Local Recurrence of Invasive Secretory Breast Carcinoma in a Gravid Patient Post-Mastectomy.

This is a case of locally recurrent invasive secretory carcinoma of the breast during pregnancy, detected as a palpable mass in the reconstructed right breast of a 32-year-old female at 24 weeks gestation. The patient was initially diagnosed with secretory carcinoma 8 years prior, for which she underwent nipple sparing mastectomy followed by adjuvant chemotherapy and endocrine therapy. Due to pregnancy, the recurrence was treated initially with conservative excision alone, followed by definitive management postpartum which included wide local excision, sentinel lymph node biopsy and adjuvant chest wall radiation. Secretory carcinoma of the breast is a rare cancer with a predilection for young age and indolent course. This case report describes an unusual case of recurrent secretory carcinoma, of interest due to both its diagnosis during pregnancy, and its recurrence after nipple sparing mastectomy.

Nodular sclerosing adenosis detected as focal uptake on molecular breast imaging.

We report a case of nodular sclerosing adenosis presenting as false-positive uptake on molecular breast imaging (MBI). A 51-year-old woman with elevated lifetime risk of breast cancer underwent supplemental MBI which showed focal uptake in the right breast. A corresponding mass was found on ultrasound with subsequent biopsy yielding nodular sclerosing adenosis. After the biopsy results were reviewed, a problem solving breast MR was recommended. Breast MR showed a solitary enhancing right breast mass containing a marker clip, and the sonographic biopsy was then deemed concordant with pathology. While adenosis lesions are known mimickers of malignancy on other breast imaging modalities, their appearance on MBI has not been previously published.

Masses in the era of screening tomosynthesis: Is diagnostic ultrasound sufficient?

METHODS:: All masses recalled from screening digital breast tomosynthesis between July 1, 2017 and December 31, 2017 that were sent either to diagnostic mammography or ultrasound were compared. Size, shape, margins, visibility on ultrasound, diagnostic assessment and pathology of all masses along with breast density were evaluated. RESULTS:: 102/212 digital breast tomosynthesis screen-detected masses were worked up with diagnostic mammography initially and 110/212 were worked up with ultrasound directly. There was no significant difference in ultrasound visibility of masses sent to diagnostic mammography first with those sent to ultrasound first (p = 0.42). 4 (4%) masses sent to mammogram first and 2 (2%) masses sent to ultrasound first were not visualized. There was a significant difference in size between masses that were visualized under ultrasound versus those that were not (p = 0.01), when masses in both groups were assessed cumulatively. CONCLUSIONS:: 98% of digital breast tomosynthesis screen-detected masses sent to ultrasound directly were adequately assessed without diagnostic mammography. ADVANCES IN KNOWLEDGE:: There is potential for avoiding a diagnostic mammogram for evaluation of majority of digital breast tomosynthesis screen-detected masses.

Evaluation of Shimming Techniques on MRI Breast Image Quality at 1.5T.

OBJECTIVE: The quality of all clinical MRI is dependent on B0 homogeneity, which is optimized during the shimming part of a prescan or preparatory phase before image acquisition. The purpose of this study was to assess shimming techniques clinically employed for breast MRI across our practice, and to determine factors that correlate with higher image quality for contrast-enhanced breast MRI at 1.5T. METHODS: One hundred consecutive female patients were retrospectively collected with Institutional Review Board approval. Shimming-related parameters, including shim-box placement and shimming gradient offsets were extracted from prior contrast-enhanced 3D fat-suppressed T1-weighted gradient echo image acquisitions. Three breast radiologists evaluated these images for fat saturation, breast density, overall image quality, and artifacts. Technologist experience was also evaluated for variability of shimming. Generalized linear mixed models were used to compare acquisition parameters between fat saturation. P < 0.05 was considered as statistical significance. RESULTS: The percentage of soft tissue inside the field of view (FOV) (ie, Tissue/FOV) in the good fat-saturation group (0.37 ± 0.06) was significantly lower (P < 0.01) than that in the poor fat-saturation group (0.39 ± 0.06). Other shimming-related parameters were found not significantly affecting the fat-saturation outcomes. Technologists with more experience tended to have less variable shimming performance than junior technologists did. CONCLUSIONS: The quality of clinical MRI and especially breast MRI is highly dependent on shimming. Decreasing Tissue/FOV was associated with good image quality (good fat saturation). Optimization of shimming may require manual shimming or higher-order field-correction strategies.