51% for ages 40 to 74 years, and 13% for ages ≥75 years.

Conclusion: Female breast cancer mortality rates have stopped declining in women <40 years of age and >74 years of age. The higher mortality rates in Black women compared with White women are age dependent and substantially higher in younger women.

Ovarian metastasis to the breast is extremely rare. The clinical and radiologic presentation of metastasis to the breast is nonspecific and can mimic primary breast cancers. The most common mammographic findings of ovarian metastasis are superficial, circumscribed, high-density masses without architectural distortion. Compared with other malignancies that metastasize to the breast, ovarian cancer can more frequently show microcalcifications. On US, these masses can be hypoechoic or have heterogeneous echogenicity with posterior acoustic enhancement. Less commonly, ovarian metastasis can present similarly to inflammatory breast cancer, demonstrating diffuse skin thickening on mammography and US. Immunohistochemistry is useful in differentiating ovarian metastasis from primary breast lesions. Ovarian and breast markers, including Wilm's tumor, paired box 8, cancer antigen 125, GATA binding protein 3, and gross cystic disease fluid protein 15, are particularly helpful. Overall, metastatic ovarian cancer to the breast provides a diagnostic challenge requiring close radiologic and pathologic correlation to reach the correct diagnosis.