Journal of Breast Imaging最新文献

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.

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.