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Oncologic safety of postmastectomy breast reconstruction in young women with breast cancer is not well-defined, especially in the setting of neoadjuvant chemotherapy (NACT). We retrospectively compared the oncologic outcomes following nipple-sparing (NSM)/skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) and conventional mastectomy (CM) alone in young breast cancer patients after NACT. A total of 1266 women with primary breast cancer who underwent NACT followed by total mastectomy with or without IBR were reviewed. Of these, only young patients (age ≤ 40 years at diagnosis) were included in the outcome analysis (n = 375). After propensity score-matching by clinical T and N stage, molecular subtype, response to NACT, and adjuvant radiotherapy status, 228 patients were 1:1 matched, comprising balanced IBR group (with NSM/SSM) and CM-alone group. The 5-year locoregional recurrence-free, disease-free, distant metastasis (DM)-free, and breast cancer-specific survival (BCSS) rates for the entire cohort of young patients were 83.4%, 65.3%, 71.7%, and 85.4%, respectively. Locoregional recurrence rates between the matched groups were similar (14% vs. 15.8%; p = 0.710); however, IBR group had significantly lower DM rate (27.2% vs. 40.4%; p = 0.036) and breast cancer mortality (14.9% vs. 27.2%; p = 0.023) than CM-alone group. IBR group showed significantly improved 5-year DM-free survival (74.1% vs. 62.6%; p = 0.043) and BCSS (89.1% vs. 77.6%; p = 0.048) rates than CM-alone group. Our results indicated that IBR with NSM/SSM does not negatively affect long-term oncologic outcomes compared to CM alone in young women with breast cancer receiving NACT.

To evaluate the usefulness of bilateral mammography in male patients with unilateral breast symptoms, including investigation of the diagnostic performance of unilateral and bilateral reviews and the average glandular dose (AGD) per exposure. Two hundred seventy-one consecutive male patients (mean age, 57 years) with unilateral breast symptoms underwent bilateral mammography. Image interpretation was performed in two ways, first with a unilateral review of the symptomatic breast and then with a bilateral review. A modified BI-RADS scale (from 1 to 5) was used. The diagnostic performance of unilateral and bilateral reviews was compared, and contralateral breast abnormalities and the AGD per exposure were recorded. We also analyzed ultrasound (US) results and compared them with mammography. Of 271 male patients, 29 were pathologically diagnosed with breast cancer. There was no bilateral breast cancer. The sensitivity, specificity, positive and negative predictive values, and accuracy were 96.6%, 96.7%, 77.8%, 99.6%, and 96.7%, respectively, for unilateral review, and 96.6%, 95.9%, 73.7%, 99.6%, and 95.9% for bilateral review. Receiver operator characteristic analysis showed excellent diagnostic performance for both methods: the area under the curve (AUC) was 0.966 for unilateral review and 0.962 for bilateral review (p = 0.415). The mean AGD per exposure was 1.10 ± 0.29 mGy for symptomatic breast and 1.04 ± 0.30 mGy for contralateral breast (p

Background The upgrade rate of biopsy-confirmed ductal carcinoma in situ (DCIS) to invasive carcinoma is up to 50% on final pathology. We investigated MRI and clinicopathologic predictors of the invasive components of DCIS diagnosed by preoperative biopsy and then compared MRI features between patients with DCIS, microinvasive ductal carcinoma (mIDC), and invasive ductal carcinoma (IDC) diagnosed on final pathology. Methods Two hundred and one patients with 206 biopsy-confirmed DCIS lesions were enrolled. MRI and clinicopathologic features were used to predict either mIDC or IDC via a cumulative logistic regression analysis. For the lesions detected on MRI, morphologic and kinetic analyses were performed using the Chi-square, Fisher’s exact, and Kruskal-Wallis tests. Results Of all the lesions, 112 (54.4%) were diagnosed as DCIS, 50 (24.3%) were upgraded to mIDC, and 44 (21.4%) to IDC. The detection on MRI as mass (Odds ratio (OR) = 8.84, 95% confidence interval (CI) = 1.05–74.04, P = 0.045) or non-mass enhancement (NME; OR = 11.17, 95% CI = 1.35–92.36, P = 0.025), negative progesterone receptor (PR; OR = 2.40, 95% CI = 1.29–4.44, P = 0.006), and high Ki-67 level (OR = 2.42, 95% CI = 1.30–4.50, P = 0.005) were significant independent predictors of histologic upgrade. On MRI, 87 (42.2%) lesions appeared as mass and 107 (51.9%) as NME. Irregularly shaped, not-circumscribed, heterogeneous, or rim-enhancing masses with intratumoral high signal intensity or peritumoral edema, clumped or clustered ring-enhancing NMEs, and high peak enhancement were significantly associated with histologic upgrade (P Conclusion MRI detection, negative PR, and high Ki-67 levels are associated with a histologic upgrade in patients with biopsy-confirmed DCIS. Suspicious MRI features are more frequent in such patients.

To assess the diagnostic performance of unenhanced abbreviated protocol (AP) comprising fused diffusion-weighted imaging (DWI) using T1-weighted imaging (T1WI) with DWI maximum-intensity projections (DWI MIPs) for screening patients with a personal history of breast cancer (PHBC). This institutional review board-approved retrospective observational study included 343 patients with PHBC who underwent 3T breast magnetic resonance imaging (MRI) between November 2013 and September 2015. Three breast radiologists reviewed the DWI MIPs of the AP to identify lesions, and the remaining axial AP images to characterize the detected lesions and establish the breast imaging reporting and data system final assessment. The conventional protocol (CP) images were also evaluated in the same way. The decision-making times were recorded. MRI acquisition time was approximately 5 min for AP. The mean times to read MIPs and remaining images were shorter in AP than in CP (5.5 and 22.1 s vs. 7.8 and 29.6 s). On DWI MIPs, the readers detected 9, 8, and 9 of 9 pathologically proven cancers, with negative predictive values (NPVs) of 100.0, 99.6, and 100.0%. Complete AP showed sensitivities of 88.9, 100.0, and 88.9% and specificities of 94.8, 93.4, and 95.1%. Complete CP showed sensitivities of 100.0, 100.0, and 88.9% and specificities of 93.4, 94.0, and 96.3%. An unenhanced AP had a short acquisition time of 5 min, and DWI MIPs showed NPVs greater than 99% across readers. The diagnostic performance of complete AP was equivalent to that of CP for screening patients with PHBC.

The purpose of our study was to review mammographic findings which were previously negative in women with interval breast cancer and to analyze the histopathological features of the interval breast cancer. A total of 5521 women underwent surgery for breast cancer between January 2009 and December 2011. Among them, 240 women who had undergone available, previous mammography studies reported as normal or benign (mean interval between examinations, 9.7 months) were included in our study. We reviewed the previous mammographic features and categorized as true interval breast cancer, minimal sign, and missed interval breast cancer. Histopathological findings were also reviewed. Of the 240 diagnosed cancers, 78 (32.5 %) were classified as true interval breast cancer, 78 (32.5 %) as minimal sign, and 84 (35 %) as missed interval breast cancer. True interval breast cancer occurred in a younger age and showed dense breast compared with missed breast cancer. The breast density of 169 patients (70.4 %) was dense. In the minimal sign group, the most common finding was normal appearing tissue (61/78), followed by benign-appearing calcification (17/78). There were no significant differences in the histopathological findings in each of the three groups and tended to have smaller tumor size, negative nodal status, a lower AJCC stage, and frequent luminal A subtype. The majority of interval breast cancers was not detectable in patients with dense breast or showed subtle mammographic findings on previous mammography. Although the majority of breast cancers showed a low grade in the histopathological findings, a better understanding of the mammographic findings will influence the sensitivity of mammography.

To compare the performance of radiologists in the use of conventional ultrasound (US) and automated breast volume ultrasound (ABVU) for the characterization of benign and malignant solid breast masses based on breast imaging and reporting data system (BI-RADS) criteria. Conventional US and ABVU images were obtained in 87 patients with 106 solid breast masses (52 cancers, 54 benign lesions). Three experienced radiologists who were blinded to all examination results independently characterized the lesions and reported a BI-RADS assessment category and a level of suspicion of malignancy. The results were analyzed by calculation of Cohen’s κ coefficient and by receiver operating characteristic (ROC) analysis. Assessment of the agreement of conventional US and ABVU indicated that the posterior echo feature was the most discordant feature of seven features (κ = 0.371 ± 0.225) and that orientation had the greatest agreement (κ = 0.608 ± 0.210). The final assessment showed substantial agreement (κ = 0.773 ± 0.104). The areas under the ROC curves (Az) for conventional US and ABVU were not statistically significant for each reader, but the mean Az values of conventional US and ABVU by multi-reader multi-case analysis were significantly different (conventional US 0.991, ABVU 0.963; 95 % CI −0.0471 to −0.0097). The means for sensitivity, specificity, positive predictive value, and negative predictive value of conventional US and ABVU did not differ significantly. There was substantial inter-observer agreement in the final assessment of solid breast masses by conventional US and ABVU. ROC analysis comparing the performance of conventional US and ABVU indicated a marginally significant difference in mean Az, but not in mean sensitivity, specificity, positive predictive value, or negative predictive value.