Malignancy rates of non-masslike enhancement on breast magnetic resonance imaging using American College of Radiology Breast Imaging Reporting and Data System descriptors.

The purpose of this study was to evaluate the malignancy rates for non-masslike enhancement on breast magnetic resonance imaging by American College of Radiology Breast Imaging Reporting and Data System descriptors. We retrospectively reviewed breast magnetic resonance imaging reports with non-masslike enhancement performed at Mayo Clinic Florida from April 1, 2003, through March 14, 2007. Each descriptor of non-masslike enhancement as per the American College of Radiology Breast Imaging Reporting and Data System magnetic resonance lexicon was correlated with percutaneous biopsy pathologic results and/or surgical pathologic results and follow-up imaging. Positive predictive values were obtained for each Breast Imaging Reporting and Data System descriptor. We identified 578 incidents of non-masslike enhancement in 378 patients. Of 343 non-masslike enhancements that could be correlated with pathology results, 141 (41.1%) were malignant. Of the malignant lesions, 53% were found to be ductal carcinoma in situ at percutaneous biopsy. Clumped pattern of enhancement and segmental distribution of non-masslike enhancement had the highest sensitivities of 40.5% and 23.5%, respectively. Asymmetric pattern and segmental distribution had the highest positive predictive values of 75.0% and 57.4%, respectively. We concluded that the moderate positive predictive values make it difficult to establish guidelines for management of non-masslike enhancement and reveal the current limitations of breast magnetic resonance imaging.

Breast Density Reporting Laws and Supplemental Screening-A Survey of Referring Providers' Experiences and Understanding.

Dense breast parenchyma obscures breast lesions on mammography and is an independent risk factor for development of breast cancer. Many states have approved laws requiring patient notification of dense breast tissue. Supplemental screening modalities are available however their utilization and efficacy are quite variable. Our aim was to survey primary care providers in an effort to gauge awareness of and familiarity with dense breast legislation and supplemental screening. A multisite survey was administered via e-mail to all Mayo Clinic staff physicians, residents and fellows, as well as nurse practitioners and physician assistants in the departments of Internal Medicine, Family Medicine, and Obstetrics and Gynecology. 362 responses were collected. 68% of respondents were aware of breast density notification laws; 32% had no knowledge of these laws. Implementation of supplemental imaging was variable. Of eligible respondents, 26% offered a supplemental examination to every patient with dense breasts, 47% offered it only to certain patients based upon unique patient or risk factors, 15% did not offer supplemental examinations, and 11% offered an examination based on other criteria. When assessing comfort level in answering questions regarding breast density, 32% were "slightly comfortable" and 18% were "not comfortable." When estimating the percentage of patients with adequate insurance coverage for supplemental imaging, 62% were unsure while 11% did not inquire. Despite public and legislative support, there is a lack of familiarity and considerable practice variation among primary care providers when managing patients with mammographically dense breast tissue. Further research and advances in patient and provider education on this topic are needed to improve management. Radiologists can assist by educating referring providers and consolidating imaging strategies to help circumvent systems-based flaws.

Clinical experience with MRI-guided vacuum-assisted breast biopsy.

OBJECTIVE: The objective of our study was to evaluate a new commercially available method of MRI-guided vacuum-assisted breast biopsy using an open coil and a closed 1.5-T scanner. MATERIALS AND METHODS: Consecutive MRI-guided vacuum-assisted breast biopsies of 38 lesions in 28 women performed between May and September 2003 at two practice sites in the United States were retrospectively reviewed. Lesion characteristics including size, morphology, and enhancement were recorded. Times to perform each procedure, defined as the time from the start of the first localizing scan to the final scan after biopsy, were recorded. Histologic results for all lesions were obtained, and surgical, imaging, or clinical follow-up was performed. RESULTS: Enhancing masses and foci ranged from 2.5 to 19 mm. Nonmasslike enhancements ranged from 6 to 70 mm. All 38 biopsies (100%) were technically successful, and no complications were associated with any of the biopsy procedures. The average time to perform the 19 single-site MRI-guided procedures was 38 min (range, 23-57 min). The 11 multiple-site biopsies performed in a single breast averaged 59 min (range, 51-68 min), and eight bilateral biopsies averaged 64 min (range, 46-80 min). Histologic results from vacuum-assisted breast biopsy revealed malignancy in 14 lesions (37%), atypical ductal hyperplasia in two lesions (5%), and benign findings in 22 lesions (58%). One of two lesions with atypical ductal hyperplasia was upgraded to ductal carcinoma in situ after surgery, for an overall cancer yield of 40% (15/38). CONCLUSION: This new method of MRI-guided vacuum-assisted breast biopsy is a safe, effective, and time-efficient means of MRI-guided tissue sampling.

The role of positron emission tomographic imaging in breast cancer.

Studies have shown that deoxy-2-fluorodeoxyglucose ((18)FDG) positron emission tomography (PET) has limited value in detecting primary tumors and axillary lymph node involvement in breast cancer. PET is most successful when it is used to evaluate locally advanced breast tumors. Identification of smaller, earlier-stage tumors and noninvasive or lobular tumors has been suboptimal. Because of several factors, PET should not replace standard techniques for evaluation of breast cancer, especially for micrometastasis. However, PET can provide invaluable information about disease extent, recurrent disease, and distant metastases, and this information can affect treatment decisions. (18)FDG PET can also facilitate the differentiation of therapy responders from nonresponders, allowing treatment regimen changes at an earlier stage.