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Boyoung Park,1,2 Hye Mi Cho,2 Eun Hye Lee,3 Seunghoon Song,2 Mina Suh,2 Kui Son Choi,1,2 Bong Joo Kang,4 Kyungran Ko,5 Ann Yi,6 Hae Kyoung Jung,7 Joo Hee Cha,8 Jae Kwan Jun,1,2 1National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea; 2National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea; 3Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; 4Department of Radiology, Seoul St Mary’s Hospital, Catholic University of Korea College of Medicine, Seoul, Republic of Korea; 5Center for Breast Cancer, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea; 6Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea; 7Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; 8Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea Purpose: The purpose of this study was to investigate the effects of breast density on breast cancer risk among women screened via a nationwide mammographic screening program. Patients and methods: We conducted a nested case–control study for a randomly selected population of 1,561 breast cancer patients and 6,002 matched controls from the National Cancer Screening Program. Breast density was measured and recorded by two independent radiologists using the Breast Imaging Reporting and Data System (BI-RADS). Associations between BI-RADS density and breast cancer risk were evaluated according to screening results, time elapsed since receiving non-recall results, age, and menopausal status after adjusting for possible covariates. Results: Breast cancer risk for women with extremely dense breasts was five times higher (adjusted odds ratio [aOR] =5.0; 95% confidence interval [CI]) =3.7–6.7) than that for women with an almost entirely fatty breast, although the risk differed between recalled women (aOR =3.3, 95% CI =2.3–3.6) and women with non-recalled results (aOR =12.1, 95% CI =6.3–23.3, P-heterogeneity =0.001). aORs for BI-RADS categories of breast density were similar when subjects who developed cancer after showing non-recall findings during initial screening were grouped according to time until cancer diagnosis thereafter (

Purpose Women with dense breast are known to be at high risk for breast cancer, but their prevalence and number of Korean women are unknown. The current study was to investigate the distribution of mammographic breast density by age of women undergoing screening mammography, and to estimate the prevalence of Korean women with dense breasts, quantitatively. Materials and methods For obtaining a nationwide representative sample, 6,481 mammograms were collected from 86 screening units participated in the National Cancer Screening Program for breast cancer. Based on the American College of Radiology Breast Imaging Reporting and Data System classification, breast density was evaluated by six breast radiologists, qualitatively. We applied these breast density distributions to age-specific counts of the Korean women population derived to mid-year 2017 to estimate the number of Korean women with dense breasts. Results Overall, 54.4% (95% confidence interval [CI], 52.9% to 55.8%) of women 40 to 69 years of age had heterogeneously or extremely dense breasts, and this proportion was inversely associated with age. Based on the age distribution of Korean women, we estimated that 6,083,000 women (95% CI, 5,919,600 to 6,245,600) age 40-69 years in Korean have dense breasts. Women aged 40-49 years (n=3,450,000) accounted for 56.7% of this group. Conclusion More than half of Korean women aged 40 and over have dense breasts. To prevent breast cancer effectively and efficiently, it is necessary to develop a new personalized prevention strategy considering her status of breast density.

PURPOSE Dense breasts have been suggested as a risk factor for breast cancer, but controversy still remains. This study evaluates the association of reproductive and hormonal factors with dense breasts among Korean women. MATERIALS AND METHODS Using a cross-sectional design, 516 women were recruited and classified for breast density patterns as being either fatty or dense, using the Breast Imaging Reporting and Data System (BI-RADS) of the American College of Radiology. Univariate and multivariate logistic regression models were used for statistical analysis. RESULTS In univariate logistic regression, older age, higher body mass index, older age at menarche, and oral contraceptive use were associated with more fatty breasts. On the contrary, longer duration of education, alcohol consumption, lower parity, menopause and use of hormone replacement therapy were associated with dense breasts. After adjustment, age and body mass index were inversely associated with breast density (p-value for trend

Objective: To investigate the usefulness of targeted ultrasound (US) in the identification of additional suspicious lesions found by magnetic resonance (MR) imaging in breast cancer patients and the changes in treatment based on the identification of the lesions by the use of targeted US. Materials and Methods: One-hundred forty nine patients who underwent breast MR imaging for a preoperative evaluation of breast cancer between January 2002 and July 2004 were included in the study. We searched all cases for any additional lesions that were found initially by MR imaging and investigated the performance of targeted US in identifying the lesions. We also investigated their pathological outcomes and changes in treatment as a result of lesion identification. Results: Of the 149 patients with breast cancer, additional suspicious lesions were detected with MR imaging in 62 patients (42%). Of the 69 additional lesions found in those 62 patients, 26 (38%) were confirmed as cancers by histology. Thirty-eight lesions in 31 patients were examined with targeted US and were histologically revealed as cancers in 18 (47%), high risk lesions in two (5%), benign lesions in 15 (39%), and unidentified lesions in three (8%). The cancer rate was statistically higher in lesions with a US correlate than in lesions without a US correlate (p = 0.028). Of 31 patients, the surgical plan was altered in 27 (87%). The use of targeted US justified a change in treatment for 22 patients (81%) and misled five patients (19%) into having an unnecessary surgical excision. Conclusion: Targeted US can play a useful role in the evaluation of additional suspicious lesions detected by MR imaging in breast cancer patients, but is limited in lesions without a US correlate.

Magnetic resonance imaging (MRI) of the breast is used for various indications. Contrary to computed tomography as a staging tool, breast MRI focuses on the breast parenchyma and axilla. In spite of narrow field of view, many structures such as the anterior portion of the lungs, mediastinum, bony structures and the liver are included which should not be neglected because the abnormalities detected on the above structures may influence the staging and provide a clue to systemic metastasis, which results in the change of treatment strategy. The purpose of this pictorial essay was to review the unexpected extra-mammary findings seen on the preoperative breast MRI.

Bone is the most common site to which breast cancer metastasizes (1). Bone represents the first site of metastasis for 26~50% of patients with metastatic breast cancer (2, 3). If hot uptake in a patient with breast cancer is noted on the bone scintigraphy, the possibility of bone metastasis should be considered. However, because metastatic arthritis rarely occurs and the costosternoclavicular region is not common site for metastasis, other possibility should be considered such as SAPHO syndrome; it is an acronym of syndrome of synovitis, acne, pustulosis, hyperostosis, and osteitis (4) and its diagnosis can be made on the base of the solely musculoskeletal system without even skin lesions. And the costosternoclavicular region is known to be typical site of it (4). So, if the sclerotic and hyperostotic bone change of costosternoclavicular region was incidentally found in early breast cancer patient, try to include the SAPHO syndrome as a possible differential diagnosis. Here, we present a patient with right breast cancer and incidentally found sclerotic and hyperostotic bony lesion of her left costosternoclavicular region, which was confirmed as chronic active inflammation without causative organism. INTRODUCTION

A 47-year-old Korean woman with right middle lobe lung adenocarcinoma, malignant pleural effusion, and multiple lymph node and bone metastases, after three months of lung cancer diagnosis, presented with a palpable right breast mass. Images of the right breast demonstrated architectural distortion that strongly suggested primary breast cancer. Breast biopsy revealed metastatic lung cancer with a negative result for estrogen receptor (ER), progesterone receptor (PR) and mammaglobin, and a positive result for thyroid transcription factor-1 (TTF-1). We present a case of breast metastasis from a case of lung cancer with an extensive micropapillary component, which was initially misinterpreted as a primary breast cancer due to unusual image findings with architectural distortion.

Primary primitive neuroectodermal tumors (PNET) are rare malignant tumors, affecting mostly children and adolescents. Only three cases of primary breast PNETs have been reported in the medical literature, with none in Korea. We present a case of a primary PNET of the breast in a 33-year-old woman, with imaging and immunohistopathology findings.

Purpose: to evaluate the serial ultrasonographic findings of experimental intramuscular hemorrhaging to determine if there is a correlation with the pathologic findings. Materials and Methods: An uiltrasonography (US) was performed before and immediately after an intramuscular blood injection in nine rabbits. In addition, follow-up US images were obtained at 1, 4, 7, 10, 14, 21, and 28 days after the intramuscular blood injections in seven of the rabbits. The pathologic specimens, compared to the US findings on each date, and consisted of samples of left thigh muscle. Results: A US, performed immediately after a blood injection, showed two patterns; 6 cases of hyperechoic muscle thickening and 3 cases of hyperechoic muscle thickening with extravasation between the epimysium and muscle bundle or within muscle bundle. A follow-up US showed a marked decrease in intramuscular hemorrhaging and microcalcifications, which appeared on the 4th, 7th and 10th day after the blood injection. The pathologic findings revealed several short echogenic lines in the muscular bundles which were hemosiderin. Moreover, a 28 day follow-up US revealed that the normal findings are correlated with the normal gross pathologic findings. Conclusion: The US findings of the intramuscular hemorrhaging, for each of the follow-up dates, in comparison to the pathologic findings, revealed a high correlation with the pathologic specimens. Consequently, a US transducer with high resolution can be considered as a helpful technique in the diagnosing and evaluating the follow-up treatment of intramuscular hemorrhaging.

Objective To investigate the value of ultrasound-guided tattooing localization (US-tattoo) using a charcoal suspension for breast lesions. Materials and Methods One hundred sixty-four nonpalpable breast lesions in 134 patients (mean age 47 years; range 30-74 years) were marked with a charcoal suspension under US guidance. The medical records associated with the US-tattoo, the pathology results and the follow-up US results were reviewed. Results The average size of the localized lesions was 1.0 cm. The procedure time was < 5 minutes (range, 2-10 minutes) per lesion. The US-tattoo was well tolerated in all cases. The only technical difficulty encountered was a needle tip blockage caused by a large charcoal particle (4.9%). The surgeon easily identified the tattoo with the exception one case. In addition, surgery could be safely delayed from one to 57 days after the making US-tattoo. The pathology result was benign in 108 cases, borderline in five, and malignant in 51. The excised specimen was < 4 cm in 76.6% (82/107) of the benign cases (mean; 2.7 cm). The pathologist could identify the mass around the tattoo and was able to make a specific diagnosis in 81.3% (87/107) of benign lesions. The only complication encountered was residual charcoal marking along the incision scar (3.6%). All follow-up US documented the removal of the lesions. Conclusion An US-tattoo for nonpalpable breast lesions is a very simple and accurate method that can help surgeons design and schedule an open biopsy.

To assess the accuracy of CT for the diagnosis of histologically confirmed adrenal adenoma and nonadenoma using CT numbers.Our study included 91 adrenal masses in 83 patients; histopathological diagnoses were 45 adenomas, 31 pheochromocytomas, 6 hyperplasias, 4 metastasis, and 5 miscellaneous lesions. Unenhanced CT in 46 patients and unenhanced and delayed contrast-enhanced (DCE) CT in 37 patients were retrospectively reviewed to examine the correlation between CT findings and those on pathological examination and to obtain diagnostic accuracy.Sensitivity, specificity, and accuracy for adenoma were 40% (18/45), 91% (42/46), and 66% (60/91) with unenhanced CT, and 96% (24/25), 61% (11/18), and 81% (35/43) with DCE CT. Adrenal masses falsely diagnosed as adenoma on unenhanced CT included three hyperplasias and one endothelial cyst, and those falsely diagnosed as adenoma on DCE CT were five pheochromocytomas, one oncocytic cortical tumor, and one primary pigmented nodular adrenocortical dysplasia. Twenty-five lipid-poor adenomas were falsely diagnosed as nonadenomas on unenhanced CT and one degenerated adenoma both on unenhanced CT and on DCE CT.Diagnosing adenoma merely on CT numbers can lead to misdiagnosis. The lower specificity than expected is due to pheochromocytomas presenting as false positives.