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Tuberculosis mastitis can be a challenging diagnosis, often presenting with clinical and imaging findings that are suspicious for malignancy. We present a case of a 49-year-old female with a breast mass initially diagnosed as idiopathic granulomatous mastitis. Failure to respond to standard treatments, development of new breast masses, and discovery of a concurrent ulcerating thigh rash with similar histologic findings as the breast masses prompted further investigation, which ultimately lead to the diagnosis of tuberculosis mastitis. There was rapid resolution of both breast and skin symptoms after initiation of empiric drug therapy., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To evaluate outcomes of benign concordant magnetic resonance imaging (MRI)-guided breast biopsy., Methods: We retrospectively reviewed 611 consecutive MRI-guided breast core biopsies at our institution from 2005 to 2012. Benign concordant cases with MRI follow-up constituted the study group. Lesion appearance on follow-up MRI was assessed and the false-negative rate was calculated., Results: Eighty-four lesions in 68 women underwent benign concordant MRI-guided biopsy with subsequent MRI follow-up. Mean time to first follow-up MRI was 10.5 months. Two false negatives were identified on follow-up at 8 and 26 months., Conclusions: We report a false-negative rate of MRI-guided breast biopsy of 2.4%., (Copyright © 2016 Elsevier Inc. All rights reserved.)

OBJECTIVE. The purpose of this article is describe the origins and provisions of breast density legislation and to evaluate these mandates with regard to the balance between the potential benefit of supplementary screening and the substantial risk of false-positive findings and the adjunctive tests they necessitate. CONCLUSION. Many states have passed breast density notification legislation, and federal legislation is pending. These mandates present a number of challenges for patients and physicians. There is no consensus regarding the need for supplementary testing solely because a woman has dense breasts. The failure of density legislation to require insurance coverage in many states further complicates implementation of the mandates.

The breasts undergo marked physiologic changes during lactation that can make conventional imaging evaluation with mammography and US challenging. MRI can be a valuable diagnostic aid to differentiate physiologic and benign processes from malignancy in patients who are lactating. In addition, MRI may allow more accurate delineation of disease involvement than does conventional imaging and assists in locoregional staging, screening of the contralateral breast, assessment of response to neoadjuvant chemotherapy, and surgical planning. Although the American College of Radiology recommends against patients undergoing contrast-enhanced MRI during pregnancy because of fetal safety concerns, contrast-enhanced MRI is safe during lactation. As more women delay childbearing, the incidence of pregnancy-associated breast cancer (PABC) and breast cancer in lactating women beyond the 1st year after pregnancy is increasing. Thus, MRI is increasingly being performed in lactating women for diagnostic evaluation and screening of patients at high risk. PABC is associated with a worse prognosis than that of non-PABCs, with delays in diagnosis contributing to an increased likelihood of advanced-stage disease at diagnosis. Familiarity with the MRI features of the lactating breast and the appearance of various pathologic conditions is essential to avoid diagnostic pitfalls and prevent delays in cancer diagnosis and treatment. The authors review clinical indications for breast MRI during lactation, describe characteristic features of the lactating breast at MRI, and compare MRI features of a spectrum of benign and malignant breast abnormalities. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Chikarmane in this issue.

To review the imaging and pathologic features of a series of lesions detected at digital breast tomosynthesis ( DBT), which are occult to conventional digital mammography ( DM). We retrospectively reviewed 268 consecutive breast imaging reporting and data system 4 and 5 lesions imaged with both DM and DBT at our facility from July 2012 through April 2013. For each lesion, we recorded the mammographic finding, breast density, mode of biopsy, and pathology results. A total of 19 lesions were identified at DBT that were occult to DM. Sixty three percent (12/19) of these lesions were identified in dense breasts. Architectural distortion was seen in 74% (14/19) of cases and spiculated masses accounted for the remaining 26% (5/19). The positive predictive value of biopsy was 53% (10/19). Seven cases were infiltrating ductal carcinomas and three were infiltrating lobular carcinomas. High-risk lesions accounted for 47% (9/19) of the lesions, the majority of which were radial scars 67% (6/9). Eighty four percent (16/19) of the lesions underwent ultrasound guided core biopsy while the remainder underwent magnetic resonance imaging guided core biopsy. DBT may demonstrate suspicious lesions that are occult to DM, particularly in women with dense breasts. Such lesions have a high likelihood of malignancy and warrant biopsy. [ABSTRACT FROM AUTHOR]

Localization of metastatic axillary lymph nodes in breast cancer patients is an increasingly common procedure performed by radiologists. In 2014, the National Comprehensive Cancer Network guidelines stated that "clinically positive axillary lymph node (s) should be sampled by FNA or core biopsy and clipped with image-detectable marker; clipped lymph nodes must be removed if FNA or core biopsy was positive prior to neoadjuvant therapy". Since then, multiple studies have further supported targeted axillary surgery after neoadjuvant chemotherapy (NAC), with excision of the clipped metastatic axillary node in addition to the sentinel node (s). Requests for image guided localization of clipped axillary nodes will continue to increase and likely become the standard of care. However, when lymph nodes have decreased in size after NAC, or when small deep lymph nodes are sampled, the clipped node can be difficult to identify under ultrasound at the time of localization. When the target node is questionable, we have found it valuable to place an intermediary clip, and use an axillary mammographic view to confirm this intermediary clip co-localizes with the intended target. With this confirmation, safe, accurate localization can then be performed. We describe 3 cases of intermediary clip placement facilitating successful localization of previously clipped axillary lymph nodes. [ABSTRACT FROM AUTHOR]

To assess the use and outcomes of ultrasound for the evaluation of breast signs and symptoms in pediatric females. A retrospective database review identified all patients ≤18-years-old who underwent breast ultrasound at an academic institution over a 20-year period. Each symptomatic site was designated a case and analyses were performed on each case. Imaging findings were obtained from the radiology reports. Clinical and pathology data were obtained from the medical records. Descriptive statistics were performed. The final cohort comprised 124 cases in 101 patients. Mean age was 15 years (range 1–18). The most common indication for ultrasound was a palpable lump (71%). Thirty-seven cases (30%) demonstrated no sonographic correlate to the symptom; 36 (29%) had a benign correlate. The most common benign correlates were abscess/phlegmon and cyst. All cases of abscess/phlegmon had infectious symptoms. Fifty-one cases (41%) demonstrated a sonographic mass that was not characteristically benign. Of these indeterminate masses, 27 were recommended for biopsy, 13 for short-interval follow-up, and 6 had no recommendation. Of 27 biopsied masses, 63% were fibroadenomas. No symptoms were due to malignancy. Therefore, the NPV of ultrasound was 100% and the PPV 0%. In this cohort of pediatric and adolescent patients, malignancy was never the cause of breast symptoms. Imaging yielded false positives with a biopsy recommendation in 22% of cases. Ultrasound provided value in evaluating infectious symptoms. Given the extreme rarity of breast cancer in this population, surveillance may be a safe alternative for most indeterminate lesions. • While there are well-established guidelines for imaging breast symptoms in adults but the literature in pediatric patients is sparse. • Malignancy was never the cause of breast symptoms in our cohort of 124 ultrasound cases over 20 years. • Imaging led to false positives with biopsy recommendation in 22% of cases. • Close imaging or clinical surveillance may be a safe alternative to biopsy, although larger studies are needed. • Current BI-RADS guidelines may not be applicable to the pediatric patient population. [ABSTRACT FROM AUTHOR]