Mean glandular dose in digital mamography in women with breast implants.

PURPOSE: Mean Glandular Dose (MGD) is the quantity related to the risk of radiation-induced breast cancer. This study aimed to evaluate the MGD in screening mammography for women with breast implants. METHODS: This retrospective study used data of 2680 mammographies of 335 asymptomatic women with mammary implants examined in a digital direct x-ray unit. Each woman had a total of eight images: four in standard views and four with posterior displacement of the implant (ID). Data on kV, mAs, target/filter combination, compressed breast thickness and MGD were obtained from the DICOM header of the stored images. Quantitative variables were presented through descriptive statistics for median (5th-95th percentiles); and the qualitative variables were presented by numbers and percentages. Mean glandular doses of standard views and ID views were compared and statistical analysis was used to assess the influence of implant position, breast glandularity and thickness on mean glandular doses. RESULTS: Median MGD for standard views were 3.30 (2.60-4.00) mGy for CC and 3.31 (2.70-4.20) mGy for MLO. For ID views, median were 1.20 (0.90-2.20) mGy and 1.40 (0.97-3.74) mGy for CC and MLO views, respectively. Median MGD for the whole examination of women with breast implants was 9.60 (7.92-12.07) mGy, ranging from 6.25 to 21.50 mGy. When comparing MGD median for standard and ID views it was found a statistically significant difference (p < 0.05), with higher doses for the standard views due to the greater compressed breast thickness in these views. It was observed that, in the standard views, MGD decreases with increasing breast thickness due to the manual radiographic techniques used to expose the women. It was also observed that implant position does not affect MGD in breast augmentation mammography. CONCLUSION: Mammography of women with mammary implants gives higher radiation doses when compared with those without implants. For more accurate dose assessment in augmented breast mammography, it is necessary that specific conversion factors for the calculation of MGD based on air kerma at entrance of breasts with implants are made available.

From the radiologic pathology archives: diseases of the male breast: radiologic-pathologic correlation.

Male breast disease includes a variety of benign and malignant conditions, many of which are hormonally influenced. Gynecomastia and skin lesions account for the majority of conditions in symptomatic men with a palpable abnormality, and these conditions should be accurately recognized. Imaging patterns of gynecomastia include nodular, dendritic, and diffuse patterns. Histopathologically, the nodular and dendritic patterns correlate with the florid and quiescent (fibrotic) phases of gynecomastia, respectively. The diffuse pattern may have features of both phases and is associated with exposure to exogenous estrogen. Benign-appearing palpable masses in male patients should be approached cautiously, given the overlapping morphologic features of benign and malignant tumors. In addition to gynecomastia, other benign male breast tumors include lipoma, pseudoangiomatous stromal hyperplasia, granular cell tumor, fibromatosis, myofibroblastoma, schwannoma, and hemangioma. Male breast cancer accounts for 1% of all breast carcinomas. Invasive ductal carcinoma accounts for the majority of cases in adult males and typically appears as a subareolar mass without calcifications that is eccentric to the nipple. Other epithelial and mesenchymal tumors that may occur, albeit not as commonly as in women, include papillary carcinoma, invasive lobular carcinoma, adenoid cystic carcinoma, liposarcoma, dermatofibrosarcoma, pleomorphic hyalinizing angiectatic tumor, basal cell carcinoma of the nipple, hematopoietic malignancies, and secondary tumors. Knowledge of the natural history, clinical characteristics, and imaging features of tumors that occur in the male breast will help narrow the radiologic differential diagnosis and optimize treatment.

Vascular abnormalities of the breast: arterial and venous disorders, vascular masses, and mimic lesions with radiologic-pathologic correlation.

Vascular abnormalities of the breast include a wide spectrum of arterial and venous disorders, as well as benign and malignant vascular masses. Multimodality imaging is often necessary to accurately diagnose several of these uncommon conditions, and pathologic correlation can be important for accurate diagnosis of vascular masses. After a review of the vascular anatomy of the breast, the authors discuss the imaging appearance of several native arterial disorders (atherosclerosis and aneurysm) and venous disorders (superior vena cava syndrome, congestive heart failure, thrombophlebitis, and varix). Benign vascular tumors (hemangioma, lymphangioma, and angiolipoma) and malignant vascular tumors (angiosarcoma and hemangiopericytoma) that may be encountered in the breast are also reviewed. In addition, pitfalls in the correct interpretation of vascular breast lesions (devascularization of masses and pathologic mimics) are reviewed. Understanding and assessing normal and pathologic breast vasculature will permit more accurate diagnosis and treatment planning and allow breast imagers to have a more active role in breast care.

From the archives of the AFIP: breast masses in children and adolescents: radiologic-pathologic correlation.

The spectrum of breast lesions in children and adolescents varies markedly from that for adults, with the former lesions being overwhelmingly benign. A breast mass in a young boy or girl may arise from normal and abnormal breast development. Other causes of masses include infection, trauma, and cyst formation. After onset of puberty, most cases of breast enlargement arise from benign fibroadenoma in girls and gynecomastia in boys. These conditions have specific imaging appearances, although juvenile (often giant) fibroadenoma cannot be distinguished from phyllodes tumor, which can be benign or malignant. In children, both conditions usually appear as well-circumscribed, hypoechoic masses at sonography and show diffuse enhancement except for nonenhancing septations at magnetic resonance imaging. A diagnosis of juvenile papillomatosis (a benign lesion) portends later development of breast cancer, and patients with this condition should be closely monitored. Malignant lesions of the breast in children are rare. The most common malignant lesions are metastases and are usually associated with widespread disease. The most common primary breast malignancy is malignant phyllodes tumor. Primary breast carcinoma is exceedingly rare in the pediatric age group, but its imaging appearance in children is the same as seen in adults and is different from that of almost all benign lesions. In girls, diagnostic interventions may injure the developing breast and cause subsequent disfigurement. Given this risk and the low prevalence of malignant disease in this population, a prudent course should be followed in the diagnosis of breast lesions. Imaging findings are very helpful for selecting patients for further diagnostic procedures. Although malignancy is rare, lesions with suspicious imaging findings or progressive growth should be subjected to cytologic or histologic examination.