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Breast microcalcifications are observed in 80% of mammograms, and a notable proportion can lead to invasive tumors. However, diagnosing microcalcifications is a highly complicated and error-prone process due to their diverse sizes, shapes, and subtle variations. In this study, we propose a radiomic signature that effectively differentiates between healthy tissue, benign microcalcifications, and malignant microcalcifications. Radiomic features were extracted from a proprietary dataset, composed of 380 healthy tissue, 136 benign, and 242 malignant microcalcifications ROIs. Subsequently, two distinct signatures were selected to differentiate between healthy tissue and microcalcifications (detection task) and between benign and malignant microcalcifications (classification task). Machine learning models, namely Support Vector Machine, Random Forest, and XGBoost, were employed as classifiers. The shared signature selected for both tasks was then used to train a multi-class model capable of simultaneously classifying healthy, benign, and malignant ROIs. A significant overlap was discovered between the detection and classification signatures. The performance of the models was highly promising, with XGBoost exhibiting an AUC-ROC of 0.830, 0.856, and 0.876 for healthy, benign, and malignant microcalcifications classification, respectively. The intrinsic interpretability of radiomic features, and the use of the Mean Score Decrease method for model introspection, enabled models' clinical validation. In fact, the most important features, namely GLCM Contrast, FO Minimum and FO Entropy, were compared and found important in other studies on breast cancer., (© 2024. The Author(s).)

Importance: Benign breast diseases (BBDs) are common and associated with breast cancer risk, yet the etiology and risk of BBDs have not been extensively studied., Objective: To investigate the risk of BBDs by age, hormonal factors, and family history of breast cancer., Design, Setting, and Participants: This retrospective cohort study assessed 70 877 women from the population-based Karolinska Mammography Project for Risk Prediction of Breast Cancer (KARMA) who attended mammographic screening or underwent clinical mammography from January 1, 2011, to March 31, 2013, at 4 Swedish hospitals. Participants took part in a comprehensive questionnaire on recruitment. All participants had complete follow-up through high-quality Swedish national registers until December 31, 2015. Pathology medical records on breast biopsies were obtained for the participants, and BBD subtypes were classified according to the latest European guidelines. Analyses were conducted from January 1 to July 31, 2020., Exposures: Hormonal risk factors and family history of breast cancer., Main Outcomes and Measures: For each BBD subtype, incidence rates (events per 100 000 person-years) and multivariable Cox proportional hazards ratios (HRs) with time-varying covariates were estimated between the ages of 25 and 69 years., Results: A total of 61 617 women within the mammographic screening age of 40 to 69 years (median age, 53 years) at recruitment with available questionnaire data were included in the study. Incidence rates and risk estimates varied by age and BBD subtype. At premenopausal ages, nulliparity (compared with parity ≥3) was associated with reduced risk of epithelial proliferation without atypia (EP; HR, 0.62; 95% CI, 0.46-0.85) but increased risk of cysts (HR, 1.38; 95% CI, 1.03-1.85). Current and long (≥8 years) oral contraceptive use was associated with reduced premenopausal risk of fibroadenoma (HR, 0.65; 95% CI, 0.47-0.90), whereas hormone replacement therapy was associated with increased postmenopausal risks of epithelial proliferation with atypia (EPA; HR, 1.81; 95% CI, 1.07-3.07), fibrocystic changes (HR, 1.60; 95% CI, 1.03-2.48), and cysts (HR, 1.98; 95% CI, 1.40-2.81). Furthermore, predominantly at premenopausal ages, obesity was associated with reduced risk of several BBDs (eg, EPA: HR, 0.31; 95% CI, 0.17-0.56), whereas family history of breast cancer was associated with increased risk (eg, EPA: HR, 2.11; 95% CI, 1.48-3.00)., Conclusions and Relevance: These results suggest that the risk of BBDs varies by subtype, hormonal factors, and family history of breast cancer and is influenced by age. Better understanding of BBDs is important to improve the understanding of benign and malignant breast diseases.

Introduction: As physician-performed point-of-care ultrasound (POCUS) becomes more prevalent in the evaluation of patients presenting with various complaints in the emergency department (ED), one application that is significantly less used is breast ultrasound. This study evaluates the utility of POCUS for the assessment of patients with breast complaints who present to the ED and the impact of POCUS on medical decision-making and patient management in the ED., Methods: This was a retrospective review of ED patients presenting with breast symptoms who received a POCUS examination. An ED POCUS database was reviewed for breast POCUS examinations. We then reviewed electronic health records for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and impact of the POCUS study on patient care and disposition., Results: We included a total of 40 subjects (36 females, 4 males) in the final analysis. Most common presenting symptoms were breast pain (57.5%) and a palpable mass (37.5%). "Cobblestoning," ie, dense bumpy appearance, was the most common finding on breast POCUS, seen in 50% of the patients. Simple fluid collections were found in 37.5% of patients., Conclusion: Our study findings illustrate the utility of POCUS in the evaluation of a variety of breast complaints in the ED.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a complex topic with evolving classification and etiology. Commonalities between BIA-ALCL and lymphoproliferative disorders exist, suggesting that BIA-ALCL may be better represented on a spectrum of disease from benign effusion to malignant metastatic lymphoma. Meticulous sterile surgical technique, involving the use of betadine-containing irrigation, should be used to decrease the biological burden introduced into the surgical field and possibly prevent future incidences of BIA-ALCL., Competing Interests: Conflict of interest/funding None of the authors have any conflict of interest with the study or its findings, and no funding was received for the study., (Copyright © 2020 Elsevier Inc. All rights reserved.)

To assist radiologists in breast cancer classification in automated breast ultrasound (ABUS) imaging, we propose a computer-aided diagnosis based on a convolutional neural network (CNN) that classifies breast lesions as benign and malignant. The proposed CNN adopts a modified Inception-v3 architecture to provide efficient feature extraction in ABUS imaging. Because the ABUS images can be visualized in transverse and coronal views, the proposed CNN provides an efficient way to extract multiview features from both views. The proposed CNN was trained and evaluated on 316 breast lesions (135 malignant and 181 benign). An observer performance test was conducted to compare five human reviewers' diagnostic performance before and after referring to the predicting outcomes of the proposed CNN. Our method achieved an area under the curve (AUC) value of 0.9468 with five-folder cross-validation, for which the sensitivity and specificity were 0.886 and 0.876, respectively. Compared with conventional machine learning-based feature extraction schemes, particularly principal component analysis (PCA) and histogram of oriented gradients (HOG), our method achieved a significant improvement in classification performance. The proposed CNN achieved a >10% increased AUC value compared with PCA and HOG. During the observer performance test, the diagnostic results of all human reviewers had increased AUC values and sensitivities after referring to the classification results of the proposed CNN, and four of the five human reviewers' AUCs were significantly improved. The proposed CNN employing a multiview strategy showed promise for the diagnosis of breast cancer, and could be used as a second reviewer for increasing diagnostic reliability., Competing Interests: Conflict of interest disclosure The authors declare that they have no conflicts of interest., (Copyright © 2020 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Background: Breast cancer is one of the most leading causes of cancer deaths among women. Early detection of cancer increases the survival rate of the affected women. Machine learning approaches that are used for classification of breast cancer usually takes a lot of processing time during the training process. This paper attempts to propose a Machine Learning approach for breast cancer detection in mammograms, which does not depend on the number of training samples., Objectives: The paper aims to develop a core vector machine-based diagnosis system for breast cancer detection using the date from MIAS. The main motivation behind using this system is to reduce the computational and memory requirement for large training data and to improve the classification accuracy., Methods: The proposed method has four stages: 1) Pre-processing is done to extract the breast region using global thresholding and enhancement using histogram equalization; 2) identification of potential mass using Otsu thresholding; 3) feature extraction using Laws Texture energy measures; and 4) mass detection is done using Core vector machine (CVM) classifier., Results: Comparative analysis was done with different existing algorithms: Artificial Neural Network (ANN), Support Vector Machine (SVM), and Fuzzy Support Vector Machines (FSVM). The results illustrate that the proposed Core Vector Machine (CVM) classifier produced a promising result in terms of sensitivity (96.9%), misclassification rate (0.0443) and accuracy (95.89%). The time taken for training process is 0.0443, which is less when compared with other machine learning algorithms., Conclusion: Performance analysis shows that CVM classifier is superior to other classifiers like ANN, SVM and FSVM. The computational time of the CVM classifier during the training process was also analysed and found to be better than other discussed algorithms. The results achieved show that CVM classifier is the best algorithm for breast mass detection in mammograms., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: The purpose of this work was to evaluate computable Breast Imaging Reporting and Data System (BI-RADS) radiomic features to classify breast masses on ultrasound B-mode images., Methods: The database consisted of 206 consecutive lesions (144 benign and 62 malignant) proved by percutaneous biopsy in a prospective study approved by the local ethical committee. A radiologist manually delineated the contour of the lesions on greyscale images. We extracted the main ten radiomic features based on the BI-RADS lexicon and classified the lesions as benign or malignant using a bottom-up approach for five machine learning (ML) methods: multilayer perceptron (MLP), decision tree (DT), linear discriminant analysis (LDA), random forest (RF), and support vector machine (SVM). We performed a 10-fold cross validation for training and testing of all classifiers. Receiver operating characteristic (ROC) analysis was used for providing the area under the curve with 95% confidence intervals (CI)., Results: The classifier with the highest AUC at ROC analysis was SVM (AUC = 0.840, 95% CI 0.6667-0.9762), with 71.4% sensitivity (95% CI 0.6479-0.8616) and 76.9% specificity (95% CI 0.6148-0.8228). The best AUC for each method was 0.744 (95% CI 0.677-0.774) for DT, 0.818 (95% CI 0.6667-0.9444) for LDA, 0.811 (95% CI 0.710-0.892) for RF, and 0.806 (95% CI 0.677-0.839) for MLP. Lesion margin and orientation were the optimal features for all the machine learning methods., Conclusions: ML can aid the distinction between benign and malignant breast lesion on ultrasound images using quantified BI-RADS descriptors. SVM provided the highest ROC-AUC (0.840).

Objective: To analyze the image features of shear wave elastrography (SWE) in breast masses, and to evaluate their values in the differentiation of benign and malignant breast lesions. Methods: A total of 361 patients with 403 breast lesions who simultaneously underwent conventional ultrasound and SWE examination from February 2015 to January 2018 were selected. Diagnosis in all patients was confirmed by aspiration biopsy or operative pathology. The SWE images were collected and the elastic images were divided into 5 types. The SWE image features of different breast pathological types were summarized, and their values in benign and malignant breast lesion diagnoses were evaluated. Results: The main features of benign breast lesion were type Ⅰ and Ⅱ, the main features of the malignant lesion were type Ⅳ and Ⅴ, and the proportion of which were 43.6% (71/163), 37.4% (61/163), 22.1% (53/240) and 57.9% (139/240), respectively. Type Ⅲ accounted for a certain proportion in both benign and malignant lesions. The SWE image features of benign and malignant lesions were compared and a significant difference was observed ( P <0.001). The type Ⅴ features were mainly observed in invasive ductal carcinoma, invasive lobular carcinoma and other types of invasive carcinoma, while the type Ⅳ features were mostly presented in ductal carcinoma in situ and mucinous carcinoma. Fibroadenoma, fibroadenosis accompanied with fibroadenoma, and fibroadenosis were featured with type Ⅰ. Both intraductal papilloma and benign phyllodes tumor were mostly type Ⅱ, while type Ⅲ and Ⅴ were more common in chronic granulomatous mastitis. When type Ⅰ and typeⅡof breast lesions were classified as benign features while type Ⅳ and Ⅴ were malignant features, the sensitivity and specificity of breast malignant lesion diagnosis were 91.2% and 84.7% by application of SWE combined with breast imaging reporting and data system (BI-RADS). The sensitivity of combined diagnosis was slightly lower than that of conventional ultrasound ( P >0.05), but the specificity was significantly higher than conventional ultrasound ( P <0.01). Conclusion: The SWE is a simple and effective method. Combination of SWE with conventional ultrasound may improve the diagnostic differentiation of benign and malignant breast lesions.

Certain dermatologic conditions are unique to the breast and nipple, whereas others may incidentally involve these structures. All require a nuanced approach to diagnosis and treatment because of the functional, sexual, and aesthetic importance of this area. The lactating patient requires special management because certain treatment options are contraindicated. All dermatologic conditions involving the breast and nipple require careful evaluation because malignancy of the breast can be mistaken for a benign condition or may trigger the development of certain dermatologic conditions. The second article in this continuing medical education series reviews common and uncommon inflammatory and infectious conditions of the breast and nipple and provides insight into both the diagnosis and the treatment of this heterogeneous group of diseases. For the purposes of this article, these conditions are divided into 4 distinct categories: 1) dermatitis; 2) radiation-induced changes; 3) mastitis; and 4) miscellaneous dermatologic conditions of the breast and nipple., (Copyright © 2019. Published by Elsevier Inc.)

The evaluation and management of dermatologic diseases of the breast and nipple requires an understanding of the unique anatomy of the breast and nipple and an awareness of the significant emotional, cultural, and sexual considerations that may come into play when treating this anatomic area. The first article in this continuing medical education series reviews breast anatomy, congenital breast anomalies, and benign and malignant breast tumors. An emphasis is placed on inflammatory breast cancer and breast cancer with noninflammatory skin involvement and on cutaneous metastases to the breast and from breast cancer. Familiarity of the dermatologist with the cutaneous manifestations of breast cancer will facilitate the diagnosis of breast malignancy and assist with staging, prognostication, and evaluation for recurrence. This article also discusses genodermatoses that predispose to breast pathology and provides imaging recommendations for evaluating a palpable breast mass., (Copyright © 2019. Published by Elsevier Inc.)

Background: Multiparametric positron emission tomography/magnetic resonance imaging (mpPET/MRI) shows clinical potential for detection and classification of breast lesions. Yet, the contribution of features for computer-aided segmentation and diagnosis (CAD) need to be better understood. We proposed a data-driven machine learning approach for a CAD system combining dynamic contrast-enhanced (DCE)-MRI, diffusion-weighted imaging (DWI), and 18 F-fluorodeoxyglucose ( 18 F-FDG)-PET., Methods: The CAD incorporated a random forest (RF) classifier combined with mpPET/MRI intensity-based features for lesion segmentation and shape features, kinetic and spatio-temporal texture features, for lesion classification. The CAD pipeline detected and segmented suspicious regions and classified lesions as benign or malignant. The inherent feature selection method of RF and alternatively the minimum-redundancy-maximum-relevance feature ranking method were used., Results: In 34 patients, we report a detection rate of 10/12 (83.3%) and 22/22 (100%) for benign and malignant lesions, respectively, a Dice similarity coefficient of 0.665 for segmentation, and a classification performance with an area under the curve at receiver operating characteristics analysis of 0.978, a sensitivity of 0.946, and a specificity of 0.936. Segmentation but not classification performance of DCE-MRI improved with information from DWI and FDG-PET. Feature ranking revealed that kinetic and spatio-temporal texture features had the highest contribution for lesion classification. 18 F-FDG-PET and morphologic features were less predictive., Conclusion: Our CAD enables the assessment of the relevance of mpPET/MRI features on segmentation and classification accuracy. It may aid as a novel computational tool for exploring different modalities/features and their contributions for the detection and classification of breast lesions.

Objective: To compare the performance of synthetic mammography (SM) and digital mammography (DM) with digital breast tomosynthesis (DBT) or alone for the evaluation of microcalcifications., Methods: This retrospective study includes 198 mammography cases, all with DM, SM, and DBT images, from January to October 2013. Three radiologists interpreted images and recorded the presence of microcalcifications and their conspicuity scores and final BI-RADS categories (1, 2, 3, 4a, 4b, 4c, 5). Readers' area under the ROC curves (AUCs) were analyzed for SM plus DBT vs. DM plus DBT and SM alone vs. DM alone using the BI-RADS categories for the overall group and dense breast subgroup., Results: Conspicuity scores of detected microcalcifications were neither significantly different between SM and DM with DBT nor alone (p>0.05). In predicting malignancy of detected microcalcifications, no significant difference was found between readers' AUCs for SM and DM with DBT or alone in the overall group or dense breast subgroup (p>0.05)., Conclusions: Diagnostic performances of SM and DM for the evaluation of microcalcifications are not significantly different, whether performed with DBT or alone., Key Points: • In DBT-imaging, SM and DM show comparable performances when evaluating microcalcifications. • For BI-RADS classification of microcalcifications, SM and DM show similar AUCs. • DBT with SM may be sufficient for diagnosing microcalcifications, without DM.

Purpose of Review: The aim of this review is to summarize recently published literature addressing atypical ductal hyperplasia (ADH), lobular neoplasia (atypical lobular hyperplasia [ALH] and classic lobular carcinoma in situ [C-LCIS]), non-classic lobular carcinoma in situ (NC-LCIS), papillary lesions, and flat epithelial atypia (FEA)., Recent Findings: While ADH, ALN, and C-LCIS are well-established markers of an increased risk of future breast cancers, the risk implications are less clear for papillary lesions and FEA. NC-LCIS is the least well-characterized lesion, with scant published literature on its natural history and surgical management when encountered on needle biopsy. Recent data suggest that lobular neoplasia on core biopsy of a BI-RADS ≤ 4 concordant lesion does not require an excision, while ADH, atypical papillomas, and NC-LCIS should be excised. Evidence on FEA and papillomas without atypia suggests a low risk of upgrade on excision, and prospective studies on the upgrade of these lesions are ongoing.

Background: Tuberous breast (TB) is a rare congenital deformity, which may appear in different clinical forms representing various degrees of a single pathological entity. The worst cases are characterized by severe hypoplasia. Following a detailed analysis of the available relevant literature and a significant number of treated cases, in this article, the authors propose a new classification, with the aim of summarizing and simplifying a more intuitive categorization of the malformation, considering all the clinical aspects and including all types of TBs, even the minor ones, thus allowing a more immediate diagnosis and surgical planning., Methods: Between September 2006 and December 2015, 78 patients with TBs underwent surgical procedures to correct the deformity. The patients' mean age was 18.6 years, ranging between 17 and 26 years. There being 11 monolateral deformities, the treated TBs amounted to 145. A periareolar approach, adipo-glandular flaps, and dual plane breast implant placements were performed. Postoperative follow-up include photos collected 12 months after operation. The authors present a personal classification including all the forms of the deformity, plus the minor forms based on the following 2 principal categories: hypoplastic and normoplastic TBs, taking into account all the clinical aspects of the malformation including the morphology and the consistency of the breast., Conclusions: Preoperative identification of the type of the deformity is essential to obtain satisfactory results and a complete and intuitive classification including all the possible variants of the deformity, even the minor forms, and fundamental in diagnosing and resolving the problem. In this article, the authors propose a personal classification and surgical procedure to resolve the malformation.

Objectives: The study was to classify lesions identified on mammograms using Breast Imaging Reporting and Data System (BIRADS) grading method. This was in view of ascertaining the rate of occurrence of breast malignancy of the studied population., Methods: A retrospective cohort study of 416 mammographic reports of women was undertaken. The reports were written by consultant radiologists of 10 years' experience and above. The reports were evaluated and characterised using Breast Imaging Reporting and Data system (BIRADS). Demographic data of patients were sourced from the request cards. The data was entered into a proforma and analysed using SPSS version 17. All request cards with incomplete data were excluded from the study., Results: Using the BI-RADS Classification, the mammographic reports shows that 29.57% of the lesions were benign, and 4.57% were suspicious and biopsy recommended, while 3.60% were highly suggestive of malignancy. The right breast was predominantly affected with 42.7% of the patients (P<0.05)., Conclusion: Classification of breast lesion using BI-RADS grading system is a veritable tool in the diagnosis of the breast lesion. The present study shows that 3.6% of the population has a high index of malignancy.

Benign breast disease is a spectrum of common disorders. The majority of patients with a clinical breast lesion will have benign process. Management involves symptom control when present, pathologic-based and imaging-based evaluation to distinguish from a malignant process, and counseling for patients that have an increased breast cancer risk due to the benign disorder.

Background and Aim: The use of conventional needle core biopsy for palpable masses and vacuum-assisted needle core biopsy for microcalcifications has significantly increased the preoperative diagnosis rate, but the strategy for those patients with lesions of uncertain malignant potential (B3) still remains controversial. The aim of this study was to evaluate the positive predictive value (PPV) of the malignancy of B3 lesions in order to establish their correct management in the setting of a multidisciplinary care pathway., Methods: Data from all patients who had a Needle Core Biopsy (NCB) or a Vacuum-Assisted Needle Core Biopsy (VANCB) between 2005 and 2014 were retrospectively collected and analyzed. The B3 patients were discussed by the Multidisciplinary Team (MDT) deciding for surgery or for follow-up, based on a score in which clinical-instrumental factors and environmental factors were considered. The PPV of malignancy of all surgically excised B3 lesions was calculated., Results: One hundred and seventy-eight B3 NCBs were included in the study and Atypical Epithelial Proliferation of Ductal Type (AEDPT) was the most represented subcategory. The final histopathology report of the 128 patients operated on showed 94 benign and 34 malignant lesions. The PPV of B3 patients referred to surgery was 26.5%., Conclusion: B3 patients should be evaluated by a breast MDT in order to make the right therapeutic decision, in particular for patients with contrasting clinical/diagnostic findings. Larger prospective studies are required to assess the definitive PPV of each B3 subcategory., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Aim: This survey investigated the variation in the use of the breast core biopsy categories B1 normal and B2 benign., Method: A survey with case scenarios was circulated to 701 breast pathologists in the UK., Results: The response rate was 40%. If there was concordance between the radiological and histological findings, then there was a clear consensus on the appropriate B category. However, if there was discordance between the radiological and histological findings, then frequently there was poor agreement on the appropriate category. Analysis of these cases and supplementary questions on the criteria used to make a pathological categorisation showed that some pathologists are influenced by the radiological features or by the multidisciplinary discussion, rather than just using the histological features., Conclusions: This survey shows that pathologists frequently do not follow the National Health Service breast screening guideline that B categories should be based solely on the histological changes., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

In the last few years, diagnostics of high-risk breast lesions (atypical ductal hyperplasia [ADH], flat epithelial atypia [FEA], lobular neoplasia: atypical lobular hyperplasia [ALH], lobular carcinoma in situ [LCIS], radial scar [RS], usual ductal hyperplasia [UDH], adenosis, sclerosing adenosis [SA], papillary breast lesions, mucocele-like lesion [MLL]) have increased with the growing number of breast percutaneous biopsies. The management of these lesions is highly conditioned by the enlarged risk of breast cancer combined with either an increased probability of finding cancer after surgery, either a possible malignant transformation (in situ or invasive cancer), or an increased probability of developing cancer on the long range. An overview of the literature reports grade C recommendations concerning the management and follow-up of these lesions: in case of ADH, FEA, ALH, LCIS, RS, MLL with atypia, diagnosed on percutaneous biopsies: surgical excision is recommended; in case of a diagnostic based on vacuum-assisted core biopsy with complete disappearance of radiological signal for FEA or RS without atypia: surgical abstention is a valid alternative approved by multidisciplinary meeting. In case of ALH (incidental finding) associated with benign lesion responsible of radiological signal: abstention may be proposed; in case of UDH, adenosis, MLL without atypia, diagnosed on percutaneous biopsies: the concordance of radiology and histopathology findings must be ensured. No data is available to recommend surgery; in case of non-in sano resection for ADH, FEA, ALH, LCIS (except pleomorphic type), RS, MLL: surgery does not seem to be necessary; in case of previous ADH, ALH, LCIS: a specific follow-up is recommended in accordance with HAS's recommendations. In case of FEA and RS or MLL combined with atypia, little data are yet available to differ the management from others lesions with atypia; in case of UDH, usual sclerosing adenosis, RS without atypia, fibro cystic disease: no specific follow-up is recommended in agreement with HAS's recommendations., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Management of the tuberous breast represents one of the greatest surgical challenges in aesthetic breast surgery, requiring careful assessment and a methodical approach to obtain an acceptable result. The surgeon must be familiar with multiple techniques that can be performed individually or may be combined to address various aspects of the tuberous deformity. This article describes the etiology, anatomic features, identification, and classification of the tuberous breast, focusing on surgical management and potential pitfalls. Through case study, expected outcomes in the management of this complex problem are described., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: Owing to advances in ultrasound (US) technology, optimal US techniques with a high-frequency transducer can identify more and more breast lesions. However, some lesions show up as non-mass-like lesions, which are difficult to be correctly identified and often result in missed diagnosis and misdiagnosis. The purpose of the present study was to develop a classification of the US features of non-mass-like breast lesions correlated with pathology, so as to improve the diagnostic accuracy of US in non-mass-like breast lesions., Materials and Methods: A total of 854 breast lesions in 836 consecutive women scheduled for US-guided core-needle biopsy or US-guided vacuum-assisted biopsy between May 2008 and October 2011 were initially included in this study. Finally, 80 breast lesions in 78 women were classified as non-mass-like lesion and included in this study. The US features of the 80 non-mass-like breast lesions were classified and their correlation with pathology was analysed., Results: Of the 80 non-mass-like breast lesions, 43 cases (53.8 %) were malignant and 37 cases (46.2 %) were benign. Fifty-two cases (73.7 %) appeared as a hypoechoic area, 22 cases (21.1 %) appeared as a hypoechoic area with sporadic or clustered microcalcification, four cases appeared as architectural distortion, and two cases appeared as solid echogenicity within a duct. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of US for non-mass-like breast lesions were 71.25, 95.35, 43.24, 66.13 and 88.89 %, respectively. The finding of a hypoechoic area with microcalcification showed a statistically significant association with malignant lesions and its positive predictive value for carcinoma was 78.26 %., Conclusion: Non-mass-like breast lesions usually appeared as a hypoechoic area or a hypoechoic area with microcalcification. The finding of a hypoechoic area with microcalcification had a close correlation with malignant lesions. US had a high sensitivity but a low specificity in the diagnosis of non-mass-like breast lesions and a definitive diagnosis requires a US-guided biopsy.

Objective: the aim of this study was to investigate the addition of elastography to the BI-RADS® lexicon for the classification of breast lesions., Methods: a total of 955 consecutive patients who were subjected to breast percutaneous biopsy from January 2010 to December 2012 were retrospectively assessed. Overall, 26 patients who did not present with masses on conventional ultrasound were excluded. The patients were classified according to the fifth edition of the breast imaging and reporting data system (BI-RADS®) lexicon, which includes elastographic findings. The BI-RADS®classification is based on the same classification principles that have been suggested by the author, which classify lesions as soft, intermediate, or hard., Results: the addition of elastographic findings to the BI-RADS® lexicon improved the sensitivity (S), specificity (SP), and diagnostic accuracy (DA) of ultrasound in the assessment of breast lesions, which increased from 93.85, 72.07, and 76.64 to 95.90, 80.65, and 91.39%, respectively., Conclusion: these findings suggest that the addition of elastography to the BIRADS ® lexicon will improve the SP and DA of ultrasound in the screening of breast lesions.

Purpose: To develop a new computer-aided diagnosis (CAD) scheme using a content-based image retrieval (CBIR) approach for classification between the malignant and benign breast lesions depicted on the digital mammograms and assess CAD performance and reproducibility., Methods: An image dataset including 820 regions of interest (ROIs) was used. Among them, 431 ROIs depict malignant lesions and 389 depict benign lesions. After applying an image preprocessing process to define the lesion center, two image features were computed from each ROI. The first feature is an average pixel value of a mapped region generated using a watershed algorithm. The second feature is an average pixel value difference between a ROI's center region and the rest of the image. A two-step CBIR approach uses these two features sequentially to search for ten most similar reference ROIs for each queried ROI. A similarity based classification score was then computed to predict the likelihood of the queried ROI depicting a malignant lesion. To assess the reproducibility of the CAD scheme, we selected another independent testing dataset of 100 ROIs. For each ROI in the testing dataset, we added four randomly queried lesion center pixels and examined the variation of the classification scores., Results: The area under the ROC curve (AUC) = 0.962 ± 0.006 was obtained when applying a leave-one-out validation method to 820 ROIs. Using the independent testing dataset, the initial AUC value was 0.832 ± 0.040, and using the median classification score of each ROI with five queried seeds, AUC value increased to 0.878 ± 0.035., Conclusions: The authors demonstrated that (1) a simple and efficient CBIR scheme using two lesion density distribution related features achieved high performance in classifying breast lesions without actual lesion segmentation and (2) similar to the conventional CAD schemes using global optimization approaches, improving reproducibility is also one of the challenges in developing CAD schemes using a CBIR based regional optimization approach.

Filariasis is a parasitic disease with a benign course caused by nematodes. Filariasis is endemic in some tropical regions, and immigration has made it increasingly common in some centers in Spain. The death of the parasites can lead to calcifications that are visible in mammograms; these calcifications have specific characteristics and should not be confused with those arising in other diseases. However, the appearance of calcifications due to filariasis is not included in the most common systems used for the classification of calcifications on mammograms (BI-RADS), and this can lead to confusion. In this article, we discuss the need to update classification systems and warn radiologists about the appearance of these calcifications to ensure their correct diagnosis and avoid confusion with other diseases., (Copyright © 2014 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Goal: The presence of microcalcification clusters is a primary sign of breast cancer; however, it is difficult and time consuming for radiologists to classify microcalcifications as malignant or benign. In this paper, a novel method for the classification of microcalcification clusters in mammograms is proposed., Methods: The topology/connectivity of individual microcalcifications is analyzed within a cluster using multiscale morphology. This is distinct from existing approaches that tend to concentrate on the morphology of individual microcalcifications and/or global (statistical) cluster features. A set of microcalcification graphs are generated to represent the topological structure of microcalcification clusters at different scales. Subsequently, graph theoretical features are extracted, which constitute the topological feature space for modeling and classifying microcalcification clusters. k-nearest-neighbors-based classifiers are employed for classifying microcalcification clusters., Results: The validity of the proposed method is evaluated using two well-known digitized datasets (MIAS and DDSM) and a full-field digital dataset. High classification accuracies (up to 96%) and good ROC results (area under the ROC curve up to 0.96) are achieved. A full comparison with related publications is provided, which includes a direct comparison., Conclusion: The results indicate that the proposed approach is able to outperform the current state-of-the-art methods. Significance: This study shows that topology modeling is an important tool for microcalcification analysis not only because of the improved classification accuracy but also because the topological measures can be linked to clinical understanding.

Background: Breast diseases are rising in incidence especially in developing countries. However, most research focuses on breast cancer. Analysing the spectrum of breast disease will enable establishment of efficient breast clinics within an existing general surgery out-patient department with minimal additional investment or personnel whilst providing quality care., Objectives: To study the spectrum of breast disease in an urban general surgical centre in India. To use a `Clinic-within-a-Clinic' model to provide affordable care and accurate early diagnosis to patients with breast disorders., Materials & Methods: A prospective study was conducted over 1 year at M. S. Ramaiah Hospital, Bangalore by a single general surgical unit. 903 patients who presented to the OPD with a variety of breast-related symptoms were included in the study (896 women and 7 men). Relevant history was taken; the patients were then examined and investigated according to our protocol and patterns were recognized., Results: Benign breast disease formed the majority of the cases (640 patients, 70.87%). The 21-30 years age group had the most patients (272 patients, 30.12%). ANDI was the commonest diagnosis (522 patients, 57.8%). 92 patients (10.18%) were diagnosed with cancer. More than 50% of these were less than 50 years of age. Majority of the patients (511 patients, 56.58%) could be managed conservatively. The cost of diagnosis and treatment was found to be a small fraction of that in specialized breast units of western countries using our `Clinic-within-a-clinic' model., Conclusion: Research on the demographic and clinical pattern of breast disease can help establish and efficient, effective and affordable diagnostic and therapeutic systems in developing nations.

Objective: We aimed to assess the cytological findings from fine-needle aspiration (FNA) of breast lesions with conventional smear (CS) and SurePath® (SP) cytology., Study Design: This was a cross-sectional study of women who underwent FNA from January 2012 to June 2013 for breast lesions with benign ultrasonography impressions in Fortaleza, Brazil. Two groups were formed. The first was composed of 102 samples subjected to CS and the second of 65 samples subjected to SP. The number of smears, the cellularity and the diagnostic hypotheses were compared. Fisher's exact tests with 95% confidence intervals were applied., Results: The women ranged in age from 22 to 75 years. SP cytology indicated greater cellularity than CS for the cystic lesions (p < 0.05). In the CS group, 72.5% of the samples required 3-4 slides, but in the SP group, only 9.2% required a second slide. The cellularity of the cystic samples was significantly greater with the SP method (p < 0.01)., Conclusion: In FNA cytology of the breast, SP is a tool that is comparable to CS, but with the added benefits of better cellularity results for cystic lesions and requiring fewer slides for analysis., (© 2015 S. Karger AG, Basel.)

Microcalcifications are actually indirect signs of pathological processes, and only a few of these processes may be correctly correlated to the morphologic pattern of calcifications. This is true of the microcalcifications typically classified as benign by the 4th edition of the BI-RADS Atlas, except for round and punctuate microcalcifications. This is also the case of polymorphous fine and linear fine microcalcifications most often, but not exclusively, associated with DCIS with necrosis. For other types of microcalcifications, other parameters are analyzed in a more global approach: the associated clinical or mammographical signs; the context, especially genetic; the spatial distribution; the number; the evolution over time. The radiologist should compare the images with the anatomy of the terminal ductal-lobular unit, from where most cancers arise, and estimates the risk by taking into account the clinical context and the antecedents., (Copyright © 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

The accuracy of an ultrasound (US) computer-aided diagnosis (CAD) system was evaluated for the classification of BI-RADS category 3, probably benign masses. The US database used in this study contained 69 breast masses (21 malignant and 48 benign masses) that at blinded retrospective interpretation were assigned to BI-RADS category 3 by at least one of five radiologists. For computer-aided analysis, multiple morphology (shape, orientation, margin, lesions boundary, and posterior acoustic features) and texture (echo patterns) features based on BI-RADS lexicon were implemented, and the binary logistic regression model was used for classification. The receiver operating characteristic curve analysis was used for statistical analysis. The area under the curve (Az) of morphology, texture, and combined features were 0.90, 0.75, and 0.95, respectively. The combined features achieved the best performance and were significantly better than using texture features only (0.95 vs. 0.75, p value = 0.0163). The cut-off point at the sensitivity of 86 % (18/21), 95 % (20/21), and 100 % (21/21) achieved the specificity of 90 % (43/48), 73 % (35/48), and 33 % (16/48), respectively. In conclusion, the proposed CAD system has the potential to be used in upgrading malignant masses misclassified as BI-RADS category 3 on US by the radiologists.

The tuberous breast classification proposed by Grolleau does not account for a minor form of the deformity characterized by isolated nipple-areola protrusion with a normal breast base. We have observed this minor form in six patients with normal breast shape and in ten patients with hypertrophic breasts. We propose an anatomical and physiological hypothesis for the development of the mammary gland. The breast is subjected to hormonal influences as early as the prepubertal period. These influences result in thrusting forces with both horizontal (estrogen) and vertical (progesterone) vectors, unfortunately not always balanced and harmonious. Close observation of the anomaly in our patients substantiated the basic anatomical defect, namely, the structural congenital dermal weakness of the nipple-areola complex (NAC) already described in all forms of tuberous breast deformity. This weakness explains the morphologic anomaly and confirms that all types of tuberous breast deformity constitute a spectrum of a single entity. It indicates also that the classification of tuberous breasts should include, in addition to the three types (types I-III) already described, a fourth type (type 0) to describe isolated simple areola protrusion, either permanent or intermittent, that is associated with a normal mammary base. The revised classification of tuberous breasts and the proposed hypothesis of breast development allow better assessment of all possible variants of breast morphologic anomalies. In the six cases of isolated herniated NAC, the deformity was corrected through a perinipple approach (not circumareolar), with adequate stable correction of the deformity and minimal scarring.

Our study involved 870 eligible women with suspected pathological breast lesion discovered by mammography (MMG) or ultrasound examination (USG) which were recommended to pass histological examination to verify the diagnosis. All patients included in our study were divided into two age groups: the 1st group - patients older than 40 years (total of 724 patients) , the 2nd group - patients younger than 40 years (total of 146 patients). The purpose of our study was to analyze the possibilities of electrical impedance tomography (EIT) implementation to the differential diagnosis of pathologic lesions of the breast either solely, or in a combination with MMG/USG. The following results were obtained: in the 1st group the average specificity of MMG was 79.5%; when added EIT the average specificity decreased to 72.8%. The sensitivity of MMG, by contrast, increased from 87.8% when using it as an independent method to 94.5% when added EIT. In the 2nd group the average specificity of USG was 90.2%; when added EIT the average specificity decreased to 86.4%. Similarly, as in the 1st group the sensitivity of USG increased from 86.7% when using it as an independent method to 93.3% when added EIT.Analysis of false-negative results of electrical impedance tomography depending on the stage of the process has shown that as the earlier stage of the disease and as the smaller is the dimensions of the tumor, the higher is the number of false-negative results. In addition, we observed the dependence of the false-negative results of the tumor grade. The results of our study show that the use of EIT in addition to MMG/USG can improve the sensitivity of these methods and to increase the rate of early detection of breast cancer with minimal economic costs and highly qualified staff time expenditures.

To determine the pattern of disease in patients presenting with breast lumps and to determine the sensitivity and specificity of fine needle aspiration cytology of benign and malignant diseases as a diagnostic tool by correlating with histopathology findings. This retrospective study was carried out in the Department of Pathology, Maharaja Agrasen Medical College, Agroha, from Jan 2008 to April 2012. Fine needle aspiration cytology was performed on 370 cases and out of these 52 cases were received in the Department for histopathological examination. Fibroadenoma was the most common disease encountered, in 88 (24%), with a peak incidence in second and third decade of life. Fibrocystic disease was second, being common in the third and fourth decades of life. Peak incidences of duct ectasia, granulomatous and tubercular mastitis were seen in the third decade. Gynaecomastia showed two peak incidences in second and sixth decades of life . Out of total 370 cases undergoing fine needle aspiration, benign cases were 316 (85.4%), malignant and suspicious were 54 (14.6%) and 10 (2.70%) respectively. Out of total 22 histological confirmed malignant lesions 19 were interpreted as malignant cytologically while two as suspicious and one as benign. All thirty histologically confirmed benign cases were diagnosed as benign cytologically. The sensitivity, specificity, positive and negative predictive values were 98%, 100%, 100% and 96.4% respectively. FNA cytology is highly accurate for diagnosis of breast masses. However, the clinician should correlate FNA cytological results with physical examination and imaging findings to prevent false negative and false positive events and to obtain optimal management of their patients.

Mondor's disease (MD) is a rare and self-limited benign disease first described in 1939. Originally its clinical presentation was a superficial vein thrombosis (SVT) without contiguous skin inflammation of the chest wall veins. Over time its definition has evolved and now also includes subcutaneous thrombosis of the dorsal vein of the penis but also retractile scarring of the fascia after breast surgery without concomitant SVT. In all cases clinical examination constitutes the first step of diagnostic management. It is followed by an ultrasound exploration (US) to search for a thrombus. In about half of all cases the disease is considered as idiopathic and cancer is rare. Whatever the location considered, the follow-up is usually uneventful with low rates of recurrence and of subsequent cancer. Treatment is debated and ranges from therapeutic abstention to anticoagulants or even surgery. It is likely that the new locations and mechanisms (without thrombosis) of the MD have lead to the constitution of a heterogeneous entity precluding from a consensual mode of care., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Benign conditions of the breast are common, but a great deal of confusion exists in their nomenclature, classification, and, treatment protocols. The Aberration of Normal Development and Involution (ANDI) classification provides a comprehensive framework within which to correlate clinical presentation with pathogenesis. Most clinical studies have not used this classification system. We studied the spectrum of benign breast conditions in Indian patients with reference to the ANDI system and performed a clinicopathologic correlation., Methods: This prospective study was carried out on 262 consecutive patients attending the surgery department on an outpatient basis for benign breast conditions., Results: A total of 199 (76 %) patients had a diagnosis of benign breast disorder, and 44 (17 %) had benign breast disease. There were 19 (7 %) women with non-ANDI and other conditions. The spectrum of benign breast disorders included fibroadenoma 77, mastalgia with nodularity 98, galactocele 7, cysts 4, and nipple discharge (ND) 13. Benign breast diseases included giant/multiple fibroadenomas 18, incapacitating mastalgia and nodularity 13, subareolar abscess with mammary fistula 7, periductal mastitis with suppuration 4, and ND 2. Cytopathologic correlation performed in 115 patients showed nonproliferative disease in 82, proliferative disease without atypia in 19, proliferative disease with atypia in 3, and miscellaneous 11., Conclusions: The ANDI classification is a comprehensive system that delineates the borderline between normal and abnormal, achieves correlation of clinical signs and symptoms with histologic changes, and provides risk stratification and pragmatic definition of management protocols.

On behalf of the NHS Breast Screening Programme Pathology Coordinating Group we present recommendations for terminology and diagnostic criteria for a number of key areas of practice in breast pathology where terminology can be confusing and where accurate communication will ensure appropriate clinical management. These recommendations cover columnar cell lesions and the spectrum of changes that can be seen in these epithelial proliferations, lobular neoplasia, micrometastases and isolated tumour cells in axillary lymph nodes, the use of basal/myoepithelial markers in diagnostic practice and oestrogen receptor testing in ductal carcinoma in situ.

Fine needle aspiration, an accepted minimally invasive diagnostic procedure for breast masses, leads to an indeterminate (borderline) diagnosis in a significant proportion of cases. This study was aimed at evaluation of the utility of image analysis and morphometry in the cytologic assessment of borderline breast cases. A 'study' group of 45 cases (including fibroadenoma, fibrocystic change and ductal carcinoma) and a 'test' group of 25 cytologically borderline cases were included. Nuclei from each of the groups (nuclei of monolayer sheet of fibroadenoma, naked nuclei of fibroadenoma, ductal cells nuclei of fibrocystic change and nuclei of carcinoma) were manually traced and analyzed using self-written image analysis software. Discriminant analysis was done on the 'study' group and the resultant discriminant functions were applied to the 'test' group. The percentage of nuclei correctly classified of the study as well as test group was noted. On step-wise discriminant analysis, various morphometric, textural parameters and color information parameters were selected. Of the original 'study' group, 98.49% of nuclei could be correctly classified. No overlapping of benign and malignant nuclei was observed in the 'study' group. When the resulting functions were tested on the 'test' group, all the cases were correctly classified as benign or malignant (compared with the final histologic diagnosis). This study suggests that application of computerized image analysis to cytologically borderline breast cases can help in the classification of these cases as benign or malignant. This may prevent unnecessary surgery in many of these cases., (Copyright © 2010 Wiley Periodicals, Inc.)

Aim: To assess whether the BI-RADS classification in MR-Mammography (MRM) can distinguish between benign and malignant lesions., Material and Method: 207 MRM investigations were categorised according to BI-RADS. The results were compared to histology. All MRM studies were interpreted by two examiners. Statistical significance for the accuracy of MRM was calculated., Results: A significant correlation between specific histology and MRM-tumour-morphology could not be reported. Mass (68%) was significant for malignancy. Significance raised with irregular shape (88%), spiculated margin (97%), rim enhancement (98%), fast initial increase (90%), post initial plateau (65%), and intermediate T2 result (82%). Highly significant for benignity was an oval mass (79%), slow initial increase (94%) and a hyperintense T2 result (77%), also an inconspicuous MRM result (77%) was often seen in benign histology. Symmetry (90%) and further post initial increase (90%) were significant, whereas a regional distribution (74%) was lowly significant for benignity., Conclusion: On basis of the BI-RADS classification an objective comparability and statement of diagnosis could be made highly significant. Due to the fact of false-negative and false-positive MRM-results, histology is necessary.

Although breast lesions are commonly detected because of their hypoechogenicity, some lesions may present with hyperechogenicity due to their histological components. Hyperechogenicity has been shown to be highly predictive of benignity; however, hyperechoic lesions can occasionally be malignant. This article reviews hyperechoic lesions of the breast, describes the underlying histological causes associated with hyperechogenicity, and the sonographic features useful for the differential diagnosis between benign and malignant hyperechoic lesions., (Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Aims: To provide updated evidence of the outcome of breast lesions of uncertain malignant potential (B3) and suspicious of malignancy (B4) diagnosed on needle core biopsy (NCB) and analyse the outcome of the different types of intraductal epithelial atypia., Methods and Results: One-hundred and forty-nine B3 and 26 B4 NCBs diagnosed over a 2-year period (2007-2008) were compared with those diagnosed over a previous 2-year period (1998-2000). The proportion of B3 diagnoses increased from 3.1% to 4.5%, and the positive predictive value (PPV) of malignancy of a B3 core decreased from 25% to 10%. Increased diagnosis of radial scar and reductions in the PPV of lobular neoplasia and of atypical intraductal proliferation may explain the reduction in the PPV of the B3 group as a whole. There were no significant changes in the proportion of B4 diagnosis (1.1% and 0.8%) or the PPV of B4 (83% and 88%). Review of cores with intraductal atypia showed a wide range of PPVs, from 100% for suspicious of ductal carcinoma in situ, to 40% for atypical ductal hyperplasia categorized as B3, and 14% for isolated flat epithelial atypia., Conclusion: The study has found a decrease in the PPV for a B3 diagnosis and suggests possible explanations., (© 2011 Blackwell Publishing Limited.)

The MR imaging BI-RADS atlas includes a category for probably benign findings, and many radiologists recommend short-term interval follow-up for breast MR imaging lesions. However, the characteristics of those MR imaging findings that could appropriately be considered probably benign are not well defined. This article reviews the published retrospective and prospective data regarding the use and cancer yield of the BI-RADS 3 assessment category as well as the morphology and kinetics of lesions that may be considered suitable for short-term follow-up. Consideration is also given to how the costs, clinical indication for the examination, experience of the reader, and availability of comparisons may affect the use of the BI-RADS 3 category. Based on the evidence that is available, an algorithm is offered with imaging examples as a guide for determining if lesions are appropriate for short-term follow-up. Additional research is needed to fully clarify the distinct morphologic and kinetic characteristics that allow patients to safely avoid biopsy without changing prognosis if malignancy is present., (Copyright 2010 Elsevier Inc. All rights reserved.)

In this study, the authors proposed a classification of inflammatory breast disorders based on which a practical systematic scheme in diagnosis was applied aiming to differentiate simple forms of mastitis from more complicated and malignant forms. The study population included 197 female patients who were clinically or pathologically diagnosed as having mastitis. All patients underwent Ultrasound examination. Mammography was performed for 133/197 cases. Cases of simple mastitis and periductal mastitis were followed up to ensure complete resolution. Abscess cavities and postoperative collections were drained. Other cases were biopsied to confirm diagnosis and were managed accordingly by their treating physicians. Statistical analysis was performed by the Statistical Package for Social Science. Nominal Data were expressed as frequency and relative frequencies (percentage). Ultrasound and Mammography categorical results were compared using the Pearson Chi Square and Fisher's exact test. Patients were classified into three groups; infectious, noninfectious and malignant mastitis. Simple and malignant forms of mastitis showed many signs in common. The presence of ill defined collections and abscess cavities on ultrasound favored simple over malignant forms of mastitis while extensive skin thickening and infiltrated malignant nodes favored malignant forms. Interstitial edema, edematous fat lobules, abscess cavities, skin thickening seen on ultrasound examination were significantly lower in noninfectious than simple and malignant mastitis. Mammography signs were less discriminating. Diffuse skin thickening and increased density favored malignant mastitis while dilated retro areolar ducts and characteristic calcification patterns favored noninfectious forms. Simple mastitis showed nonspecific signs. Ultrasound examination in mastitis cases shows more specific signs in differentiating between the three forms of mastitis and is useful in monitoring treatment, excluding complications and guide for interventional procedures. Mammography should be performed whenever complicated, malignant and uncommon forms of mastitis are suspected.

Purpose: Proposal for the classification of breast masses through ultrasound elastography in order to differentiate benign and malignant lesions with histological correlation., Materials and Methods: 188 patients enrolled for percutaneous biopsy of 228 breast lesions. Elastography was performed and interpreted according to criteria created by the authors, with scores varying from 1 to 4 based on elasticity of images obtained upon release of compression. These results were compared with the histological results; elasticity scores of 1 and 2 were considered benign, a score of 3 as probably benign, and 4 as suspicious for malignancy. Positive predictive value, specificity, and diagnostic accuracy have been calculated. The results were evaluated using Fisher's exact test and the analysis of the receiver operating characteristic (ROC) curve to determine the association with the histological results, and diagnostic accuracy of the proposed classification., Results: The positive predictive value, specificity, and diagnostic accuracy of the scores were 76.5%, 95.9%, and 94.7%, respectively. Of 228 lesions tested, 26 tests yielded true positive results; 8 yielded false positive results; 190 true negative results; and 4 false negative results. There was association with the histological results by the Fisher method (P < 0.05) and an excellent area below the ROC curve of 0.954 (confidence range of 95%, 0.925-0.982)., Conclusion: The classification by elastography proposed by the authors can be used as an important tool combined with ultrasonographic studies for differentiating benign and malignant lesions of the breast.

Standardisation of the classification of breast imaging reports will improve communication between the referrer and the radiologist and avoid ambiguity, which may otherwise lead to mismanagement of patients. Following wide consultation, the Royal College of Radiologists Breast Group has produced a scoring system for the classification of breast imaging. This will facilitate audit and the development of nationally agreed standards for the investigation of women with breast disease. This five-point system is as follows: 1, normal; 2, benign findings; 3, indeterminate/probably benign findings; 4, findings suspicious of malignancy; 5, findings highly suspicious of malignancy. It is recommended that this be used in the reporting of all breast imaging examinations in the UK.

Background: The fine-needle aspiration (FNA) diagnosis of proliferative breast lesion is an indeterminate category. The aim of this correlative study was to determine whether a subcategory of "proliferative breast lesion with atypia" was achievable and whether this subcategory has management utility., Methods: Breast FNA cases from 2000 through 2005 diagnosed as proliferative breast lesion and proliferative breast lesion with atypia were retrieved. Both cytologic and surgical slides of these cases were reviewed blindly. A cytologic diagnosis of proliferative breast lesion (without atypia) or proliferative breast lesion with atypia was used if the findings of the proliferative breast lesion did not fit a more specific category., Results: Of the 3934 breast FNAs performed on palpable breast masses from January 2000 to December 2005 at the LAC + USC Medical Center, 317 (8.1%) were diagnosed cytologically as proliferative breast lesion with atypia, without atypia or without mention of atypia. There was subsequent histopathology on 201 of these cases. After the cytologic smears were reviewed, 29 cases were excluded from this study. Of the 172 remaining cases, 21 (12.2%) were found to be malignant and the remaining 151 (87.8%) were found to be benign on histology. Of the malignant cases, 90% had an FNA diagnosis of proliferative breast lesion with atypia; of the benign cases, 78% were interpreted as proliferative breast lesion without atypia., Conclusions: Proliferative breast lesion with atypia was clinically significant because it was associated with a significantly increased likelihood of malignancy compared with proliferative breast lesion without atypia. Most of the malignancies had hypocellularity or low nuclear grade on the FNA smears. Fibroadenoma accounted for most of the benign lesions in both proliferative breast lesion and proliferative breast lesion with atypia., ((c) 2009 American Cancer Society.)

Introduction: In surgical residency education, "hands-on" learning is important in the operating room. Mastering the interpretation of preoperative data is a must for intraoperative decisions. Because preoperative evaluations of breast masses by ultrasound are performed and interpreted in the Department of Radiology, our study aimed to assess and improve surgical residents' ability to perform ultrasound and to interpret their results before performing breast mass biopsies., Methods: Between January 2000 and May 2007, 128 female patients found to have palpable breast masses were scheduled for biopsy. An on-table ultrasound was performed by a surgical resident under the supervision of an attending surgeon. The resident was unaware of the result reported by the Department of Radiology. The parameters used to evaluate on-table ultrasound were the echogenicity, diameter (transverse vs vertical), and margins (regular vs irregular) of patients' lesions. Based on these criteria, residents classified lesions as benign, malignant, or indeterminate. The results were compared with the preoperative ultrasound evaluations provided by the Department of Radiology and pathology reports., Results: Eliminating the 10 indeterminate lesions on ultrasound, the residents found that 87 lesions were benign and 31 lesions were malignant. The residents' assessment of the breast lumps had a sensitivity of 90.32% and a specificity of 96.55%, with a positive predictive value of 90.32% and a negative predictive value of 96.55%., Conclusions: The residents' overall accuracy of 94.91% approximates that of the radiologists in differentiating between benign and malignant lesions. The study allowed us to assess the knowledge and skills of residents who responded as required by Accreditation Council for Graduate Medical Education core competencies.

Objective: To review the histology of breast biopsies carried out in our hospital with a view to designing management and preventive strategies., Patients and Methods: 179 patients who had breast biopsies over a five year-period (January 1999 - December 2003) were included in the study. The patients were sorted out from the records in both the casualty and main theatres of the hospital. The medical records from their case files were analysed in terms of age, sex and the histology of the tissue obtained on biopsy., Results: Benign breast lesions accounted for 73.2% with fibroadenoma constituting a greater percentage. Whereas benign breast lesions were most commonly encountered in the third decade of life, malignant lesions occurred most commonly in the fourth decade. After the age of 60, all the cases analysed were of the malignant variety., Conclusion: Young patients with breast lump should be encouraged to come for consultation as most of them are benign. However, any lump in a woman above 30 should be properly screened for cancer. Similarly, any patient who presents with a breast lesion after the age of 60 should be regarded as having breast cancer until proved otherwise.

As a consequence of breast imaging development and increased interventional radiology, benign epithelial breast diseases (BEBD) represent a growing percentage of breast pathology diagnoses. BEBD include numerous entities such as cysts, fibrosis, adenosis, duct ectasia, which require neither surgery nor follow-up. Some BEBD have to be individualized (radial scars, papillomas, complex sclerosing adenosis, lobular intraepithelial neoplasia, flat epithelial atypia, atypical hyperplasia), being preinvasive lesions or markers of increased breast cancer risk, or being associated with suspect radiological aspect. BEBD should be managed in a pluridisciplinar way and correctly diagnosed by percutaneous biopsies or surgical specimens. The goals of surgery vary according to lesions. It always allows a complete surgical specimen analysis and therefore a search for atypical or cancerous cells. Surgery can also have a preventive role by reducing the risk of potential malignant transformation. Finally, it enables in some cases the excision of a radiologically suspect mass. So the aim of this review is to give a clinical and morphological description of most common BEBD, underlying their cancer risk, specific diagnosis, therapeutic, follow-up and psychological repercussions.

Purpose: the aim of this study is to evaluate the accuracy of mammography in the diagnosis of suspicious breast microcalcifications, using BI-RADS and Le Gal's classifications., Methods: one hundred and thirty cases were selected with mammograms contain only microcalcifications of file and initially classified as suspicious (categories 4 and 5) without lesions clinical detectable and reclassified by two examiners, getting a consensus diagnosis. The biopsies were reviewed by two pathologists getting also a consensus diagnosis. Both, mammogram and histopathologic analysis were double blinded reviewed. Chi-square test, Fleiss-square statistic and EPI-INFO 6.0 were used in this study., Results: the correlation between histopathological and mammographic analysis using BI-RADS and Le Gal classification showed the same sensitivity of 96.4%, specificity of 55.9 and 30.3%, positive predictive value (PPV) of 37.5 and 27.5%, and accuracy of 64.6 and 44.6% respectively. The PPV by BI-RADS categories was: category 2, 0%; category 3, 1.8%; category 4, 30.8%; and category 5, 60%. The PPV by Le Gal classification was: category 2, 3.1%; category 3, 18.1%; category 4, 26.4%;category 5, 66.7%, and non classified 5.2%., Conclusions: the results were better for the classification of BI-RADS, but it did not get to reduce the ambiguity in assessment of breast microcalcifications.