Use of the probably benign (BI-RADS category 3) assessment for masses on breast MRI: Is it transferable to general clinical practice?

The purpose of this study was to identify potential BI-RADS 3 mass descriptors on breast magnetic resonance imaging by systematically defining positive predictive values (PPV). In a blinded retrospective review of BI-RADS 4 masses, reader 1 identified 132 masses and reader 2 identified 76 masses. PPV for mass descriptors and for descriptor combinations was determined. No mass descriptor resulted in a PPV ≤2% (BI-RADS 3 threshold). Descriptors with the lowest PPVs were circumscribed margin (8%), rim internal enhancement and persistent kinetics (13% each), and oval shape (15%). The results demonstrate the difficulty in transferring the theoretical concept of lesion surveillance to systematic clinical use.

Impact of Breast Density Legislation on Breast Cancer Risk Assessment and Supplemental Screening: A Survey of 110 Radiology Facilities.

Breast density notification laws, passed in 19 states as of October 2014, mandate that patients be informed of their breast density. The purpose of this study is to assess the impact of this legislation on radiology practices, including performance of breast cancer risk assessment and supplemental screening studies. A 20-question anonymous web-based survey was emailed to radiologists in the Society of Breast Imaging between August 2013 and March 2014. Statistical analysis was performed using Fisher's exact test. Around 121 radiologists from 110 facilities in 34 USA states and 1 Canadian site responded. About 50% (55/110) of facilities had breast density legislation, 36% of facilities (39/109) performed breast cancer risk assessment (one facility did not respond). Risk assessment was performed as a new task in response to density legislation in 40% (6/15) of facilities in states with notification laws. However, there was no significant difference in performing risk assessment between facilities in states with a law and those without (p < 0.831). In anticipation of breast density legislation, 33% (16/48), 6% (3/48), and 6% (3/48) of facilities in states with laws implemented handheld whole breast ultrasound (WBUS), automated WBUS, and tomosynthesis, respectively. The ratio of facilities offering handheld WBUS was significantly higher in states with a law than in states without (p < 0.001). In response to breast density legislation, more than 33% of facilities are offering supplemental screening with WBUS and tomosynthesis, and many are performing formal risk assessment for determining patient management.

Breast density legislation: mandatory disclosure to patients, alternative screening, billing, reimbursement.

OBJECTIVE. The purpose of this article is describe the origins and provisions of breast density legislation and to evaluate these mandates with regard to the balance between the potential benefit of supplementary screening and the substantial risk of false-positive findings and the adjunctive tests they necessitate. CONCLUSION. Many states have passed breast density notification legislation, and federal legislation is pending. These mandates present a number of challenges for patients and physicians. There is no consensus regarding the need for supplementary testing solely because a woman has dense breasts. The failure of density legislation to require insurance coverage in many states further complicates implementation of the mandates.

Breast MR imaging for extent of disease assessment in patients with newly diagnosed breast cancer.

Breast cancer staging and surgical planning are affected by the burden of pathologically proven cancer detected on clinical examination and/or imaging. Magnetic resonance (MR) imaging has superior sensitivity and accuracy for the detection of invasive and in situ breast cancer as compared with physical examination, mammography, and ultrasound but can be limited in specificity. The use of preoperative breast MR imaging for evaluating the extent of disease remains controversial at present because studies have not definitively shown it to improve overall survival, decrease re-excision rates, or to decrease the cost of care.

Timing bolus dynamic contrast-enhanced (DCE) MRI assessment of hepatic perfusion: Initial experience.

PURPOSE: To assess whether dynamic contrast-enhanced (DCE) MRI timing bolus data from routine clinical examinations can be postprocessed to obtain hepatic perfusion parameters for diagnosing cirrhosis. MATERIALS AND METHODS: We retrospectively identified 57 patients (22 with cirrhosis and 35 without cirrhosis) who underwent abdominal MRI, which included a low-dose (2 mL gadodiamide) timing bolus using a volumetric spoiled gradient echo T1-weighted sequence through the abdomen. Using a dual-input single-compartment model, the following perfusion parameters were measured: arterial, portal, and total blood flow; arterial fraction; mean transit time; and distribution volume. Those parameters were compared between patients with and without cirrhosis using t-tests. Receiver operating characteristic (ROC) curve analysis was used to identify the perfusion parameters that can best predict the presence of cirrhosis. RESULTS: The hepatic arterial fraction, arterial flow, and distribution volume in patients with cirrhosis (27.7 +/- 8.3%, 44.8 +/- 14.1 mL/minute/100 g, and 16.3 +/- 4.5%, respectively) were significantly higher than those without cirrhosis (18.7 +/- 4.4%, 28.5 +/- 11.7 mL/minute/100 g, and 14.0 +/- 4.2%, respectively; P < 0.05 for all). ROC analysis showed arterial fraction as the best predictor of cirrhosis, with sensitivity of 73% and specificity of 86%. CONCLUSION: Timing bolus DCE MR images from routine examinations can be postprocessed to yield potentially useful hepatic perfusion parameters.