A Case of Breast Papillary Carcinoma in an Elderly Black Male Patient With Pathology, Ultrasound, and Mammogram Imaging Findings.

The patient was an 84-year-old man who presented with a palpable, left breast mass. Following ultrasound, mammography, and ultrasound-guided core needle biopsy, the lesion was diagnosed as papillary carcinoma. Findings included a complex, cystic mass on ultrasound; a well-circumscribed, high-density lesion on mammogram; and a lack of highlighting of myoepithelial cells within fibrovascular cores on immunostaining. With this case report, we aim to add to the literature an additional example of breast papillary carcinoma in a male patient and its corresponding imaging and pathologic findings.

Framework for Successful Integration of Health Services Research Into a Breast Imaging Career.

Health services research (HSR) is a multidisciplinary field of inquiry that examines how health care is structured, providing valuable data on health care outcomes and delivery. Over the past few decades, a shift in the U.S. health care system toward value-based care has placed a priority on health services topics. Health services research has been central to the evolution of breast imaging over this period, with increased emphasis placed on the following: (1) design of appropriate-use criteria for imaging services; (2) determination of cost-effectiveness of imaging protocols and screening regimens guiding policy; and (3) evaluation of policy related to reimbursement for diagnostic imaging and image-guided procedures. Examples of HSR topics that can be applied directly to breast imaging include evaluation of health care availability and accessibility, analysis of health care use patterns, exploration of patient preferences, assessment of technological innovation, development and implementation of clinical practice guidelines and screening strategies, and examination of health care organization and delivery models. Breast imaging radiologists who perform HSR are uniquely positioned to advocate for patients, to promote transformative health care interventions, and to influence policy changes and public health initiatives in breast imaging through analysis of health care data and translation of their research findings. In this Training and Professional Development article, we aim to provide practical approaches to explore interest in HSR and to describe a framework for successful integration of HSR into a breast imaging career.

Current status and prospects of breast cancer imaging-based diagnosis using artificial intelligence.

Breast imaging has several modalities, each unique in terms of its imaging position, evaluation index, and imaging method. Breast diagnosis is made by combining a large number of past imaging features with the clinical course and histological findings. Artificial intelligence (AI), which extracts the features from image data and evaluates them based on comprehensive analysis, has been making rapid progress in this regard. Many previous studies have demonstrated the usefulness and development potential of AI, such as machine learning and deep learning, in breast imaging. However, despite studies showing the good performance of AI models, their overall utilization remains low, since a large amount of diverse imaging data is required, and prospective verification is necessary to prove its high reproducibility and robustness. Sharing information and collaborating with multiple institutions to collect and verify images of different conditions and backgrounds are vital. If image diagnosis using AI can indeed ensure a more detailed diagnosis, such as breast cancer subtypes or prognosis, it can help develop personalized medicine, which is urgently required. The positive results of AI research, using such image information, can make each modality more valuable than ever. The current review summarized the results of previous studies using AI in each evaluation field and discussed the related future prospects.

Radio-pathological characteristics of primary neuroendocrine breast carcinoma: Series of 4 cases.

Neuroendocrine breast cancers (NEBCs) are a rare and distinct subtype of breast tumors, characterized by their neuroendocrine differentiation. Despite accounting for less than 1% of all breast cancers, NEBCs present unique diagnostic and therapeutic challenges due to their heterogeneous nature and variable prognosis. Accurate imaging plays a crucial role in the diagnosis, treatment planning, and follow-up of NEBCs, yet remains a complex area due to the rarity of these tumors and overlapping features with more common breast cancers. We present a series of 4 cases of primary NEBC, emphasizing the imaging features and their histopathological correlations. All patients presented with breast lump. Diagnostic Mammography followed by Ultrasound was performed in each case. All 4 cases were categorized as Breast Imaging- Reporting and Data System (BI-RADS)-4. Trucut biopsy was performed and histopathological analysis revealed the diagnosis of NEBC. Patients underwent Surgery followed by Chemotherapy, Hormonal Therapy or Radiation therapy alone or in combination with each other depending upon the histopathological characteristics.

An initial exploration of factors that may impact radiographer performance in reporting mammograms.

OBJECTIVES: In the United Kingdom, radiographers with a qualification in image interpretation have interpreted mammograms since 1995. These radiographers work under the title of radiography advanced practitioners (RAP) or Consultant Radiographer. This study extends upon what has been very recently published by exploring further clinical, non-clinical and experiential factors that may impact the reporting performance of RAPs. METHODS: Fifteen RAPs interpreted an image test set of 60 2D mammograms of known truth using the Detected-X software platform. Unknown to the reader, twenty cases contained a malignancy. Sensitivity, specificity, lesion sensitivity, receiver operating characteristic (ROC) and jack-knife free response operating characteristic (AFROC) values were established for each RAP. Specific features that had significant impact on accuracy were identified using Student's-T and Mann Whitney tests. RESULTS: RAPs with more than 10 years' experience in image interpretation, compared to those with less than 10 years' experience, demonstrated lower specificity (51.3% vs 84.8%, p = 0.0264), ROC (0.83 vs 0.91, p = 0.0264) and AFROC (0.75 vs 0.87, p = 0.0037) values. Further, higher sensitivity values of 90.7% were seen in those RAPs who had an eye test in the last year compared to those who had not, 82% (p = 0.021). Other changes are presented in the paper. CONCLUSION: These data reveal previously unidentified factors that impact the diagnostic efficacy of RAPs when interpreting mammographic images. Highlighting such findings will empower screening authorities to better examine ways of standardising performance and offer a baseline for performance benchmarks. IMPLICATIONS FOR PRACTICE: This study for the first time performs an initial exploration of the factors that may be associated with RAP performance when interpreting screening mammograms.

Meta-analysis and systematic review of the diagnostic value of contrast-enhanced spectral mammography for the detection of breast cancer.

OBJECTIVE: The objective is to evaluate the diagnostic effectiveness of contrast-enhanced spectral mammography (CESM) in the diagnosis of breast cancer. DESIGN: DATA SOURCES: PubMed, Embase and Cochrane libraries up to 18 June 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included trials studies, compared the results of different researchers on CESM in the diagnosis of breast cancer, and calculated the diagnostic value of CESM for breast cancer. DATA EXTRACTION AND SYNTHESIS: Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) evaluated the methodological quality of all the included studies. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses specification. In addition to sensitivity and specificity, other important parameters were explored in an analysis of CESM accuracy for breast cancer diagnosis. For overall accuracy estimation, summary receiver operating characteristic curves were calculated. STATA V.14.0 was used for all analyses. RESULTS: This meta-analysis included a total of 12 studies. According to the summary estimates for CESM in the diagnosis of breast cancer, the pooled sensitivity and specificity were 0.97 (95% CI 0.92 to 0.98) and 0.76 (95% CI 0.64 to 0.85), respectively. Positive likelihood ratio was 4.03 (95% CI 2.65 to 6.11), negative likelihood ratio was 0.05 (95% CI 0.02 to 0.09) and the diagnostic odds ratio was 89.49 (95% CI 45.78 to 174.92). Moreover, there was a 0.95 area under the curve. CONCLUSIONS: The CESM has high sensitivity and good specificity when it comes to evaluating breast cancer, particularly in women with dense breasts. Thus, provide more information for clinical diagnosis and treatment.

Supplemental Automated Breast US Screening in Patients With Dense Breasts: 5-Year Experience From an Academic Medical Center.

OBJECTIVE: To assess features of automated breast US (ABUS) use in women with dense breasts. The number of additional cancers found by ABUS not detected by mammography was also determined. METHODS: This study was approved by the IRB and is HIPAA compliant. Automated breast US use was defined as completing at least 1 ABUS examination during the study. Data from 51 086 women who presented for a mammogram from October 1, 2017, to September 30, 2022, were extracted from the electronic health record. Descriptive statistics of ABUS use were performed to assess the significance of difference between age and race categories. Pairwise analysis with Bonferroni correction was performed to assess differences between each race and the White category. RESULTS: Automated breast US was used for 9865/24 637 (40%) patients with dense breasts. Patients with ABUS use were older than those without. Among women with dense breasts, White patients (4943/10 667 [46%]) were more likely to use ABUS than Black/African American (2604/6843 [38%]), Hispanic/Latino (1466/4278 [34%]), Asian (521/1590 [33%]), and other (331/1249 [26%]) patients (P <.05). Approximately 3025/9865 (31%) of patients using ABUS had their first ABUS within 90 days of their mammogram. By the third annual mammogram, 2684/3160 (85%) of patients who used ABUS had their ABUS and mammogram scheduled on the same day. For every 1000 ABUS exams, 2.4 additional cancers were found and were primarily early-stage tumors. CONCLUSION: Among women with dense breasts, 9865/24 637 (40%) used ABUS, and they were more likely to be older and White.

Comparison of Visual and Quantra Software Mammographic Density Assessment According to BI-RADS® in 2D and 3D Images.

Mammographic density (MD) assessment is subject to inter- and intra-observer variability. An automated method, such as Quantra software, could be a useful tool for an objective and reproducible MD assessment. Our purpose was to evaluate the performance of Quantra software in assessing MD, according to BI-RADS® Atlas Fifth Edition recommendations, verifying the degree of agreement with the gold standard, given by the consensus of two breast radiologists. A total of 5009 screening examinations were evaluated by two radiologists and analysed by Quantra software to assess MD. The agreement between the three assigned values was expressed as intraclass correlation coefficients (ICCs). The agreement between the software and the two readers (R1 and R2) was moderate with ICC values of 0.725 and 0.713, respectively. A better agreement was demonstrated between the software's assessment and the average score of the values assigned by the two radiologists, with an index of 0.793, which reflects a good correlation. Quantra software appears a promising tool in supporting radiologists in the MD assessment and could be part of a personalised screening protocol soon. However, some fine-tuning is needed to improve its accuracy, reduce its tendency to overestimate, and ensure it excludes high-density structures from its assessment.

Diffuse unilateral MRI breast entities.

Many benign and malignant breast entities can present with diffuse unilateral magnetic resonance imaging (MRI) findings. The unilateral breast findings can be broken down into three broad categories including asymmetric diffuse masses/non-mass enhancement (NME), diffuse unilateral skin thickening, and diffuse asymmetric background enhancement. Although correlation with clinical history is always necessary, biopsy is often needed to make a definitive diagnosis. There are some findings on MRI which can help narrow the differential including morphology, distribution, T2W signal, enhancement kinetics, and associated skin thickening. Malignant entities which will be discussed in this review include ductal carcinoma in situ, invasive ductal carcinoma, invasive lobular carcinoma, Paget disease, inflammatory breast cancer, and locally advanced breast cancer. Benign entities which will be discussed in this review include idiopathic granulomatous mastitis (IGM), infectious mastitis, pseudoangiomatous stromal hyperplasia, giant fibroadenoma, early and late radiation changes, unilateral breast feeding, and central venous obstruction, all which have varied MRI appearances. It is important for radiologists to be familiar with the common entities that can present with diffuse asymmetric unilateral MRI breast findings to ensure the correct diagnosis and management is undertaken.

Addressing Global Gaps in Mammography Screening for Improved Breast Cancer Detection: A Review of the Literature.

Breast cancer is the second most common cancer globally, with 2.3 million new cases annually, constituting 11.6% of all cancer cases. It is also the fourth leading cause of cancer deaths, claiming 670,000 lives a year. This high incidence of breast cancer morbidity worldwide has increased the urgent need for standardized and adequate screening methods, including clinical breast examination, self-breast examination, and mammography screening tests for non-symptomatic individuals. Mammography is considered the gold standard for breast cancer screening, with early randomized control trials showing significant reductions in mortality rates in women aged 50 and over (International Agency for Research on Cancer and American College of Radiology). Despite this, discrepancies in mammography practices across different healthcare settings regarding adherence to international standards raise concerns. A comprehensive review of the vast literature looking at the practices and norms of mammography screening worldwide highlighted several domains that present limitations to screening. These include epidemiological data deficits, lack of educational training offered to radiographers and varied image quality indices, exposure technique, method of breast compression, dose calculation, reference levels, screening frequency intervals, and diverse distribution of resources, particularly in developing countries. These factors shed light on the substantial discrepancies in the implementation and efficacy of screening programs, underscoring the necessity for future research endeavors to collaborate in creating coherent, standardized, evidence-based guidelines. Addressing these issues can enhance the feasibility, sensitivity, and accessibility of screening programs, resulting in favorable impacts on the early diagnosis and survival of breast cancer on a global scale.

Asymmetric uptake on molecular breast imaging: A manifestation of unilateral breastfeeding.

Molecular breast imaging (MBI) is an adjunctive screening tool that can be helpful in evaluating women with dense breasts or in high-risk patients. We present the case of a 43-year-old female who had markedly asymmetric uptake in one of her breasts on MBI study. Further evaluation with diagnostic mammogram and ultrasound did not demonstrate any suspicious findings in the affected breast. Discussion with the patient and additional clinical history revealed that the patient was exclusively breastfeeding from that side, accounting for the unilateral MBI findings.

Monte Carlo simulation of spatial frequency domain imaging for breast tumors during compression.

Significance: Near-infrared optical imaging methods have shown promise for monitoring response to neoadjuvant chemotherapy (NAC) for breast cancer, with endogenous contrast coming from oxy- and deoxyhemoglobin. Spatial frequency domain imaging (SFDI) could be used to detect this contrast in a low-cost and portable format, but it has limited imaging depth. It is possible that local tissue compression could be used to reduce the effective tumor depth. Aim: To evaluate the potential of SFDI for therapy response prediction, we aim to predict how changes to tumor size, stiffness, and hemoglobin concentration would be reflected in contrast measured by SFDI under tissue compression. Approach: Finite element analysis of compression on an inclusion-containing soft material is combined with Monte Carlo simulation to predict the measured optical contrast. Results: When the effect of compression on blood volume is not considered, contrast gain from compression increases with the size and stiffness of the inclusion and decreases with the inclusion depth. With a model of reduction of blood volume from compression, compression reduces imaging contrast, an effect that is greater for larger inclusions and stiffer inclusions at shallower depths. Conclusions: This computational modeling study represents a first step toward tracking tumor changes induced by NAC using SFDI and local compression.

Lesion-mimicking DIXON swap artifact in contrast-enhanced subtraction breast MRI.

Breast cancer is the most common cancer in women; approximately 1 in 8 women is diagnosed with breast cancer in their lifetime. Some women are at significantly higher risk of developing breast cancer, including women carrying mutations in the BRCA1/2, TP53, or other genes and women with other risk factors. Women with a high lifetime risk for breast cancer are frequently offered annual breast magnetic resonance imaging (MRI) examinations for early breast cancer detection. Breast MRI is commonly performed using a multiparametric imaging protocol, including dynamic contrast-enhanced T1-weighted acquisitions. The dynamic contrast-enhanced T1-weighted acquisitions are frequently transformed into subtraction series, allowing the focused visualization of areas with high signal intensity and masses associated with elevated contrast agent uptake, which are among the hallmarks of suspicious findings. Here, we report a case in which a suspicious lesion-mimicking swap artifact occurred using a T1-weighted contrast-enhanced DIXON acquisition technique in a high-risk breast cancer screening MRI examination.

Correlation of preoperative sonographic staging and postoperative histopathologic staging in patients with invasive breast cancer.

PURPOSE: To assess the accuracy of preoperative sonographic staging in patients with primary invasive breast cancer. METHODS: We retrospectively analyzed a prospectively kept service database of patients with newly diagnosed, unifocal, cT1-3, invasive breast cancer. All patients were diagnosed at a single center institution between January 2013 and December 2021. Clinical T stage was assessed preoperatively by ultrasound and correlated with the definite postoperative pathologic T stage. Demographics, clinical and pathological characteristics were collected. Factors influencing accuracy, over- and underdiagnosis of sonographic staging were analyzed with multivariable regression analysis. RESULTS: A total of 2478 patients were included in the analysis. Median patients' age was 65 years. 1577 patients (63.6%) had clinical T1 stage, 864 (34.9%) T2 and 37 (1.5%) T3 stage. The overall accuracy of sonography and histology was 76.5% (n = 1896), overestimation was observed in 9.1% (n = 225) of all cases, while underestimation occurred in 14.4% (n = 357) of all cases. Accuracy increased when clinical tumor stage cT was higher (OR 1.23; 95% CI 1.10-1.38, p ≤ 0.001). The highest accuracy was seen for patients with T2 stage (82.8%). The accuracy was lower in Luminal B tumors compared to Luminal A tumors (OR 0.71; 95% CI 0.59-0.87, p ≤ 0.001). We could not find any association between sonographic accuracy in HER2 positive patients, and demographic characteristics, or tumor-related factors. CONCLUSION: Our unicentric study showed a high accuracy of sonography in predicting T stage, especially for tumors with clinical T2 stage. Tumor stage and biological tumor factors do affect the accuracy of sonographic staging.

Optimizing biopsy training experience for trainees and faculty: Utilizing 5S methodology with a focus on safety.

This manuscript explores the application of the 5S methodology in optimizing workplace safety and efficiency within the context of biopsy training equipment. Drawing from a Quality Improvement Report presented at the 2023 RSNA annual meeting, our manuscript focuses on implementing 5S principles with a dedicated emphasis on safety (the 6th S). We demonstrate how the systematic application of 5S principles can revolutionize the functionality of biopsy training equipment, mitigate safety risks, and enhance overall workplace productivity. This manuscript offers valuable insights and practical strategies for improving healthcare training environments, with broader implications for quality improvement initiatives in the healthcare sector.

Imaging for breast pain: A useful paradigm to promote breast cancer screening and reduce unnecessary breast imaging.

OBJECTIVE: Identify the proportion of patients presenting for diagnostic breast imaging with clinically insignificant breast pain who are eligible for screening mammography and analyze the impact of routing these patients to screening on resource utilization, healthcare spending and cancer detection. METHODS: We retrospectively reviewed 100 consecutive women ≥40 years old without a history of breast cancer who underwent diagnostic mammogram and breast ultrasound for clinically insignificant breast pain from 1/2022 to 4/2022. Patients were screen-eligible if their last bilateral mammogram was over 12 months prior to presentation. Patients with only screening views during diagnostic mammography were assumed to have a negative/benign screening mammogram. Costs were calculated using the Centers for Medicare & Medicaid Services Physician Fee Schedule. RESULTS: 68 of 100 patients with breast pain were screen-eligible at time of diagnostic imaging. With a screen first approach, 47/68 would have had negative/benign screening mammograms, allowing for the availability of 47 diagnostic breast imaging appointments. The current workflow led to 100 diagnostic mammograms and ultrasounds, 29 follow-up ultrasounds, and 10 image-guided biopsies, with a total cost of $42,872.41. With a screen first approach, there would have been 68 screening mammograms, 53 diagnostic mammograms and ultrasounds, 10 follow-up ultrasounds, and 9 image-guided biopsies, with a total cost of $34,231.60. Two cancers were identified, both associated with suspicious mammographic findings. None would have been missed in a screen-first approach. DISCUSSION: Identifying screen-eligible patients with clinically insignificant breast pain and routing them to screening mammogram improves radiology resource allocation and decreases healthcare spending without missing any cancers.

'Humans think outside the pixels' - Radiologists' perceptions of using artificial intelligence for breast cancer detection in mammography screening in a clinical setting.

OBJECTIVE: This study aimed to explore radiologists' views on using an artificial intelligence (AI) tool named ScreenTrustCAD with Philips equipment) as a diagnostic decision support tool in mammography screening during a clinical trial at Capio Sankt Göran Hospital, Sweden. METHODS: We conducted semi-structured interviews with seven breast imaging radiologists, evaluated using inductive thematic content analysis. RESULTS: We identified three main thematic categories: AI in society, reflecting views on AI's contribution to the healthcare system; AI-human interactions, addressing the radiologists' self-perceptions when using the AI and its potential challenges to their profession; and AI as a tool among others. The radiologists were generally positive towards AI, and they felt comfortable handling its sometimes-ambiguous outputs and erroneous evaluations. While they did not feel that it would undermine their profession, they preferred using it as a complementary reader rather than an independent one. CONCLUSION: The results suggested that breast radiology could become a launch pad for AI in healthcare. We recommend that this exploratory work on subjective perceptions be complemented by quantitative assessments to generalize the findings.

Dedicated Breast CT: Getting Ready for Prime Time.

Dedicated breast CT is an imaging modality that provides true 3D imaging of the breast with many advantages over current conventional breast imaging modalities. The addition of intravascular contrast increases the sensitivity of breast CT substantially. As such, there are immediate potential applications in the clinical workflow. These include using breast CT to replace much of the traditional diagnostic workup when faced with indeterminate breast lesions. Contrast-enhanced breast CT may be appropriate as a supplemental screening tool for women at high risk of breast cancer, similar to breast MRI. In addition, emerging studies are demonstrating the utility of breast CT in neoadjuvant chemotherapy tumor response monitoring as well as planning for surgical treatment options. While short exam times and fully 3D imaging in a noncompressed position are advantages of this modality, limited coverage of chest wall/axilla due to prone positioning and use of ionizing radiation are drawbacks. To date, several studies have reported on the performance characteristics of this promising modality.

Feasibility and Accuracy of Ultrasound-Guided Core Needle Biopsy for Nipple Lesions: A Pilot Study.

BACKGROUND: Due to the superficial location, suspicious findings of the nipple-areolar complex (NAC) are not amenable to stereotactic or MRI-guided sampling and have historically necessitated surgical biopsy or skin-punch biopsy. There are limited reports of US-guided core biopsy of the nipple (US-CBN). OBJECTIVE: We report our nearly 3-year pilot experience with US-CBN at an academic breast imaging center. METHODS: An institutional review board-exempt and HIPAA-compliant retrospective review was performed. We assessed patient demographics, breast imaging characteristics, procedural data, pathology, and outcomes. RESULTS: Nine female patients aged 27 to 64 underwent US-CBN from January 2021 to October 2023. Initial imaging abnormalities included abnormal MRI enhancement, mammographic calcifications, and sonographic masses. After initial or second-look US, all imaging findings had sonographic correlates for biopsy specimens, the majority of which were sonographic masses (8/9). US-CBN was performed by 6 breast radiologists using a variety of devices. All biopsy specimen results were concordant with sonographic abnormalities, although 1 was considered discordant from the initial abnormality seen on MRI. There were no complications, and discomfort during the procedure was well-treated. Two patients (22%, 2/9) were diagnosed with malignancy. CONCLUSION: This pilot study demonstrated that US-CBN can be performed by a breast radiologist for definitive diagnosis of suspicious nipple abnormalities seen on breast imaging, avoiding surgery, and maintaining nipple integrity. In our population, 22% (2/9) of US-CBNs revealed malignancy.

Fat-signal suppression in breast diffusion-weighted imaging: the Good, the Bad, and the Ugly.

OBJECTIVES: Fat-signal suppression is essential for breast diffusion magnetic resonance imaging (or diffusion-weighted MRI, DWI) as the very low diffusion coefficient of fat tends to decrease absolute diffusion coefficient (ADC) values. Among several methods, the STIR (short-tau inversion recovery) method is a popular approach, but signal suppression/attenuation is not specific to fat contrary to other methods such as SPAIR (spectral adiabatic (or attenuated) inversion recovery). This article focuses on those two techniques to illustrate the importance of appropriate fat suppression in breast DWI, briefly presenting the pros and cons of both approaches. METHODS AND RESULTS: We show here through simulation and data acquired in a dedicated breast DWI phantom made of vials with water and various concentrations of polyvinylpyrrolidone (PVP) how ADC values obtained with STIR DWI may be biased toward tissue components with the longest T1 values: ADC values obtained with STIR fat suppression may be over/underestimated depending on the T1 and ADC profile within tissues. This bias is also illustrated in two clinical examples. CONCLUSION: Fat-specific methods should be preferred over STIR for fat-signal suppression in breast DWI, such as SPAIR which also provides a higher sensitivity than STIR for lesion detection. One should remain aware, however, that efficient fat-signal suppression with SPAIR requires good B0 shimming to avoid ADC underestimation from residual fat contamination. CLINICAL RELEVANCE STATEMENT: The spectral adiabatic (or attenuated) inversion recovery (SPAIR) method should be preferred over short-tau inversion recovery (STIR) for fat suppression in breast DWI. KEY POINTS: Fat-signal suppression is essential for breast DWI; the SPAIR method is recommended. Short-tau inversion recovery (STIR) is not specific to fat; as a result, SNR is decreased and ADC values may be over- or underestimated. The STIR fat-suppression method must not be used after the injection of gadolinium-based contrast agents.