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Purpose: The positron emission tomography (PET)-magnetic resonance (MR) system is a newly emerging technique that yields hybrid images with high-resolution anatomical and metabolic information. With PET-MR imaging, a definitive diagnosis of breast abnormalities will be possible with high spatial accuracy and images will be acquired for the optimal fusion of anatomic locations. Therefore, we propose a PET-compatible two-channel breast MR coil with minimal disturbance to image acquisition which can be used for simultaneous PET-MR imaging in patients with breast cancer., Materials and Methods: For coil design and construction, the conductor loops of the Helmholtz coil were tuned, matched, and subdivided with nonmagnetic components. Element values were optimized with an electromagnetic field simulation. Images were acquired on a GE 600 PET-computed tomography (CT) and GE 3.0 T MR system. For this study, we used the T1-weighted image (volunteer; repetition time (TR), 694 ms; echo time (TE), 9.6 ms) and T2-weighted image (phantom; TR, 8742 ms; TE, 104 ms) with the fast spin-echo sequence., Results: The results of measuring image factors with the proposed radiofrequency (RF) coil and standard conventional RF coil were as follows: signal-to-noise ratio (breast; 207.7 vs. 175.2), percent image uniformity (phantom; 89.22%-91.27% vs. 94.63%-94.77%), and Hounsfield units (phantom; -4.51 vs. 2.38)., Conclusions: Our study focused on the feasibility of proposed two-channel Helmholtz loops (by minimizing metallic components and soldering) for PET-MR imaging and found the comparable image quality to the standard conventional coil. We believe our work will help significantly to improve image quality with the development of a less metallic breast MR coil., (© 2021 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.)

A major limitation of screening breast ultrasound (US) is a substantial number of false-positive biopsy. This study aimed to develop a deep learning-based computer-aided diagnosis (DL-CAD)-based diagnostic model to improve the differential diagnosis of screening US-detected breast masses and reduce false-positive diagnoses. In this multicenter retrospective study, a diagnostic model was developed based on US images combined with information obtained from the DL-CAD software for patients with breast masses detected using screening US; the data were obtained from two hospitals (development set: 299 imaging studies in 2015). Quantitative morphologic features were obtained from the DL-CAD software, and the clinical findings were collected. Multivariable logistic regression analysis was performed to establish a DL-CAD-based nomogram, and the model was externally validated using data collected from 164 imaging studies conducted between 2018 and 2019 at another hospital. Among the quantitative morphologic features extracted from DL-CAD, a higher irregular shape score (P = .018) and lower parallel orientation score (P = .007) were associated with malignancy. The nomogram incorporating the DL-CAD-based quantitative features, radiologists' Breast Imaging Reporting and Data Systems (BI-RADS) final assessment (P = .014), and patient age (P < .001) exhibited good discrimination in both the development and validation cohorts (area under the receiver operating characteristic curve, 0.89 and 0.87). Compared with the radiologists' BI-RADS final assessment, the DL-CAD-based nomogram lowered the false-positive rate (68% vs. 31%, P < .001 in the development cohort; 97% vs. 45% P < .001 in the validation cohort) without affecting the sensitivity (98% vs. 93%, P = .317 in the development cohort; each 100% in the validation cohort). In conclusion, the proposed model showed good performance for differentiating screening US-detected breast masses, thus demonstrating a potential to reduce unnecessary biopsies.

Objectives: To evaluate the recall rates of digital mammography (DM) and synthetic images after adding digital breast tomosynthesis (DBT) in patients with breast-conserving surgery., Methods: From November 2015 to April 2017, 229 women with breast-conserving surgery due to breast cancer who underwent DBT after surgery were included (mean interval, 12.9 ± 1.4 months). All women underwent combo-mode DBT examinations including full-field DM, tomosynthesis, and reconstructed synthetic 2D images. Three board-certified breast radiologists reviewed the images sequentially: synthetic 2D+DBT and, 1 month later, DM and then DM+DBT. Recall rates and the abnormality type causing the recall were calculated and compared for each mammographic modality and breast density., Results: Of the 229 patients included, 230 mammography images were reviewed. One patient (0.4%) developed locoregional recurrences during follow-up (mean duration, 25.8 ± 4.5 months). Recall rates for synthetic 2D+DBT were significantly lower than for DM alone (4.1% (2.6-6.2) vs. 11.6% (9.2-14.5), respectively; p < 0.001). Recall rates did not differ between synthetic 2D+DBT and DM+DBT (4.1% (2.6-6.2) vs. 2.9% (1.9-4.5), respectively; p = 0.234). Recall rates of synthetic 2D+DBT and DM+DBT were significantly lower than those of DM alone, regardless of mammographic breast density (all p < 0.05, respectively)., Conclusion: Adding DBT to synthetic 2D images or DM shows significant reduction in recall rates compared with DM alone for women who undergo breast-conserving surgery for breast cancer, regardless of mammographic density., Key Points: • Recall rates for synthetic 2D+DBT were significantly lower than those of DM alone (4.1% (2.6-6.2) vs. 11.6% (9.2-14.5), respectively; p < 0.001). • No significant differences were seen in recall rates between synthetic 2D+DBT and DM+DBT (4.1 (2.6-6.2) vs. 2.9 (1.9-4.5), respectively; p = 0.234). • Reader-averaged recall rates after adding DBT to synthetic 2D or DM were significantly lower than those of DM alone, regardless of mammographic breast density (all p < 0.05, respectively).

Objectives: To investigate outcomes and retrospectively evaluate characteristics of additional lesions initially assessed as BI-RADS category 3, 4, and 5 at preoperative MRI to determine appropriate follow-up management., Methods: We retrospectively reviewed 429 lesions other than primary cancer initially assessed as BI-RADS category 3, 4, and 5 at preoperative MRI in 391 patients with breast cancer from March 2012 to December 2013. We investigated their malignancy rate and outcome according to BI-RADS category assessments. We also analyzed clinical and imaging characteristics of each lesion. Pathological results and imaging follow-up of at least 2 years were used as reference standards., Results: Of 429 lesions in 391 patients (mean 48.1 years ± 9.4), the malignancy rate of BI-RADS 3, 4, and 5 lesions was 1.4% (3/213), 17.8% (38/214), and 50% (1/2), respectively. Of BI-RADS 3 lesions or BI-RADS 4 or 5 lesions that were followed up after benign-concordant biopsy (n = 114), two contralateral masses (2/306, 0.7%) were diagnosed as malignancy at 13.3 and 33.2 months after initial detection, within a median follow-up of 63.3 months. None of the NME or foci or lesions followed up after benign-concordant biopsy had a delayed diagnosis of malignancy. Of the 391 patients, 97.4% (381/391) received at least one type of adjuvant therapy., Conclusion: The incidence of delayed cancer diagnosis among additionally detected lesions other than primary cancer is very low and short-term follow-up is unnecessary. Contralateral masses which were not confirmed by biopsy may need annual follow-up., Key Points: • 1.4% (3/213) of BI-RADS 3 lesions were malignant including 2 delayed diagnoses after 13.2 months and 33.2 months, and 17.8% (38/214) of BI-RADS 4 lesions and 50% (1/2) of BI-RADS 5 lesions were malignant. • The incidence of delayed diagnosis from additional MRI-detected lesions was very low (0.7%, 2/306) during follow-up, which were all T1N0 contralateral cancer. • Annual follow-up might be adequate for preoperative MRI-detected BI-RADS 3 lesions and BI-RADS 4 lesions followed up after benign-concordant biopsy.

Objective: To examine time trends in ultrasonography (US)-guided 14-gauge core needle biopsy (CNB) for breast lesions based on the lesion size, Breast Imaging-Reporting and Data System (BI-RADS) category, and pathologic findings., Materials and Methods: We retrospectively reviewed consecutive US-guided 14-gauge CNBs performed from January 2005 to December 2016 at our institution. A total of 22,297 breast lesions were included. The total number of biopsies, tumor size (≤ 10 mm to > 40 mm), BI-RADS category (1 to 5), and pathologic findings (benign, high risk, ductal carcinoma in situ [DCIS], invasive cancer) were examined annually, and the malignancy rate was analyzed based on the BI-RADS category., Results: Both the total number of US scans and US-guided CNBs increased while the proportion of US-guided CNBs to the total number of US scans decreased significantly. The number of biopsies classified based on the tumor size, BI-RADS category, and pathologic findings all increased over time, except for BI-RADS categories 1 or 2 and category 3 (odds ratio [OR] = 0.951 per year, 95% confidence interval [CI]: 0.902, 1.002 and odds ratio = 0.979, 95% CI: 0.970, 0.988, respectively). Both the unadjusted and adjusted total malignancy rates and the DCIS rate increased significantly over time. BI-RADS categories 4a, 4b, and 4c showed a significant increasing trend in the total malignancy rate and DCIS rate., Conclusion: The malignancy rate in the results of US-guided 14-gauge CNB for breast lesions increased as the total number of biopsies increased from 2005 to 2016. This trend persisted after adjusting for the BI-RADS category., Competing Interests: All authors have no conflict of interest including financial or consultant, institutional and other relationship in this study., (Copyright © 2020 The Korean Society of Radiology.)

Purpose: To investigate the potential of diffusional kurtosis imaging (DKI) and conventional diffusion-weighted imaging (DWI) in the evaluation of additional suspicious lesions at preoperative breast magnetic resonance imaging (MRI) in patients with breast cancer., Materials and Methods: Fifty-three additional suspicious lesions in 45 patients with breast cancer, which were detected on preoperative breast MRI, were examined with a 3-T MR system. DKI and DWI data were obtained using a spin-echo single-shot echo-planar imaging sequence with b-values of 0, 50, 600, 1000, and 3000 s/mm 2 . Histogram parameters (mean, standard deviation, minimum, maximum, 10th, 25th, 50th, 75th, 90th percentiles, kurtosis, skewness and entropy) of ADC from DWI and diffusivity (D), kurtosis (K) from DKI were calculated after postprocessing. Parameters were compared between benign vs. ductal carcinoma in situ (DCIS) vs. invasive breast lesions and diagnostic performances were evaluated by receiver operating characteristic (ROC) analysis. Correlation between the mean values of D and K was analyzed according to lesion type., Results: Multiple histogram parameters of D (mean, 25th, 50th percentile, 75th percentile, and entropy) differed between benign and invasive breast lesions (all P < 0.005), but none differed between benign vs. DCIS. D-90th percentile differed between DCIS vs. invasive cancer (P = 0.040). K-10th percentile differed between benign vs. DCIS (P = 0.015). ADC-75th percentile differed between benign vs. invasive cancer and ADC-75th percentile, ADC-90th percentile differed between DCIS vs. invasive cancer, respectively (all P < 0.005). ROC curve analysis showed high specificity for discrimination between benign and invasive cancer. D-mean and K-mean showed strong correlation in benign (r s  = -0.813) and invasive lesions (r s  = -0.853), but no significant correlation in DCIS., Conclusion: DKI may aid in the differentiation of additional suspicious lesions at preoperative breast MRI. Both ADC and DKI may have lower potential in differentiating DCIS from benign lesions., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background The BI-RADS provides descriptors for microcalcifications based on morphology and distribution. However, the descriptor for category 4A microcalcifications is not specified in the 5th BI-RADS nor in the prior editions. Purpose To investigate how the category 4A assessment is applied to suspicious microcalcifications, and the appropriate descriptors for category 4A assessment for microcalcifications seen on mammography. Material and Methods From June 2008 to November 2011, 296 women with 305 suspicious microcalcifications that were assessed as BI-RADS category 4A, who underwent imaging-guided biopsy or surgery, were included. Mammograms were reviewed and imaging features were analyzed according to the morphology and distribution descriptors of the 5th edition of BI-RADS. Pathological results were considered as the reference standard. Positive predictive values were calculated and compared between morphology and distribution descriptors. Results The overall positive predictive value (PPV) of category 4A microcalcifications was 17.7% (54/305). Most common descriptors for category 4A microcalcifications were amorphous morphology (73.1%) and grouped distribution (71.1%). PPVs of individual morphology descriptors were as follows: amorphous = 7.2%; coarse heterogeneous = 12.8%; fine pleomorphic or fine linear/fine linear branching = 91.4% ( P < 0.001). PPVs of distribution descriptors were as follows: regional = 13.2%; grouped = 16.1%; linear/segmental = 54.5% ( P < 0.001). For morphology and distribution descriptors combinations, PPVs for amorphous/regional and amorphous/grouped microcalcifications were 6.8% and 6.9%, while PPVs of other combinations were higher than 10%, respectively. Conclusion Common descriptors used in category 4A assessment for microcalcifications are amorphous morphology and grouped distribution. PPV of amorphous/regional and amorphous/grouped microcalcifications were suitable for category 4A assessment.

Background: Women with a personal history of breast cancer are at increased risk of future breast cancer events, and may benefit from supplemental screening methods that could enhance early detection of subclinical disease. However, current literature on breast magnetic resonance (MR) imaging surveillance is limited. We investigated outcomes of surveillance breast magnetic resonance (MR) imaging in women with a personal history of breast cancer., Methods: We reviewed 1053 consecutive breast MR examinations that were performed for surveillance in 1044 women (median age, 53 years; range, 20-85 years) previously treated for breast cancer between August 2014 and February 2016. All patients had previously received supplemental surveillance with ultrasound. Cancer detection rate (CDR), abnormal interpretation rate and characteristics of MR-detected cancers were assessed, including extramammary cancers. We also calculated the PPV 1 , PPV 3 , sensitivity and specificity for MR-detected intramammary lesions. Performance statistics were stratified by interval following initial surgery., Results: The CDR for MR-detected cancers was 6.7 per 1000 examinations (7 of 1053) and was 3.8 per 1000 examinations (4 of 1053) for intramammary cancers. The overall abnormal interpretation rate was 8.0%, and the abnormal interpretation rate for intramammary lesions was 7.2%. The PPV 1 , PPV 3 , sensitivity and specificity for intramammary lesions was 5.3% (4 of 76), 15.8% (3 of 19), 75.0% (3 of 4) and 98.3% (1031 of 1049), respectively. For MR examinations performed ≤36 months after surgery, the overall CDR was 1.4 per 1000 examinations. For MR examinations performed > 36 months after surgery, the overall CDR was 17.4 per 1000 examinations., Conclusions: Surveillance breast MR imaging may be considered in women with a history of breast cancer, considering the low abnormal interpretation rate and its high specificity. However, the cancer detection rate was low and implementation may be more effective after more than 3 years after surgery.

Objective: The aim of this study was to investigate the association between perfusion parameters on MRI performed before treatment and survival outcome (disease-free survival [DFS], disease-specific survival [DSS]) in patients with triple-negative breast cancer (TNBC)., Materials and Methods: Sixty-one patients (median age, 50 years; age range, 27-77 years) with TNBC (tumor size on MRI: median, 25.5 mm; range, 11.0-142.0 mm) were included. We analyzed clinical and pathologic variables and MRI parameters. Cox proportional hazards models were used to determine associations with survival outcome., Results: The median follow-up time was 46.1 months (range, 13.9-58.4 months). Eleven of 61 (18.0%) patients had events (i.e., local, regional, or distant recurrence or contralateral breast cancer) and seven (11.5%) died of breast cancer. Among the pretreatment variables, a larger tumor size on MR images (hazard ratio [HR] = 1.024, p = 0.003) was associated with worse DFS at univariate analysis. In multivariate pretreatment models for DSS, a higher fractional volume of extravascular extracellular space per unit volume of tissue (v e ) value (HR = 1.658, p = 0.038), higher peak enhancement (HR = 1.843, p = 0.018), and a larger tumor size on MR images (HR = 1.060, p = 0.001) were associated with worse DSS. In multivariate posttreatment models, a larger pathologic tumor size (HR for DFS, 1.074 [p = 0.005]; HR for DSS, 1.050 [p = 0.042]) and metastasis in surgically resected axillary lymph nodes (HR for DFS, 5.789 [p = 0.017]; HR for DSS, 23.717 [p = 0.005]) were associated with worse survival outcome., Conclusion: A higher v e value, higher peak enhancement, and larger tumor size of the primary tumor on pretreatment MRI were independent predictors of worse DSS in patients with TNBC.

We investigated whether the application of the downgrade criteria to supplemental screening ultrasound (US) for women with negative mammography but dense breasts can reduce the rate of Breast Imaging Reporting and Data System (BI-RADS) categories 3 to 4a without a loss of cancer detection.This retrospective study was approved by the Institutional Review Board, and the need to obtain informed consent was waived. A total of 3171 consecutive women (978 women, 1173 women, and 1020 women in the first, second, and third year, respectively) with negative mammography but dense breast who underwent radiologist-performed, hand-held supplemental screening US from March 2010 to February 2013 were included. Downgrade criteria for BI-RADS category 2 were complicated cysts ≤5 mm observed as circumscribed, homogeneous, and hypoechoic lesions and circumscribed oval-shaped solid masses ≤5 mm. Changes in the distribution of BI-RADS category, biopsy rate, and cancer detection yield over 3 years were analyzed. Performances of less-experienced (12 fellows with <2 years of experience) and experienced (3 staffs with >12 years of experience) radiologists were compared. Outcomes of initial examinations (prevalence screening) and noninitial examinations (incidence screening) were compared.Application of the downgrade criteria reduced BI-RADS categories 3 to 4a in both less-experienced (from 39.4% to 16.0%, P < 0.001) and experienced radiologists (from 22.6% to 11.1%, P < 0.001) over 3 years. Biopsy rates also significantly decreased from 6.5% to 2.4% (P < 0.001). Cancer detection yield of supplemental screening US was 2.8 per 1000 examinations (9 of 3171: 2 ductal carcinoma in situ and 7 invasive cancers). There were no differences in cancer detection yield per each year (P = 0.539). There was no interval cancer. In noninitial examinations, BI-RADS categories 3 to 4a rates, biopsy rates, and cancer detection rates were lower compared to initial examinations.Application of the downgrade criteria reduced BI-RADS categories 3 to 4a without a loss of cancer detection. We suggest that our downgrade criteria can be used to reduce the false positive rate in the supplemental screening US. Further large-scale, multicenter, prospective studies are needed to validate the effectiveness of the downgrade criteria.

An increasing number of radial scars are detected by ultrasound (US), but their management is controversial. This study investigated the upgrade rate in mammographically occult radial scars/complex sclerosing lesions without epithelial atypia at US-guided 14-gauge core needle biopsy in asymptomatic patients. Nineteen mammographically occult benign radial scars/complex sclerosing lesions (median size, 7 mm; range, 3-23 mm) were included. Patients underwent surgical excision (n = 10) or vacuum-assisted excision, with follow-up US at least 6 mo after benign vacuum-assisted excision results (n = 8), or underwent US follow-up for 2 y after core needle biopsy (n = 1). Any cases with change in diagnosis to high-risk lesions or malignancy at excision were considered upgrades. The upgrade rate was 0.0%. Based on US findings, 15.8% (3/19) were Breast Imaging Reporting and Data System (BI-RADS) category 3, 68.4% (13/19) were BI-RADS category 4a and 15.8% (3/19) were BI-RADS category 4b. Follow-up with US can be considered for mammographically occult benign radial scar/complex sclerosing lesions diagnosed by US core needle biopsy in asymptomatic patients., (Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Background: We investigated whether short-term follow-up in 6 months was appropriate for asymptomatic benign concordant lesions on ultrasonography-guided core needle biopsy (ultrasonography-guided CNB)., Methods: Of 1,111 lesions, 944 underwent follow-up within 4 to 9 months after CNB, and 359 of 944 underwent a 2nd follow-up within 9 to 15 months. One hundred sixty-seven underwent a 1st follow-up within 9 to 15 months. Follow-up intervals were classified according to an interval of 6 and 12 months with 2 different methods. First, 944 and 167 lesions were classified into the 6- and 12-month groups. Second, 944 and 526 lesions (sum of 167 and 359 lesions) were classified into the 6- and 12-month groups. Clinicopathologic factors were compared between the 2 groups., Results: None of the benign concordant lesions were malignant; 1.4% of the lesions showed progression in the 6-month group, not significantly different from 1.2% and .8% of the 12-month group. Mean age, mean lesion size, final assessments, and specific or nonspecific pathologies were not different between the 2 groups., Conclusions: Short-term follow-up in 6 months is unnecessary for asymptomatic benign concordant breast lesions at ultrasonography-guided CNB., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To evaluate the diagnostic outcomes of ultrasonography-guided core needle biopsy (US-CNB), US-guided vacuum-assisted biopsy (US-VAB), and stereotactic-guided vacuum-assisted biopsy (S-VAB) for diagnosing suspicious breast microcalcification., Materials and Methods: We retrospectively reviewed 336 cases of suspicious breast microcalcification in patients who subsequently underwent image-guided biopsy. US-CNB was performed for US-visible microcalcifications associated with a mass (n = 28), US-VAB for US-visible microcalcifications without an associated mass (n = 59), and S-VAB for mammogram-only visible lesions (n = 249). Mammographic findings, biopsy failure rate, false-negative rate, and underestimation rate were analyzed. Histological diagnoses and the Breast Imaging Reporting and Data System (BI-RADS) categories were reported., Results: Biopsy failure rates for US-CNB, US-VAB, and S-VAB were 7.1% (2/28), 0% (0/59), and 2.8% (7/249), respectively. Three false-negative cases were detected for US-CNB and two for S-VAB. The rates of biopsy-diagnosed ductal carcinoma in situ that were upgraded to invasive cancer at surgery were 41.7% (5/12), 12.9% (4/31), and 8.6% (3/35) for US-CNB, US-VAB, and S-VAB, respectively. Sonographically visible lesions were more likely to be malignant (66.2% [51/77] vs. 23.2% [46/198]; p < 0.001) or of higher BI-RADS category (61.0% [47/77] vs. 22.2% [44/198]; p < 0.001) than sonographically invisible lesions., Conclusion: Ultrasonography-guided vacuum-assisted biopsy is more accurate than US-CNB when suspicious microcalcifications are detected on US. Calcifications with malignant pathology are significantly more visible on US than benign lesions.

The aim of this study was to compare the mammography, ultrasound (US) and histologic features of triple-negative (TN) invasive carcinoma of no special type (NST) to non-TN invasive carcinoma of NST. The second aim was to assess whether the distinct imaging characteristics of TN breast cancer would persist after controlling for the histologic features. A total of 344 invasive carcinomas of NST in 337 patients from January 2007 to February 2008 were included in this study. Two radiologists retrospectively reviewed the mammography and US findings using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon and our institution's criteria. On mammography, TN invasive carcinoma of NST most commonly presented as a mass with round shape and non-spiculated margin. On US, it was more likely to have internal hypoechogenicity, an abrupt boundary and posterior acoustic enhancement. TNBC lacked major suspicious imaging findings such as an irregular shape, spiculated margin and calcification., (Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

This paper investigates whether photoacoustic imaging (PAI) can provide the visualization of microcalcifications in breast tissue. For this, the geometrical correlation between the 3-D PA images of breast microcalcifications within ex vivo specimens and the corresponding mammograms was ascertained. Also, the optical absorbance of the calcification compositions (i.e., hydroxyapatite and calcium oxalate) was measured and compared with the PA responses of the microcalcifications. The experimental results demonstrated that the PA images discriminated between the microcalcifications and the surrounding tissue, and their locations in PA images reasonably meshed with those of the microcalcifications appeared in the mammograms. Also, the change in PA signal amplitude along the laser wavelength agreed with the absorbance of hydroxyapatite associated with the relatively high potential of malignant cancers, but not calcium oxalate with only benign cases., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Objective: To evaluate the upgrade rate and delayed false-negative results of percutaneous vacuum-assisted removal (VAR) and surgical excision in women with imaging-histologic discordance during ultrasound (US)-guided automated core needle biopsy (CNB) of the breast and to validate the role of VAR as a rebiopsy method for these discordant lesions., Materials and Methods: Percutaneous US-guided 14-gauge CNB was performed on 7470 patients between August 2005 and December 2010. Our study population included 161 lesions in 152 patients who underwent subsequent rebiopsy due to imaging-histologic discordance. Rebiopsy was performed using VAR (n = 88) or surgical excision (n = 73). We investigated the upgrade rate immediately after rebiopsy and delayed false-negative results during at least 24 months of follow-up after rebiopsy. We also evaluated the clinicoradiological differences between VAR and surgical excision., Results: Total upgrade to malignancy occurred in 13.7% (22/161) of lesions at rebiopsy including both VAR and surgical excision: 4.6% (4/88) of VAR cases (4/88) and 24.7% (18/73) of surgical excision cases (p < 0.001). Surgical excision was performed significantly more frequently in older patients and for larger-sized lesions than that of VAR, and a significant difference was detected between VAR and surgical excision in the Breast Imaging and Reporting and Data System category (p < 0.007). No delayed false-negative results were observed after VAR or surgical excision during the follow-up period., Conclusion: Long-term follow-up data showed no delayed cancer diagnoses after US-guided VAR in imaging-histologic discordant lesions of the breast, suggesting that VAR might be a rebiopsy method for these lesions.

Background: We presented the photoacoustic imaging (PAI) tool and to evaluate whether microcalcifications in breast tissue can be detected on photoacoustic (PA) images., Methods: We collected 21 cores containing microcalcifications (n = 11, microcalcification group) and none (n = 10, control group) in stereotactic or ultrasound (US) guided 8-gauge vacuum-assisted biopsies. Photoacoustic (PA) images were acquired through ex vivo experiments by transmitting laser pulses with two different wavelengths (700 nm and 800 nm). The presence of microcalcifications in PA images were blindly assessed by two radiologists and compared with specimen mammography. A ratio of the signal amplitude occurring at 700 nm to that occurring at 800 nm was calculated for each PA focus and was called the PAI ratio., Results: Based on the change of PA signal amplitude between 700 nm and 800 nm, 10 out of 11 specimens containing microcalcifications and 8 out of 10 specimens without calcifications were correctly identified on blind review; the sensitivity, specificity, accuracy, positive predictive and negative predictive values of our blind review were 90.91%, 80.0%, 85.71%, 83.33% and 88.89%. The PAI ratio in the microcalcification group was significantly higher than that in the control group (the median PAI ratio, 2.46 versus 1.11, respectively, P =  .001). On subgroup analysis in the microcalcification group, neither malignant diagnosis nor the number or size of calcification-foci was proven to contribute to PAI ratios., Conclusion: Breast microcalcifications generated distinguishable PA signals unlike breast tissue without calcifications. So, PAI, a non-ionizing and non-invasive hybrid imaging technique, can be an alternative in overcoming the limitations of conventional US imaging.

The diagnosis of axillary masses can be challenging because various tumors can develop in parts of the axilla other than lymph nodes, even though we frequently encounter axillary masses in daily practice. These lesions include soft tissue masses associated with nontumorous conditions (accessory breast tissue and chronic granulomatous inflammation) and benign and malignant tumorous conditions (lipomas, epidermal inclusion cysts, lymphangiomas, fibroadenomas, schwannomas, malignant neuroendocrine tumors, and lymph node-associated diseases). In this pictorial essay, we display commonly encountered sonographic findings of various axillary lesions to assist in the differential diagnosis of axillary masses.

Objectives: To evaluate the interobserver agreement and the diagnostic performance of 3D shear-wave elastography (SWE) for breast lesions in comparison with 2D SWE., Methods: A total of 163 breast lesions (malignant 48, benign 115) in 146 women who underwent B-mode ultrasound and SWE before biopsy were included. Two radiologists reviewed six data sets (B-mode, SWE, and a combination of both for 2D and 3D ultrasound). B-mode and SWE features were recorded. BI-RADS category was assigned for B-mode and combined sets. Interobserver variability was assessed using the κ statistic. Diagnostic performance of each data set was evaluated using the area under the ROC curve (AUC)., Results: SWE showed substantial to almost perfect agreement, with Ehomo in 2D SWE being higher than in 3D SWE. The AUC of 2D SWE was higher than 3D SWE for all SWE features, significantly so for Ecol (0.933 vs. 0.867, P = 0.002) and Emax (0.961 vs. 0.874, P = 0.006). After adding SWE to B-mode ultrasound, the AUC in 2D ultrasound increased significantly (0.968 vs. 0.912, P = 0.008), but 3D ultrasound showed no significant difference (0.966 vs. 0.935; P = 0.07)., Conclusion: For 3D SWE, interobserver agreement was good, but the diagnostic performance was inferior to 2D SWE even after adding to B-mode ultrasound., Key Points: • Shear-wave elastography (SWE) provides further diagnostic information during breast ultrasound. • 3D SWE diagnostic performance is inferior to 2D SWE. • In 3D SWE, interobserver agreement was good. • 2D B-mode ultrasound showed significant diagnostic improvement when combined with 2D SWE. • 3D B-mode ultrasound performance was not significantly improved when combined with 3D SWE.

The objective of this study was to evaluate the positive predictive value (PPV) in ultrasonographically (US)-detected breast lesions of BI-RADS category 4a, 4b and 4c and to find how various clinical factors influenced the PPV of category 4. A total of 2142 women with 2430 breast lesions diagnosed on US as BI-RADS category 4 and underwent biopsy were included. Among them, 452 (18.6%) were pathologically confirmed as malignancy. PPV of each US BI-RADS subcategory was 7.6% (149/1963) for category 4a, 37.8% (68/180) for category 4b and 81.9% (235/287) for category 4c. Several clinical factors were more significantly seen in malignancy of category 4a and 4b, whereas none of the factors showed significance in category 4c. Subcategorization of category 4 is a feasible method in predicting malignancy in which patients' age, lack of multiplicity and symptoms affected the PPV of category 4 lesions., (Copyright © 2011 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate the malignancy rate in probably benign lesions with interval growth on follow-up ultrasound (US) and the cut-off values for predicting malignancy., Methods: By retrospective reviewing 19,435 US examinations assessed as probably benign lesions, a total of 214 lesions with interval growth in 199 patients were included. The increased volume (%V),%V per month, the most increased diameter (D), and D per month were compared between malignant and benign lesions. Malignancy rates were compared between lesions with or without newly developed suspicious malignant features., Results: Twenty-two (10.3%) malignancies showed significant increase in%V,%V per month, D, and D per month compared with 192 (89.7%) benign lesions (p = 0.0083, <0.0001, <0.0001, and <0.0001, respectively). Fifteen (38.5%) of 39 lesions where suspicious features developed proved malignant, whereas 7 (4%) out of 175 without were malignant (p = 0.0011). In nodules without suspicious features, 24.2% of%V per month and 1.9 mm of D per month showed high sensitivity (85.7% and 71.4%) and specificity (67.8% and 97.6%) for predicting malignancy., Conclusions: Probably benign lesions with interval growth should undergo prompt biopsy because of the 10.3% malignancy rate. In lesions where suspicious features developed, the malignancy rate increased to 38.5%.

Objective: To assess the performance of breast ultrasound based on BI-RADS final assessment categories in women with mammographically negative dense breast., Methods: Of 3,820 cases with mammographically negative dense breast and subsequent hand-held bilateral whole-breast ultrasound, a total of 1,507 cases in 1,046 women who had biopsy or at least 2-year follow-up ultrasound constituted the basis of this retrospective study. Cancer rate of each sonographic BI-RADS category was determined and medical audit was performed separately in screening-general, screening-treated, and diagnostic group., Results: A total of 43 cases (2.9%) were confirmed as malignancy. Cancer rate among BI-RADS categories was significantly different (p < 0.0001). Among three groups, the cancer rate was significantly different (p < 0.0001) and the highest in diagnostic group (15.8%, 22 of 139). Abnormal interpretation rate, PPV of biopsy performed, cancer detection rate, and rate of early stage cancer, and the size of invasive cancer were significantly different among three groups and the highest in diagnostic group. Regarding cancer characteristics, the proportion of advanced cancer was the highest in diagnostic group., Conclusion: Breast ultrasound based on BI-RADS as an adjunctive to negative mammography can be useful for predicting malignancy in women with dense breast.

Asymmetric breast findings are frequently encountered at screening and diagnostic mammography. However, there has been some confusion about the applicable terminology for describing asymmetric breast findings. The fourth edition of the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) has incorporated changes in the lexicon for asymmetric breast findings to address such problems and improve the clinical utility of reporting. The fourth edition has replaced "asymmetric breast tissue" with "global asymmetry," "density seen in only a single projection" with "asymmetry," and "focal asymmetric density" with "focal asymmetry." Once an asymmetric finding is perceived, it should be determined whether it is due to a definite lesion. To interpret and manage asymmetric breast findings, additional imaging studies such as straight lateral views, rolled views, and spot compression views at mammography and ultrasonography or magnetic resonance imaging should be applied appropriately in a logical work flow, and the radiologist should be aware of the pitfalls and pearls of each technique and modality.

Objective: To evaluate the diagnostic accuracy of the use of an ultrasonography (US)-guided vacuum-assisted biopsy for microcalcifications of breast lesions and to evaluate the efficacy of the use of US-guided vacuum-assisted biopsy with long-term follow-up results., Materials and Methods: US-guided vacuum-assisted biopsy cases of breast lesions that were performed between 2002 and 2006 for microcalcifications were retrospectively reviewed. A total of 62 breast lesions were identified where further pathological confirmation was obtained or where at least two years of mammography follow-up was obtained. These lesions were divided into the benign and malignant lesions (benign and malignant group) and were divided into underestimated group and not-underestimated lesions (underestimated and not-underestimated group) according to the diagnosis after a vacuum-assisted biopsy. The total number of specimens that contained microcalcifications was analyzed and the total number of microcalcification flecks as depicted on specimen mammography was analyzed to determine if there was any statistical difference between the groups., Results: There were no false negative cases after more than two years of follow-up. Twenty-nine lesions were diagnosed as malignant (two invasive carcinomas and 27 carcinoma in situ lesions). Two of the 27 carcinoma in situ lesions were upgraded to invasive cancers after surgery. Among three patients diagnosed with atypical ductal hyperplasia, the diagnosis was upgraded to a ductal carcinoma in situ after surgery in one patient. There was no statistically significant difference in the number of specimens with microcalcifications and the total number of microcalcification flecks between the benign group and malignant group of patients and between the underestimated group and not-underestimated group of patients., Conclusion: US-guided vacuum-assisted biopsy can be an effective alternative to stereotactic-guided vacuum-assisted biopsy in cases where microcalcifications are visible with the use of high-resolution US.

Venous engorgement of the breast demonstrated on mammography is usually considered a minor sign of malignancy. We report the sonographic and mammographic findings in an unusual case of asymmetric enlargement of the mammary veins in a middle-aged patient as a complication of long-term hemodialysis., (Copyright 2006 Wiley Periodicals, Inc.)

Objective: The purpose of this study was to evaluate the frequency of focal fibrosis of the breast diagnosed by a sonographically guided core biopsy of nonpalpable lesions, to characterize imaging features, and to evaluate their clinical relevance., Methods: In a retrospective review of 724 lesions that underwent sonographically guided core biopsy of nonpalpable breast lesions, 62 cases had a diagnosis of focal fibrosis. Two radiologists analyzed the sonographic and mammographic findings according to the Breast Imaging Reporting and Data System. The results were compared with histologic findings at surgery or imaging findings during surveillance., Results: The incidence of focal fibrosis was 8.6% (62/724). Sonographic films were available in 56 cases, so 56 cases were reviewed for their sonographic findings. Among the mammograms reviewed, 64.7% (33/51) had negative findings. Among the sonograms reviewed, the most common features were oval shape (32/56, 57.1%), parallel orientation (36/56, 64.3%), microlobulated margin (24/56, 42.9%), abrupt interface (50/56, 89.3%), isoechoic pattern (42/56, 75.0%), and a lack of posterior acoustic features (45/56, 80.4%). The Breast Imaging Reporting and Data System final assessment was category 3 in 27 (48.2%) and category 4 in 29 (51.8%). Most of the category 4 lesions were category 4A (26/29, 89.7%). Surgical excision (n = 7) and follow-up for at least 1 year (n = 49) showed no malignancy., Conclusions: Focal fibrosis was found in 8.6% by a sonographically guided core biopsy of nonpalpable breast lesions. Most of the lesions were categorized as probably benign (category 3) or having a low suggestion of malignancy (category 4A). Focal fibrosis diagnosed at core biopsy can be managed with a 6-month follow-up protocol.

A 37-year-old woman presented with breast pain after breast augmentation utilizing autologous fat obtained by liposuction. Mammography and sonography demonstrated fat necrosis in the right breast and a solid inflammatory mass in the left breast. The diagnoses were confirmed by biopsy., (Copyright 2004 Wiley Periodicals, Inc.)

Objective: To compare sonography and mammography in terms of their diagnostic value in breast cancer cases which initially presented as an axillary mass without a palpable mass or other clinical symptoms., Materials and Methods: Seven patients with enlarged axillary lymph nodes who first presented with no evidence of palpable breast lesions and who underwent both mammography and sonography were enrolled in this study. In six of the seven, the presence of metastatic adenocarcinoma was confirmed preoperatively by axillary needle aspiration biopsy; in four, subsequent sonographically-guided breast core biopsy performed after careful examination of the primary site indicated that primary breast cancer was present. In each case, the radiologic findings were evaluated by both breast sonography and mammography., Results: Breast lesions were detected mammographically in four of seven cases (57%); in three of the four, the lesion presented as a mass, and in one as microcalcification. In three of these four detected cases, fatty or scattered fibroglandular breast parenchyma was present; in one, the parenchyma was dense. In the three cases in which lesions were not detected, mammography revealed the presence of heterogeneously dense parenchyma. Breast sonography showed that lesions were present in six of seven cases (86%); in the remaining patient, malignant microcalcification was detected at mammography. Final pathologic examination indicated that all breast lesions except one, which was a ductal carcinoma in situ, with microinvasion, were infiltrating ductal carcinomas whose size ranged from microscopic to greater than 3 cm. At the time of this study, all seven patients were alive and well, having been disease free for up to 61 months after surgery., Conclusion: In women with a palpable axillary mass confirmed as metastatic adenocarcinoma, breast sonography may be a valuable adjunct to mammography.

We performed mammography and sonography on a 49-year-old woman who had a mass in her left axilla that had been present for 1 month and who had undergone excision of a primitive neuroectodermal tumor (PNET) on her back 1 year before. Mammography revealed 2 adjacent, dense nodules in the left breast and enlarged lymph nodes, without a fatty hilum or internal microcalcifications, in the left axilla. Sonography showed 2 round to oval, markedly hypoechoic nodules in the left breast and enlarged, markedly hypoechoic lymph nodes, without microcalcifications, in the left axilla. We then performed sonographically guided core biopsy. Histopathologic analysis of the specimens confirmed the presence of PNET in the left breast and axillary lymph nodes. The patient was then treated with chemotherapy. To our knowledge, this report is the first to describe radiologic findings of metastasis of PNET to the breast., (Copyright 2002 Wiley Periodicals, Inc.)

BackgroundBackground parenchymal enhancement (BPE) on dynamic contrast-enhanced (DCE)-MRI has been associated with breast cancer risk, both based on qualitative and quantitative assessments.PurposeTo investigate whether BPE of the contralateral breast on preoperative DCE-MRI is associated with therapy outcome in ER-positive, HER2-negative, node-negative invasive breast cancer.Study typeRetrospective.PopulationIn all, 289 patients with unilateral ER-positive, HER2-negative, node-negative breast cancer larger than 5 mm.Field strength/sequence3T, T1 -weighted DCE sequence.AssessmentBPE of the contralateral breast was assessed qualitatively by two dedicated radiologists and quantitatively (using region-of-interest and automatic breast segmentation).Statistical testsCox regression analysis was used to determine associations with recurrence-free survival (RFS) and distant metastasis-free survival (DFS). Interobserver variability for parenchymal enhancement was assessed using kappa statistics and intraclass correlation coefficient (ICC).ResultsThe median follow-up time was 75.8 months. Multivariate analysis showed receipt of total mastectomy (hazard ratio [HR]: 5.497) and high Ki-67 expression level (HR: 5.956) were independent factors associated with worse RFS (P

Background Women at high risk for breast cancer and women at average risk have different pretest probabilities. Probably benign lesions on screening ultrasound (US) should be assessed and managed differently for these two risk groups. Purpose To evaluate the effectiveness of short-term follow-up for probably benign lesions on screening US in women at average risk for breast cancer with dense breasts. Material and Methods A total of 445 women at average risk for breast cancer with probably benign lesions on screening US, dense breasts, and negative or benign mammography results were included. Women were classified into the six-month group (n = 345) or 12-month group (n = 100) according to when the first follow-up was performed (3-9 months or 9-15 months). The cancer detection rate, frequencies of newly developed lesions and progressed lesions, and biopsy rate were compared. Results There were no malignancies from three to 15 months. Three cancers newly developed after 15 months. One was a 3-mm ductal carcinoma in situ and two were 10-mm and 18-mm invasive ductal carcinoma without lymph node metastasis. The frequency of newly developed lesions and progressed lesions and biopsy rate were not significantly different between the six-month and 12-month groups ( P = 0.320, 0.621, and >0.999). Conclusion A follow-up at 12 months can be considered for probably benign lesions on screening US in women at average risk for breast cancer with dense breasts. However, a large series prospective study is needed before clinical application. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether the intrinsic subtypes of breast cancers initially assessed as American College of Radiology Breast Imaging and Reporting System (BI‐RADS) category 3 or 4a differ according to tumor size. Methods: A total of 444 breast cancers in 439 patients initially assessed as BI‐RADS 3 or 4a through ultrasound‐guided core needle biopsy were included. Tumors were classified by the size criterion of 10 mm or smaller or larger than 10 mm and categorized as the luminal type (estrogen receptor [ER] positive and/or progesterone receptor [PR] positive and human epidermal growth factor receptor 2 [HER2] negative), HER2 type (HER2 positive regardless of ER or PR status), or triple‐negative type (ER negative, PR negative, and HER2 negative). The relationships between tumor size and breast cancer intrinsic subtypes were analyzed. Results: A total of 247 (55.6%) cancers were 10 mm or smaller, and 197 (44.4%) were larger than 10 mm. The luminal type was more frequently present in tumors of 10 mm or smaller (185 of 247 [74.9%]) than those larger than 10 mm (112 of 197 [56.9%]; P < .001). No significant difference was noted in the frequency of the HER2 type in tumors of 10 and mm smaller and those larger than 10 mm (27 of 247 [10.9%] versus 36 of 197 [18.3%]; P = .084). The triple‐negative type was more frequently present in tumors larger than 10 mm than those of 10 mm or smaller (49 of /197 [24.9%] versus 35 of 247 [14.2%]; P = .012). Conclusions: Breast cancers assessed as BI‐RADS category 3 or 4a had differing intrinsic subtypes according to tumor size, as the luminal type was more frequently present in tumors of 10 mm or smaller than those larger than 10 mm, whereas the triple‐negative type was more frequently present in tumors larger than 10 mm. [ABSTRACT FROM AUTHOR]

Objectives To investigate the feasibility of a computer-aided diagnosis (CAD) system (S-Detect; Samsung Medison, Co, Ltd, Seoul, Korea) for breast ultrasonography (US), according to radiologists with various degrees of experience in breast imaging. Methods From December 2015 to March 2016, 119 breast masses in 116 women were included. Ultrasonographic images of the breast masses were retrospectively reviewed and analyzed by 2 radiologists specializing in breast imaging (7 and 1 years of experience, respectively) and S-Detect, according to the individual ultrasonographic descriptors from the fifth edition of the American College of Radiology Breast Imaging Reporting and Data System and final assessment categories. Diagnostic performance and the interobserver agreement among the radiologists and S-Detect was calculated and compared. Results Among the 119 breast masses, 54 (45.4%) were malignant, and 65 (54.6%) were benign. Compared to the radiologists, S-Detect had higher specificity (90.8% compared to 49.2% and 55.4%) and positive predictive value (PPV; 86.7% compared to 60.7% and 63.8%) (all P < .001). Both radiologists had significantly improved specificity, PPV, and accuracy when using S-Detect compared to US alone (all P < .001). The area under the receiving operating characteristic curves of the both radiologists did not show a significant improvement when applying S-Detect compared to US alone (all P > .05). Moderate agreement was seen in final assessments made by each radiologist and S-Detect (κ = 0.40 and 0.45, respectively). Conclusions S-Detect is a clinically feasible diagnostic tool that can be used to improve the specificity, PPV, and accuracy of breast US, with a moderate degree of agreement in final assessments, regardless of the experience of the radiologist. [ABSTRACT FROM AUTHOR]

Background Breast cancer can present as non-mass lesions (NMLs) on ultrasound. However, knowledge of and understanding about NMLs are scarce. Purpose To retrospectively investigate the final outcomes of sonographic breast NMLs and determine the clinical and radiologic variables associated with malignancy Material and Methods In our radiologic database of breast ultrasound examinations between 2011 and 2014, we found 119 women with 121 NMLs with available histopathologic or sonographic follow-up (over 2 years) data. We collected the clinical variables (patient's age, symptoms, and mammographic density) and histopathologic data as well as radiologic variables (mammographic and ultrasound findings) after retrospective review by two radiologists, the authors of the current paper, in consensus. We classified the ultrasound findings according to distribution (focal, linear or segmental, and regional) and associated features (calcification, architectural distortion, and ductal changes) and analyzed the associations between variables and malignancy using the t test and χ2 test. Results Of the 121 NMLs, 88 (72.7%) were benign and 33 (27.3%) were malignant. Ductal carcinoma in situ (DCIS) (17/33, 51.5%) and invasive ductal cancer with or without DCIS (13/33, 39.4%) comprised the main malignancies, and malignancy was significantly associated with palpability ( P = 0.000). Mammographic findings and sonographic distribution and associated features were significantly different between benign and malignant lesions ( P = 0.000, P = 0.004, and P = 0.001, respectively). Malignant lesions showed more frequent calcifications combined with asymmetry ( P = 0.000) on mammography and linear-segmental distributions ( P = 0.001) and associated calcifications ( P = 0.019) or architectural distortions ( P = 0.015) on ultrasound. Conclusion Breast NMLs on ultrasound showed high risk of malignancy. Symptoms and mammographic and ultrasound findings can be possible predictors of malignancy in NMLs. [ABSTRACT FROM AUTHOR]

Background: The signal enhancement ratio (SER) of surrounding non-tumor parenchyma at breast magnetic resonance imaging (MRI) can be helpful in breast cancer patients, but has not been investigated in patients with triple negative breast cancer (TNBC). Purpose: To investigate the association between background parenchymal SER around the tumor on preoperative dynamic contrast-enhanced MRI with recurrence-free survival in patients with TNBC. Material and Methods: Between April 2012 and May 2013, 71 TNBC patients who underwent preoperative MRI were included. SER values were calculated from regions of interest placed in the breast parenchyma around the tumor. Cox proportional hazards models were used to determine associations between MRI variables, clinical-pathologic variables, and recurrence-free survival. Results: Recurrence occurred in 8.5% (6/71) of patients. At univariate analysis, a higher SER around the tumor, larger tumor size, lymphovascular invasion, lymph node metastasis, receipt of neoadjuvant chemotherapy, receipt of total mastectomy, and not receiving adjuvant chemotherapy were associated with worse recurrence-free survival. At multivariate analysis of preoperative variables, a higher SER around the tumor was independently associated with worse recurrence-free survival (hazard ratio [HR] = 7.072, P = 0.003 for SER1; HR = 6.268, P = 0.006 for SER2; HR = 3.004, P = 0.039 for SER3). Conclusion: Higher SER around the tumor at preoperative dynamic contrast-enhanced MRI is an independent predictor for recurrence in TNBC patients. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the correlation between conductivity and prognostic factors of invasive breast cancer using magnetic resonance electric properties tomography (MREPT).Methods: This retrospective study was approved by the Institutional Review Board, and verbal informed consent was obtained prior to breast MRI. This study included 65 women with surgically confirmed invasive breast cancers measuring 1 cm or larger on T2-weighted fast spin echo (FSE). Phase-based MREPT and the coil combination technique were used to reconstruct conductivity. Simple and multiple linear regression analysis were used to find an independent factor associated with conductivity.Results: In total tumours, tumours with HER-2 overexpression showed lower conductivity than those without, and HER-2 overexpression was independently associated with conductivity. In 37 tumours 2 cm or larger, tumours with high mitosis or PR positivity showed higher conductivity than those without, and high mitosis and PR positivity were independently associated with conductivity. In 28 tumours 1-2 cm in size, there were no differences in conductivity according to the prognostic factors.Conclusion: Conductivity values measured using MREPT are associated with the HER-2 overexpression status, and may provide information about mitosis and the PR status of invasive breast cancers 2 cm or larger.Key Points: • In all tumours, HER-2 overexpression was independently associated with conductivity. • In tumours ≥ 2 cm, high mitosis and PR positivity were associated with conductivity. • Conductivity is associated with the HER-2 overexpression status of invasive breast cancers. [ABSTRACT FROM AUTHOR]

Axillary ultrasound (US) with US-guided fine-needle aspiration (US-FNA) for suspicious lymph nodes is important for pre-operative staging and planning of surgical management. Invasive lobular carcinoma (ILC) metastases were previously thought to be difficult to detect, but with a limited amount of evidence. This study investigated the ability of US and US-FNA to detect ILC metastases by assessing 142 patients with ILC. The sensitivity of US in detection of metastasis was 52.3%, and US was able to exclude 96% of N2 and N3 axillary metastases. The false-negative rate of US-FNA in detection of metastasis for suspicious lymph nodes on US was 34.8%, and lymph nodes with longer maximal dimensions were associated with false-negative US-FNA results. Multiplicity of breast lesions and maximal cortical thickness ≥3.1 mm of lymph nodes were independently associated with metastasis. Although pre-operative US in ILC can reliably exclude advanced axillary nodal disease, US-FNA results should be carefully interpreted. [ABSTRACT FROM AUTHOR]

Background: Triple-negative breast cancer (TNBC) which expresses neither hormonal receptors nor HER-2 is associated with poor prognosis and shorter survival. Several studies have suggested that TNBC patients attaining pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) show a longer survival than those without pCR.Purpose: To assess the accuracy of 3.0-T breast magnetic resonance imaging (MRI) in predicting pCR and to evaluate the clinicoradiologic factors affecting the diagnostic accuracy of 3.0-T breast MRI in TNBC patients treated with anthracycline and taxane (ACD).Material and Methods: This retrospective study was approved by the institutional review board; patient consent was not required. Between 2009 and 2012, 35 TNBC patients with 3.0-T breast MRI prior to (n = 26) or after (n = 35) NAC were included. MRI findings were reviewed according to pCR to chemotherapy. The diagnostic accuracy of 3.0-T breast MRI for predicting pCR and the clinicoradiological factors affecting MRI accuracy and response to NAC were analyzed.Results: 3.0-T MRI following NAC with ACD accurately predicted pCR in 91.4% of TNBC patients. The residual tumor size between pathology and 3.0-T MRI in non-pCR cases showed a higher correlation in the Ki-67-positive TNBC group (r = 0.947) than in the Ki-67 negative group (r = 0.375) with statistical trends (P = 0.069). Pre-treatment MRI in the non-pCR group compared to the pCR group showed a larger tumor size (P = 0.030) and non-mass presentation (P = 0.015).Conclusion: 3.0-T MRI in TNBC patients following NAC with ACD showed a high accuracy for predicting pCR to NAC. Ki-67 can affect the diagnostic accuracy of 3.0-T MRI for pCR to NAC with ACD in TNBC patients. [ABSTRACT FROM AUTHOR]

Abstract: The objective of this study was to determine the frequency of imaging-histologic discordance and to compare the frequency of carcinoma between concordant and discordant lesions in sonographically (US)-guided 14-gauge core needle biopsies (CNBs). From January 2005 to December 2006, we performed US-guided 14-gauge automated CNB on 3339 breast lesions and obtained benign results in 2194 cases. Five radiologists prospectively reviewed the pathologic reports in conjunction with the imaging. We included a total of 1588 lesions that were either excised (n = 658) or followed up for at least 2 years (n = 930) after CNB. We evaluated the rate of discordance and the clinical findings for both discordant and concordant lesions. We also analyzed the clinical and imaging differences between the upgrade and non-upgrade groups. Imaging-histologic discordance was present in 103 of 1588 (6.5%) lesions. The upgrade rate was 6.8% (7/103) in discordant lesions and 0.4% (6/1485) in concordant lesions (p < 0.01). Lesion size, Breast Imaging, Reporting and Data System (BI-RADS) category and the presence or absence of symptoms was statistically significant between the upgrade and non-upgrade groups in discordant cases (p < .05). Imaging-histologic discordance is an indication for excision because it has a higher upgrade rate than concordant lesions. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of this study was to assess the role of power Doppler US in differentiating benign from malignant solid breast masses when used in conjunction with grayscale sonography (US) and the relationship with axillary lymph node metastasis. Subjects and Methods: Grayscale US of 353 solid lesions was categorized using the US BI-RADS final assessment system prospectively. On power Doppler US, the presence of identified or penetrating vessels within the mass was evaluated, respectively. Diagnostic accuracy was calculated at grayscale US with and without power Doppler US. Among malignant cases, tumor vascularity was correlated with lymph node involvement. Results: When the size of the masses was controlled, the identified or penetrating vessels were significantly more frequent in malignant lesions (P<.05). By using the identified and penetrating vessels in the mass as one of the diagnostic criteria for malignancy, the diagnostic accuracy was improved. In 54 infiltrating ductal carcinomas, although lymph node involvement was more frequently seen in the group having identified or penetrating vessels (40 and 35.3%) than in the avascular group (16.7 and 27%), it was not statistically significant (P>.05). Conclusion: We suggest that identified or penetrating vessels within the mass on power Doppler US can be one of the malignant criteria. [Copyright &y& Elsevier]

Abstract: Objective: To determine the frequency of imaging-histologic discordance at percutaneous breast biopsy and to evaluate differences in clinical and radiologic findings between pathologically upgraded lesions and non-upgraded lesions. Materials and methods: From February 2000 to June 2005, we reviewed 386 cases that had suspicious imaging findings but yielded benign histology at US-core needle biopsy and that underwent subsequent excisional biopsy. In 74 of 386 cases, the benign histology at core needle biopsy could not provide a satisfactory explanation for the radiologically suspicious lesions. The clinical, radiologic and histologic findings were reviewed for those 74 cases that were classified as the upgrade group and the non-upgrade group after excisional biopsy. Results: The upgrade rate was 17.6% (95% confidence interval, 10.6–27.8%, 13 of 74 cases) revealed upgraded pathology at the subsequent excisional biopsy. Besides the size of masses, there were no statistically significant differences in imaging findings between the upgrade and non-upgrade groups at excisional biopsy. Conclusion: This upgrade rate of 17.6% suggests that excisional biopsy or re-biopsy is warranted in those cases presenting imaging-histologic discordance at US-guided core biopsy. [Copyright &y& Elsevier]

Objectives: Columnar cell lesions are being encountered with increasing frequency in breast biopsies performed. The purpose of our study was to determine whether columnar cell lesions of the breast have any distinctive imaging characteristics. Materials and Methods: We retrospectively reviewed our institutional database for all records of breast pathology obtained in a 17-month period. Columnar cell lesion was diagnosed in 53 lesions and 12 of these 53 lesions contained columnar cell lesions as the sole histopathologic findings. These 12 lesions in nine patients made up our study population. They included columnar cell change (n=4), columnar cell hyperplasia (n=5), and columnar cell hyperplasia with atypia (n=3). Results: All nine patients underwent mammography and sonography within 1 month of each other. Of the mammograms in nine patients, nine lesions (75%) appeared as clustered amorphous or indistinct (n=5), fine pleomorphic (n=3), or round (n=1) microcalcifications. The tenth lesion showed a focal mass without microcalcifications and the remaining two lesions showed no abnormal findings. At sonography, not-circumscribed masses were depicted in six lesions and microcalcifications were visible in four lesions, of which three lesions were concurrent with masses. There were no sonographically focal lesions in the remaining five. Overall 11 lesions were classified as BI-RADS category 4 (92%) and one as category 3. Of the three lesions with atypia, two were classified as category 4a and one was classified as category 4c, and they showed no distinct imaging appearance from those without atypia. Conclusion: Columnar cell lesions usually present as nonpalpable, clustered indeterminate or suspicious microcalcifications on mammography. They are indistinguishable from other causes of suspicious microcalcifications such as atypical ductal hyperplasia or ductal carcinoma in situ and require needle biopsy or excisional biopsy for diagnosis. [ABSTRACT FROM AUTHOR]

A radiomics-based classifier to distinguish phyllodes tumor and fibroadenoma on gray-scale breast ultrasonography was developed and validated. A total of 93 radiomics features were extracted from representative transverse plane ultrasound images of 182 fibroepithelial lesions initially diagnosed by core needle biopsy. High-throughput radiomics features were selected using the intra-class correlation coefficient between two radiologist readers and the Least Absolute Shrinkage and Selection Operator regression through 10-fold cross-validation. When applied to the validation set, the radiomics classifier for the differentiation of phyllodes tumors and benign/fibroadenomas achieved an area under the receiver operating characteristic curve of 0.765 (95% confidence interval [CI]: 0.597-0.888) with an accuracy of 0.703 (sensitivity: 0.857; specificity: 0.5). Our radiomics signature-based classifier may help predict phyllodes tumors among fibroepithelial lesions on breast ultrasonography. [ABSTRACT FROM AUTHOR]