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Mammographic density (MD) assessment is subject to inter- and intra-observer variability. An automated method, such as Quantra software, could be a useful tool for an objective and reproducible MD assessment. Our purpose was to evaluate the performance of Quantra software in assessing MD, according to BI-RADS® Atlas Fifth Edition recommendations, verifying the degree of agreement with the gold standard, given by the consensus of two breast radiologists. A total of 5009 screening examinations were evaluated by two radiologists and analysed by Quantra software to assess MD. The agreement between the three assigned values was expressed as intraclass correlation coefficients (ICCs). The agreement between the software and the two readers (R1 and R2) was moderate with ICC values of 0.725 and 0.713, respectively. A better agreement was demonstrated between the software's assessment and the average score of the values assigned by the two radiologists, with an index of 0.793, which reflects a good correlation. Quantra software appears a promising tool in supporting radiologists in the MD assessment and could be part of a personalised screening protocol soon. However, some fine-tuning is needed to improve its accuracy, reduce its tendency to overestimate, and ensure it excludes high-density structures from its assessment. [ABSTRACT FROM AUTHOR]

Breast cancer is a complex disease that includes entities with different characteristics, behaviors, and responses to treatment. Breast cancers are categorized into subgroups based on histological type and grade, and these subgroups affect clinical presentation and oncological outcomes. The subgroup of "special types" encompasses all those breast cancers with insufficient features to belong to the subgroup "invasive ductal carcinoma not otherwise specified". These cancers account for around 25% of all cases, some of them having a relatively good prognosis despite high histological grade. The purpose of this paper is to review and illustrate the radiological appearance of each special type, highlighting insights and pitfalls to guide breast radiologists in their routine work. [ABSTRACT FROM AUTHOR]

Objective: to determine the positive predictive value (PPV) of tomosynthesis (DBT)-detected architectural distortions (ADs) and evaluate correlations between AD's imaging characteristics and histopathologic outcomes. Methods: biopsies performed between 2019 and 2021 on ADs were included. Images were interpreted by dedicated breast imaging radiologists. Pathologic results after DBT-vacuum assisted biopsy (DBT-VAB) and core needle biopsy were compared with AD detected by DBT, synthetic2D (synt2D) and ultrasound (US). Results: US was performed to assess a correlation for ADs in all 123 cases and a US correlation was identified in 12/123 (9.7%) cases, which underwent US-guided core needle biopsy (CNB). The remaining 111/123 (90.2%) ADs were biopsied under DBT guidance. Among the 123 ADs included, 33/123 (26.8%) yielded malignant results. The overall PPV for malignancy was 30.1% (37/123). The imaging-specific PPV for malignancy was 19.2% (5/26) for DBT-only ADs, 28.2% (24/85) for ADs visible on DBT and synth2D mammography and 66.7% (8/12) for ADs with a US correlation with a statistically significant difference among the three groups (p = 0.01). Conclusions: DBT-only ADs demonstrated a lower PPV of malignancy when compared with syntD mammography, and DBT detected ADs but not low enough to avoid biopsy. As the presence of a US correlate was found to be related with malignancy, it should increase the radiologist's level of suspicion, even when CNB returned a B3 result. [ABSTRACT FROM AUTHOR]

Angiosarcoma of the breast is a rare breast cancer, which can arise de novo (primary breast angiosarcoma, PBA) or as a secondary malignancy (secondary breast angiosarcoma, SBA) as a result of a biological insult. In the latter case, it is usually diagnosed in patients with a previous history of radiation therapy following a conserving treatment for breast cancer. Over the years, the advances in early diagnosis and treatment of breast cancer, with increasing use of breast-conserving surgery and radiation therapy (instead of radical mastectomy), brought about an increased incidence of the secondary type. PBA and SBA have different clinical presentations and often represent a diagnostic challenge due to the nonspecific imaging findings. The purpose of this paper is to review and describe the radiological features of breast angiosarcoma, both in conventional and advanced imaging to guide radiologists in the diagnosis and management of this rare tumor. [ABSTRACT FROM AUTHOR]

Objectives: To conduct a review of evidence about papillomatosis/multiple papillomas (MP), its clinical and imaging presentation, the association between MP and malignancy and the management strategies that follow. Methods: A computerized literature search using PubMed and Google Scholar was performed up to January 2021 with the following search strategy: "papilloma" OR "intraductal papilloma" OR "intraductal papillary neoplasms" OR "papillomatosis" OR "papillary lesion" AND "breast". Two authors independently conducted a search, screening and extraction of data from the eligible studies. Results: Of the 1881 articles identified, 29 articles met the inclusion criteria. The most common breast imaging methods (mammography, ultrasound) showed few specific signs of MP, and evidence about magnetic resonance imaging were weak. Regarding the association between MP and malignancy, the risk of underestimation to biopsy methods and the frequent coexistence of MP and other high-risk lesions needs to be taken into consideration. Results about the risk of developing breast carcinoma of patients affected by MP were inconsistent. Conclusions: MP is a challenge for all breast specialists, and familiarity with its features is required to make the correct diagnosis. Further studies are needed to evaluate the factors to take into account to plan management, time of follow-up and imaging methods. [ABSTRACT FROM AUTHOR]