RESUMO
PURPOSE: To outline the demographics, clinical presentation, imaging features, and treatment modalities observed among a series of patients diagnosed with biopsy-proven granulomatous mastitis (GM). METHOD: Following approval by institutional review board, retrospective chart review was performed on patients with biopsy-proven granulomatous mastitis at our institution in the period from January 2013 until October 2017. RESULTS: A total of 90 patients were identified: 87 women and 3 men. The mean age was 35 years, mostly women in their reproductive age. In our study, patients with GM were more likely to be Hispanic compared to the general population. Sixty-three percent of patients were within 5 years of previous pregnancy. Painful palpable mass-like lesion was the most common physical finding. Breast ultrasound (US) was performed in all patients, and most commonly showed a hypoechoic irregular-shaped mass. Mammography (MG) showed asymmetry or irregular mass as the main finding. Definitive diagnosis was obtained by imaging-guided core needle biopsies in 94.4%. Conservative management was preferred, and only one patient underwent surgery. CONCLUSION: Although clinical and radiological findings of patients with GM may mimic those of breast carcinoma, our study showed that women of childbearing age, especially among Hispanic ethnicity with a recent history of pregnancy or high prolactin level and newly tender mass-like lesion, in addition to new focal asymmetry on mammogram and heterogeneous hypoechoic irregular-shaped mass on ultrasound exam, should raise concern for GM. Non-invasive approach and clinical follow-up were the preferred treatment method.
Assuntos
Neoplasias da Mama/diagnóstico , Diagnóstico Diferencial , Mastite Granulomatosa/diagnóstico , Adulto , Biópsia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Feminino , Mastite Granulomatosa/diagnóstico por imagem , Mastite Granulomatosa/epidemiologia , Mastite Granulomatosa/patologia , Hispânico ou Latino , Humanos , Masculino , Mamografia , Ultrassonografia MamáriaRESUMO
PURPOSE: The aim of this study is to determine the impact of a simulation-based ultrasound-guided (USG) breast biopsy training session on radiology trainee procedural knowledge, comfort levels, and overall procedural confidence and anxiety. METHODS: Twenty-one diagnostic radiology residents from a single academic institution were recruited to participate in an USG breast biopsy training session. The residents filled out a questionnaire before and after the training session. Ten multiple-choice questions tested general knowledge in diagnostic breast ultrasound and USG breast biopsy concepts. Subjective comfort levels with ultrasound machine and biopsy device functionality, patient positioning, proper biopsy technique, image documentation, needle safety and overall procedural confidence and anxiety levels were reported on a 5-point Likert scale before and after training. RESULTS: Participants demonstrated significant improvement in number of correctly answered general knowledge questions after training (P < .0001). Significant improvement was seen in resident comfort level in ultrasound machine functionality, patient positioning, biopsy device functionality, biopsy technique, image documentation, as well as overall confidence level (all P < .05). Participants indicated a slight but not significant reduction in anxiety levels (P = .27). CONCLUSIONS: A simulation-based USG breast biopsy training session may improve radiology trainee procedural knowledge, comfort levels, and overall procedural confidence.
Assuntos
Biópsia por Agulha/métodos , Mama/patologia , Educação de Pós-Graduação em Medicina/métodos , Treinamento por Simulação , Ultrassonografia de Intervenção , Currículo , Avaliação Educacional , Feminino , Humanos , Internato e Residência , Imagens de FantasmasRESUMO
PURPOSE: The utilization of staging preoperative breast MRI in biopsy-proven cancer patients varies based on institution and individual clinicians. It is unclear whether primary breast cancer subtype influences a clinician's decision to obtain a preoperative breast MRI based on likelihood of multicentric or contralateral disease, which may change surgical or medical management. Our purpose was to compare the four main breast cancer subtypes in our patient population (i.e., luminal A, luminal B, HER2 enriched and triple-negative) who underwent pretreatment staging MRIs to determine whether certain breast cancer subtypes are more likely to have multicentric or contralateral disease. METHODS: We retrospectively reviewed 435 patients with biopsy-proven invasive breast cancer who had staging MRI. RESULTS: Of these patients, 14 had biopsy-proven multicentric disease (3.2% of total) and 15 had biopsy-proven contralateral second tumor sites (3.4% of total). There was no statistically significant difference between primary tumor subtype and likelihood of multicentric or contralateral disease (p = 0.3065). CONCLUSION: Pretreatment staging MRI can detect multicentric and/or contralateral additional tumor sites, which ultimately changes staging, treatment options, and outcomes for patients with biopsy-proven breast cancer. There is no correlation between primary breast cancer subtype and likelihood of multicentric or contralateral disease.
Assuntos
Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Imageamento por Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Neoplasias da Mama/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos RetrospectivosRESUMO
Granulomatous mastitis is a rare and benign inflammatory condition of the breast most commonly affecting women of child-bearing age as well as patients on oral contraceptives. This condition is important to identify due to its diagnostic mimicry of malicious entities such as breast carcinoma. Clinical and radiological findings are nonspecific and may overlap with breast carcinomas, thus pathologic confirmation is often necessary for definitive diagnosis. Although cases of granulomatous mastitis have been described in cisgender females, there have been no reported cases in the transgender patient, a growing patient population with few imaging guidelines. Transgender patients are at risk of developing this breast entity due to the use of long-term hormone treatments or presence of residual breast tissue. A trial of antibiotics or steroids may be administered. However, surgical treatment is often necessary in recurrent or refractory cases.
Assuntos
Mastite Granulomatosa/diagnóstico por imagem , Pessoas Transgênero , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Mamografia , Ultrassonografia MamáriaRESUMO
Spindle cell lesions of the breast comprise a wide-range of entities including reactive, benign and malignant proliferations. They can be pathologically challenging to differentiate as there is often immunohistochemical and morphologic similarities with characteristic spindle shaped cellular patterns. Radiological and pathological correlation is essential. Radiology detects, defines the size and extent, and assists in localizing the lesions. Pathology confirms the diagnosis and provides prognostic parameters. Familiarity with the clinicoradiological features of these diagnostically challenging lesions helps to establish an accurate pathological diagnosis and subsequent clinical decision making.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Diferenciação Celular/efeitos da radiação , Imagem Multimodal/métodos , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Humanos , PrognósticoAssuntos
Biópsia com Agulha de Grande Calibre/normas , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Melhoria de Qualidade , Adulto , Feminino , Hospitais de Condado , Humanos , Imageamento por Ressonância Magnética , Mamografia , Ultrassonografia Mamária , Estados UnidosRESUMO
RATIONALE AND OBJECTIVES: Core needle biopsy results of segmental calcifications on mammography can have direct impact on surgical management. Although dependent on breast size, cancer spanning greater than 5 cm is usually treated with mastectomy, and cancer less than 5 cm is managed with lumpectomy. Approach to stereotactic biopsy of morphologically similar segmental calcifications that span more than 5 cm on mammography varies geographically and is currently largely based on preference of the surgical or medical oncology colleagues. Some clinicians prefer biopsy of the anterior and posterior aspects of the abnormality, whereas others believe a single biopsy within the abnormality is adequate. There is insufficient data to support whether a single biopsy of calcifications is adequate to establish the need for mastectomy, or if pathology-proven cancer in the anterior and posterior components to define the extent of disease is required. This study aims to evaluate concordance rates of paired biopsies of suspicious segmental mammographic calcifications. MATERIALS AND METHODS: From a 5-year review of our imaging database, 32 subjects were identified with breast imaging reporting and data system (BI-RADS) 4 or 5 segmental calcifications on mammography who underwent anterior and posterior stereotactic biopsies. The paired biopsy results were independently analyzed for concordance on benign, high-risk, or malignant pathology. RESULTS: Of the 32 cases, there was perfect agreement (32/32 cases = 100% concordance, 95% confidence interval = 89.3-100%) in anterior and posterior pairs in benign, high-risk, or malignant findings (kappa = 1, P < 0.001). CONCLUSIONS: The absence of data on pathological concordance in anterior and posterior aspects of suspicious, morphologically similar, segmental calcifications spanning 5 cm or more has led to a varied clinical approach to stereotactic biopsy. The 100% rate of pathological concordance in our study suggests that a single biopsy is adequate for diagnosis and representative of the whole mammographic abnormality. Implementation of this approach will potentially reduce unnecessary biopsies and surgeries, minimize healthcare costs, and decrease patient morbidity.
Assuntos
Biópsia com Agulha de Grande Calibre/métodos , Doenças Mamárias/patologia , Neoplasias da Mama/patologia , Calcinose/patologia , Adulto , Idoso , Doenças Mamárias/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Feminino , Humanos , Mamografia , Pessoa de Meia-IdadeAssuntos
Modelos Organizacionais , Cultura Organizacional , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Melhoria de Qualidade/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Radiologia/organização & administração , Objetivos Organizacionais , TexasAssuntos
Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Administração da Prática Médica/organização & administração , Intensificação de Imagem Radiográfica/métodos , Procedimentos Clínicos , Feminino , Humanos , Estudos de Casos Organizacionais , Objetivos Organizacionais , Texas , Carga de Trabalho/estatística & dados numéricosRESUMO
This review will discuss changes relevant to breast cancer caregivers in the fifth edition of the Breast Imaging Reporting and Data System.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Cuidadores , Implantes de Mama , Neoplasias da Mama/terapia , Feminino , Humanos , Imageamento por Ressonância Magnética , Glândulas Mamárias Humanas/patologia , Guias de Prática Clínica como Assunto , Radiografia , UltrassonografiaRESUMO
OBJECTIVE: The purpose of this article is to determine whether formal instruction regarding the BI-RADS ultrasound lexicon results in improved appropriate use of the lexicon. MATERIALS AND METHODS: Ninety test questions depicting the features outlined by the 2003 BI-RADS lexicon were identified in our PACS. Informed consent was obtained from 34 radiology residents. The participants took the preinstruction test and then had 1 hour of formal instruction regarding the BI-RADS ultrasound lexicon, which included images depicting the different sonographic features and final assessment (including subcategories 4a, 4b, and 4c). The participants then completed the postinstruction test, which examined the same content. Test scores were calculated for both the pre- and postinstruction tests and then were compared by a linear mixed model and Wilcoxon signed rank tests. RESULTS: The participants' postinstruction test scores showed significant improvement in the overall use of the BI-RADS ultrasound lexicon (p < 0.0001). There was also significant improvement in the following specific areas: final assessment (p = 0.0005), margin (p = 0.0003), orientation (p = 0.0104), and lesion boundary (p = 0.0050). The categories for which test scores did not show significant improvement were echo pattern (p = 0.07), posterior acoustic features (p = 0.50), shape (p = 0.98), and subset of the final assessment (p = 0.24). CONCLUSION: Formal instruction regarding the BI-RADS ultrasound lexicon results in improved lesion characterization and final assessment.