The ability of digital breast tomosynthesis to reduce additional examinations in older women.

Aims: To assess the diagnostic performance of digital breast tomosynthesis (DBT) in older women across varying breast densities and to compare its effectiveness for cancer detection with 2D mammography and ultrasound (U/S) for different breast density categories. Furthermore, our study aimed to predict the potential reduction in unnecessary additional examinations among older women due to DBT. Methods: This study encompassed a cohort of 224 older women. Each participant underwent both 2D mammography and digital breast tomosynthesis examinations. Supplementary views were conducted when necessary, including spot compression and magnification, ultrasound, and recommended biopsies. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were calculated for 2D mammography, DBT, and ultrasound. The impact of DBT on diminishing the need for supplementary imaging procedures was predicted through binary logistic regression. Results: In dense breast tissue, DBT exhibited notably heightened sensitivity and NPV for lesion detection compared to non-dense breasts (61.9% vs. 49.3%, p < 0.001) and (72.9% vs. 67.9%, p < 0.001), respectively. However, the AUC value of DBT in dense breasts was lower compared with non-dense breasts (0.425 vs. 0.670). Regarding the ability to detect calcifications, DBT demonstrated significantly improved sensitivity and NPV in dense breasts compared to non-dense breasts (100% vs. 99.2%, p < 0.001) and (100% vs. 94.7%, p < 0.001), respectively. On the other hand, the AUC value of DBT was slightly lower in dense breasts compared with non-dense (0.682 vs. 0.711). Regarding lesion detection for all cases between imaging examinations, the highest sensitivity was observed in 2D mammography (91.7%, p < 0.001), followed by DBT (83.7%, p < 0.001), and then ultrasound (60.6%, p < 0.001). In dense breasts, sensitivity for lesion detection was highest in 2D mammography (92.9%, p < 0.001), followed by ultrasound (76.2%, p < 0.001), and the last one was DBT. In non-dense breasts, sensitivities were 91% (p < 0.001) for 2D mammography, 50.7% (p < 0.001) for ultrasound, and 49.3% (p < 0.001) for DBT. In terms of calcification detection, DBT displayed significantly superior sensitivity compared to 2D mammography in both dense and non-dense breasts (100% vs. 91.4%, p < 0.001) and (99.2% vs. 78.5%, p < 0.001), respectively. However, the logistic regression model did not identify any statistically significant relationship (p > 0.05) between DBT and the four dependent variables. Conclusion: Our findings indicate that among older women, DBT does not significantly decrease the requirement for further medical examinations.

Radiological and Histological Correlation in Small Cell Neuroendocrine Carcinoma of the Breast: A Case Report.

BACKGROUND Primary breast small cell neuroendocrine carcinoma is a rare subtype of breast cancer with about 57 cases reported in the literature. This rare type of cancer represents about 0.1% of breast carcinomas. Recently, the World Health Organization defined this type of cancer as a separate entity from other breast cancer types. The diagnosis of this type of cancer in the breast is difficult because the histological pattern is similar to the small cell neuroendocrine carcinoma of other more common primary sites of origin, including the lung. CASE REPORT A 39-year-old woman presented to our hospital with a left breast mass and recurrent mastitis. Physical examination revealed a painless lump in her left breast with a brown-colored discharge from the nipple, and her child refused breastfeeding from the left breast. A high-density well-defined rounded mass was observed upon mammography in the upper lateral aspect of the left breast. This mass lesion appeared hypoechoic with no posterior acoustic shadowing on ultrasound scan. A core-needle biopsy of the mass was performed and the diagnosis of small cell neuroendocrine carcinoma was rendered after histopathologic examination. Positron emission tomography scanning was helpful in the exclusion of primary origin from other organ sites; thus, the primary breast origin of the tumor was confirmed. CONCLUSIONS This case report provides a comprehensive approach to diagnose this type of small cell carcinoma originating primarily in the breast. The suspicion of this type of breast cancer should be raised if there is presence of characteristic histopathologic findings with the exclusion of any primary origin from other organ sites by the help of imaging studies.

Chest x-ray findings and temporal lung changes in patients with COVID-19 pneumonia.

BACKGROUND: Chest CT scan and chest x-rays show characteristic radiographic findings in patients with COVID-19 pneumonia. Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia. The study aims at describing the chest x-ray findings and temporal radiographic changes in COVID-19 patients. METHODS: From March 15 to April 20, 2020 patients with positive reverse transcription polymerase chain reaction (RT-PCR) for COVID-19 were retrospectively studied. Patients' demographics, clinical characteristics, and chest x-ray findings were reported. Radiographic findings were correlated with the course of the illness and patients' symptoms. RESULTS: A total of 88 patients (50 (56.8%) females and 38 (43.2%) males) were admitted to the hospital with confirmed COVID-19. Their age ranged from 3 to 80 years (35.2 ± 18.2 years). 48/88 (45%) were symptomatic, only 13/88 (45.5%) showed abnormal chest x-ray findings. A total of 190 chest x-rays were obtained for the 88 patients with a total of 59/190 (31%) abnormal chest x-rays. The most common finding on chest x-rays was peripheral ground glass opacities (GGO) affecting the lower lobes. In the course of illness, the GGO progressed into consolidations peaking around 6-11 days (GGO 70%, consolidations 30%). The consolidations regressed into GGO towards the later phase of the illness at 12-17 days (GGO 80%, consolidations 10%). There was increase in the frequency of normal chest x-rays from 9% at days 6-11 up to 33% after 18 days indicating a healing phase. The majority (12/13, 92.3%) of patients with abnormal chest x-rays were symptomatic (P = 0.005). CONCLUSION: Almost half of patients with COVID-19 have abnormal chest x-ray findings with peripheral GGO affecting the lower lobes being the most common finding. Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia.