Variable Appearances of Ductal Carcinoma In Situ Calcifications on Digital Mammography, Synthesized Mammography, and Tomosynthesis: A Pictorial Essay.

This pictorial essay demonstrates the variable appearances of ductal carcinoma in situ on full-field digital mammography, synthesized mammography, and digital breast tomosynthesis. The spectrum of intercase and intracase variability suggests further refinement of reconstruction algorithms for synthesized mammography may be necessary to maximize early detection of ductal carcinoma in situ.

Incremental Role of Mammography in the Evaluation of Gynecomastia in Men Who Have Undergone Chest CT.

OBJECTIVE: The purpose of this study was to determine whether additional breast imaging is clinically valuable in the evaluation of patients with gynecomastia incidentally observed on CT of the chest. MATERIALS AND METHODS: In a retrospective analysis, 62 men were identified who had a mammographic diagnosis of gynecomastia and had also undergone CT within 8 months (median, 2 months). We compared the imaging findings of both modalities and correlated them with the clinical outcome. RESULTS: Gynecomastia was statistically significantly larger on mammograms than on CT images; however, there was a high level of concordance in morphologic features and distribution of gynecomastia between mammography and CT. In only one case was gynecomastia evident on mammographic but not CT images, owing to cachexia. Two of the 62 men had ductal carcinoma, which was obscured by gynecomastia. Both of these patients had symptoms suggesting malignancy. CONCLUSION: The appearance of gynecomastia on CT scans and mammograms was highly correlated. Mammography performed within 8 months of CT is unlikely to reveal cancer unless there is a suspicious clinical finding or a breast mass eccentric to the nipple. Men with clinical symptoms of gynecomastia do not need additional imaging with mammography to confirm the diagnosis if they have undergone recent cross-sectional imaging.

Breast cancer in male-to-female transsexuals: use of breast imaging for detection.

OBJECTIVE: The purposes of this article are to describe two cases of breast cancer in male-to-female transsexuals and to review eight cases previously reported in the literature. CONCLUSION: Breast cancer occurs in male-to-female transsexuals who receive high doses of exogenous estrogen and develop breast tissue histologically identical to that of a biologically female breast. This exposure to estrogen results in increased risk of breast cancer. The first patient described is a male-to-female transsexual with screening-detected ductal carcinoma in situ and a family history of breast cancer. The other patient is a male-to-female transsexual with invasive ductal carcinoma that was occult on diagnostic digital mammographic and ultrasound findings but visualized on digital breast tomosynthesis and breast MR images. The analysis of the eight previously reported cases showed that breast cancer in male-to-female transsexuals occurs at a younger age and is more frequently estrogen receptor negative than breast cancer in others born biologically male. Screening for breast cancer in male-to-female transsexuals should be undertaken for those with additional risk factors (e.g., family history, BRCA2 mutation, Klinefelter syndrome) and should be available to those who desire screening, preferably in a clinical trial.

Early discussion of breast density and supplemental breast cancer screening: is it possible?

The purpose of this study is to determine whether it is possible to make breast cancer screening more efficient in those with dense breasts. Over 12 states require that patients with dense breasts receive notification about their breast density in lay letters that are sent after the screening mammogram. Some of these letters advise patients to speak with their primary care providers about the possibility of supplemental breast cancer screening. We sought to determine whether primary care providers can discuss breast density and recommend supplemental breast cancer screening using the density of the previous mammography. This would reduce the burden of additional appointments and might increase the number of patients choosing to have supplemental screening. The mammographic breast density of 250 consecutive patients from May 2011 to September 2011 was compared with the immediate prior mammogram. Patients whose prior mammograms were more than 36 months prior or less than 8 months prior to the current exam were excluded, leaving 217 patients. The proportion of patients with breast density change was analyzed. The concordance of breast density between the two exams was assessed and the effects of patient age and the length of time between mammograms were examined. The breast density of the current and most recent prior mammogram was stable for 86.6% of patients. Neither age nor length of time between mammograms affected concordance. Primary care providers can decrease the need for multiple appointments and decrease patient anxiety by discussing breast density and screening choices prior to the patient's screening mammography. The great majority of patients will receive the correct information about their breast density by using a prior report.

Pre-biopsy psychological factors predict patient biopsy experience.

BACKGROUND: Excisional/surgical breast biopsy has been related to anticipatory emotional distress, and anticipatory distress has been associated with worse biopsy-related outcomes (e.g., pain, physical discomfort). PURPOSE: The present study was designed to investigate (a) whether anticipatory distress before an image-guided breast biopsy would correlate with biopsy-related outcomes (pain and physical discomfort during the biopsy) and (b) whether type of distress (i.e., general anxiety, worry about the procedure, worry about biopsy results) would differentially relate to biopsy-related outcomes. METHODS: Fifty image-guided breast biopsy patients (mean age = 44.4 years) were administered questionnaires pre- and post-biopsy. Pre-biopsy, patients completed the Profile of Mood States-tension/anxiety subscale and two visual analog scale items (worry about the biopsy procedure, worry about the biopsy results). Post-biopsy, patients completed two visual analog scale items (pain and physical discomfort at their worst during the procedure). RESULTS: The following results were gathered: (1) Pre-biopsy worry about the procedure was significantly related to both pain (r = 0.38, p = 0.006) and physical discomfort (r = 0.31, p = 0.026); (2) pre-biopsy general anxiety was significantly related to pain (r = 0.36, p = 0.009), but not to physical discomfort; and (3) Pre-biopsy worry about the biopsy results did not significantly relate to pain or physical discomfort. CONCLUSIONS: Worry about the procedure was the only variable found to be significantly correlated with both biopsy-related outcomes (pain and physical discomfort). From a clinical perspective, this item could be used as a brief screening tool to identify patients who might be at risk for poorer biopsy experiences and who might benefit from brief interventions to reduce pre-biopsy worry.

Validating racial and ethnic non-bias of artificial intelligence decision support for diagnostic breast ultrasound evaluation.

Purpose: Breast ultrasound suffers from low positive predictive value and specificity. Artificial intelligence (AI) proposes to improve accuracy, reduce false negatives, reduce inter- and intra-observer variability and decrease the rate of benign biopsies. Perpetuating racial/ethnic disparities in healthcare and patient outcome is a potential risk when incorporating AI-based models into clinical practice; therefore, it is necessary to validate its non-bias before clinical use. Approach: Our retrospective review assesses whether our AI decision support (DS) system demonstrates racial/ethnic bias by evaluating its performance on 1810 biopsy proven cases from nine breast imaging facilities within our health system from January 1, 2018 to October 28, 2021. Patient age, gender, race/ethnicity, AI DS output, and pathology results were obtained. Results: Significant differences in breast pathology incidence were seen across different racial and ethnic groups. Stratified analysis showed that the difference in output by our AI DS system was due to underlying differences in pathology incidence for our specific cohort and did not demonstrate statistically significant bias in output among race/ethnic groups, suggesting similar effectiveness of our AI DS system among different races (p>0.05 for all). Conclusions: Our study shows promise that an AI DS system may serve as a valuable second opinion in the detection of breast cancer on diagnostic ultrasound without significant racial or ethnic bias. AI tools are not meant to replace the radiologist, but rather to aid in screening and diagnosis without perpetuating racial/ethnic disparities.

Corrigendum to "Reactivation tuberculosis presenting with unilateral axillary lymphadenopathy" [Radiology Case Reports 13 (2018) 1188-1191].

[This corrects the article DOI: 10.1016/j.radcr.2018.07.014.].

Reactivation tuberculosis presenting with unilateral axillary lymphadenopathy.

Unilateral axillary lymphadenopathy has various benign and malignant etiologies. Although benign causes are more common, it is important to exclude malignant causes, including metastasis from primary breast carcinoma. Benign etiologies include reactive adenopathy, granulomatous disease, and collagen vascular disease. We present a case of unilateral right axillary lymphadenopathy in a patient with rheumatoid arthritis. The pathologic diagnosis of granulomatous lymphadenitis and interval discovery of patient's history of latent tuberculosis led to a second biopsy for special mycobacterial staining and cultures with a final diagnosis of reactivation tuberculosis. The extrapulmonary manifestation of reactivation tuberculosis with tuberculous lymphadenitis is uncommon and particularly rare in the axillary lymph nodes.

Spuriously aggressive features of a lactating adenoma prompting repeated biopsies.

We present an atypical presentation of a common pregnancy-related breast mass, a lactating adenoma with imaging and pathologic correlation. The patient presented with a rapidly enlarging left breast mass associated with skin changes and severe pain in the perinatal period. Core biopsies were considered discordant, and the patient went on to surgical excision for the definitive diagnosis of an infarcted lactating adenoma. The symptoms of infarction may obscure the diagnosis of common entities and result in additional evaluation.

The mammary ridge-A case report of multiple ectopic breast masses.

Ectopic or accessory breasts describe residual breast tissue that fails to regress during normal embryologic development anywhere outside the expected locations. Ectopic breast tissue is seen in 2-6% of the population and is categorized into two types: supernumerary and aberrant breast tissue . The extent of development of this accessory tissue varies from rudimentary to complete with organized glandular and ductal development. Given this, it is possible for the same pathology that affects normally positioned breast tissue to also affect accessory breast tissue.

Cellular fibroadenoma on Core needle biopsy: management recommendations for the radiologist.

INTRODUCTION: Cellular fibroadenomas (CFA) are difficult to distinguish from phyllodes tumor (PT) at biopsy. This study's purpose was to determine what CFA characteristics were associated with recommendations to follow-up or excise and if the current algorithm was correct. MATERIALS AND METHODS: Databases from 2002 to 2014 were reviewed. Mass characteristics and post biopsy recommendations were recorded. RESULTS: 81 CFAs were diagnosed; 19 cellular and 62 with slightly cellular stroma. 21 masses were surgically excised with 2 PTs diagnosed. CONCLUSION: Larger mass size and increased histologic cellularity were associated with excision recommendation, but only clinical growth was associated with PT.

Introductory pictorial atlas of 3D tomosynthesis.

Mammography is an essential tool for early detection of breast cancer. Breast imaging based on three-dimensional digital breast tomosynthesis (DBT) is a new method for breast cancer screening and diagnosis that uses three-dimensional digital images to allow separation of overlapping breast structures, which may allow for improved visualization of potentially significant findings. This article will highlight the utility of DBT as a tool for the detection of breast pathology; it will demonstrate normal findings as well as breast pathology on DBT and two-dimensional conventional mammography. DBT is a very promising modality, which may decrease the false-positive rate of mammography and find additional abnormalities not seen on two-dimensional mammography.

Digital breast tomosynthesis of gynecomastia and associated findings-a pictorial review.

Men referred for breast imaging most frequently present with a unilateral palpated breast lump or breast enlargement. In the vast majority of these cases, the cause is benign and the most common etiology is gynecomastia. This pictorial review illustrates the appearance by full field digital mammography and digital breast tomosynthesis of gynecomastia as well as additional findings in the male breast including sternalis muscle and hypertrophied pectoralis muscle, lipoma, intramammary lymph node, fat necrosis, breast cancer, and atypical ductal hyperplasia.