Search

Objective: To compare the performance of one-view digital breast tomosynthesis (DBT) and two-view full-field digital mammography (FFDM) in the detection and characterization of breast lesions in a selective diagnostic population. Methods: A total of 598 breasts of 319 diagnostic patients were prospectively enrolled. Participants underwent bilateral one-view, mediolateral oblique (MLO) DBT and two-view, craniocaudal and MLO FFDM. The sensitivity and specificity of these methods and their classification into correct Breast Imaging-Reporting and Data System (BI-RADS) categories were compared. These methods were also compared in patients subgrouped by mammographic parenchymal density. Receiver operating characteristic (ROC) curve analysis was performed using the probability of cancer scores. Results: DBT had higher overall sensitivity than FFDM (88.7% vs 80.7%, p - 0.001). Subgroup analyses showed that DBT had significantly higher sensitivity in assessing dense breasts and invasive cancers than FFDM. The BI-RADS category assessment was significantly better for DBT than for FFDM. The differences between the two modalities in specificity (94.1% and 93.2% for FFDM and DBT) were not significant (p = 0.664). The area under the ROC curves using the probability of cancer scores were 0.93 [95% confidence interval (Ci), 0.91-0.95] for FFDM and 0.96 (95% Cl, 0.94-0.97) for DBT (p = 0.005). ROC curve analysis indicated that most of the increased performance of DBT was due to dense breasts. Conclusion: A beneficial effect on the detection and characterization of breast lesions was found for one-view DBT compared with two-view FFDM in a selective diagnostic population. Improvements were especially enhanced in females with dense breasts. These results need to be examined in studies using large-scale consecutive sampling of a diagnostic population. Advances in knowledge: In this study, using selective diagnostic study cases, one-view DBT offered improved reader performance compared with two-view FFDM for detection and characterization of breast cancers. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 23-year-old man with median sacral artery injury during lumbar disc decompression using the Dekompressor who presented complaints of dizziness and abdominal pain after the procedure. Topics include Iatrogenic vascular injuries as serious complication, presence of hematoma after computed tomography (CT) scan and treatment of patient by conservative management process.

Background: Despite the excellent contribution of contrast-enhanced breast magnetic resonance imaging (MRI), there are variable false-negative cases on MRI. Purpose: To evaluate the false-negative findings of breast cancer on previous MRI. Material and Methods: Between 2012 and 2016, we collected 132 patients who underwent surgery for a second primary cancer and had both current and previous MRI at an interval of <3 years. We included 45 patients; we excluded 38 patients who could not find a second cancer in the previous MRI and 49 patients who had a second cancer near to the original cancer and within within the same quadrant. Compared with current MRI, we retrospectively assessed the second primary cancer on previous MRI according to BI-RADS and analyzed the reasons of misinterpretation. Results: Analysis of previous MRI revealed 26 (57.8%) masses (mean size 7.7±2.25 mm), 12 (26.7%) non-mass enhancements (mean size 14.7±4.76 mm), and 7 (15.5%) foci. At first reading, 24 (53.3%) were missed, 17 (37.8%) were assessed as BI-RADS category 2 or 3, and 4 (8.9%) were assessed as category 4. On current MRI, 39 (86.7%) lesions showed an increase in size and 22 (48.9%) showed a change in kinetics to wash-out pattern. Conclusion: On previous MRI, missed or misinterpreted cancers show variable findings of mass and non-mass enhancements with any types of kinetics. Careful application of BI-RADS is necessary as well as an appropriate biopsy. Any lesion that increases in size and changes in kinetics should not be underestimated. [ABSTRACT FROM AUTHOR]

Objectives: Female breast cancer patients generally have limited knowledge regarding issues related to preservation of ovarian function and fertility. The present study aimed to explore the change in the understanding of these issues when female breast cancer patients are educated and counseled about ovarian function and fertility after anticancer treatment. Methods: One hundred nine young female breast cancer patients completed a questionnaire, which revealed their thoughts and opinions before and after receiving the education about ovarian function and fertility. Their responses were analyzed to determine the impact of the education on their perception and understanding of the aforementioned issues. Results: The objective survey had four main themes: planning and desire for children, degree of baseline understanding of the effects of anticancer therapy on fertility and ovarian function, resultant change in cognition after education about cancer treatment and its relationship with fertility, and need for education regarding the types of therapies received and their effects on subsequent ovarian function and fertility before treatment. Conclusions: The preservation of ovarian function and fertility is an important factor that must be included in the discussion prior to initiation of anticancer therapy. Although the study results do not have high educational effectiveness or a high satisfaction with education, there is a need for information and education regarding the impact of anticancer treatment on preservation of ovarian function and fertility. [ABSTRACT FROM AUTHOR]

Purpose: Our study investigated whether any sonographic findings could be useful for differentiating between small triple-negative breast cancer (TNBC) and fibroadenoma. Methods: This retrospective study was approved by our Institutional Review Board, which waived the requirement for patient consent. From January 2009 to December 2010, the sonographic features of 181 pathologically proven TNBC tumors and 172 fibroadenomas measuring less than or equal to 2 cm in the longest dimension were reviewed and analyzed according to the fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) lexicon. Mean tumor roundness was also measured using in-house software. Results: The median longest lesion dimension was 16 mm (range, 13 to 18 mm) in TNBCs and 13 mm (range, 10 to 16 mm) in fibroadenomas. In comparison to fibroadenomas, small TNBC tumors presented with a higher incidence of irregular shapes (66.9%), noncircumscribed margins (91.7%), hypoechoic echotexture (59.1%), posterior acoustic enhancement (65.2%), and associated features (24.4%). Most TNBCs were classified as BI-RADS category 4 (65.2%) or 5 (28.2%). The mean tumor roundness of small TNBCs was greater than that of fibroadenomas (60%±12% vs. 53%±13%). Multivariate analysis showed that older patient age, irregular shape, nonparallel orientation, posterior acoustic enhancement, associated features, a BI-RADS final assessment category of 4 or 5, and greater tumor roundness were significant independent factors indicative of TNBCs. Conclusion: TNBC tumors tend to demonstrate more suspicious sonographic features and greater tumor roundness than fibroadenomas. These features may have the potential to help differentiate between small TNBCs and fibroadenomas. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of our study was to investigate the morphology and distribution of calcifications initially interpreted as benign or probably benign, but proven to be malignant by subsequent stereotactic biopsy, and to identify the reason for misinterpretation or underestimation at the initial diagnosis. Materials and Methods: Out of 567 women who underwent stereotactic biopsy for calcifications at our hospital between January 2012 and December 2014, 167 women were diagnosed with malignancy. Forty-six of these 167 women had previous mammography assessed as benign or probably benign which was changed to suspicious malignancy on follow-up mammography. Of these 46 women, three women with biopsy-proven benign calcifications at the site of subsequent cancer were excluded, and 43 patients were finally included. The calcifications (morphology, distribution, extent, associated findings) in the previous and follow-up mammography examinations were analyzed according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon and assessment category. We classified the patients into two groups: 1) group A patients who were still retrospectively re-categorized as less than or equal to BI-RADS 3 and 2) group B patients who were re-categorized as equal to or higher than BI-RADS 4a and whose results should have prompted previous diagnostic assessment. Results: In the follow-up mammography examinations, change in calcification morphology (n = 27, 63%) was the most frequent cause of assessment change. The most frequent previous mammographic findings of malignant calcification were amorphous morphology (n = 26, 60%) and grouped distribution (n = 36, 84%). The most frequent calcification findings at reassessment were amorphous morphology (n = 4, 9%), fine pleomorphic calcification (n = 30, 70%), grouped distribution (n = 23, 53%), and segmental calcification (n = 12, 28%). There were 33 (77%) patients in group A, and 10 patients (23%) in group B. Conclusion: Amorphous morphology and grouped distribution were the most frequent mammographic findings of calcifications that were misinterpreted or underestimated by the initial radiologist and confirmed as malignancy at follow-up. [ABSTRACT FROM AUTHOR]

Purpose: To assess the imaging and clinicopathologic outcomes of recurrent and second breast cancer after breast-conserving surgery for invasive ductal carcinomas detected on follow-up mammography and breast ultrasound (US). Materials and Methods: Seventy-six women with an ipsilateral breast tumor recurrence (IBTR) or regional lymph node recurrence and/or contralateral breast cancer (RLNR & CBC) after breast-conserving surgery were included in this study. The mammography and US images were analyzed and the clinicopathologic parameters were compared between the groups. Results: Thirty had an IBTR, and 46 had a RLNR & CBC. The IBTR group’s mammography and US images frequently revealed calcification and masses on the breast, respectively. The most frequent site of RLNR detected during follow-up mammography and breast US was the axilla. In univariate analysis, the tumors in the IBTR group were predominantly estrogen receptor (ER)-negative, HER-2 overexpression, and p53-positive. ER and HER-2 were shown by the multivariate analysis to be independent parameters associated for both types of recurrences. Conclusion: A mass or calcification is frequently present in IBTR and the axillary lymph node is the most frequent site of RLNR. ER and HER-2 status are major independent factors associated with recurrent and second breast cancer. [ABSTRACT FROM AUTHOR]

Primary breast melanoma is extremely rare, and as such, there are no established radiologic findings in the literature. This report describes a case of primary malignant melanoma with mammography, ultrasonography, and magnetic resonance imaging findings. Our case study demonstrates a well-circumscribed heterogeneous rim-enhancing mass, with an internal cystic or necrotic portion seen using three modalities. Thus, although rare, this condition should be included in the differential diagnosis of a well-demarcated heterogeneous breast mass, and further pathological confirmation is needed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to evaluate the use of second-look ultrasonography (US) for investigating additional suspicious lesions detected on preoperative staging magnetic resonance imaging (MRI) for breast cancer. Methods: Between September 2008 and August 2010, 1,970 breast MRIs were performed at our medical institution for the evaluation of breast cancer before surgery. Second-look US was recommended for 135 patients with 149 suspicious lesions, following the MRI interpretation, and 108 patients with 121 lesions were included in this study. The detection rate on second-look US, according to the lesion type, diameter, and histopathological outcome, was analyzed. Results: Of the 121 lesions considered in this study, 97 (80.2%) were diagnosed on MRI as masses and 24 (19.8%) as non-mass-like lesions; 105 lesions (86.8%) were correlated and 16 (13.2%) were not correlated with the findings of second-look US. Of the 105 correlated lesions, 29 (27.6%) were proven to be malignant and 76 (72.4%) were benign. Although a greater number of large malignant lesions were correlated on second-look US than small benign lesions, there was no statistkally significant difference according to lesion diameter or type, as seen on MRI or pathology. Conclusion: We have concluded that second-look US is a useful diagnostic tool for lesions incidentally detected on breast MRI, as in this study, it could identify 86.8% of the MRI-detected breast lesions. [ABSTRACT FROM AUTHOR]

Purpose:To evaluate the diagnostic performance of an apparent diffusion coefficient (ADC) and quantitative kinetic parameters in patients with newly diagnosed breast cancer.Materials and Methods:We enrolled 169 lesions in 89 patients with breast cancer who underwent dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI). Comparisons between benign and malignant lesions were performed for lesion type (mass or nonmass-like enhancement), size (⩾1cm or <1cm), ADC, kinetic parameters and the presence of a US correlate. Results:There were 63 benign and 106 malignant lesions. The mean size and initial peak enhancement of the benign lesions were significantly lower than those of malignant lesions ( P<0.001 for both). The ADC of the benign lesions was significantly higher than that of malignant lesions (1.42 ×10-3 mm/sec vs. 1.04 ×10-3 mm/sec<0.001). The area under the receiver operating characteristic curve (AUC) for predicting malignancy was 0.87 for the combined parameters of size, ADC, and initial peak enhancement, which was higher than those of each parameter.Conclusions:Combination of quantitative kinetic parameters and ADC showed higher diagnostic performance for predicting malignancy than each parameter alone for the evaluation of patients with breast cancer. [ABSTRACT FROM AUTHOR]