Journal of Breast Imaging最新文献

Receiving feedback can sometimes be difficult and uncomfortable but is an essential component of professional development in breast imaging. Trainees have an opportunity to leverage feedback in breast imaging by incorporating self-assessments, real-world patient outcomes, procedural feedback, patient interactions, and available audit data to build confidence and competency in residency and fellowship. We present strategies for seeking and receiving feedback with a growth mindset, including specific scenarios in breast imaging where trainees can incorporate feedback and maximize learning potential.

Objective: The purpose of this study was to describe the safety and efficacy of percutaneous drain placement for postoperative fluid collections in the breast.

Methods: A retrospective review was conducted of the patient characteristics, intervention data, and clinical outcomes of the 43 adult patients who underwent percutaneous drain placement for fluid collections at a tertiary care hospital over a 13-year period ending February 28, 2023.

Results: Most fluid collections treated with percutaneous drain placement were secondary to ipsilateral breast surgery (92%, 44/48), most commonly breast reduction (23%, 10/44) and mastectomy with immediate tissue expander reconstruction (16%, 7/44). Additional patients had fluid collections without prior ipsilateral breast surgery (8%, 4/48) and were excluded from further analysis. The fluid cultures from 39% of the cultured postsurgical fluid collections were positive (16/41), and Staphylococcus aureus was the most commonly cultured organism (15%, 6/41). The only immediate complication was the rupture of a tissue expander during drain placement in 1 patient. The median duration of percutaneous drainage for postsurgical fluid collections was 12 days (range: 1 to 49 days). Percutaneous drain placement achieved clinical success without any subsequent treatments in 73% (32/44) of patients. An additional 7% (3/44) of patients required subsequent image-guided aspiration procedures and/or percutaneous drain placements but avoided surgical treatment for a persistent fluid collection.

Conclusion: Postsurgical fluid collections after diverse breast surgeries represented the vast majority of the fluid collections referred to our academic practice for percutaneous drain placement. Percutaneous drain placement was a safe and effective treatment in this patient population.

Errors and misdiagnosis in breast imaging are significant concerns for breast imaging radiologists due to the negative impacts on patients and the high legal risks. Using missed and nearly missed diagnoses of breast cancer cases, this article introduces radiologists to common factors contributing to errors and misdiagnosis in breast imaging, including radiologist errors, improper imaging techniques, lesion characteristics, and work environment challenges. The article also provides practical recommendations and potential strategies to reduce these errors focusing on actions applicable to individual radiologists. Understanding the common causes of diagnostic errors in breast imaging and implementing targeted mitigating strategies can help radiologists improve diagnostic precision, reduce malpractice risk, and enhance patient care.

Objective: To determine sociodemographic and clinical factors associated with breast density awareness and anxiety in women with dense breasts.

Methods: This cross-sectional retrospective study, from a breast cancer screening prospective case collection registry (NCT03257839), analyzed patient-reported awareness of their breast density and related anxiety with sociodemographic variables. Asymptomatic women aged ≥40 with heterogeneously or extremely dense breasts completed a prescreening questionnaire at 9 Mammography Quality Standards Act-certified centers spanning 8 states with and without breast density notification laws (BDNLs).

Results: Among 6873 women (mean age 54.6 ± 9.3 years) with 99.4% (6833/6873) questionnaire completion, 71.7% (4930/6873) of participants were aware of their breast density. Self-reported Hispanic/Latina women comprised 15.4% (1055/6873), of whom 75.5% (796/1055) had a state BDNL. Fewer Hispanic/Latina women with a BDNL in effect were aware of density than non-Hispanic/Latina women (50.7% [403/795] vs 83.9% [2416/2880], P <.001). In multivariable analyses, the adjusted odds ratio (AOR) of breast density awareness was higher in women with some college education (AOR 2.70 [95% CI, 2.36-3.08]), BDNL in effect (AOR 2.09 [95% CI, 1.86-2.34]), self-reported ethnicity of not Hispanic or Latina (AOR 1.68 [95% CI, 1.45-1.96]), and aged 70 to 79 years (AOR 1.73 [95% CI, 1.35-2.22]), 60 to 69 years (AOR 1.45 [95% CI, 1.25-1.69]), or 50 to 59 years (AOR 1.30 [95% CI, 1.15-1.48]) when compared with 40 to 49 years. Women with awareness were more likely to be anxious (AOR 1.98 [95% CI, 1.76-2.24]).

Conclusions: Despite overall density awareness in women with dense breasts and BDNL implementation, health care providers should address disparities of awareness and target discussions with women under 50, individuals with a Hispanic/Latina background, and those less educated.

For the breast imaging radiologist, developing a career as a clinician-educator can be accomplished in a number of ways. Whether it be a new graduate or perhaps a radiologist making a midcareer or late-career pivot to the academic world, there are several opportunities and resources that can support a faculty member at any stage in this journey. In this article, the breast imaging radiologist will learn a variety of methods to strengthen their professional identity and career path as a clinician-educator through the early-, mid-, and late-career professional journey.

We used focus groups of radiologists who led the implementation of contrast-enhanced mammography (CEM) in their practice to identify barriers and strategies for adoption. Members of the Society of Breast Imaging in the United States who served as lead on CEM implementation were invited to participate in 2 separate focus groups. Ten breast imaging radiologists with varied geographic and practice type (60% academic, 30% private, and 10% community practice) participated. There were 4 major themes identified: patient selection, workflow, contrast, and billing. Patient selection varied widely among practices, with some limiting CEM to patients unable to obtain MRI and others routinely using CEM for diagnostic workup. Lack of Food and Drug Administration approval limited screening applications in some practices. Workflow challenges were numerous, and site-specific solutions were developed for ordering, scheduling, staffing, and intravenous access. There were universal concerns regarding contrast, including safe administration, response to reactions, and biopsy planning for findings only visible on CEM. Contrast reaction training, including conducting mock codes at some practices, helped alleviate concerns of the radiologists and technologists. Finally, billing was an administrative hurdle that influenced patient selection. Ample preparation is needed to successfully start a CEM program with particular attention to patient selection, workflow, contrast administration/reactions, and billing.

Objective: Peri-implant enhancement can be seen on contrast-enhanced breast MRI, but its association with malignancy has not been described, leading to considerable variability in assessment and recommendations by radiologists. This study evaluated imaging features, management, and outcomes of implant-related enhancement.

Methods: This multisite IRB-approved retrospective review queried all breast MRI reports for keywords describing peri-implant enhancement, fluid, and/or masses (plus synonymous descriptions) and implant-associated malignancies, with subsequent imaging and chart review. Peri-implant enhancement and implant features were characterized. Assessments and outcomes were evaluated via clinical and imaging follow-up, aspiration/biopsy, and/or capsulectomy to evaluate for association of peri-implant enhancement with implant-related malignancy.

Results: A total of 100 patients had peri-implant enhancement. Uniform thin peripheral enhancement was most common (79/100, 79%). Capsulectomy was performed in 31/100 (31%), with benign capsular fibrosis/inflammation discovered in 26/31 (83.9%). Breast implant-associated anaplastic large cell lymphoma was present in 2/100 (2%), both with textured implants, while 98/100 (98%) had no implant-related malignancy. MRI recommendations varied: resume routine imaging (26/100, 26%), clinical management (18/100, 18%), follow-up MRI (17/100, 17%), MRI-directed US (17/100, 17%), aspiration/biopsy (11/100, 11%), and surgical consultation (10/100, 10%).

Conclusion: Peri-implant enhancement is a nonspecific imaging finding with a low malignant association, especially when seen in isolation (no associated effusion, mass, or adenopathy). Implant surface texture should be considered in management recommendations; diagnostic capsulectomy is not recommended in patients with smooth implants. Additional studies are encouraged to validate nonoperative management recommendations.

Radiologists face a range of challenges to maximize the life-saving benefits of screening mammography, including pressure to maintain accuracy, manage heavy workloads, and minimize the risk of fatigue and burnout. This review provides targeted strategies to address these challenges and, ultimately, to improve interpretive performance of screening mammography. Workflow optimizations, including offline vs online and batched vs nonbatched interpretation, interrupted vs uninterrupted reading, and the importance of comparing current mammograms with prior examinations will be explored. Each strategy has strengths, weaknesses, and logistical challenges that must be tailored to the individual practice environment. Moreover, as breast radiologists contend with increasingly busy and hectic working conditions, practical solutions to protect reading environments and minimize distractions, such as the "sterile cockpit" approach, will be described. Additionally, breast radiologists are at greater risk for fatigue and burnout due to rising clinic volumes and an inadequate workforce. Optimizing the approach to reading screens is critical to helping breast imaging radiologists maintain and maximize the benefits of screening mammography, ensure the best outcomes for our patients, and maintain radiologist job satisfaction.