Effect of testosterone therapy on breast tissue composition and mammographic breast density in trans masculine individuals.

BACKGROUND: The effect of gender-affirming testosterone therapy (TT) on breast cancer risk is unclear. This study investigated the association between TT and breast tissue composition and breast tissue density in trans masculine individuals (TMIs). METHODS: Of the 444 TMIs who underwent chest-contouring surgeries between 2013 and 2019, breast tissue composition was assessed in 425 TMIs by the pathologists (categories of lobular atrophy and stromal composition) and using our automated deep-learning algorithm (% epithelium, % fibrous stroma, and % fat). Forty-two out of 444 TMIs had mammography prior to surgery and their breast tissue density was read by a radiologist. Mammography digital files, available for 25/42 TMIs, were analyzed using the LIBRA software to obtain percent density, absolute dense area, and absolute non-dense area. Linear regression was used to describe the associations between duration of TT use and breast tissue composition or breast tissue density measures, while adjusting for potential confounders. Analyses stratified by body mass index were also conducted. RESULTS: Longer duration of TT use was associated with increasing degrees of lobular atrophy (p < 0.001) but not fibrous content (p = 0.82). Every 6 months of TT was associated with decreasing amounts of epithelium (exp(ß) = 0.97, 95% CI 0.95,0.98, adj p = 0.005) and fibrous stroma (exp(ß) = 0.99, 95% CI 0.98,1.00, adj p = 0.05), but not fat (exp(ß) = 1.01, 95%CI 0.98,1.05, adj p = 0.39). The effect of TT on breast epithelium was attenuated in overweight/obese TMIs (exp(ß) = 0.98, 95% CI 0.95,1.01, adj p = 0.14). When comparing TT users versus non-users, TT users had 28% less epithelium (exp(ß) = 0.72, 95% CI 0.58,0.90, adj p = 0.003). There was no association between TT and radiologist's breast density assessment (p = 0.58) or LIBRA measurements (p > 0.05). CONCLUSIONS: TT decreases breast epithelium, but this effect is attenuated in overweight/obese TMIs. TT has the potential to affect the breast cancer risk of TMIs. Further studies are warranted to elucidate the effect of TT on breast density and breast cancer risk.

Effect of testosterone therapy on breast tissue composition and mammographic breast density in trans masculine individuals.

Objective: Determine the association between TT and breast tissue composition and breast tissue density in trans masculine individuals (TMIs). Design: This is a cross-sectional study. Setting: TMIs (n=444) underwent chest-contouring surgeries to treat their gender dysphoria between 2013 and 2019 at an urban medical center. Participants: Of the 444 TMIs, 425 had pathology images analyzed by our deep-learning algorithm to extract breast tissue composition. A subset of 42/444 TMIs had mammography prior to surgery; mammography files were available for 25/42 TMIs and analyzed using a breast density software, LIBRA. Main Outcomes and Measures: The first outcome was the association of duration of TT and breast tissue composition assessed by pathologists (categories of lobular atrophy and stromal composition) or by our algorithm (% epithelium, % fibrous stroma, and % fat). The second outcome is the association of TT and breast density as assessed by a radiologist (categorical variable) or by LIBRA (percent density, absolute dense area, and absolute non-dense area). Results: Length of TT was associated with increasing degrees of lobular atrophy ( p <0.001) but not fibrous content ( p =0.821) when assessed by the pathologists. Every six months of TT was associated with decreased amounts of both epithelium (exp(ß)=0.97, 95% CI 0.95-0.98, adj p =0.005) and stroma (exp(ß)=0.99, 95% CI 0.98-1.00, adj p =0.051), but not fat (exp(ß)=1.01, 95%CI 0.98-1.05, p =0.394) in fully adjusted models. There was no association between TT and radiologist's breast density assessment ( p =0.575) or LIBRA measurements ( p >0.05). Conclusions: TT decreases breast epithelium and fibrous stroma, thus potentially reducing the breast cancer risk of TMIs. Further studies are warranted to elucidate the effect of TT on breast density and breast cancer risk. Summary Box: Very little is known about the effect of gender-affirming testosterone therapy on cancer risks, such as breast cancer.Epidemiological studies had different conclusions about the association between testosterone and breast cancer in cisgender women (positive association) and trans masculine individuals (inverse association).More laboratory-based research are needed to understand the effect of testosterone on breast cancer risk in the understudied trans masculine population.Our study provides quantitative histological evidence to support prior epidemiological reports that testosterone may reduce breast cancer risk in trans masculine individuals.

Invasive Ductal Carcinoma of the Breast in a Transgender Man: A Case Report.

There is limited literature about breast cancer in the transgender population. Very little is known about how gender-affirming hormone therapy affects their breast cancer risk. On the other end, for those diagnosed with breast cancer, there are no clinical guidelines to manage their breast cancer, specifically, how to manage their gender-affirming hormone therapy during breast cancer treatment. Here, we report a 52-year-old transman diagnosed with a grade 2 invasive ductal carcinoma (ER+/PR+/HER2-), and ductal carcinoma in situ (DCIS) of intermediate grade. We discussed his risk factors as well as treatment options.

Toker Cell Hyperplasia in the Nipple-Areolar Complex of Transmasculine Individuals.

We previously reported breast histopathologic features associated with testosterone therapy in transmasculine chest-contouring surgical specimens. During that study, we observed a high frequency of intraepidermal glands in the nipple-areolar complex (NAC) formed by Toker cells. This study reports Toker cell hyperplasia (TCH)-the presence of clusters of Toker cells consisting of at least 3 contiguous cells and/or glands with lumen formation-in the transmasculine population. Increased numbers of singly dispersed Toker cells were not considered TCH. Among the 444 transmasculine individuals, 82 (18.5%) had a portion of their NAC excised and available for evaluation. We also reviewed the NACs from 55 cisgender women who were aged <50 years old and had full mastectomies. The proportion of transmasculine cases with TCH (20/82; 24.4%) was 1.7-fold higher than cisgender women (8/55; 14.5%) but did not achieve significance (P = .20). However, in cases with TCH, the rate of gland formation is 2.4-fold higher in transmasculine cases, achieving borderline significance (18/82 vs 5/55; P = .06). Among transmasculine individuals, TCH was significantly more likely to be present in those with higher body mass index (P = .03). A subset of 5 transmasculine and 5 cisgender cases were stained for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), androgen receptor (AR), cytokeratin 7, and Ki67. All 10 cases were cytokeratin 7+ and Ki67-; 9 out of 10 cases were AR+. Toker cells in transmasculine cases demonstrated variable expression of ER, PR, and HER2. For cisgender cases, Toker cells were consistently ER+, PR-, and HER2-. In conclusion, there is a higher rate of TCH in the transmasculine than cisgender population, particularly among transmasculine individuals with high body mass index and taking testosterone. To our knowledge, this is the first study to demonstrate that Toker cells are AR+. Toker cell features display variable ER, PR, and HER2 immunoreactivity. The clinical significance of TCH in the transmasculine population remains to be elucidated.

Cancer Conspicuity on Low-energy Images of Contrast-enhanced Mammography Compared With 2D Mammography.

OBJECTIVE: Low-energy (LE) images of contrast-enhanced mammography (CEM) have been shown to be noninferior to digital mammography. However, our experience is that LE images are superior to 2D mammography. Our purpose was to compare cancer appearance on LE to 2D images. METHODS: In this IRB-approved retrospective study, seven breast radiologists evaluated 40 biopsy-proven cancer cases on craniocaudal (CC) and mediolateral oblique (MLO) LE images and recent 2D images for cancer visibility, confidence in margins, and conspicuity of findings using a Likert scale. Objective measurements were performed using contrast-to-noise ratio (CNR) estimated from regions of interest placed on tumor and background parenchyma. Reader agreement was evaluated using Fleiss kappa. Per-reader comparisons were performed using Wilcoxon test and overall comparisons used three-way analysis of variance. RESULTS: Low-energy images showed improved performance for visibility (CC LE 4.0 vs 2D 3.5, P < 0.001 and MLO LE 3.7 vs 2D 3.5, P = 0.01), confidence in margins (CC LE 3.2 vs 2D 2.8, P < 0.001 and MLO LE 3.1 vs 2D 2.9, P < 0.008), and conspicuity compared to tissue density compared to 2D mammography (CC LE 3.6 vs 2D 3.2, P < 0.001 and MLO LE 3.5 vs 2D 3.2, P < 0.001). The average CNR was significantly higher for LE than for digital mammography (CC 2.1 vs 3.2, P < 0.001 and MLO 2.1 vs 3.4, P < 0.001). CONCLUSION: Our results suggest that cancers may be better visualized on the LE CEM images compared with the 2D digital mammogram.

Testosterone therapy and breast histopathological features in transgender individuals.

Testosterone therapy (TT) is administered to enhance masculinization in transgender individuals. The long-term effect of exogenous testosterone on breast tissues remains unclear. Our study evaluated the modulation of breast morphology by TT in transgender individuals with special attention to duration of TT. We reviewed 447 breast surgical specimens from gender affirming chest-contouring surgery, and compared histopathological findings including degree of lobular atrophy, and atypical and non-atypical proliferations between subjects who did (n = 367) and did not (n = 79) receive TT. TT for one patient was unknown. TT for >12 months was associated with seven histopathological features. Longer duration of TT was significantly associated with higher degrees of lobular atrophy (p < 0.001). This relationship remained significant after accounting for age at surgery, ethnicity, body mass index, and presurgical oophorectomy (adjusted p < 0.001). Four types of lesions were more likely to be absent in breast tissues exposed to longer durations of TT: cysts (median = 16.2 months; p < 0.01; adjusted p = 0.01), fibroadenoma (median = 14.8 months; p = 0.02; adjusted p = 0.07), pseudoangiomatous stromal hyperplasia (median = 17.0 months; p < 0.001; adjusted p < 0.001), and papillomas (median = 14.7 months; p = 0.04; adjusted p = 0.20). Columnar cell change and mild inflammation were also less likely to occur in subjects receiving TT (p < 0.05), but were not linked to the duration of TT. Atypia and ductal carcinoma in situ were detected in 11 subjects (2.5%) all of whom received TT ranging from 10.1 to 64.1 months. The incidental findings of high-risk lesions and carcinoma as well as the risk of cancer in residual breast tissue after chest-contouring surgery warrant the consideration of culturally sensitive routine breast cancer screening protocols for transgender men and masculine-centered gender nonconforming individuals. Long-term follow-up studies and molecular investigations are needed to understand the breast cancer risk of transgender individuals who receive TT.

Injected Breast Materials: Review of Imaging Features and Characteristics.

In the United States, silicone and saline breast implants with their familiar radiologic appearance are the mainstays of breast augmentation. However, less well-known sequelae of unconventional injected materials introduced for cosmetic and noncosmetic purposes may also be encountered on breast imaging-for example, free silicone, paraffin and/or oil, polyacrylamide gel, autologous fat, and hyaluronic acid, which are encountered in the setting of breast augmentation. Breast injection of go-yak is not cosmetic but also results in characteristic imaging findings. Breast changes due to extravasation of chemotherapy or interstitial brachytherapy can mimic the appearance of injected noncosmetic materials. Because many of these materials can mimic or obscure imaging findings of breast cancer, it is important to recognize their varied appearances and the limitations of imaging alone in delineating breast injection material from cancer. Given the relatively uncommon incidence of injected materials into the breast, this article aims to review the imaging appearance in order to aid radiologists in maximizing cancer detection and ensuring optimal patient management.

Establishing a Cohort of Transgender Men and Gender Nonconforming Individuals to Understand the Molecular Impact of Testosterone on Breast Physiology.

Purpose: To characterize a cohort of transgender men and masculine-centered gender nonconforming individuals who underwent gender-affirming chest-contouring surgeries at our institution between 2013 and 2018. Methods: Demographics, medical history, and breast histopathological assessment for 340 patients were retrieved from medical records. Results: Most of our patients were white, non-Hispanic (75.0%), were taking testosterone (83.2%), and opted for chest-contouring surgery after 12-14 months of testosterone therapy. Ten patients were parous (2.9%). Seventy-nine (23.2%) and 27 (7.9%) patients had a family history of breast cancer or ovarian cancer, respectively. One transgender man was incidentally diagnosed with ductal carcinoma in situ at chest-contouring surgery. Conclusion: Future studies on this cohort will provide valuable insights about the impact of testosterone on breast physiology.

Lumpectomy Specimen Radiography: Does Orientation or 3-Dimensional Tomosynthesis Improve Margin Assessment?

PURPOSE: Our purpose was twofold. First, we sought to determine whether 2 orthogonal oriented views of excised breast cancer specimens could improve surgical margin assessment compared to a single unoriented view. Second, we sought to determine whether 3D tomosynthesis could improve surgical margin assessment compared to 2D mammography alone. MATERIALS AND METHODS: Forty-one consecutive specimens were prospectively imaged using 4 protocols: single view unoriented 2D image acquired on a specimen unit (1VSU), 2 orthogonal oriented 2D images acquired on the specimen unit (2VSU), 2 orthogonal oriented 2D images acquired on a mammogram unit (2V2DMU), and 2 orthogonal oriented 3D images acquired on the mammogram unit (2V3DMU). Three breast imagers randomly assessed surgical margin of the 41 specimens with each protocol. Surgical margin per histopathology was considered the gold standard. RESULTS: The average area under the curve (AUC) was 0.60 for 1VSU, 0.66 for 2VSU, 0.68 for 2V2DMU, and 0.60 for 2V3DMU. Comparing AUCs for 2VSU vs 1VSU by reader showed improved diagnostic accuracy using 2VSU; however, this difference was only statistically significant for reader 3 (0.73 vs 0.63, P = .0455). Comparing AUCs for 2V3DMU vs 2V2DMU by reader showed mixed results, with reader 1 demonstrating increased accuracy (0.72 vs 0.68, P = .5984), while readers 2 and 3 demonstrated decreased accuracy (0.50 vs 0.62, P = .1089 and 0.58 vs 0.75, P = .0269). CONCLUSIONS: 2VSU showed improved accuracy in surgical margin prediction compared to 1VSU, although this was not statistically significant for all readers. 3D tomosynthesis did not improve surgical margin assessment.

Potential role of abbreviated MRI for breast cancer screening in an academic medical center.

The purpose is to determine whether an abbreviated MRI protocol (ABMR) is ready to be used for breast cancer screening in an academic practice setting. Two hundred and fifty nine breast MRIs from 1/1/2012 to 6/30/2012 were retrospectively reviewed using ABMR (MIP, Pre-contrastT1, single dynamic post-contrastT1, and subtraction). Five breast radiologists (4-28 year-expr) participated in this reader study performed in two phases: Phase1 - radiologist's privy to clinical history but not to comparison imaging. Phase2 - radiologists provided comparison imaging. For phase1, studies were reviewed using three steps: (a) MIP only (positive/negative/intermediate); (b) ABMR (recall/no recall) and (c) With T2 (for changes in recommendations). Radiologist also recorded total time for interpretation. In Phase2 the MRIs coded as "recall" were re-reviewed with available comparison studies, noting changes in final recommendation. The abnormal interpretation rates (AIRs) were calculated for phase1 and phase2 results with comparison to the original full protocol. Of the 259 patients (avg. age-52 years; range 26-78), there were seven cancers (three invasive, three DCIS and one breast lymphoma). Acquisition time for ABMR was 3 minutes, ABMR + T2-8 minutes, and original full protocol 16 minutes. Average MIP was positive or indeterminate in 86% (6/7) and negative in 14% (1/7) cancers. The average AIR for MIP only was 20.8% (sens-77.1%; spec-80.8%. The AIR w/o comparisons was 25.6% (sens-91.4%; spec- 76.2%); however the average AIR decreased in phase 2 with comparisons to 13.7% (sens-91.4%; spec-88.5%). The AIR of the original full protocol read was 16.2% (sens-100%; spec-85.7%). Addition of T2 changed assessment in only 3% (1.2%-6.5%). Avg. read time for ABMR including T2 was 2.5 minutes (1.6-4.0 minutes). ABMR is reliable for breast cancer screening, with acceptable interpretation time and acceptable AIR.

Contrast-Enhanced Mammography: A Systematic Guide to Interpretation and Reporting.

OBJECTIVE: The purpose of this article is to discuss the essential steps involved in performing, interpreting, managing, and reporting findings on contrast-enhanced mammography for successful implementation into clinical practice. CONCLUSION: To successfully implement contrast-enhanced mammography into clinical practice, an understanding about the acquisition of images, image interpretation, and reporting of the spectrum of negative, benign, and malignant findings is essential.

Pearls and Pitfalls of Contrast-Enhanced Mammography.

Contrast-enhanced mammography (CEM) is a promising new imaging modality that uses a dual-energy acquisition to provide both morphologic and vascular assessment of breast lesions. Although no official BI-RADS lexicon exists, interpretation entails using the mammographic BI-RADS lexicon in combination with that for breast MRI. CEM has comparable performance to breast MRI, with sensitivity of 93-100% and specificity of 80-94%. Currently FDA approved for diagnostic imaging, this technology can be helpful in determining disease extent in patients with newly diagnosed breast malignancy, monitoring response to neoadjuvant therapy, identifying mammographically occult malignancies, and diagnostic problem-solving. Studies are ongoing about its role in screening, especially in women with dense breasts or at elevated risk. There are some challenges to successful implementation into practice, but overall, patients tolerate the study well, and exam times are less than the full breast MRI protocol.

Key Ingredients of a Breast Imaging Fellowship-A Recipe for Success.

OBJECTIVE: In 2013, the ACR and Society of Breast Imaging created a curriculum to standardize the knowledge of graduates from breast imaging fellowships. Despite this, however, there remains a need to provide guidance to programs as to how to structure and organize the fellowship. In this article, we review key elements of a breast imaging fellowship to ensure that programs graduate radiologists that are well prepared to practice safely and independently. Such a program would provide a developmental framework using the Dreyfus model of skill acquisition. The training should be comprised of multiple and varied opportunities that promote active learning with appropriate supervision but progressive independence. SUMMARY: A successful fellowship program in breast imaging should embrace developmental milestones to ensure mastery of both basic and complex skills. Organized rotations, regular feedback, structured and self-directed learning activities, and participation in local, regional, and national meetings and organizations contribute to well-rounded graduates.

Indications for biopsy of imaging-detected intramammary and axillary lymph nodes in the absence of concurrent breast cancer.

To evaluate the prevalence of malignancy in imaging-detected abnormal lymph nodes (LNs) in women without concurrent cancer and to identify imaging features predictive of malignancy in this population. This is an IRB-approved study with waived informed consent. We retrospectively reviewed medical records of all image-guided LN FNAs and CNBs performed at our institution from 1/1/08 through 12/31/10. LNs sampled in patients without concurrent breast cancer comprised our study group (SG; n = 77), and with concurrent breast cancer our reference group (RG; n = 124). Blinded to cytology/histology, imaging features of the LNs including size, loss of fatty hilum, and cortical thickness were reviewed. A low/high suspicion category was then assigned based on LN appearance. The prevalence of malignancy in LNs in SG was 6% (5/77) and in RG 52% (64/124; P < .0001). Complete loss of fatty hilum had 100% (5/5) sensitivity, and 100% (56/56) NPV for detecting cancer in SG, compared to 39% (25/64) sensitivity and 61% (60/99) NPV in RG. When a "high suspicion" imaging feature was used as a threshold to biopsy, the sensitivity (5/5) and NPV (45/45) in SG were 100%, and in RG 78% (50/64) and 77% (47/61), respectively. The prevalence of cancer in imaging-detected abnormal LNs in patients without concurrent breast cancer is low. In the absence of concurrent cancer, using highly suspicious features of loss of fatty hilum or cortical thickness ≥ 5 mm as a threshold to biopsy will maintain high sensitivity with lower false-positive biopsy rate.

Deciphering the Breast Density Inform Law Movement: Implications for Practice.

Although dense breast tissue is a normal and routine finding on screening mammography, dense breast tissue is associated with an independent increased risk for breast cancer. It is well known that screening mammography has a decreased sensitivity for cancer detection in women with dense breasts. Over the past decade, there has been increased interest generated among patients, physicians, and legislators regarding how best to screen dense-breasted women culminating in 2009 with the passage of a breast density notification law in Connecticut. Since that time, over half the United States has passed similar notification laws. Despite this, controversy remains as to the optimal supplemental screening modality to complement mammography as each imaging modality (digital breast tomosynthesis, whole breast ultrasound, magnetic resonance imaging, contrast-enhanced mammography, and molecular breast imaging) has variable benefits and limitations.

Proposed biopsy performance benchmarks for MRI based on an audit of a large academic center.

Performance benchmarks exist for mammography (MG); however, performance benchmarks for magnetic resonance imaging (MRI) are not yet fully developed. The purpose of our study was to perform an MRI audit based on established MG and screening MRI benchmarks and to review whether these benchmarks can be applied to an MRI practice. An IRB approved retrospective review of breast MRIs was performed at our center from 1/1/2011 through 12/31/13. For patients with biopsy recommendation, core biopsy and surgical pathology results were reviewed. The data were used to derive mean performance parameter values, including abnormal interpretation rate (AIR), positive predictive value (PPV), cancer detection rate (CDR), percentage of minimal cancers and axillary node negative cancers and compared with MG and screening MRI benchmarks. MRIs were also divided by screening and diagnostic indications to assess for differences in performance benchmarks amongst these two groups. Of the 2455 MRIs performed over 3-years, 1563 were performed for screening indications and 892 for diagnostic indications. With the exception of PPV2 for screening breast MRIs from 2011 to 2013, PPVs were met for our screening and diagnostic populations when compared to the MRI screening benchmarks established by the Breast Imaging Reporting and Data System (BI-RADS) 5 Atlas® . AIR and CDR were lower for screening indications as compared to diagnostic indications. New MRI screening benchmarks can be used for screening MRI audits while the American College of Radiology (ACR) desirable goals for diagnostic MG can be used for diagnostic MRI audits. Our study corroborates established findings regarding differences in AIR and CDR amongst screening versus diagnostic indications.

Incidental liver lesions seen on Breast MRI: When is additional imaging warranted?

PURPOSE: Incidental hepatic lesions identified on breast MR can be a diagnostic dilemma due to concern for liver metastases or other significant hepatic lesions. The purpose of this study was to identify the incidence and nature of liver lesions seen on breast MR, and determine if additional imaging is necessary. METHODS AND MATERIALS: Imaging reports of all breast MR examinations performed at our institution from January 1, 2010 to December 31, 2011 were reviewed to identify reports with hepatic abnormalities. Lesion characteristics, subsequent diagnosis, duration of follow up and additional imaging results (if performed) were all recorded. RESULTS: Of 1664 breast MRs, incidental hepatic lesions were seen in 207 studies (12.4%) in 169 patients. In 154 of 169 patients (91.1%) the lesions were characterized as T2 hyperintense and clearly as bright as adjacent fat on T2-weighted or localizer sequences. 0 of these 154 lesions were clinically significant at clinical or radiological follow-up. In the remaining 8.9% (15 of 169), lesions were characterized as not as bright as adjacent fat on T2 weighted or localizer imaging. In two cases, lesions were confirmed as incidental hepatic metastatic disease. CONCLUSION: 91.1% of incidental hepatic lesions were circumscribed, T2 hyperintense lesions and characterised as clearly as bright as adjacent fat on T2 weighted imaging at additional review. None of which were clinically significant at clinical or radiological follow-up. We advocate that circumscribed T2 hyperintense lesions which are clearly as bright as adjacent fat on T2 weighted imaging are of unlikely clinical significance and follow-up imaging should not be recommended, reducing the rate of additional imaging from 37.3% to 5.3%.

Clinical Value of Mammography in the Evaluation of Palpable Breast Lumps in Women 30 Years Old and Older.

OBJECTIVE: The purpose of this study was to determine whether mammography adds clinical value in the diagnostic imaging workup of women 30 years old and older who present with palpable breast lumps. MATERIALS AND METHODS: We retrospectively identified the records of all women 30 years old and older who underwent imaging evaluation with mammography and ultrasound for a palpable lump between January 1, 2009, and December 31, 2010. Imaging reports were reviewed for findings related to the lump and for incidental nonpalpable findings. Benign versus malignant outcomes were determined by pathologic analysis or 24-month imaging or clinical follow-up. The contribution of mammography to final diagnosis was assessed on the basis of objective criteria to determine the clinical impact of mammographic findings. RESULTS: The study cohort included 861 patients presenting with 935 palpable lumps. Imaging correlates were reported for 568 of 935 (60.7%) lumps, and imaging findings were negative in 367 of 935 (39.3%). Of the 935 palpable lumps, 858 (91.8%) were benign and 77 (8.2%) were malignant. Mammography added clinical value in the evaluation of 27 of 77 (35.0%) malignant lumps by better delineating extent of disease and in the evaluation of 26 of 858 benign lumps (3.0%) by confirming benignity. Fifty-two of 861 (6.0%) patients had incidental findings that led to a recommendation for biopsy. Twenty-nine of the 52 findings were originally seen with mammography and 23 with ultrasound. Mammography also depicted seven incidental malignancies in nonpalpable areas, and ultrasound depicted one incidental malignancy. CONCLUSION: Adjunct mammography is warranted for evaluation of palpable breast lumps in women 30 years old and older because of the value added to clinical management. In all age cohorts, mammography contributed to delineation of disease extent, detection of incidental malignancies, and confirmation of benign diagnoses.

Imaging Features of Spindle Cell Breast Lesions.

OBJECTIVE: The purpose of our study is to review the clinical presentation, multimodality appearance, and management of the most common benign and malignant spindle cell lesions of the breast. CONCLUSION: Spindle cell lesions of the breast exhibit characteristic features at mammography, ultrasound, and MRI. Although a definitive diagnosis of these lesions cannot be made with diagnostic imaging alone, knowledge of their characteristic imaging features can assist in refining the differential diagnosis and guiding appropriate management.