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Context: Annual ultrasound screening may detect small, node-negative breast cancers that are not seen on mammography. Magnetic resonance imaging (MRI) may reveal additional breast cancers missed by both mammography and ultrasound screening.Objective: To determine supplemental cancer detection yield of ultrasound and MRI in women at elevated risk for breast cancer.Design, Setting, and Participants: From April 2004-February 2006, 2809 women at 21 sites with elevated cancer risk and dense breasts consented to 3 annual independent screens with mammography and ultrasound in randomized order. After 3 rounds of both screenings, 612 of 703 women who chose to undergo an MRI had complete data. The reference standard was defined as a combination of pathology (biopsy results that showed in situ or infiltrating ductal carcinoma or infiltrating lobular carcinoma in the breast or axillary lymph nodes) and 12-month follow-up.Main Outcome Measures: Cancer detection rate (yield), sensitivity, specificity, positive predictive value (PPV3) of biopsies performed and interval cancer rate.Results: A total of 2662 women underwent 7473 mammogram and ultrasound screenings, 110 of whom had 111 breast cancer events: 33 detected by mammography only, 32 by ultrasound only, 26 by both, and 9 by MRI after mammography plus ultrasound; 11 were not detected by any imaging screen. Among 4814 incidence screens in the second and third years combined, 75 women were diagnosed with cancer. Supplemental incidence-screening ultrasound identified 3.7 cancers per 1000 screens (95% CI, 2.1-5.8; P < .001). Sensitivity for mammography plus ultrasound was 0.76 (95% CI, 0.65-0.85); specificity, 0.84 (95% CI, 0.83-0.85); and PPV3, 0.16 (95% CI, 0.12-0.21). For mammography alone, sensitivity was 0.52 (95% CI, 0.40-0.64); specificity, 0.91 (95% CI, 0.90-0.92); and PPV3, 0.38 (95% CI, 0.28-0.49; P < .001 all comparisons). Of the MRI participants, 16 women (2.6%) had breast cancer diagnosed. The supplemental yield of MRI was 14.7 per 1000 (95% CI, 3.5-25.9; P = .004). Sensitivity for MRI and mammography plus ultrasound was 1.00 (95% CI, 0.79-1.00); specificity, 0.65 (95% CI, 0.61-0.69); and PPV3, 0.19 (95% CI, 0.11-0.29). For mammography and ultrasound, sensitivity was 0.44 (95% CI, 0.20-0.70, P = .004); specificity 0.84 (95% CI, 0.81-0.87; P < .001); and PPV3, 0.18 (95% CI, 0.08 to 0.34; P = .98). The number of screens needed to detect 1 cancer was 127 (95% CI, 99-167) for mammography; 234 (95% CI, 173-345) for supplemental ultrasound; and 68 (95% CI, 39-286) for MRI after negative mammography and ultrasound results.Conclusion: The addition of screening ultrasound or MRI to mammography in women at increased risk of breast cancer resulted in not only a higher cancer detection yield but also an increase in false-positive findings.Trial Registration: clinicaltrials.gov Identifier: NCT00072501. [ABSTRACT FROM AUTHOR]

Eighth and tenth grade students (n = 1,619) reported on exposure to risk and protective assets in their day-to-day lives. The relationship between carrying a weapon to school and risk and protective factors in the home and school ecological domains was explored through logistic regression conducted separately by gender. Environmental control in the home, one factor previously unexplored in the context of resiliency to interpersonal violence-related risk behavior, was incorporated into the analysis. Results support previous research that suggests school violence prevention efforts should address both risk and protective factors in multiple ecological domains. Further, results suggest violence prevention efforts should be sensitive to gender differences, and that additional research is necessary to clarify the role of environmental control as a factor influencing youth resiliency to violence. [ABSTRACT FROM AUTHOR]

A national task force consisting of members from the American College of Radiology, the American College of Surgeons, and the College of American Pathologists examined the issues surrounding stereotactic core-needle biopsy for occult breast lesions. Their report includes indications and contraindications, informed consent, specimen handling, and management of indeterminate, atypical, or discordant lesions. [ABSTRACT FROM AUTHOR]

The debate about mammography for women in their 40s is escalating. Uncertainties about when and why to use tamoxifen persist. But a corner has been turned: For the first time ever, breast cancer survival is increasing. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the occurrence of adverse blood pressure (BP) events during transurethral microwave therapy (TUMT) for benign prostatic hyperplasia. PATIENTS AND METHODS: We conducted a retrospective study of the vital signs of 185 consecutive patients who received TUMT (via 6 devices) at 4 institutions from March 1, 2003, to September 18, 2005. Maximum change, percent change in systolic BP, diastolic BP, mean arterial pressures, heart rate, and oxygen saturation were evaluated. RESULTS: Of the 185 patients, 77 patients (42%; 95% confidence interval [CI], 35%-49%) experienced an increase in systolic BP of more than 30 mm Hg during TUMT; 30 patients (16%; 95% CI, 12%-22%), an increase of more than 50 mm Hg; and 10 patients (5%; 95% CI, 3%-10%), an increase of more than 70 mm Hg. A greater than 20% change in systolic BP from baseline was observed in 95 patients (51%; 95% CI, 44%-58%). Many men experienced multiple events, with an average time of onset of 15.9 minutes into treatment. Significant differences were noted among the devices. CONCLUSION: This retrospective study demonstrates a significant number of BP surges during TUMT for benign prostatic hyperplasia. These BP changes represent a potential risk of cardiovascular events in patients with known or occult cardiovascular disease. Our study is the first to recognize the incidence of this BP response. Until further studies identify the mechanisms responsible for these surges in BP, the results of this study suggest that BP should be monitored, treatment adjusted, and antihypertensive medications continued during all TUMT. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the impact of COVID-19 on county safety-net breast imaging services and describe the steps taken to actively manage and mitigate delays., Methods: This was an IRB exempt retrospective review of our county safety-net breast imaging practice analyzed for 4 distinct time periods: (1) "Shut-down period": March 17, 2020 to May 17, 2020; (2) "Phased re-opening": May 18, 2020 to June 30, 2020; (3) "Ramp-up": July 1, 2020 to September 30, 2020; and (4) "Current state": October 1, 2020 to September 30, 2021. These time periods were compared to identical time periods 1 year prior. For "Current state," given that the 1-year prior comparison encompassed the first 3 periods of the pandemic, the identical time period 2 years prior was also compared., Results: Our safety-net practice sustained significant volume losses during the first 3 time periods with a 99% reduction in screening mammography in the shut-down period. Cancers diagnosed decreased by 17% in 2020 (n = 229) compared to 2019 (n = 276). By implementing multiple initiatives that targeted improved access to care, including building community-hospital partnerships and engagement through outreach events and a community education roadshow, we were able to recover and significantly exceed our pandemic screening volumes by 48.1% (27,279 vs 18,419) from October 1, 2020 to September 30, 2021 compared to the identical time period 1 year prior, and exceed our pre-pandemic screening volume by 17.4% (27,279 vs 23,234) compared to the identical time period 2 years prior., Conclusion: Through specific community outreach programs and optimized navigation, our safety-net breast imaging practice was able to mitigate the impact of COVID-19 on our patient population by increasing patient engagement and breast imaging services., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Accessing stigmatized persons for research purposes can be difficult, and accessing their significant others is perhaps even more challenging. We present here our defining moments of recruiting and surveying partners of persons registered as sexual offenders for our research on courtesy stigma. The challenges and successes of our journey are described within the larger hypothesis that close relationships are an important source of social support associated with adjustment and well-being outcomes for people involved in the justice system as well as their families. Ultimately, we suggest our reflections will not only encourage other researchers to seek the input of hard-to-reach populations in justice, health, and policy contexts, but also to incorporate the experiences of underrepresented voices, elucidate findings and lessons learned from these unique populations, and engage in reflexive health communication and research strategies with highly stigmatized populations.

BACKGROUND. The diagnostic performance of digital breast tomosynthesis (DBT) has been shown to be equal to that of diagnostic mammography. However, the value of additional mammographic views in diagnostic evaluations remains unclear. OBJECTIVE. The purpose of this study was to compare the performance of diagnostic breast ultrasound (US) alone with that of combined US and diagnostic mammography for specific noncalcified recalled abnormalities detected on screening DBT. METHODS. This was a prospective study with a single-arm management strategy. Women recalled for noncalcified lesions on screening DBT underwent initial diagnostic US as part of the study protocol. Additional diagnostic mammography was performed at the discretion of the radiologist. Imaging assessment decisions determined by BI-RADS assessments and management recommendations, biopsy outcomes, and follow-up were recorded using case report forms completed on the day of the diagnostic evaluation and stored in the electronic medical record. RESULTS. From July 10, 2017, to June 6, 2019, a total of 430 recalled noncalcified lesions in 399 women (mean age, 60 ± 12 [SD] years) were included. US alone was performed for 71.2% (306/430) of lesions, whereas US with diagnostic mammography was performed for 28.8% (124/430). Of the recalled lesions, 93.7% (178/190) of masses, 60.0% (51/85) of focal asymmetries, 46.1% (53/115) of asymmetries, 69.2% (9/13) of developing asymmetries, and 55.6% (15/27) of architectural distortions were evaluated with US alone. Of 93 lesions that underwent needle biopsy, 40.9% (38/93) were cancers, all of which were invasive. Thirty-five of 38 (92.1%) cancers were evaluated by US alone, whereas three (7.9%) were evaluated with US and diagnostic mammography. At a median follow-up of 25 months, six cancers were identified (three with US alone and three with US plus diagnostic mammography) in patients with initially benign workup. US alone had two false-negative cancers (one architectural distortion identified at follow-up and one mass biopsied stereotactically at initial detection). CONCLUSION. US alone is effective in the diagnostic evaluation of noncalcified masses recalled on screening tomosynthesis. For asymmetries, diagnostic mammography may be best without the need for additional US, whereas architectural distortions still warrant diagnostic mammography and US. CLINICAL IMPACT. Radiologists should consider performing US first for DBT-recalled noncalcified masses. Omitting diagnostic mammography when US is negative has a low false-negative rate.

Purpose: The main objectives of this study were to determine (1) whether family communication and school connectedness offer protection against suicidal behaviors in the presence of adverse childhood experiences (ACEs; direct protective effect) and (2) whether family communication or school connectedness buffer the association between ACEs and suicidal behaviors (interacting protective effect) on the multiplicative and additive scales., Methods: Data were obtained from a western state's 2019 Youth Risk Behavior Survey that included 5,341 middle school and 4,980 high school participants. Generalized linear models were used to estimate whether family communication and school connectedness offered direct protection against suicidal behaviors or buffered the association between ACEs and suicidal behaviors using adjusted prevalence ratios and corresponding 95% confidence intervals., Results: Family communication and school connectedness offered direct protection against suicidal behaviors in the presence of ACEs (a 1-unit higher score was associated with a 32%-42% lower prevalence of suicidal behaviors for middle school youth and a 27%-39% lower prevalence of suicidal behaviors for high school youth). There was evidence that family communication and school connectedness buffered the association between ACEs and suicidal behaviors on the multiplicative scale., Conclusions: The findings provide support for the development and implementation of interventions that build family communication and school connectedness to reduce suicidal behaviors. Furthermore, screening for trauma and suicidal behaviors is warranted., (Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to estimate associations between cumulative exposure to adverse childhood experiences (ACEs), protective factors, and co-occurrence among male and female juvenile offenders., Study Design: Cross-sectional study., Methods: Validated measures of ACEs, internal resilience, external youth assets, psychological distress, and substance abuse were collected from 429 youths involved in the juvenile justice system in Nevada. A three-level outcome variable was created using the psychological distress and substance use measures: no problems, one problem, or co-occurring problems. Hierarchical multinomial logistic regression models were used to determine the independent, direct, and moderating impact of the protective factors on ACEs and the outcome., Results: Internal resilience, family communication, school connectedness, peer role models, and non-parental adult role models were associated with lower odds of co-occurrence compared to having no problems (adjusted odds ratios [AORs] ranged from 0.11 to 0.33). When ACEs were added to the model, internal resilience and all assets except for one (non-parental adult role models) continued to offer protection against co-occurrence. Internal resilience was the only protective factor that significantly moderated the association between ACEs and co-occurrence (AOR, 0.24; 95% CI, 0.06, 0.99)., Conclusion: Most protective factors decreased co-occurring mental health and substance abuse problems in the presence of ACE exposure and internal resilience moderated the relationship between ACEs and co-occurrence. Juvenile justice systems should use positive youth development approaches to help prevent co-occurrence among youths., (Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

The widespread acceptance of screening mammography for early detection, along with advances in treatment, have combined to decrease the overall mortality rate from breast cancer. However, significant disparities in health outcomes persist. Socioeconomic factors, including the ability to obtain private insurance, income, education, disparities in the quality of healthcare delivery, and race, as well as the ability to access and complete the most advanced breast cancer treatments, form part of a complex constellation of factors that contribute to disparity in breast cancer mortality. Here, we review some of the factors influencing this disparity and discuss some of the methods that have been suggested for closing the gap in breast cancer outcomes, using our perspective as breast imaging physicians serving both a safety-net hospital and tertiary healthcare system., (© Society of Breast Imaging 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

OBJECTIVE. Contrast-enhanced digital mammography (CEDM) combines the high spatial resolution of mammography with the improved enhancement provided by contrast medium. In this article, CEDM technique-the current and potential clinical applications and current challenges-will be reviewed. CONCLUSION. CEDM is a promising technique in the supplemental evaluation of patients with mammographically inconclusive findings and potentially in the screening of women with mammographically dense breasts. CEDM is emerging as a cost-effective alternative to dynamic contrast-enhanced MRI to stage newly diagnosed breast cancer and evaluate response to neoadjuvant chemotherapy.

Purpose: The purpose of this study was to investigate whether individual, family, and community assets can 1) protect youth from binge drinking in the face of negative life events and 2) modify the relationship between negative life events and binge drinking., Methods: Data from waves 2-5 of the Youth Asset Study were analyzed. Generalized estimating equations were used to assess the relationship between negative life events, assets, and binge drinking. Multiplicative and additive interaction between negative life events and assets was evaluated., Results: When included in the same model as negative life events, individual, family, and community assets had a graded, protective relationship with binge drinking, with strongest protection for those with the greatest number of assets. For example, youth with 3 [adjusted odds ratio (AOR):0.78, 95% confidence interval (CI): 0.65-0.93], 4 [AOR: 0.60, 95% CI: 0.49-0.73], 5 [AOR: 0.53, 95% CI: 0.41-0.69], and 6 [AOR: 0.42, 95% CI: 0.28-0.63] assets within the community domain had a significantly lower odds of binge drinking than youth with 0-2 community assets. No significant interactions were observed., Conclusions: The findings suggest that while youth who are exposed to negative life events are at risk for binge drinking, building assets across individual, family, and community domains can have a protective influence., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Single-case designs are typically used in classroom and clinical settings to assess the behavioral impacts of an intervention with an individual child. Using two illustrative case studies, this article describes the extension of this model to home-visitation programs serving tribal communities and examines the lessons learned throughout the process of adapting this approach. Our experience suggests that the benefits of using this design outweigh the associated challenges and allows researchers to expand the use of single-case designs to previously unexplored settings. Specifically, some of the benefits discussed include allowing for evaluative rigor in contexts with small samples, allowing everyone who qualifies to immediately participate, providing visual representations of the outcome-making the results more tangible and accessible to a broader audience, and allowing for a deep level of cultural sensitivity. The article also provides some general guidelines to address the practical challenges one may face when attempting to use single-case designs in novel ways within nonschool settings., (© 2018 Michigan Association for Infant Mental Health.)

Breast implants are frequently encountered on breast imaging studies, and it is essential for any radiologist interpreting these studies to be able to correctly assess implant integrity. Ruptures of silicone gel-filled implants often occur without becoming clinically obvious and are incidentally detected at imaging. Early diagnosis of implant rupture is important because surgical removal of extracapsular silicone in the breast parenchyma and lymphatics is difficult. Conversely, misdiagnosis of rupture may prompt a patient to undergo unnecessary additional surgery to remove the implant. Mammography is the most common breast imaging examination performed and can readily depict extracapsular free silicone, although it is insensitive for detection of intracapsular implant rupture. Ultrasonography (US) can be used to assess the internal structure of the implant and may provide an economical method for initial implant assessment. Common US signs of intracapsular rupture include the "keyhole" or "noose" sign, subcapsular line sign, and "stepladder" sign; extracapsular silicone has a distinctive "snowstorm" or echogenic noise appearance. Magnetic resonance (MR) imaging is the most accurate and reliable means for assessment of implant rupture and is highly sensitive for detection of both intracapsular and extracapsular rupture. MR imaging findings of intracapsular rupture include the keyhole or noose sign, subcapsular line sign, and "linguine" sign, and silicone-selective MR imaging sequences are highly sensitive to small amounts of extracapsular silicone. © RSNA, 2017.

Purpose: To determine reasons for nonparticipation in a trial of supplemental screening with magnetic resonance (MR) imaging after mammography and ultrasonography (US)., Materials and Methods: Women(n = 2809) at elevated risk of breast cancer were enrolled in the American College of Radiology Imaging Network 6666 US Screening Protocol at 21 institutions. Fourteen institutions met technical and experience requirements for this institutional review board-approved, HIPAA-compliant substudy of supplemental screening with MR imaging. Those women who had completed 0-, 12-, and 24-month screenings with mammography combined with US were considered for a single contrast material-enhanced MR examination within 8 weeks after completing the 24-month mammography-US screening. A total of 1593 women had complete MR substudy registration data: 378 of them were ineligible for the study, and 1215 had analyzable data. Reasons for nonparticipation were determined. Demographic data were compared between study participants and nonparticipants., Results: Of 1215 women with analyzable data, 703 (57.9%), with a mean age of 54.8 years, were enrolled in the MR substudy and 512 (42.1%) declined participation. Women with a 25% or greater lifetime risk of breast cancer were more likely to participate (odds ratio, 1.53; 95% confidence interval: 1.10, 2.12). Of 512 nonparticipants, 130 (25.4%) refused owing to claustrophobia; 93 (18.2%), owing to time constraints; 62 (12.1%), owing to financial concerns; 47 (9.2%), because their physician would not provide a referral and/or did not believe MR imaging was indicated; 40 (7.8%), because they were not interested; 39 (7.6%), because they were medically intolerant to MR imaging; 29 (5.7%), because they did not want to undergo intravenous injection; 27 (5.3%), owing to additional biopsy or other procedures that might be required subsequently; 21 (4.1%), owing to MR imaging scheduling constraints; 11 (2.2%), because of the travel required; seven (1.4%), owing to gadolinium-related risks or allergies; and six (1.2%), for unknown reasons., Conclusion: Of 1215 women with elevated breast cancer risk who could, according to protocol guidelines, undergo breast MR imaging, only 57.9% agreed to participate.

Context: Screening ultrasound may depict small, node-negative breast cancers not seen on mammography., Objective: To compare the diagnostic yield, defined as the proportion of women with positive screen test results and positive reference standard, and performance of screening with ultrasound plus mammography vs mammography alone in women at elevated risk of breast cancer., Design, Setting, and Participants: From April 2004 to February 2006, 2809 women, with at least heterogeneously dense breast tissue in at least 1 quadrant, were recruited from 21 sites to undergo mammographic and physician-performed ultrasonographic examinations in randomized order by a radiologist masked to the other examination results. Reference standard was defined as a combination of pathology and 12-month follow-up and was available for 2637 (96.8%) of the 2725 eligible participants., Main Outcome Measures: Diagnostic yield, sensitivity, specificity, and diagnostic accuracy (assessed by the area under the receiver operating characteristic curve) of combined mammography plus ultrasound vs mammography alone and the positive predictive value of biopsy recommendations for mammography plus ultrasound vs mammography alone., Results: Forty participants (41 breasts) were diagnosed with cancer: 8 suspicious on both ultrasound and mammography, 12 on ultrasound alone, 12 on mammography alone, and 8 participants (9 breasts) on neither. The diagnostic yield for mammography was 7.6 per 1000 women screened (20 of 2637) and increased to 11.8 per 1000 (31 of 2637) for combined mammography plus ultrasound; the supplemental yield was 4.2 per 1000 women screened (95% confidence interval [CI], 1.1-7.2 per 1000; P = .003 that supplemental yield is 0). The diagnostic accuracy for mammography was 0.78 (95% CI, 0.67-0.87) and increased to 0.91 (95% CI, 0.84-0.96) for mammography plus ultrasound (P = .003 that difference is 0). Of 12 supplemental cancers detected by ultrasound alone, 11 (92%) were invasive with a median size of 10 mm (range, 5-40 mm; mean [SE], 12.6 [3.0] mm) and 8 of the 9 lesions (89%) reported had negative nodes. The positive predictive value of biopsy recommendation after full diagnostic workup was 19 of 84 for mammography (22.6%; 95% CI, 14.2%-33%), 21 of 235 for ultrasound (8.9%, 95% CI, 5.6%-13.3%), and 31 of 276 for combined mammography plus ultrasound (11.2%; 95% CI. 7.8%-15.6%)., Conclusions: Adding a single screening ultrasound to mammography will yield an additional 1.1 to 7.2 cancers per 1000 high-risk women, but it will also substantially increase the number of false positives., Trial Registration: clinicaltrials.gov Identifier: NCT00072501.

Objective: The purpose of our study was to better define the rate and variables associated with cancer underestimation when lobular neoplasia is found at minimally invasive breast biopsy., Materials and Methods: The records of 32,420 patients who underwent imaging-guided needle biopsy of the breast for mammographic or sonographic abnormalities from 1988 to 2000 were retrospectively reviewed. The 278 cases in which lobular neoplasia was the highest-risk lesion at biopsy were included. Of the 278 cases, 164 proceeded to surgical excision, allowing calculation of rates of underestimation from minimally invasive biopsy., Results: Of the 32,420 minimally invasive breast biopsies, lobular neoplasia was found in 278 (0.9%). One hundred sixty-four of the 278 (59%) continued to surgical excision, where cancer was pathologically confirmed in 38 (23%). No difference was seen in the underestimation rates for lesions diagnosed as lobular carcinoma in situ (25%, 17 of 67 lesions) versus atypical lobular hyperplasia (22%, 21 of 97 lesions). Statistically significant underestimation of carcinoma was found with biopsy of masses (with or without associated microcalcifications) rather than calcifications only, a higher BI-RADS category (p < 0.0001), use of a core biopsy device rather than a vacuum device (p < 0.01), and obtaining fewer specimens (p < 0.0001)., Conclusion: Significant sampling error occurs regardless of the type of core biopsy device, number of specimens obtained, histologic-radiographic concordance, mammographic appearance, and complete excision of the lesion as determined by imaging. For this reason, all patients with lobular neoplasia at core or vacuum-assisted biopsy should undergo surgical excision until further differentiating criteria can be determined.

This brief report presents a study undertaken to better understand the factors that are related to sense of coherence (SOC) levels among youth. Middle school students (N = 1619) reported on risk and protective factors across ecological domains. Analyses revealed that social support, anger expression, family conflict and neighborhood cohesion were predictors of SOC for both males and females. Community views regarding gang membership was a predictor of SOC only for males, while age was a predictor of SOC only for females. The findings suggest a resiliency and ecological framework may be helpful in understanding SOC in youth.

Youths transitioning out of detention are particularly in need of support systems that can divert them from recidivism. This article examines the relationship between incarcerated youths' sense of their families' functioning and their perceived likelihood for postdetention success. Despite the control of background variables, results reveal that delinquents who indicated stronger familial functioning also reported a greater likelihood of future success. Although interventions that focus on improving the supportive capacity of families have shown great promise, treatment drop-out rates remain high. To explore incarcerated youths' view of family focused interventions, respondents rated the potential utility of family and nonfamily focused intervention options. A majority of respondents reported that family focused interventions would be helpful. A group of respondents, overrepresented by adolescents with low family functioning, reported that this type of intervention would not be helpful. These results are discussed in terms of their impact on offering family focused interventions for juveniles.

In 2003, the American Cancer Society updated its guidelines for early detection of breast cancer based on recommendations from a formal review of evidence and a recent workshop. The new screening recommendations address screening mammography, physical examination, screening older women and women with comorbid conditions, screening women at high risk, and new screening technologies.

Objective: . This study was conducted to evaluate the outcome of cases of radial scar diagnosed by percutaneous core needle biopsy., Materials and Methods: Of 198 nonpalpable lesions diagnosed with radial scars found at core needle biopsy, 157 lesions constituting the study group had undergone surgical excision (n = 102) or mammographic surveillance after biopsy for at least 24 months (median, 38 months; n = 55). Mammographic lesion type, lesion size, biopsy guidance method, biopsy device, number of specimens per lesion, and presence of atypical hyperplasia at percutaneous biopsy were retrospectively analyzed. Results were compared with histologic findings at surgery or mammographic findings during surveillance., Results: . Carcinoma was found at excision in 28% (8/29) of lesions with associated atypical hyperplasia at percutaneous biopsy and 4% (5/128) of lesions without associated atypia (p < 0.0001). In the latter group, carcinoma was found at excision in 3% (2/60) of masses, 8% (3/40) of architectural distortions, and 0% (0/28) of microcalcification lesions. Malignancy was missed in 9% (5/58) of lesions biopsied with a spring-loaded device and in 0% (0/70) of lesions biopsied with a directional vacuum-assisted device (p = 0.01); and in 8% (5/60) of lesions sampled with less than 12 specimens per lesion and 0% (0/68) sampled with 12 or more specimens (p = 0.015). Lesion type, maximal lesion diameter, and type of imaging guidance (stereotactic or sonographic) were not significant factors in determining the presence of malignancy., Conclusion: . Diagnosis of radial scar based on core needle biopsy is likely to be reliable when there is no associated atypical hyperplasia at percutaneous biopsy, when the biopsy includes at least 12 specimens, and when mammographic findings are reconciled with histologic findings. When the lesion diagnosed by core needle biopsy as radial scar does not meet these criteria, excisional biopsy is indicated.

Purpose: To characterize the mammographic appearance of invasive lobular carcinoma in a large series of screening-detected consecutive breast cancers and to evaluate the ability of a computer-aided detection system to mark these carcinomas., Materials and Methods: Investigators used the Breast Imaging Reporting and Data System lexicon to characterize lesions as part of a retrospective review of 90 screening mammographic examinations that led to biopsy-proved diagnosis of 94 invasive lobular carcinoma lesions. The 40 available prior mammographic examinations (obtained 9-24 months earlier) were also reviewed to characterize any visible findings. The results of a computer-aided detection analysis were compared with the images, and the sensitivity of the algorithm was calculated for correct detection of the lesions., Results: Fifty-six (60%) of 94 lesions manifested as masses, of which 40 (71%) were described as irregular and spiculated; 20 (21%) of 94, as architectural distortions; and the remainder, 18 (20%), as either asymmetric densities or calcifications. On the screening mammograms showing biopsy-proved cancers, the sensitivity of the computer-aided detection system was 86 (91%) of 94 lesions. Thirty-one of the 40 prior mammograms showed retrospectively visible findings, and 24 (77%) of 31 were marked by the computer-aided detection system., Conclusion: Spiculated masses and architectural distortions are the predominant appearances of invasive lobular carcinoma, and a computer-aided detection system correctly marked a high percentage of invasive lobular carcinoma lesions.

A case of a 48-year-old male with an inflammatory breast cancer is used to illustrate this uncommon malignancy. The physical examination of thickening and erythema made the clinical diagnosis. Mammographic findings of increased density in the right breast with coarsened stroma and an underlying mass confirmed the clinical findings. The sonographic evaluation revealed a 2-cm ill-defined hypoechoic mass. The pathologic examination of the mastectomy specimen showed an infiltrating duct cell carcinoma with lobular features. Male breast cancer afflicts 1500 men each year. Clinically it must be differentiated from gynecomastia, a much more common and benign condition.

Purpose: To assess the accuracy of stereotactic core-needle biopsy (CNB) of nonpalpable breast lesions within the context of clinically important parameters of anticipated tissue-sampling error and concordance with mammographic findings., Materials and Methods: CNB was performed in 1,003 patients, with results validated at surgery or clinical and mammographic follow-up. Mammographic findings were scored according to the American College of Radiology Breast Imaging Reporting and Data System with a similar correlative scale for histopathologic samples obtained at either CNB or surgery. Agreement of CNB findings with surgical findings or evidence of no change during clinical and mammographic follow-up (median, 24 months) for benign lesions was used to determine results. Three forms of diagnostic discrimination measures (strict, working [strict conditioned by tissue sampling error], applied [working conditioned by concordance of imaging and CNB findings) were used to evaluate the correlation of CNB, surgical, and follow-up results., Results: Strict, working, and applied sensitivities were 91% +/- 1.9; 92% +/- 1.8, and 98% +/- 0.9, respectively; strict, working, and applied specificities were 100%, 98% +/- 0.8, and 73% +/- 0.9; strict, working, and applied accuracies were 97%, 96%, and 79%., Conclusion: Percutaneous stereotactic CNB is an accurate method to establish a histopathologic diagnosis of nonpalpable breast lesions. Accuracy increases when additional surgery is performed for lesions with anticipated sampling error or when CNB findings are discordant with mammographic findings. An understanding of the interrelationship among these parameters is necessary to properly assess results.

Purpose: To measure the effect of biopsy device, probe size, mammographic lesion type, lesion size, and number of samples obtained per lesion on the ductal carcinoma in situ (DCIS) underestimation rate., Materials and Methods: Nonpalpable breast lesions at 16 institutions received a histologic diagnosis of DCIS after 14-gauge automated large-core biopsy in 373 lesions and after 14- or 11-gauge directional vacuum-assisted biopsy in 953 lesions. The presence of histopathologic invasive carcinoma was noted at subsequent surgical biopsy., Results: By performing the chi(2) test, independent significant DCIS underestimation rates by biopsy device were 20.4% (76 of 373) of lesions diagnosed at large-core biopsy and 11.2% (107 of 953) of lesions diagnosed at vacuum-assisted biopsy (P <.001); by lesion type, 24.3% (35 of 144) of masses and 12.5% (148 of 1,182) of microcalcifications (P <.001); and by number of specimens per lesion, 17.5% (88 of 502) with 10 or fewer specimens and 11.5% (92 of 799) with greater than 10 (P <.02). DCIS underestimations increased with lesion size., Conclusion: DCIS underestimations were 1.9 times more frequent with masses than with calcifications, 1.8 times more frequent with large-core biopsy than with vacuum-assisted biopsy, and 1.5 times more frequent with 10 or fewer specimens per lesion than with more than 10 specimens per lesion.

Background: Radiologic Diagnostic Oncology Group 5 is a multicenter clinical trial designed to evaluate fine-needle aspiration (FNA) of nonpalpable breast lesions performed by multiple operators using the same protocol., Methods: Four hundred and nineteen women with mammographically detected nonpalpable breast lesions were enrolled on the trial at 18 institutions. Group A institutions randomized women to stereotactically guided FNA (SFNA) followed by stereotactically guided core needle biopsy (SCNB), or SCNB only. Group B institutions randomized women to SFNA and SCNB, SCNB, or ultrasonographically guided FNA followed by ultrasonographically guided core needle biopsy (USCNB), or USCNB only. A total of 377 women were eligible for analysis., Results: FNA yielded 128 insufficient samples for the 377 patients (33.95%; 95% confidence interval, 29.2-38.7%). The rate of insufficient samples varied by type of lesion with calcified lesions associated with a significantly higher rate of insufficient sampling than masses (P < 0.001). The radiologist's level of suspicion of the lesion was not a statistically significant predictor of insufficient samples for mass lesions, but was a predictor for calcified lesions. For the 336 lesions for which histologic information was available, insufficient samples occurred in significantly more benign than malignant lesions., Conclusions: The high rate of insufficient samples for FNA of nonpalpable breast lesions in this multicenter trial makes its use impractical in this setting. Because of this factor, the study was terminated early.

Purpose: To compare histologic findings of atypical ductal hyperplasia (ADH) at 14-gauge, directional, vacuum-assisted breast biopsy (hereafter, vacuum-assisted biopsy) and at 14-gauge, automated, large-core breast biopsy (hereafter, large-core biopsy) with findings at histologic examination after surgical biopsy., Materials and Methods: Nonpalpable breast lesions were diagnosed as ADH at histologic examination after vacuum-assisted biopsy in 88 lesions in seven institutions and after large-core biopsy in 55 previously reported lesions. Histologic findings at subsequent surgical biopsy were compared for the presence of carcinoma., Results: On the basis of histologic findings of carcinoma at surgical biopsy, the diagnosis of ADH was not correct in 26 (48%) of 54 lesions sampled at large-core biopsy and in 13 (18%) of 74 lesions sampled at vacuum-assisted biopsy (Fisher exact test, P < .0004). More tissue specimens were obtained at vacuum-assisted biopsy (mean, 15.8 specimens) than at large-core biopsy (mean, 9.7 specimens). Individual specimens were twice as large at vacuum-assisted biopsy (mean, 34 mg) as at large-core biopsy (mean, 17 mg) (previously reported)., Conclusion: ADH was diagnosed 2.7 times more reliably at vacuum-assisted biopsy than at large-core biopsy (with no increase in complications) with most of the improvement as a result of acquisition of more than 10 specimens per lesion, but carcinoma was sufficiently underestimated with both methods to necessitate surgical biopsy.

Purpose: To compare the relative incidence of impalpable ductal carcinoma in situ (DCIS) and invasive breast carcinoma detected mammographically in women younger than 50 years of age and those aged 50 years and older., Materials and Methods: Needle-wire localization and surgical biopsy were performed in 4,428 impalpable lesions in 3,734 patients. A total of 1,179 breast cancers were found. Histologic findings were reviewed retrospectively, and lesions were classified as invasive cancer or DCIS. The patients were categorized into two groups: those aged 50 years and older and those younger than 50 years of age., Results: A total of 294 cancers were found in women younger than 50 years of age. Of these cancers, 137 (46.6%) were DCIS and 157 (53.4%) were invasive. In women aged 50 years and older, 885 cancers were found. Of these, 325 (36.7%) DCIS and 558 (63.1%) invasive cancers were found., Conclusion: For mammographically detected breast carcinomas, there is a higher relative incidence (46.6% vs 36.6%) of DCIS in the younger age group, which may lend further support for aggressive screening of women younger than 50 years of age.

Objective: Our objective was to investigate the use of MR imaging in preoperative staging and characterization of lobular carcinoma., Materials and Methods: MR imaging studies and mammographic studies in 20 patients with infiltrating lobular carcinoma were evaluated and correlated with pathology findings on serially sectioned tissue. The MR images and mammograms were reviewed retrospectively by three independent examiners unaware of the clinical, imaging, and pathology findings., Results: The extent of disease found pathologically correlated with that predicted by MR imaging studies in 85% of patients, compared with a 32% correlation (p < .0001) with mammographic studies. Interobserver agreement on lesion morphology and extent of disease was higher for MR imaging (91% and 100%, respectively) than for mammography (64% and 91%, respectively). The retrospective MR readings did not differ from the prospective reports. No false-positive lymphadenopathy was interpreted on MR imaging. Lymph nodes having metastatic lobular carcinoma on the pathology examination were missed on MR imaging in four patients., Conclusion: MR imaging is significantly more accurate than mammography in determining the extent of disease and characterizing the morphology of infiltrating lobular carcinoma. MR imaging may play a role in preoperative planning, especially when breast conservation is being considered.

Purpose: To assess whether rotating delivery of excitation off resonance (RODEO) breast magnetic resonance (MR) imaging can help detect ductal carcinoma in situ (DCIS) lesions, determine tumor extent, and differentiate pure DCIS from DCIS with an invasive component., Materials and Methods: Twenty-two patients with DCIS lesions were evaluated with three-dimensional RODEO MR imaging. Nineteen patients had available mammograms for review., Results: MR imaging enabled detection of all 22 cases of DCIS, DCIS with microinvasion, or invasive ductal carcinoma with extensive intraductal component. A clumped enhancement pattern was seen on MR images in all cases of pure DCIS. Spiculated enhancement was seen in four of six (67%) patients who had DCIS with microinvasion and in nine of 11 (82%) who had invasive ductal carcinoma with extensive intraductal component. RODEO MR imaging enabled accurate determination of tumor extent in 21 of 22 (95%) patients. Mammography depicted 18 of 19 DCIS lesions. No mammographic feature helped differentiate pure DCIS from DCIS with microinvasion. Mammography enabled accurate determination of tumor extent in 14 of 19 (74%) patients., Conclusion: Three-dimensional RODEO MR imaging can be an adjunct to mammography because of its ability to enable better determination of tumor extent and differentiation of pure DCIS from DCIS with an invasive component.

Objective: The purpose of our study was to assess the degree of operator experience and the number of core biopsy samples required to achieve an accurate histologic diagnosis for each of five common mammographically defined lesions, using percutaneous core breast biopsy performed on a dedicated prone biopsy table., Subjects and Methods: A prospective multisite study was performed that involved nine institutions (academic and private) with experienced breast radiologists and the use of dedicated prone biopsy table units with digital assistance and standardized protocol. Asymptomatic women evaluated during a 2-year study period were assigned a mammographic diagnosis reported in a manner prescribed by the American College of Radiology Breast Imaging Reporting and Data System lexicon. Mammographic lesions evaluated included masses, masses with calcifications, clustered calcifications, focal asymmetries, and architectural distortions. Where histologic diagnosis was indicated, core biopsy was performed with five individual samples obtained and sequentially analyzed. Two hundred thirty patients had immediate excisional biopsy, the results of which provided the basis for a statistical analysis to compare the accuracy of each sequential core biopsy sample with surgical results. Statistical analysis was also done to ascertain the accuracy of core biopsy diagnosis as a function of operator experience., Results: Trends toward increasing accuracy were observed by increasing the number of core biopsies for each of five types of mammographically defined lesions, especially for clustered calcifications. Statistically significant increased accuracy was observed when the number of biopsies was increased beyond one (p = .003). Trends toward increased accuracy with more experience were observed for all lesions, especially for calcifications. Of the 230 lesions studied with immediate surgical validation, more than 80% of all lesions except clustered calcifications (75%) were diagnosed on the basis of two core biopsies; accuracy after five biopsies was 98% for masses, 91% for calcifications, 100% for masses with calcification, 100% for focal asymmetries, and 86% for architectural distortions., Conclusions: Accuracy of diagnosis based on the results of percutaneous core breast biopsy improved with an increase in the number of core biopsy samples obtained for any given lesion seen on mammograms and with increased experience in performing the procedure. Five samples yielded an overall diagnostic accuracy of 97%. Familiarity with expected accuracy from this procedure for different mammographic lesions and following increased experience may assist physicians in planning patient management.

Detection and management of a breast mass requires an optimal environment for interpretation, relevant use of clinical information, technically excellent imaging procedures, proper interpretation of the findings, and pertinent recommendations. Masses suspicious for malignancy by only a single modality ideally should undergo some form of biopsy, as the consequences of delayed diagnosis of breast cancer can be devastating. Early invasive breast cancer can be identified and treated if the appropriate evaluation is performed.

Background: Health care cost continues to play a dominant role in our society. Technological advances are expensive, with the possible exception of stereotactic breast biopsy. We must learn other alternatives that give the same diagnostic accuracy at lower cost. The intention of this study was to find other acceptable alternatives to open excisional breast biopsies., Methods: Patients were referred to Baylor University Medical Center between May 1990 and June 1992 for stereotactic breast biopsy of nonpalpable mammographic abnormalities. Before stereotactic biopsy, lesions were categorized into low or high suspicion for malignancy based on screening mammography. Slides were reviewed by a pathologist and the histological diagnosis was compared with mammographic characterization. Benign histology confirming the low-suspicion mammographic abnormality demonstrated mammographic and histologic correlation. Mammographic follow-up was recommended., Results: Two hundred twenty-five women underwent 250 stereotactic breast biopsies. Malignancy was diagnosed in 47 patients; the remaining 203 lesions were benign on pathological examination and are being followed regularly. Seventy-eight percent of the lesions were characterized as low suspicion for malignancy, and 22% were characterized as high suspicion. The average cost savings per lesion using stereotactic biopsy was $1,629., Conclusion: Stereotactic breast biopsy is an acceptable, less expensive alternative to open excisional biopsy for diagnosing nonpalpable mammographic findings.

Objective: A new silicone-suppressed MR technique was developed, and its efficacy in identifying free silicone and differentiating it from other breast tissues was investigated., Materials and Methods: Silicone-suppressed MRI was performed using the RODEO (rotating delivery of excitation off-resonance) pulse sequence, which selectively eliminated signal from the narrow range of (CH3)4Si resonance. Ninety breasts in 61 patients were evaluated with both a fat-suppressed 3D MR sequence and a silicone-suppressed 3D MR sequence., Results: Extracapsular free silicone and silicone injections demonstrated a unique appearance compared with normal breast tissue in all cases. Magnetic resonance identified free silicone in 26 breasts, 10 of which were confirmed pathologically or from a history of previous silicone injections. No free silicone was present on MR in 64 breasts; 8 of these were confirmed by biopsy or mastectomy as showing no evidence of free silicone. This technique was useful in evaluation of prosthesis integrity, free silicone, focal palpable or mammographic lesions, and the breast with silicone injections., Conclusion: Silicone-suppressed RODEO MRI of the breast can accurately identify free and intracapsular silicone and can distinguish silicone from other tissues. This provides unique information about the breast in a number of specific applications.

Background: Prostate specific antigen (PSA) is useful as a tumor marker for monitoring patients with prostate cancer after definitive therapy. Limitations have been noted when PSA was used for the early detection of prostate cancer. The use of prostate specific antigen density [PSAD = PSA (ng/ml)/prostate volume (cc)] has been suggested to differentiate benign from malignant prostate disease., Methods: A retrospective analysis of 559 men who underwent transrectal prostate ultrasound and biopsy for an abnormal PSA value (> 4.0 ng/ml) and/or an abnormal prostate gland by digital rectal examination (DRE) was performed. Prostate specific antigen density evaluation was performed on all men, and its utility for diagnosing prostate cancer was compared with those of PSA and DRE., Results: Two hundred, sixty seven (47%) of the 559 men had positive biopsies for prostate cancer. Sixty-one men had PSA levels of less than 4.0 ng/ml, and 17 (27.8%) of these men had positive biopsies for prostate cancer. No patient with a normal DRE had a positive biopsy regardless of the prostate specific antigen density (PSAD) value. PSAD was not more useful than PSA alone in detecting prostate cancer in this group. Two hundred, seventy-seven men had PSA values between 4.1 and 10.0 ng/ml, and 110 (40.0%) had positive biopsies for prostate cancer. For this group as a whole, the mean PSA values of the positive and negative biopsy groups showed no significant difference. The mean PSAD was significantly different (P < 0.0001) between the positive and negative biopsy groups. Two hundred, twenty-one men had PSA values of greater than 10.0 ng/ml, and 140 (63%) had positive biopsies for prostate cancer. Prostate specific antigen density was no more useful than PSA alone in distinguishing men with positive or negative biopsies for prostate cancer in the entire group. In the subset of patients with a normal DRE, (including no benign prostatic hyperplasia) the mean PSAD appeared useful (P < 0.004) in distinguishing the positive from the negative biopsy groups, whereas the mean PSA was not., Conclusion: These results suggest that PSAD is useful in discriminating prostate cancer in men with normal DRE and PSA levels between 4.1 and 10.0 ng/ml.

Current and potential roles for MR imaging in the management of breast disorders are reviewed along with the specific technical requirements for each application. Major topics include (1) evaluating breasts before biopsy to reduce the number of surgical biopsies for benign lesions, (2) staging of breast carcinoma in breast conservation candidates, (3) evaluating breasts with inconclusive conventional imaging, (4) coordination of minimally invasive surgery, and (5) evaluating silicone implant integrity.