Low Compliance in a Health-Conscience Spending Era Likely Helps Obviates the Need for 6 month BI-RADS 3 Breast MRI Follow-up After 1 year.

The goal of our IRB-approved study was to assess if a follow-up MRI every 6 months for 2 years is the most appropriate short-interval follow-up schedule. 203 breast MRI exams were performed from October 2009 to January 2014 as part of a BI-RADS 3 follow-up representing 2.6% of all breast MRIs (7,822) performed. We performed a retrospective longitudinal medical records review of compliance; malignancy rate of BI-RADS 3 exams; and average time and number of breast MRIs necessary prior to definitive disposition. While 77.8% eventually returned, only 45.5% of patients were compliant with follow-up at or near 6 months (4.5-7.5 months). Of those who eventually returned, it took an average of 1.31 follow-up MRIs (95% CI: 1.20-1.43 exams) and 10.3 months (95% CI: 9.0-11.7 months) before definitive disposition. 93.5% of initial findings were dispositioned as benign after two follow-up MRI exams (malignancy rate: 0.98%). Our results lend support to the possibility that the follow-up interval for BI-RADS 3 breast MRIs could be lengthened to 12 months if additional follow-up MRIs are necessary after the first year of 6-month follow-up breast MRIs. Foremost, this appears to be a safe follow-up alternative since benign definitive disposition can usually be made in less than 1 year. Supplemental reasons include persistent low-patient compliance (as redemonstrated in our study) and the higher cost of breast MRI compared to mammogram/ultrasound follow-up. Finally, this paper's findings further support the suggested MRI follow-up interval in the newest BI-RADS atlas.

The true impact of breast magnetic resonance imaging on the management of in situ disease: more is not better.

BACKGROUND: The optimal role of breast magnetic resonance imaging (MRI) in the management of ductal carcinoma in situ (DCIS) remains controversial. We sought to better define the impact of breast MRIs when utilized during the workup of DCIS. METHODS: Patients with biopsy-proven DCIS without any additional invasive disease were prospectively enrolled in the multidisciplinary breast cancer pathway and comprised the study group. Patients who met any additional criteria for MRI screening were excluded. RESULTS: From 2008 to 2014, 93 women met the inclusion criteria. 81 patients underwent MRI as part of their workup. One patient benefited from MRI via identification of occult malignancy not previously identified. 35 MRIs identified no additional information whereas 46 had additional findings. These findings led to 23 procedures and 16 negative biopsies; recommendations for 16 radiographic studies that were normal; and influenced nodal sampling in 7 women with 1 positive metastatic focus. CONCLUSIONS: The routine use of breast MRI for women diagnosed with DCIS has limited benefit. Often, it leads to multiple procedures and studies that are clinically insignificant and delays surgical treatment.

The role of early post-treatment mammography after breast conservation therapy.

BACKGROUND: Current major national guidelines recommend early mammographic evaluation after completion of breast conservation therapy (BCT). However, the clinical utility of these recommendations are not well defined. Our objective was to determine the role of post-treatment mammogram after BCT. METHODS: A retrospective review at a single tertiary referral institution of all female patients (>18 years old) who underwent BCT for invasive breast cancer and ductal carcinoma in situ was performed. RESULTS: Between 2004 and 2013, 342 patients met inclusion criteria. All patients underwent post-BCT mammograms with a mean time of 198 ± 59 days after treatment. Nineteen patients (5%) had findings that prompted biopsy on initial post-treatment mammogram. Of those 19 patients, there was 1 (5%) patient that had malignancy identified on biopsy. This represents .3% of overall patients who underwent mammography in the early postoperative period. CONCLUSIONS: The utility of early mammogram after BCT is limited and prompts unnecessary diagnostic procedures, which are marginally beneficial. We recommend resetting the timing of mammography to resume 12 months after BCT is complete.

Benign papillomas diagnosed on large-gauge vacuum-assisted core needle biopsy which span <1.5 cm do not need surgical excision.

The objective of our study is to determine if a carefully selected subset of benign breast papillomas (size ≤1.5 cm) can be safely followed by imaging surveillance instead of immediate surgical excision. Over a 6½-year period, 86 breast lesions were diagnosed as a benign papilloma (BP) utilizing an 11- or 8-gauge vacuum-assisted core needle biopsy (VACNB) device. In general, it was our intent to remove as much of the radiologically evident lesion as possible. These 86 lesions underwent ≥2 years of imaging surveillance, without surgical excision following initial detection. With ≥2 years of radiologic follow-up, none of the 86 BPs demonstrated imaging findings that necessitated repeat biopsy or surgical excision. Benign breast papillomas ≤1.5 cm that are biopsied using an 11- or 8-gauge VACNB device with intent to remove as much of the radiologically evident lesion as possible are safe to undergo serial imaging surveillance rather than immediate surgical excision.

Serial MR findings and comprehensive review of bilateral lupus mastitis with an additional case report.

Lupus Mastitis (LM) is a rare presentation of lupus panniculitis involving the breast. Because it often presents as a tender palpable mass, a workup for malignancy usually ensues. It is well documented that surgery may worsen the condition; therefore, it is important to consider LM in the differential of a palpable breast mass in patients with systemic lupus erythematosus (SLE). Currently, management of LM remains primarily medical. We discuss the multi-disciplinary work-up of LM, and further describe its appearance on serial Magnetic Resonance (MR) exams.

Primary renal lymphoma mimicking a subcapsular hematoma: a case report.

Primary renal lymphoma (PRL) is a rare entity with a history of controversy regarding its existence. Lymphomatous involvement of the kidney is more commonly seen secondarily to spread from an adjacent lymphomatous mass, rather than arising primarily from the kidney. PRL can mimic other renal lesions such as renal cell carcinoma, renal abscess, and metastasis; therefore, an early diagnosis is crucial to guide treatment and properly assess prognosis. We present a rare case of a 77 year-old male who presented with hematuria and PRL mimicking a subcapsular hematoma.

Bladder schwannoma -- a case presentation.

Bladder schwannomas are exceedingly rare, benign or malignant, nerve sheath tumors that are most often discovered in patients with a known diagnosis of Neurofibromatosis type 1 (NF1). A few sporadic case reports of bladder schwannoma have been published in urologic, obstetric/gynecologic, and pathologic journals. However, this is the first case report in the radiologic literature where computed tomography imaging and radiology-specific descriptions are discussed. Furthermore, the patient presented in this case is only the fifth published patient without NF1 to be diagnosed with a bladder schwannoma, to the best of our knowledge.

Chondrosarcoma in childhood: the radiologic and clinical conundrum.

Less than 10% of chondrosarcomas occur in children. In addition, as little as 0.5% of low-grade chondrosarcomas arise secondarily from benign chondroid lesions. The presence of focal pain is often used to crudely distinguish a chondrosarcoma (which is usually managed with wide surgical excision), from a benign chondroid lesion (which can be followed by clinical exams and imaging surveillance). Given the difficulty of localizing pain in the pediatric population, initial radiology findings and short-interval follow-up, both imaging and clinical, are critical to accurately differentiate a chondrosarcoma from a benign chondroid lesion. To our knowledge, no case in the literature discusses a chondrosarcoma possibly arising secondarily from an enchondroma in a pediatric patient. We present a clinicopathologic and radiology review of conventional chondrosarcomas. We also attempt to further the understanding of how to manage a chondroid lesion in the pediatric patient with only vague or bilateral complaints of pain.

Malignant priapism secondary to adenocarcinoma of the prostate.

The authors report a case of an older gentleman with a history of metastatic prostate cancer who presented to the emergency department following 3 weeks of progressively intermittent and then continuous priapism. After an initial clinical workup, an MRI was performed of the pelvis for further evaluation of the patient's condition which demonstrated metastatic lesions within his corpora cavernosa. The patient underwent follow-up core-needle biopsy with pathologically proven metastasis.