Incidental detection of ground glass nodules and primary lung cancer in patients with breast cancer: prevalence and long-term follow-up on chest computed tomography.

Background: Patients with breast cancer have a higher risk of developing lung cancer than the general population. The study aimed to evaluate the prevalence of ground glass nodule (GGN) and risk factors for GGN growth in patients with breast cancer and to evaluate the prevalence and pathologic features of lung cancer. Methods: We retrospectively reviewed the clinical data and chest computed tomography (CT) of 1,384 patients diagnosed with breast cancer who underwent chest CT between January 2008 and December 2022. We evaluated the prevalence of GGNs and their size changes on follow-up chest CT with volume doubling time (VDT) and identified independent risk factors associated with the growth of GGN using multivariable logistic regression analyses. Furthermore, the prevalence and pathologic features of lung cancer were also evaluated. Results: We detected persistent GGNs in 69 of 1,384 (5.0%) patients. The initial diameter of GGNs was 6.3±3.6 mm on average, with primarily (85.5%) pure GGNs. Among them, 27 (39.1%) exhibited interval growth with a median VDT of 1,006.0 days (interquartile range, 622.0-1,528.0 days) during the median 959.0 days (interquartile range, 612.0-1,645.0 days) follow-up period. Older age (P=0.026), part-solid nodules (P=0.006), and total number of GGNs (≥2) (P=0.007) were significant factors for GGN growth. Lung cancer was confirmed in 13 of 1,384 patients (0.9%), all with adenocarcinoma, including one case of minimally invasive adenocarcinoma. The cancers demonstrated a high rate of epidermal growth factor receptor (EGFR) mutation (69.2%). Conclusions: Persistent GGNs in breast cancer patients with high-risk factors should be adequately monitored for early detection and treatment of lung cancer.

Myxoid Liposarcoma of the Breast Mimicking Phyllodes Tumor: A Case Report.

Myxoid liposarcoma is an extremely rare malignant breast tumor. We report the case of a 44-year-old woman who had myxoid liposarcoma of the breast with a history of phyllodes tumor and describe the imaging findings on US, mammography, and MRI. Before surgery, the mass was considered to be a recurrent phyllodes tumor. However, using US, we retrospectively identified some differences between myxoid liposarcomas and phyllodes tumors.

Corrigendum: Artificial Intelligence for Breast Cancer Screening in Mammography (AI-STREAM): A Prospective Multicenter Study Design in Korea Using AI-Based CADe/x.

This corrects the article on p. 57 in vol. 25, PMID: 35133093.

Improving the Performance of Radiologists Using Artificial Intelligence-Based Detection Support Software for Mammography: A Multi-Reader Study.

OBJECTIVE: To evaluate whether artificial intelligence (AI) for detecting breast cancer on mammography can improve the performance and time efficiency of radiologists reading mammograms. MATERIALS AND METHODS: A commercial deep learning-based software for mammography was validated using external data collected from 200 patients, 100 each with and without breast cancer (40 with benign lesions and 60 without lesions) from one hospital. Ten readers, including five breast specialist radiologists (BSRs) and five general radiologists (GRs), assessed all mammography images using a seven-point scale to rate the likelihood of malignancy in two sessions, with and without the aid of the AI-based software, and the reading time was automatically recorded using a web-based reporting system. Two reading sessions were conducted with a two-month washout period in between. Differences in the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and reading time between reading with and without AI were analyzed, accounting for data clustering by readers when indicated. RESULTS: The AUROC of the AI alone, BSR (average across five readers), and GR (average across five readers) groups was 0.915 (95% confidence interval, 0.876-0.954), 0.813 (0.756-0.870), and 0.684 (0.616-0.752), respectively. With AI assistance, the AUROC significantly increased to 0.884 (0.840-0.928) and 0.833 (0.779-0.887) in the BSR and GR groups, respectively (p = 0.007 and p < 0.001, respectively). Sensitivity was improved by AI assistance in both groups (74.6% vs. 88.6% in BSR, p < 0.001; 52.1% vs. 79.4% in GR, p < 0.001), but the specificity did not differ significantly (66.6% vs. 66.4% in BSR, p = 0.238; 70.8% vs. 70.0% in GR, p = 0.689). The average reading time pooled across readers was significantly decreased by AI assistance for BSRs (82.73 vs. 73.04 seconds, p < 0.001) but increased in GRs (35.44 vs. 42.52 seconds, p < 0.001). CONCLUSION: AI-based software improved the performance of radiologists regardless of their experience and affected the reading time.

Incidental Thyroid Nodule on Chest Computed Tomography: Application of Computed Tomography Texture Analysis in Prediction of Ultrasound Classification.

OBJECTIVE: The aim of the study was to evaluate the value of computed tomography (CT) texture analysis (CTTA) in predicting ultrasound (US) classification of incidentally detected thyroid nodule (ITN) on chest CT. METHODS: A total of 117 ITNs (≥1 cm in the longest diameter) on chest CT scan of 107 patients was divided into 4 categories according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) classification on recent thyroid US within 3 months. Computed tomography texture features were extracted with or without filtration using commercial software. The texture features were compared between the benign (K-TIRADS 2; n = 21) and the suspicious (K-TIRADS 3, 4, 5; n = 96) nodules. Multivariate regression and area under the receiver operating characteristic curve analysis were performed to determine significant prediction factors of the suspicious nodules. RESULTS: The mean value of positive pixels was significantly higher in the suspicious nodules except the unfiltered image (P < 0.05). Entropy of the suspicious nodules was significantly higher with unfiltered and fine filters (P < 0.05), and kurtosis of the suspicious nodules was significantly higher with medium and coarse filters (P < 0.05). A logistic regression model incorporating mean value of positive pixels and kurtosis with a medium filter using volumetric analysis demonstrated the best performance to predict the suspicious nodules with an area under the receiver operating characteristic curve of 0.842 (P < 0.001, sensitivity 82.3%, and specificity 81.0%). CONCLUSIONS: Computed tomography texture analysis for ITN larger than 1 cm showed significant correlation with systematic thyroid US classification and presented excellent performance to predict the suspicious nodules.

Artificial Intelligence for Breast Cancer Screening in Mammography (AI-STREAM): A Prospective Multicenter Study Design in Korea Using AI-Based CADe/x.

PURPOSE: Artificial intelligence (AI)-based computer-aided detection/diagnosis (CADe/x) has helped improve radiologists' performance and provides results equivalent or superior to those of radiologists' alone. This prospective multicenter cohort study aims to generate real-world evidence on the overall benefits and disadvantages of using AI-based CADe/x for breast cancer detection in a population-based breast cancer screening program comprising Korean women aged ≥ 40 years. The purpose of this report is to compare the diagnostic accuracy of radiologists with and without the use of AI-based CADe/x in mammography readings for breast cancer screening of Korean women with average breast cancer risk. METHODS: Approximately 32,714 participants will be enrolled between February 2021 and December 2022 at 5 study sites in Korea. A radiologist specializing in breast imaging will interpret the mammography readings with or without the use of AI-based CADe/x. If recall is required, further diagnostic workup will be conducted to confirm the cancer detected on screening. The findings will be recorded for all participants regardless of their screening status to identify study participants with breast cancer diagnosis within both 1 year and 2 years of screening. The national cancer registry database will be reviewed in 2026 and 2027, and the results of this study are expected to be published in 2027. In addition, the diagnostic accuracy of general radiologists and radiologists specializing in breast imaging from another hospital with or without the use of AI-based CADe/x will be compared considering mammography readings for breast cancer screening. DISCUSSION: The Artificial Intelligence for Breast Cancer Screening in Mammography (AI-STREAM) study is a prospective multicenter study that aims to compare the diagnostic accuracy of radiologists with and without the use of AI-based CADe/x in mammography readings for breast cancer screening of women with average breast cancer risk. AI-STREAM is currently in the patient enrollment phase. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05024591.

Recurrent breast amyloidosis associated with Sjögren's syndrome: A case report with description of the radiologic-pathologic correlation.

We describe the case of a 41-year-old woman with primary Sjögren's syndrome (SS) who presented multiple recurrences of breast amyloidosis. Each recurrence of breast amyloidosis showed different sonographic features, potentially mimicking malignancy. We briefly discuss the possible cause of this variability in imaging features based on the radiologic-histologic correlation.

Ultrasonographic features of pure ductal carcinoma in situ of the breast: correlations with pathologic features and biological markers.

PURPOSE: The purpose of this study was to evaluate the ultrasonographic features of pure ductal carcinoma in situ (DCIS) of the breast and to evaluate the correlations of ultrasonographic features with pathologic and biological features. METHODS: A total of 141 lesions in 138 women with pure DCIS who underwent preoperative breast ultrasonography were retrospectively reviewed. Ultrasonographic features were analyzed using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) ultrasonography lexicon and the diagnostic criteria of the Japan Society of Ultrasonics in Medicine. Pathologic features including the nuclear grade and presence of comedonecrosis were evaluated. Biological markers including estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) status, as well as the Ki-67 index, were recorded. Ultrasonographic features were compared with pathologic findings and biological markers using the chi-square test. P-values of <0.05 were considered to indicate statistical significance. RESULTS: Of the 141 lesions, 75 (53.2%) were mass lesions, 26 (39.7%) were non-mass lesions, and 10 (7.1%) were not visible. The most common feature of the mass pattern was a mass with irregular shape (32.6%), an indistinct margin (27.7%), and hypoechogenicity (37.6%). Microcalcifications were observed in 48 cases (36.6%) as an associated feature. Calcifications outside of a mass were more common than calcifications within a mass. Ultrasonographic microcalcifications and ductal changes were frequently observed in non-mass lesions. Ultrasonographic non-mass lesions were associated with high-grade DCIS (P=0.004) and the presence of comedonecrosis (P=0.006), and microcalcifications were significantly associated with high-grade DCIS, the presence of comedonecrosis, an elevated Ki-67 index (P<0.001 for all), and HER2 positivity (P=0.003). CONCLUSION: The most common ultrasonographic feature of pure DCIS was an irregular, hypoechoic mass with an indistinct margin. Ultrasonographic microcalcifications and ductal changes were more frequent in non-mass lesions, which were correlated with poor prognostic factors, such as a high nuclear grade, comedonecrosis, HER2 positivity, and an elevated Ki-67 index.

Benefit of adding digital breast tomosynthesis to digital mammography for breast cancer screening focused on cancer characteristics: a meta-analysis.

PURPOSE: We evaluated the benefit of adding digital breast tomosynthesis (DBT) to full-field digital mammography (FFDM) compared to FFDM alone for breast cancer detection, focusing on cancer characteristics. METHODS: We searched electronic databases and relevant references for published studies comparing DBT plus FFDM to FFDM alone for breast cancer screening. Pooled risk ratios (RRs) for various pathologic findings were determined using random effects models. RESULTS: Eleven eligible studies were included. Pooled RRs showed a greater cancer detection for DBT plus FFDM than for FFDM alone for invasive cancer (1.327; 95% CI, 1.168-1.508), stage T1 (1.388; 95% CI, 1.137-1.695), nodal-negative (1.451; 95% CI, 1.209-1.742), all histologic grades (grade I, 1.812; grade II/III, 1.403), and histologic types of invasive cancer (ductal, 1.437; lobular, 1.901). However, adding DBT did not increase for detection of carcinoma in situ (1.198; 95% CI, 0.942-1.524), stage ≥T2 (1.391; 95% CI, 0.895-2.163), or nodal-positive cancer (1.336; 95% CI, 0.921-1.938). Heterogeneity among studies was not significant in any subset analysis. CONCLUSIONS: Adding DBT to FFDM enabled detection of early invasive breast cancer that might have been missed with FFDM alone. Knowing which cancer characteristic DBT detects may allow it to play a complementary role in predicting long-term patient outcomes and facilitate treatment planning.

Estimation of T2* Relaxation Time of Breast Cancer: Correlation with Clinical, Imaging and Pathological Features.

OBJECTIVE: The purpose of this study was to estimate the T2* relaxation time in breast cancer, and to evaluate the association between the T2* value with clinical-imaging-pathological features of breast cancer. MATERIALS AND METHODS: Between January 2011 and July 2013, 107 consecutive women with 107 breast cancers underwent multi-echo T2*-weighted imaging on a 3T clinical magnetic resonance imaging system. The Student's t test and one-way analysis of variance were used to compare the T2* values of cancer for different groups, based on the clinical-imaging-pathological features. In addition, multiple linear regression analysis was performed to find independent predictive factors associated with the T2* values. RESULTS: Of the 107 breast cancers, 92 were invasive and 15 were ductal carcinoma in situ (DCIS). The mean T2* value of invasive cancers was significantly longer than that of DCIS (p = 0.029). Signal intensity on T2-weighted imaging (T2WI) and histologic grade of invasive breast cancers showed significant correlation with T2* relaxation time in univariate and multivariate analysis. Breast cancer groups with higher signal intensity on T2WI showed longer T2* relaxation time (p = 0.005). Cancer groups with higher histologic grade showed longer T2* relaxation time (p = 0.017). CONCLUSION: The T2* value is significantly longer in invasive cancer than in DCIS. In invasive cancers, T2* relaxation time is significantly longer in higher histologic grades and high signal intensity on T2WI. Based on these preliminary data, quantitative T2* mapping has the potential to be useful in the characterization of breast cancer.

Characteristics of quantitative perfusion parameters on dynamic contrast-enhanced MRI in mammographically occult breast cancer.

The purpose of this study was to compare the characteristics of quantitative per-fusion parameters obtained from dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in patients with mammographically occult (MO) breast cancers and those with mammographically visible (MV) breast cancers. Quantitative parameters (AUC, Ktrans, kep, ve, vp, and wi) from 13 MO breast cancers and 16 MV breast cancers were mapped after the DCE-MRI data were acquired. Various prog-nostic factors, including axillary nodal status, estrogen receptor (ER), progesterone receptor (PR), Ki-67, p53, E-cadherin, and human epidermal growth factor receptor 2 (HER2) were obtained in each group. Fisher's exact test was used to compare any differences of the various prognostic factors between the two groups. The Mann- Whitney U test was applied to compare the quantitative parameters between these two groups. Finally, Spearman's correlation was used to investigate the relation-ships between perfusion indices and four factors - age, tumor size, Ki-67, and p53 - for each group. Although age, tumor size, and the prognostic factors were not statistically different between the two groups, the mean values of the quantitative parameters, except wi in the MV group, were higher than those in the MO group without statistical significance (p = 0.219). The kep value was significantly differ-ent between the two groups (p = 0.048), but the other parameters were not. In the MO group, vp with size, ve with p53, and Ktrans and vp with Ki-67 had significant correlations (p < 0.05). However, in the MV group, only kep showed significant correlation with age. The kep value was only the perfusion parameter of statistical significance between MO and MV breast cancers.

The radiologic diagnosis of idiopathic myointimal hyperplasia of mesenteric veins with a novel presentation: case report and literature review.

Idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) is a rare condition of the rectosigmoid colon that primarily affects middle-aged men. IMHMV typically presents as proctosigmoiditis and often requires surgical resection due to complications throughout the protracted clinical course. It can be differentiated from idiopathic chronic inflammatory bowel disease by histopathologic examination of surgically resected colon specimens. This report describes a rare case of IMHMV presenting as left hemicolitis in a 64-year-old male. We also describe potentially distinguishing computed tomographic and angiographic findings that may aid in the diagnosis of IMHMV.

Discriminating renal nutcracker syndrome from asymptomatic nutcracker phenomenon using multidetector computed tomography.

PURPOSE: To retrospectively evaluate the ability of computed tomographic (CT) findings to discriminate nutcracker syndrome (NCS) from asymptomatic nutcracker phenomenon (NCP) and to investigate the diagnostic value of CT findings in diagnosis of NCS. METHODS: From January 2014 to April 2015, 216 patients who underwent initial urographic CT were included. Initially, 216 patients were categorized as "nutcracker" or "normal," based on the following CT criteria: (1) the presence of beak sign and (2) hilar-aortomesenteric left renal vein diameter ratio >4. Patients who satisfied both of these criteria were diagnosed with nutcracker. The nutcracker was then divided into "NCS" and "asymptomatic NCP" based on the presence of characteristic symptoms. CT findings in sagittal and axial scans of corticomedullary phase were evaluated. Multivariate analysis was used to identify significant factors among 30 NCS, 51 asymptomatic NCP, and 135 normal patients. Diagnostic performance and threshold using receiver operating characteristic (ROC) curve were calculated. RESULTS: A total of 131 males and 85 females, with mean age of 38.6 years (range 18-89 years), were included. Multivariate analysis demonstrated superior mesenteric artery (SMA)-aortic angle (p < 0.001) and visualization of a dilated collateral vein with reflux (p = 0.001) were independent factors for distinguishing NCS from asymptomatic NCP. The combination of SMA-aortic angle <25° and visualization of a dilated collateral vein with reflux provided the greatest diagnostic accuracy (area under the ROC curve, 0.841). CONCLUSIONS: The combination of SMA-aortic angle and visualization of a dilated collateral vein with reflux in multidetector CT can be useful to differentiate NCS from asymptomatic NCP.

Solitary fibrous tumor of the breast: a case report and review of the literature.

Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms that can be benign or malignant. SFTs have been most often documented in the pleura. Recently, involvement of extrapleural sites such as the abdomen, musculoskeletal soft tissue, upper respiratory tract, mediastinum, and head and neck were reported. Less than 15 cases of SFT of the breast have been reported. Here, we report a case of a pathologically proven SFT of the breast and review the literature on the radiologic findings. US imaging showed an oval, well-circumscribed, hypoechoic solid mass. A solitary fibrous tumor of the breast is a very rare lesion.

Femoral artery access using the US-determined inguinal ligament and femoral head as reliable landmarks: prospective study of usefulness and safety.

PURPOSE: To evaluate ultrasound (US)-guided femoral artery access using the US-determined inguinal ligament (IL; US-IL) and femoral head as anatomic landmarks to prevent "high stick" (ie, cannulation above the IL) of the common femoral artery (CFA). MATERIALS AND METHODS: Fifty consecutive US-guided femoral artery accesses for embolization of hepatocellular carcinoma (n = 49) or renal angiography (n = 1) between December 2008 and August 2009 were prospectively analyzed. Primary endpoints were evaluation of technical success and major/minor complications during the procedure and follow-up visits. Secondary endpoints were the relative locations of the US-IL, fluoroscopically determined IL (FL-IL), and origin site of the inferior epigastric artery (IEA) on completion angiography. Relationships were evaluated between CFA types and lengths on US, between CFA types on US, and between frequencies of low-lying US-IL on fluoroscopy. Spearman correlation, Student t test, and Fisher exact test were used for statistical analysis. RESULTS: Technical success of CFA access was achieved in all patients (100%), with no high stick of the CFA noted. No complications were noted. On fluoroscopy, US-IL was located significantly lower than FL-IL (P = .002). On fluoroscopy and completion angiography, US-IL was more strongly correlated (ρ = 0.823, P < .001) with the IEA origin site than with the FL-IL (ρ = 0.287, P = .043). Finally, a "slope-type" CFA was shorter than a "horizontal-type" CFA on US and was more common in patients with low-lying US-IL on fluoroscopy (P = .001). CONCLUSIONS: US-guided CFA access with US-IL and femoral head guidance is safe and useful and can be helpful in preventing high stick.

Complications related to medical devices of the abdomen and pelvis: pictorial essay.

A variety of medical devices are used to monitor or treat abdominal and pelvic diseases. They are routinely recognized on abdominal radiographs and computed tomography (CT), and complications associated with their use are not uncommon. The complications associated with the use of the medical devices are migration, malposition and fracture, which can be easily recognized on abdominal radiographs. Additional potential complications include bleeding, obstruction, infection and organ injury, which may be detected on CT. Therefore, awareness of these complications and familiarity with their imaging findings are important aspects of the management of patients with medical devices. The aim of this pictorial review is to demonstrate the abdominal radiography and CT features of potential complications associated with the use of medical devices.

A case of intussusception of the appendix secondary to endometriosis: US and CT findings.

Intussusception of the appendix is an uncommon condition that is difficult to diagnose with radiology. Endometriosis causing appendiceal intussusception is a rare condition that has only been reported a few times in the literature. Here, we report a case of appendiceal intussusception caused by endometriosis in a 33-year-old woman who presented with intermittent right lower abdominal pain. Sonography revealed a hypoechoic mass invaginating into the cecum, which was covered by echogenic cecal wall with central dimpling indicating the appendiceal orifice. On CT, the mass was identified as an enhancing mass invaginating into the cecum at the level the appendiceal orifice.

Multiple Symmetric Lipomatosis (Madelung's Disease) Presenting as Bilateral Huge Gynecomastia.

Multiple symmetric lipomatosis (MSL), or Madelung's disease, is a rare disease of unknown etiology. It is characterized by the presence of loose adipose tissue deposits localized in the cervical region and upper body. MSL presenting as bilateral huge gynecomastia is an extremely rare phenomenon. The present report describes a case of MSL in a 66-year-old man. The patients presented with bilateral breast bulging. He had a history of cigarette and alcohol use. His condition was treated with a bilateral nipple-sparing mastectomy. MSL can present as a form of gynecomastia, for its accurate diagnosis and proper treatment of MSL, increasing awareness of the clinical characteristics of the disease is required, especially amongst breast surgeons. Herein, we review the literature and discuss the clinical characteristics, pathology, and surgical treatment of MSL.

BRAF mutation may predict higher necessity of postoperative radioactive iodine ablation in papillary thyroid cancer.

PURPOSE: The primary aim of the present study was to analyze the association between high-risk clinicopathologic characteristics and the BRAFV600E mutation. METHODS: From March 2010 to September 2012, we performed analysis of the BRAF mutation (assessing V600E point mutation of BRAF gene, exon 15, on chromosome 7q34 by real-time polymerase chain reaction kit) from 499 papillary thyroid carcinoma (PTC) patients who underwent thyroidectomy. We analyzed the relation between the mutation and known clinicopathologic risk factors of PTC. RESULTS: BRAF mutations were found in 353 of 499 patients (70.7%). On univariate analysis, BRAF mutations were more frequently detected in patients with central lymph node metastasis (78.5% vs. 66.7%, P = 0.007) and classic PTC type (71.3% vs. 16.7%, P = 0.011). Patients with one or more aggressive pathologic feature such as lymph node metastasis, multifocality, and extrathyroidal extension showed higher BRAF mutation rate (73.5% vs. 62.3%, P = 0.022). BRAF mutation group showed more aggressive pathologic features, which is considered as higher necessity of radioactive iodine ablation (relative risk, 1.617; P = 0.035). CONCLUSION: This study found that BRAF mutation is associated with classic PTC and central lymph node metastasis and higher necessity of radioactive iodine ablation.

The roles of the liver and pancreas in renal nutcracker syndrome.

INTRODUCTION: To assess the frequency and significance of presence of the liver and pancreas at the left renal vein (LRV) level in patients with suspected renal nutcracker syndrome (NCS). MATERIALS AND METHODS: We included 101 patients with hematuria who underwent urography three-dimensional CT between April 2009 and November 2013. These patients were divided into NCS (n=25) and non-NCS (n=76) patients according to the following CT criteria: (1) the presence of beak sign and (2) hilar-aortomesenteric left renal vein diameter ratio >4. Patients were grouped according to the presence of the liver and pancreas at the LRV: group LP (both liver and pancreas), group L (only liver), group P (only pancreas), and group O (neither liver nor pancreas). The difference in the frequencies of groups was analyzed between NCS and non-NCS patients. Multivariate analysis was used to determine the independent factors between NCS and non-NCS patients. RESULTS: The frequencies of group LP, group L, group P, and group O in NCS vs. non-NCS were 88% vs. 5.3% (p<0.001), 4.0% vs. 2.6% (p=0.75), 4.0% vs. 11.8% (p=0.45), 4.0% vs. 80.3% (p<0.001), respectively. Multivariate analysis demonstrated that group was a predictor for differential diagnosis between NCS and non-NCS (p=0.022), and group LP was an independent factor for the presence of NCS (odds ratio, 43.8; 95% confidence interval, 3.8-500.3; p<0.002; reference, group O). CONCLUSION: The presence of the liver and pancreas at the level of the LRV was frequently found in NCS and was the independent factor for NCS.