Attitudes of Practicing Radiologists Toward the Management of Palpable Circumscribed Breast Masses.

OBJECTIVE: To investigate the attitudes of radiologists toward palpable breast masses with benign features on US and to determine the factors influencing their decision. METHODS: A 20-question online questionnaire was sent to radiologists with membership of the Iranian Society of Radiology and included questions regarding demographics, practice experience, and management approach to palpable circumscribed breast masses based on patient age and risk factors. Radiologists' management choice for masses in themselves or close relatives/friends was also queried. RESULTS: In total, 151 radiologists participated (response rate 16%). For palpable breast masses with benign imaging features in women at high risk, the majority of radiologists selected MRI (95/151, 62.9%) and core-needle biopsy (110/151, 72.8%). In average-risk patients, radiologists with >5 years of practice experience selected biopsy more frequently (33/79, 41.8%) than less experienced radiologists (17/79, 23.6%) for patients ≥40 years old (P < 0.001) and patients <40 years old (20/79, 25.3%; 11/72, 15.3%, respectively) (P = 0.014). Similarly, selecting biopsy was more common in radiologists who completed a breast imaging fellowship for patients ≥40 years old (23/45, 51.1% vs 27/106, 25.5%) (P = 0.04), as well as for patients <40 years old (18/45, 40% vs 13/106, 12.3%) (P = 0.02). Radiologists who were <40 years old selected biopsy more frequently if evaluating a mass in themselves (22/86, 25.6%) compared to patients (15/86, 17.4%) (P < 0.001). CONCLUSION: Radiologist experience and educational background, as well as patient baseline breast cancer risk, can predispose radiologists to choose biopsy for palpable breast masses despite a benign appearance on imaging.

Respiratory Disease following Illicit Injection of Silicone: A Case Report.

Unregulated, pseudomedical procedures risk serious sequelae even when otherwise safe compounds are used. Silicone is commonly used legally in cosmetic procedures owing to its durability, resistance to heat and aging, and low immunogenicity. However, inappropriate or illegal silicone injection can pose severe local and systemic complications including serious pulmonary compromise. We describe the case of a 30-year-old female who presented with hemoptysis and progressive shortness of breath following illicit silicone injections to the gluteal fat and was found to have new, diffuse, bilateral, ground-glass opacities on contrast-enhanced pulmonary computed tomography. Transbronchial biopsy elucidated that this was a lipoid pneumonia-type injury secondary to silicone infiltration.