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Rationale and Objectives To quantitatively compare breast parenchymal texture between two Digital Breast Tomosynthesis (DBT) vendors using images from the same patients. Materials and Methods This retrospective study included consecutive patients who had normal screening DBT exams performed in January 2018 from GE and normal screening DBT exams in adjacent years from Hologic. Power spectrum analysis was performed within the breast tissue region. The slope of a linear function between log-frequency and log-power, β, was derived as a quantitative measure of breast texture and compared within and across vendors along with secondary parameters (laterality, view, year, image format, and breast density) with correlation tests and t-tests. Results A total of 24,339 DBT slices or synthetic 2D images from 85 exams in 25 women were analyzed. Strong power-law behavior was verified from all images. Values of β d did not differ significantly for laterality, view, or year. Significant differences of β were observed across vendors for DBT images (Hologic: 3.4±0.2 vs GE: 3.1±0.2, 95% CI on difference: 0.27 to 0.30) and synthetic 2D images (Hologic: 2.7±0.3 vs GE: 3.0±0.2, 95% CI on difference: -0.36 to -0.27), and density groups with each vendor: scattered (GE: 3.0±0.3, Hologic: 3.3±0.3) vs. heterogeneous (GE: 3.2±0.2, Hologic: 3.4±0.1), 95% CI (-0.27, -0.08) and (-0.21, -0.05), respectively. Conclusion There are quantitative differences in the presentation of breast imaging texture between DBT vendors and across breast density categories. Our findings have relevance and importance for development and optimization of AI algorithms related to breast density assessment and cancer detection.

Background Contrast-enhanced spectral mammography (CESM) is a relatively newly developed advanced application with modification of digital mammography by the use of a contrast agent, but still has little known efficacy among Egyptian patients. Our aim in this study is to share our initial experience in evaluating symptomatic patients with different ACR breast parenchyma especially in dense breast parenchyma as it is always challenging in diagnosis. Results CESM in this study gave a sensitivity of 92% and specificity of 85% in characterization of benign and malignant lesions. For postoperative cases, sensitivity was 85% and specificity was 60%. For chemotherapy cases, sensitivity was 85% and specificity was 76%. Contrast uptake was noted in 68% of masses. Cavitary benign lesions were noted in 22.1% of cases. Multifocal and multicentric carcinomas were detected in 39.7% of pathologically proved malignant masses. Statistical analysis revealed sensitivity, specificity, and accuracy of 82.9%, 76.5%, and 81.0% for conventional mammograms as compared to 92.7%, 82.4%, and 89.7% for CESM respectively. Conclusion CESM is a promising technique that can enhance the specificity of conventional mammograms. It is an easy, simple, and rapid contrast-based procedure, especially for characterization of lesions in dense breast parenchyma. It performs proper diagnosis for high-risk patients and follow-up response to different lines of management.

Objectives: The aim of this study is to evaluate thesuperior pedicle technique in reduction mammoplasty ofbreast hypertrophy.Background: Breast reduction is a common aestheticsurgical procedure. It aims not only at bringing the size ofthe breast proportionate to the build of the individual, butalso to decrease the discomfort caused by massive, ill-shapedand hanging breasts. The operative procedure reduces thebreast tissue mass and enhances aesthetic appearance Notechnique has been shown to be superior. The superior pedicletechnique preserves superior and medial breast fullness whileproviding appropriate resection of the breast parenchyma toreduce symptoms and produce a smaller, lifted breast withmore youthful appearance.Patients and Methods: We performed a retrospective chartreview of eighty (80) consecutive patients between September2015 and October 2019. All the patients underwent bilateralbreast reductions. Preoperative assessment including history,physical examination, breast ultrasound and mammography.Also preoperative breast measurements, mainly mid-claviclepoint to NAC distance were taken. Standard breast photographywas also carried out preoperative and 4 weeks postoperative.All patients were followed 1, 3 and 6 months postoperativefor complications and patient satisfaction.Results: Patient's age ranged from 20 to 55 years old.About 71.3% of the patients complained of preoperativephysical problems. The mean distance from mid-clavicle tonipple in our cases was 33.2 (19-39) cm. The mean length ofnipple transposition was 13.2cm, ranging from 3 to 18cm.The mean weight of breast tissue resection was 924g, rangingfrom 190 to 1800g. The overall postoperative complicationswere 20%, in the form of T-junction wound dehiscence (10%),mild soft tissue infection (3.8%), asymmetry (2.5%), unilateralpartial NAC necrosis (2.5%) and unilateral complete NACnecrosis (1.3%). 91.3% of the cases were satisfied, 5% acceptableand 3,8% dissatisfied regarding improvement ofsymptoms and size, shape and symmetry of the breasts.Conclusion: The superior pedicle technique is simple,safe and reliable technique in reduction mammoplasty withmaintaining upper and medial fullness and giving good aestheticresults.

Neoadjuvant chemotherapy is the standard of care for many women with early breast cancer, depending on the cancer's hormonal and genomic profile. Post-chemotherapy breast specimens are frequently encountered by the breast pathologist and present an interesting challenge in terms of specimen processing and reporting. We briefly review the literature on current recommendations for processing breast cancer specimens following neoadjuvant chemotherapy and present a case that emphasises the care needed in recognising reactive chemotherapy-related changes in non-neoplastic breast parenchyma to avoid over-diagnosing residual malignancy.

Background Obesity and high breast density both increase breast cancer risk but paradoxically are inversely related. Bariatric surgery decreases breast cancer risk, but its impact on mammographic breast density is not well understood. Objectives We investigated how mammographic density changes after bariatric surgery and whether this change is related to weight loss. Setting University of California, San Francisco Medical Center. Methods We reviewed records from 349 prospectively collected patients who underwent bariatric surgery between 2013 and 2015 and identified 42 women with pre- and postoperative screening mammograms within 1.5 years of surgery. We recorded body mass index (BMI), height and Breast Imaging Reporting and Data System density and calculated BMI loss and total weight loss. Data were analyzed in Stata 14.2. Results Average age was 54.2 years, mean preoperative BMI was 43.8 kg/m2, mean BMI lost was 30.9%, and total weight loss was 31.1% at 1.3 years. Over one-third had a change in mammographic breast density, which increased 93.3% of the time (P Conclusions Most women with a mammographic change had an increase in breast density, despite bariatric surgery being associated with reduced breast cancer risk. Baseline breast density was associated with a density change, but amount of weight loss was not. These findings suggest the metabolic effects of bariatric surgery have an effect on breast parenchyma independent of absolute BMI reduction or weight loss.

Primary malignant melanoma of the breast (PMMB) is a rare tumor with only a few case reports available in the literature. We report two cases of PMMB, one derived from the breast parenchyma and the other from the breast skin. The first case consisted of atypical epithelioid cells without overt melanocytic differentiation like melanin pigments. The tumor cells showed diffuse positivity for S100 protein, tyrosinase, and BRAF V600E. However, the tumor cells were negative for cytokeratin, epithelial membrane antigen, and HMB-45. The second case showed atypical melanocytic proliferation with heavy melanin pigmentation. The tumor cells were positive for S100 protein, HMB-45, tyrosinase, and BRAF V600E. These two cases represent two distinct presentations of PMMB in terms of skin involvement, melanin pigmentation, and HMB-45 positivity. Although PMMB is very rare, the possibility of this entity should be considered in malignant epithelioid neoplasms in the breast parenchyma.

Reduction mammoplasty using the inferior pedicle technique has been used for more than five decades. Without doubt, it has many advantages, especially in patients with moderate to severe macromastia. Although the esthetic outcome of reduction mammoplasty in the early postoperative period is usually satisfactory, typical esthetic drawbacks appear during the first year. These drawbacks include bottoming out, loss of superior fullness, box-shaped breasts, poor definition of the infra-mammary fold (IMF), elongation of the vertical scar, star gazing of the nipple-areola complex (NAC) and, of course, the scar burden. Parenchymal reshaping and suspension have been introduced as an additional step to eliminate the drawbacks of the inferior pedicle procedure. This is a prospective study done in a period from March 2016 to March 2018 in Kasr Al-Ainy Hospital (Cairo University hospitals) by the senior author and his team of co-authors. Reduction mammoplasty (Wise pattern) with the inferior pedicle and dermal wrap technique (using two dermal wings) was performed in 20 patients. The distance from the suprasternal notch (SSN) to the NAC was > 30 cm. The patients’ ages ranged from 28 to 55 years (average age, 39 years). Body mass index (BMI) ranged from 27 to 35 kg/m2 (average BMI, 33.3 kg/m2). The distance between the SSN and NAC ranged from 33 to 45 cm (average distance, 40 cm). The nipples were lifted by 11 to 19.5 cm. The distance from the nipple to the IMF ranged from 18 to 24 cm. This distance was reduced postoperatively to between 9 and 11.5 cm (p value

Breast cancer is the most common site-specific cancer among women and it is the leading cause of cancer related deaths among women. It accounts for 29% of all newly diagnosed cancers in females and is responsible for 14% of the cancer-related deaths in women. Approximately 1 in 8 women (13%) will be diagnosed with invasive breast cancer in their lifetime. Understanding the biological behavior and natural history of breast cancer has made breast-conserving therapy (BCT) the choice of treatment in early breast cancer. Oncoplastic breast surgery (OPS) has emerged as a new approach to allow wide excision for BCS without compromising the natural shape of the breast And since one of the main factors for good oncoplastic techniques is the cosmetic outcome, inframammary crease incision is a good choice as hidden scar in the breast envelope. Here we introduce a new approach for deep breast tumors through an inframammary incision and retro glandular exploration of breast parenchyma which is a simple and easily performed techniqu

Myofibroblastoma (MFB) is a relatively rare tumor of the breast parenchyma, which belongs to the family of the ‘benign stromal tumor of the breast’. Two cases of MFB of the breast are described. Radiological imaging is nonspecific in MFB, and pathological examination of needle biopsy or surgically resected specimen is necessary for the diagnosis. Surgery is recommended and considered curative without additional treatment; however, patients should be followed-up.

Current mastopexy techniques have evolved to decrease scar length and maintain a more consistent upper pole fullness, improving the breast shape. Many different approaches have tried to suspend breast tissues to achieve a more attractive upper pole. Most of the auto-augmentation mastopexy techniques use inferior-based breast parenchymal tissues to fill the upper part. This paper presents a modified approach to fill the breast's upper pole, with an inferolateral-based breast flap. The advantages of changing the inferior-based auto-augmentation technique to the inferolateral comprise improving blood supply and increasing repositioned breast flap's mobility. In our technique, the breast tissue used to auto-augment the upper pole receives its blood supply from pectoral perforators and lateral breast tissue. When surgeons need more flap mobility, they can raise the medial edge of this flap from the pectoral fascia to mobilize this flap higher on the chest wall, depending on the lateral blood supply. One other advantage is that when the inferolateral-based breast tissue is pulled in a superomedial direction to fill the upper part, the lateral ptotic breast tissues come closer to the breast meridian to meet with medial breast parenchyma easily. The tension on the vertical parenchymal suture line is reduced with this approach. Our technique can be used in most mastopexy operations and for all types of ptosis except for cases with insufficient breast volume. It brings safety to the auto-augmentation procedure and is also time-saving. The stability of breast shape and upper pole fullness lasts as long as other auto-augmentation procedures; therefore, it can be an excellent alternative to other techniques. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Contains fulltext : 232900.pdf (Publisher’s version ) (Open Access) PURPOSE: To develop a patient-based breast density model by characterizing the fibroglandular tissue distribution in patient breasts during compression for mammography and digital breast tomosynthesis (DBT) imaging. METHODS: In this prospective study, 88 breast images were acquired using a dedicated breast computed tomography (CT) system. The breasts in the images were classified into their three main tissue components and mechanically compressed to mimic the positioning for mammographic acquisition of the craniocaudal (CC) and mediolateral oblique (MLO) views. The resulting fibroglandular tissue distribution during these compressions was characterized by dividing the compressed breast volume into small regions, for which the median and the 25th and 75th percentile values of local fibroglandular density were obtained in the axial, coronal, and sagittal directions. The best fitting function, based on the likelihood method, for the median distribution was obtained in each direction. RESULTS: The fibroglandular tissue tends to concentrate toward the caudal (about 15% below the midline of the breast) and anterior regions of the breast, in both the CC- and MLO-view compressions. A symmetrical distribution was found in the MLO direction in the case of the CC-view compression, while a shift of about 12% toward the lateral direction was found in the MLO-view case. CONCLUSIONS: The location of the fibroglandular tissue in the breast under compression during mammography and DBT image acquisition is a major factor for determining the actual glandular dose imparted during these examinations. A more realistic model of the parenchyma in the compressed breast, based on patient image data, was developed. This improved model more accurately reflects the fibroglandular tissue spatial distribution that can be found in patient breasts, and therefore might aid in future studies involving radiation dose and/or cancer development risk estimation.

This chapter describes three different techniques for tumors located in three different locations, namely, the upper inner quadrant, the 6 o’clock tumors, and the central retroaroelar tumors. Tumors located in the upper inner quadrant represent a major challenge due to the limited breast parenchyma present in this quadrant. Tumors arising in this quadrant are usually very near to the overlying skin and/or to the underlying pectoralis fascia. Matrix rotation is a very simple technique that enables the complete excision of the lesion in that quadrant together with maintaining almost equal breast volume and symmetry to the contra lateral breast.

Breast cancer is a victor among the most comprehensively saw malignancies among ladies around the world. Clump territory from mammogram helps in right on time affirmation for breast tumor. A PC-aided detection structure which will see also perceive the subverting lumps in person’s breast in an unmistakable and fiscally able way is required. It is the fantasy and reason for experts to have a CAD framework with most important affectability and low fake positives per picture (FPI). Affirmation of clump from person’s breast is badly arranged considering its plenteous geomorphological attributes and questionable edges. Clump territory execution can be overhauled by utilizing productive preprocessing instrument and geomorphological features of the clump area. As a clump makes, it enrages the breast parenchyma and widens by stirring up different coaxial layers. Geomorphological assessment of these coaxial layers is a foundation in clump conspicuous verification figuring. Particular CAD structures utilizing coaxial morphology show exist as a bit of the creation. In this article, an endeavor has made to plot a piece of the current CAD frameworks which utilize coaxial morphology appear for precisely on time and exact zone of clumps.

Summary:. Primary melanoma of the breast parenchyma (PMPB) is a rare and aggressive disease, with only a few cases reported in the literature. We present the case of a 50-year old woman who underwent mastectomy and immediate breast reconstruction using a free DIEP flap following recurrence after breast conserving surgery. This report highlights the importance of an oncoplastic approach for this diagnosis and the benefit of immediate autologous breast reconstruction.

Patients have been requesting implant removal in revisional breast surgery and options for breast improvement without the use of breast implants in primary breast surgery. This article focuses on perioperative decision making and surgical technique in performing a mastopexy with autoaugmentation and fat grafting. The use of a lower island of breast parenchyma relocated to the upper pole through a central pedicle in primary surgery and a superior pedicle in postexplantation cases, along with fat grafting can provide improvement in global volume or simply additional volume in areas of deficiency, such as the upper poles and medial cleavage region.