Follow-up results of BI-RADS 3 lesions on magnetic resonance imaging: a retrospective study

PURPOSE: The categorization of Breast Imaging Reporting and Data System (BI-RADS) 3 lesions is not as clear in magnetic resonance imaging (MRI) as it is in mammography (MG). With the increasing number of MRI scans currently being conducted globally, incidentally detected lesions falling into the probably benign category are frequently being observed. In this study, our aim was to investigate the imaging characteristics and follow-up results of BI-RADS 3 lesions detected by MRI and to determine their malignancy rates. METHODS: Breast MRI scans performed between January 2010 and January 2020 and classified as BI-RADS 3 lesions were retrospectively analyzed. The study included 216 lesions with known biopsy or surgical excision results or with at least one year of radiological follow-up. We assessed the patients' age, the presence of breast cancer, the follow-up interval, and the imaging findings at the beginning and during the follow-up. Lesions that remained stable, disappeared, or decreased in size and had a benign histopathological diagnosis were classified as benign. Lesions with the histopathological diagnosis of malignancy, identified by either biopsy or surgical excision, were classified as malignant. We determined the malignancy rate based on the histopathology and follow-up results. RESULTS: Considering the follow-up results of all cases, 8% of lesions were excised, 0.5% decreased in size, 1.4% became enlarged, 17.1% disappeared, and 73% remained stable. The malignancy rate was 2.8%. A significant relationship was found between lesion shape and malignancy, as progression to malignancy was more likely in round lesions than in other types. An irregular margin, heterogeneous enhancement, and kinetic curve (type 2) features were significant for lesion upgrade to malignancy. CONCLUSION: The malignancy rate in BI-RADS 3 lesions detected by MRI is low and falls within the accepted cancer rate for MG and sonography. Changes in size, morphology, and enhancement pattern should be considered in terms of malignancy development during follow-up. The follow-up intervals should be determined on a case-by-case basis.

Diagnostic accuracy of the breast MRI Kaiser score in suspected architectural distortions and its comparison with mammography.

Suspicious architectural distortion is an elusive finding in breast cancer diagnosis. This study aimed to evaluate the diagnostic accuracy of the Kaiser score for suspicious architectural distortions observed on mammography and compare it with the BI-RADS score of the lesion. Mammograms performed between January 2013 and March 2023 were retrospectively analyzed for the presence of suspicious architectural distortion. Forty-one patients, who had at least 1 year of radiological follow-up or pathology results, and underwent breast MRI, were included in the study. Mammography findings and the BI-RADS category of the lesion were assessed. MRI findings were evaluated and Kaiser scoring was performed according to the tree flowchart. Ninety-one percent of the enhanced lesions had a Kaiser score of 5 and above. In the diagnosis of malignancy, the Kaiser score yielded an accuracy of 75.61% (AUC 0.833). A statistically significant correlation was observed indicating that a malignant diagnosis was more prevalent in patients with a Kaiser score of 5 and above (p < 0.05). Additionally statistically significant relationship was also observed between the BI-RADS category of architectural distortions on mammography and the Kaiser score (p = 0.007). The combined utilization of mammography findings and the evidence-based Kaiser score in suspected architectural distortions provides more accurate results in the differential diagnosis of breast cancer.

High-Grade Ductal Carcinoma In Situ of the Breast With Regressive Changes: Radiological and Clinicopathological Findings.

Objective: Tumour regression is defined as continuity of changes leading to the elimination of a neoplastic population and is reflected as periductal fibrosis and intraductal tumour attenuation. The aim of this study was to describe the radiological and clinicopathological characteristics of high-grade breast ductal carcinoma in situ (DCIS) with regressive changes (RC). Materials and Methods: Thirty-two cases of high-grade DCIS with RC on biopsy specimens followed by excision were included. The mammographic, ultrasonographic (US), and magnetic resonance imaging (MRI) findings of cases were retrospectively reviewed according to the breast imaging reporting and data system (BI-RADS) lexicon. Clinical and histopathological findings [comedonecrosis, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) status and Ki-67 proliferation index] were recorded. The rate of upgrade to invasive cancer after surgical excision and lymph node involvement were evaluated. Results: The most common mammographic finding was microcalcifications alone (68.8%). The most frequently seen findings on US were microcalcifications only (21.9%), followed by microcalcifications and hypoechoic area (18.7%). On MRI, most lesions presented as clumped non-mass enhancement with segmental distribution. ER/PR negativity (53.1%, 65.6%), HER2 positivity (56.3%) and high Ki-67 (62.5%), which are known to be associated with more aggressive behavior, were found to be proportionally higher. The rate of upgrade to invasive cancer was 21.8%. Conclusion: DCIS with RC lesions present most often as microcalcifications alone on both mammography and US. MRI features are not distinguishable from those of other DCIS lesions. DCIS with RC lesions show biomarker status reflecting more aggressive behavior and high upgrade rate to invasive cancer.

Prediction of malignancy upgrade rate in high-risk breast lesions using an artificial intelligence model: a retrospective study

PURPOSE: High-risk breast lesions (HRLs) are associated with future risk of breast cancer. Considering the pathological subtypes, malignancy upgrade rate differs according to each subtype and depends on various factors such as clinical and radiological features and biopsy method. Using artificial intelligence and machine learning models in breast imaging, evaluations can be made in terms of risk estimation in different research areas. This study aimed to develop a machine learning model to distinguish HRL cases requiring surgical excision from lesions with a low risk of accompanying malignancy. METHODS: A total of 94 patients who were diagnosed with HRL by image-guided biopsy between January 2008 and March 2020 were included in the study. A structured database was created with clinical and radiological characteristics and histopathological results. A machine learning prediction model was created to make binary classifications of lesions as malignant or benign. Random forest, decision tree, K-nearest neighbors, logistic regression, support vector machine (SVM), and multilayer perceptron machine learning algorithms were used. Among these algorithms, SVM was the most successful. The estimations of malignancy for each case detected by artificial intelligence were combined and statistical analyses were performed. RESULTS: Considering all cases, the malignancy upgrade rate was 24.5%. A significant association was observed between malignancy upgrade rate and lesion size (P = 0.004), presence of mammography findings (P = 0.022), and breast imaging-reporting and data system category (P = 0.001). A statistically significant association was also found between the artificial intelligence prediction model and malignancy upgrade rate (P < 0.001). With the SVM model, an 84% accuracy and 0.786 area-underthe- curve score were obtained in classifying the data as benign or malignant. CONCLUSION: Our artificial intelligence model (SVM) can predict HRLs that can be followed up with a lower risk of accompanying malignancy. Unnecessary surgeries can be reduced, or second line vacuum excisions can be performed in HRLs, which are mostly benign, by evaluating on a case-by-case basis, in line with radiology-pathology compatibility and by using an artificial intelligence model.

Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study.

PURPOSE: The clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions. METHODS: This retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson's chi-squared test, the Fisher-Freeman-Halton test, and Fisher's exact test were used for the statistical analyses. RESULTS: The overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes. CONCLUSION: ADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision.

Radiological and clinicopathological findings of breast cancer during the COVID-19 pandemic: a comparative study with the pre-pandemic era.

PURPOSE: The diagnosis and surgical treatment delays that occurred during the coronavirus disease-2019- (COVID-19) pandemic may have affected breast cancer presentation. This study aimed to determine whether there was a difference in the clinicopathological characteristics of breast cancers during the pandemic by comparing them with similar cases from the previous year. The study also aimed to determine the radiological findings of breast cancers during the pandemic. METHODS: A retrospective review was made of patients who underwent surgery for breast cancer between March 11, 2020, and December 11, 2020 (the pandemic group). These patients were compared with similar patients from the previous year (the pre-pandemic group). The postoperative histopathology results of both groups were compared, and the preoperative radiological findings of the pandemic group were defined. RESULTS: There were 71 patients in the pandemic group and 219 patients in the pre-pandemic group. The tumor size was significantly greater, lymph node involvement was more frequent, and waiting time for surgery was longer in the pandemic group (P < 0.001, P = 0.044, P = 0.001, respectively). There was no significant difference between the groups in respect of in situ/invasive tumor distribution, histological type and histological grade of tumor, the presence of lymphovascular/perineural invasion, multifocal/multicentric focus, and Breast Imaging Reporting and Data System Classification (P > 0.15). The radiologic findings of breast cancer during the pandemic typically showed characteristics of malignancy. CONCLUSION: Patients diagnosed with breast cancer during the COVID-19 pandemic had larger tumor sizes, more frequent lymph node involvement and longer waiting time for surgical treatment. Screening programs should be continued as soon as possible by taking necessary precautions.

Breast Hemangioma Evaluation with Magnetic Resonance Imaging: A Rare Case Report.

Vascular tumors are rare in the breasts, and the most common forms include hemangiomas and angiosarcomas. Hemangiomas are rare benign vascular tumors. Most of them are asymptomatic and nonpalpable clinically, and the vast majority of such lesions are detected incidentally by mammography. Breast hemangiomas are difficult to diagnose using conventional imaging modalities since their imaging findings are variable. The following is a case presentation of an asymptomatic forty-five-year old female patient who was diagnosed with a rare hemangioma. Physical examination, ultrasonography (US) and mammographic examination were normal. Dynamic contrast enhanced magnetic resonance imaging (MRI) showed a non-mass pathological enhancement. After a short-term follow up, a comparative MRI was obtained and biopsy was planned, due to the heterogeneous non-mass enhancement on MRI. Needle core biopsy with US guidance was performed, resulting in benign findings. However, because of the discordance between imaging and histopathology, an MRI-guided wire localization followed by open surgical biopsy was performed. Histopathologic evaluation reported capillary hemangioma.The imaging findings, including US, mammography and MRI, of hemangioma are reviewed and described in this case report.

Moderating Effects of Teacher-Child Relationship on the Association Between Unsociability and Play Behaviors.

The present study aimed to examine the moderating role of the quality of the relationship between children and their teachers (i.e., closeness and conflict), in children's unsociability and play behaviors (i.e., reticent behavior, social play). Participants were 211 three- to six-year-old children (M = 64.08 months, SD = 10.92, 94 girls, 117 boys). Mothers reported their unsociability; teachers reported teacher-child relationships and children's play behaviors. Results showed that close teacher-child relationships moderated the association between unsociability and social play in children (buffering effect). Teacher-child conflict exacerbated the relations between unsociability and reticent behavior. Findings show that teacher-child closeness is effective in revealing social play behaviors of unsociable children. Teachers can improve their relationship with unsociable children to provide nurturing social play behavior.

Lupus Mastitis in a Young Female Mimicking a Breast Carcinoma; a Rare Entity Through a Case Report and Review of the Literature.

Lupus mastitis (LM) is a rare presentation of lupus panniculitis (LP) that usually affects women of childbearing age and may mimic malignancy. The condition is recurrent and progresses along with the underlying disease. Breast pathology that may be associated with LM includes fat necrosis, calcification, fibrosis, scarring, and breast atrophy. Therefore, LM should be considered in the differential diagnosis of a suspicious breast mass on mammography or ultrasound, particularly if the patient has a background of systemic lupus erythematosus (SLE) or discoid lupus erythematosus (DLE). Traumatic procedures such as surgery or biopsy may worsen the condition and it is advisable to avoid biopsy if the diagnosis can be established through accurate patient history, with identification of typical clinical and radiological features. Thus, awareness of the radiologic and clinical features of LM is essential to avoid unnecessary interventional procedures that carry the potential for disease exacerbation. The authors present here the imaging findings of LM in a 37-year old female with SLE, which presented as bilateral palpable breast lumps.

Fibroepithelial Breast Tumors in a Teenager with Beckwith-Wiedemann Syndrome: A Case Report and Review of Literature.

Beckwith-Wiedemann syndrome (BWS) is a human genomic imprinting disorder that presents with a wide spectrum of clinical features, including overgrowth, abdominal wall defects, macroglossia, neonatal hypoglycemia, and predisposition to embryonal tumors. Its diagnosis is based on molecular tests or clinical signs. However, in children with features of BWS who do not fulfill the clinical diagnostic criteria, the molecular tests may play an important role in the diagnosis. There is an increased risk of embryonal tumors in patients with BWS, but few case reports have been reported on benign breast tumors in female adolescents with this syndrome. To our knowledge, this is the first case report in the literature that describes the imaging findings of fibroepithelial breast tumors (phyllodes tumor and fibroadenomas) in a 13-year-old female with BWS, highlighting the need for lifelong tumor surveillance in this patient population.

Prevalence of Incidental Gynecomastia by Chest Computed Tomography in Patients with a Prediagnosis of COVID-19 Pneumonia.

OBJECTIVE: In this study, we aimed to determine the prevalence of gynecomastia by evaluating computed tomography (CT) images of male patients who were admitted to our hospital during the coronavirus disease-2019 (COVID-19) pandemic. MATERIALS AND METHODS: This study included a total of 1,877 patients who underwent chest CT for prediagnosis of COVID-19 pneumonia between March 15th and May 15th, 2020. All images were evaluated for the presence of gynecomastia. Gynecomastia patterns were evaluated according to morphological features, and diagnoses were made by measuring the largest glandular tissue diameter. Statistical analysis was performed with IBM SPSS software version 25.0. RESULTS: The prevalence of gynecomastia was 32.3%. In terms of pattern, 22% were nodular, 57% were dendritic, and 21% were diffuse glandular gynecomastia. A significant correlation was found between age and gynecomastia pattern (p<0.001). The incidence of nodular, dendritic, and diffuse glandular gynecomastia increased with advancing age. A significant difference was found in the analysis of the correlation between age groups and glandular tissue diameters (p<0.001). With an increase in glandular tissue diameter, the gynecomastia pattern changed from a nodular to a diffuse glandular pattern. CONCLUSION: In our study, gynecomastia diagnosis was made through axial CT images. Although CT should not replace mammography and ultrasonography for clinical diagnosis of gynecomastia, chest CT scans can be used to evaluate patients with suspected gynecomastia.

Peer Rejection and Internalizing Behavior: The Mediating Role of Peer Victimization in Preschool.

The author examined the relationship among peer rejection, peer victimization, and internalizing behaviors. The author hypothesized that physical and relational victimization would have a different indirect effect on the relationship between peer rejection and internalizing behaviors. Participants were 94 preschool children (37 girls; average age 49.97 months) from two university preschools located in the northern part of the United States. The results indicated that internalizing behaviors predicted the mediating variables only regarding relational victimization. Relational victimization indirectly affected the association between peer rejection and internalizing behaviors. The study provides evidence of the mediating effect of victimization behaviors on the relationship among peer rejection, victimization, and internalizing behaviors.