Value of Mammography for Women 30-39 Years Old Presenting With Breast Symptoms.

OBJECTIVE: The purpose of this study was to determine the performance and added value of bilateral mammography in identifying cancers distant from sites of presenting breast symptoms in women 30-39 years old. MATERIALS AND METHODS: A search identified consecutively registered women 30-39 years old who underwent mammography and ultrasound to evaluate focal breast symptoms between June 2006 and August 2016. Outcomes were determined by imaging and pathologic analysis through linkage with a tumor registry. Medical records were reviewed to determine the presence of breast cancer risk factors. Lifetime breast cancer risk was calculated with the International Breast Cancer Intervention Study model. RESULTS: The study included 4426 diagnostic examinations of 3997 women 30-39 years old. Sixty-eight breast cancers were diagnosed (cancer detection rate, 15.4 per 1000 examinations). Sixty examinations led to biopsy of a finding distant from the presenting symptom site, yielding nine incidental malignancies (positive predictive value, 15.0%; incidental cancer detection rate, 2.0 per 1000 examinations [9/4426]). Among the other 59 cancers diagnosed in the symptomatic area, bilateral mammography depicted multicentric or contra-lateral disease in seven (11.9%). Average lifetime risk of breast cancer among the 68 women with cancer was significantly higher than that among age-matched control subjects (22.8% vs 13.1%, p < 0.001); 45 of these 68 women (66.2%) had identifiable risk factors. Lifetime risk among the nine women with incidental cancers was higher than that of age-matched control subjects, although without statistical significance (24.9% vs 13.2%, p = 0.07). CONCLUSION: Bilateral mammographic evaluation of women 30-39 years old presenting with breast symptoms yielded an additional 2.0 incidental cancers per 1000 examinations. The low added cancer yield may support the judicious rather than routine use of mammography in this patient cohort.

Multiphase Multi-Detector Row Computed Tomography Imaging Characteristics of Large (>5 cm) Focal Hepatocellular Carcinoma.

OBJECTIVE: The aim of this study was to describe the multiphase multi-detector row computed tomography (MDCT) imaging findings of large (>5 cm) focal hepatocellular carcinoma (HCC). METHODS: Following review of the medical records of 321 patients with newly diagnosed HCC who underwent MDCT within the radiology database from January 2007 to November 2014, 27 patients (20 men and 7 women; mean age, 69 [SD, 10.1] years [range, 49-87 years]) with histologically confirmed HCC greater than 5 cm were included in this institutional review board-approved study. Multiphase, dedicated liver MDCT images of these cases were retrospectively reviewed by 2 radiologists in consensus to describe the enhancement characteristics of these lesions. RESULTS: Mean tumor diameter was 8.4 (SD, 2.4) cm (range, 5.2-13.5 cm). Cirrhosis was present in 16 (59%) of 27 patients. Seventeen (85%) of 20 patients with available laboratory data presented with elevated alpha-fetoprotein (median, 97 ng/mL). Twenty-three (85%) of 27 demonstrated either heterogeneous enhancement with gradual fill-in (14/27 [52%]) or peripheral enhancement with centripetal fill-in (9/27 [33%]). Twenty-two (81%) of 27 lacked washout on delayed phase images, and 21 (78%) of 27 demonstrated a pseudocapsule. Twenty-seven of 27 lesions were well defined, 8 (30%) of 27 were exophytic, 15 (56%) of 27 were unifocal, 5 (25%) of 20 cases demonstrated vascular invasion, and 7 (26%) of 27 cases presented with extrahepatic metastases. CONCLUSIONS: Large (>5 cm) focal HCC may present as a dominant mass with a pseudocapsule and initial heterogeneous or peripheral enhancement with gradual or centripetal fill-in without washout on multiphase MDCT. Awareness of this variant is important to allow distinction from other benign (eg, hemangioma) and malignant (eg, cholangiocarcinoma) focal liver lesions.

MRI phenotype of breast cancer: Kinetic assessment for molecular subtypes.

PURPOSE: To evaluate the dynamic contrast-enhanced magnetic resonance imaging (MRI) kinetic characteristics of newly diagnosed breast cancer molecular subtypes. MATERIALS AND METHODS: Breast MRI examinations of 112 patients with newly diagnosed breast cancer were reviewed. Cases of newly diagnosed invasive ductal carcinoma were sorted by molecular subtype (28 TN, 11 HER2 +, 73 Lum A/B) and MRI field strength, with lesion segmentation and kinetic analyses performed on a dedicated workstation. For kinetic assessment, 50% and 100% thresholds were employed for display of medium and rapid uptake. Kinetic profiles in terms of percent volume for six kinetic types (medium-persistent, medium-plateau, medium-washout, fast-persistent, fast-plateau, fast-washout) relative to the whole volume of the lesion were obtained. Statistical analysis of the kinetic profiles was performed using Welch's t-test. RESULTS: Percent volume of HER2-positive lesions with >100% uptake at early phase on 3T strength MRI exams was significantly greater compared with luminal A/B (93.8 ± 0.92 vs. 77.3 ± 7.2; P < 0.01) and triple negative (93.8 ± 0.92 vs. 81.3 ± 8.2; P < 0.05) subtypes. The >50% early phase uptake for HER2+ lesions was also higher than Lum A/B (99.1 ± 0.73 vs. 93.6 ± 3.05; P < 0.01) at 3T. In the 1.5T subgroup the percent volume of HER2+ tumors with >50% and >100% early phase uptake trended higher than Lum A/B lesions without reaching significance. CONCLUSION: The percent volume of HER2-positive tumors demonstrating rapid early contrast uptake is significantly increased compared to other molecular subtypes.

Postoperative imaging of phalloplasties and their complications.

OBJECTIVE: In this article, we summarize the common phalloplasty indications, surgical techniques, and relevant anatomy. We review the appropriate imaging techniques used in postoperative evaluation of the neophallus and illustrate the postoperative appearance and complications associated with phalloplasty. CONCLUSION: Phalloplasty is an infrequently encountered yet complex procedure requiring careful postoperative imaging assessment. Modern microsurgical techniques have made free flaps the reference standard in phalloplasty, and the radiologist must be aware of the expected postoperative appearance and complications to appropriately manage these patients.