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Background and Rationale: Biomarker evaluation on breast tumor tissue is an important component of clinical research. There is a concern that tissues collected at different times (pre- vs intra-op) and with different techniques (core biopsy vs. surgical excision) produce different results that may confound comparisons of patient samples. Our objective is to address the difference between tumor tissue from the same patient collected pre- vs intra-op and by core biopsy (Core Bx) vs surgical excision, with an emphasis on ER/PgR/HER2/Ki-67 and biomarkers related to insulin metabolism. Design: Following a protocol approved by the IRB, patients with Core Bx proven invasive breast cancer (BC) >1.5 cm in size by imaging underwent a peri-operative Core Bx followed by surgical excision. No neoadjuvant therapy was administered. Formalin-fixed paraffin-embedded tumor sections of the diagnostic and peri-operative Core Bx and surgical excision were immunohistochemically (IHC) stained for ER, PgR, HER2, Ki-67, insulin receptor (IR), phospho-AKT (pAKT), and phospho-AMPK (pAMPK) using standardized protocols on the same platforms. A pathologist (MCC) scored all sections in blinded order to yield H-Scores (which combine percentage of stain-positive cells and staining intensity). The level of agreement for each assay between specimens was assessed by using pairwise models based on normal theory. Results: 18 women (mean age = 66.8 years, 16/18 postmenopausal) provided all specimens. Mean (± SD) invasive tumor size was 2.7 (± 1.2) cm. 1 BC was Nottingham Grade 1 (6%), 9 Grade 2 (50%), and 8 Grade 3 (44%). An in situ component was present in 4/18 (22%) cases (all non-extensive). Lymphovascular invasion was present in 6/18 (33%) cases. 10/18 were node-negative (N0, 56%), 2/18 had isolated tumor cells (pN0[i+], 22%), 5/18 had 1 to 3 nodes (pN1, 28%), 1/18 had >9 nodes involved (pN3, 6%).There was high concordance between diagnostic Core Bx, peri-op Core Bx, and excisions for the standard prognostic markers ER, PgR, and HER2. ER was concordant in all samples including 16/18 (89%) ER-positive and 2/19 (11%) ER-negative BCs. PgR was concordant in 16/18 (89%) of cases. In the 2 discordant cases, PgR was negative in 2 of 3 tissue samples with low expression in the 3rd sample (1 diagnostic Core Bx and 1 excision). HER2 was concordant in all samples in 16/18 (89%) HER2-negative cases and in 2/18 (11%) HER2-positive cases including 1/18 cases (6%) positive by IHC, and 1/18 cases (6%) positive by ISH. Table 1 summarizes the agreement between samples for Ki-67, IR, pAKT, and pAMPK. Ki-67 scores were statistically similar between diagnostic and peri-op Core Bx and excision samples. The IR, pAKT, and pAMPK H-Scores were statistically similar between diagnostic and peri-op Core Bx, but significantly different between Core Bxs versus excisional specimens. There was a systematic tendency towards lower IHC H-Scores in the excisional specimen for IR, pAKT, and pAMPK. Conclusion: Tissue from surgical excisions are susceptible to reduced IHC staining for metabolic markers such as IR, and phosphorylated kinases, when compared to core biopsies. When evaluating non-standard biomarkers for research, core biopsies should be used when possible. Funding: This study was funded by the Hold'Em For Life Charity and the Breast Cancer Research Foundation Table 1: Concordance Between IHC Scores for Ki-67, Insulin Receptor, pAKT, and pAMPKScore: Mean ± Standard DeviationPeri-Operative Core Bx versus Diagnostic Core BxExcision versus Diagnostic Core BxDiagnostic Core BxPeri-Operative Core BxExcisionDifferenceP-valueDifferenceP-valueKi-67 (% Positive)33.5 ± 28.235.9 ± 31.034.2 ± 29.1Mean ± SD: 2.4 ± 5.60.09Mean ± SD: 0.6 ± 6.30.68Range: -7.7 to 12.3Range: -11.5 to 12.2Insulin Receptor (H-Score**)136 ± 102124 ± 9986 ± 78Mean ± SD: -13 ± 530.32Mean ± SD: -51 ± 540.001*Range: -215 to 40Range: -150 to 5Phospho-AKT (H-Score**)102 ± 70100 ± 8641 ± 41Mean ± SD: -1 ± 750.95Mean ± SD: -61 ± 520.0001*Range: -170 to 170Range: -144 to 0Phospho-AMPK (H-Score**)201 ± 79185 ± 78157 ± 86Mean ± SD: -15 ± 760.41Mean ± SD: -44 ± 690.016*Range: -225 to 120Range: -215 to 70* Statistically significant difference in pairwise values based on t-test** H-Score is the percentage of stain-positive cells multiplied by the average intensity score (0 = absent, 1 = faint, 2 = moderate, 3 = strong) Citation Format: Martin C. Chang, Marguerite Ennis, Jaime Escallon, Karina Bukhanov, Ryan JO Dowling, Vuk Stambolic, Pamela J Goodwin. Concordance of immunohistochemical assays between peri-operative and post-operative breast tumor specimens: A prospective observational study of 18 cases [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS18-25.

Highlights • Avoiding transmission of COVID-19 pandemic while providing essential breast cancer care is critical. • Tailored recommendations and algorithms have been developed promptly at the breast imaging department to face the COVID-19 pandemic outbreak. • Discussions are underway on the best way to resume regular patient care, given the uncertainty course and duration of the COVID-19 pandemic., The pandemic caused by the new Coronavirus has changed the way patient care is provided worldwide. This review focuses on the description of the operational measures implemented in a breast imaging department in accordance with existing recommendations for the treatment of breast cancer during the COVID-19 pandemic to make optimal use of finite resources without interruption of essential imaging services for breast cancer patients. It will also apply during a second-wave of the pandemic, which, according to experts, is inevitable and requires us to be better prepared.

Purpose To evaluate the value of mammography in detecting breast cancer in high-risk women undergoing screening breast magnetic resonance (MR) imaging. Materials and Methods An ethics-approved, retrospective review of prospective databases was performed to identify outcomes of 3934 screening studies (1977 screening MR imaging examinations and 1957 screening mammograms) performed between January 2012 and July 2014 in 1249 high-risk women. Performance measures including recall and cancer detection rates, sensitivity, specificity, and positive predictive values were calculated for both mammography and MR imaging. Results A total of 45 cancers (33 invasive and 12 ductal carcinomas in situ) were diagnosed, 43 were seen with MR imaging and 14 with both mammography and MR imaging. Additional tests (further imaging and/or biopsy) were recommended in 461 screening MR imaging studies (recall rate, 23.3%; 95% confidence interval [CI]: 21.5%, 25.2%), and mammography recalled 217 (recall rate, 11.1%; 95% CI: 9.7%, 12.6%). The cancer detection rate for MR imaging was 21.8 cancers per 1000 examinations (95% CI: 15.78, 29.19) and that for mammography was 7.2 cancers per 1000 examinations (95% CI: 3.92, 11.97; P < .001). Sensitivity and specificity of MR imaging were 96% and 78% respectively, and those of mammography were 31% and 89%, respectively (P < .001). Positive predictive value for MR imaging recalls was 9.3% (95% CI: 6.83%, 12.36%) and that for mammography recalls was 6.5% (95% CI: 3.57%, 10.59%). Conclusion Contemporaneous screening mammography did not have added value in detection of breast cancer for women who undergo screening MR imaging. Routine use of screening mammography in women undergoing screening breast MR imaging warrants reconsideration. © RSNA, 2017 Online supplemental material is available for this article.

Purpose The purpose of this study was to evaluate the sensitivity of a direct computer-aided detection (CAD) system (d-CAD) in full-field digital mammography (FFDM) for the detection of microcalcifications not associated with mass or architectural distortion. Materials and Methods A database search of 1063 consecutive stereotactic core biopsies performed between 2002 and 2005 identified 196 patients with Breast Imaging-Reporting and Data System (BI-RADS) 4 and 5 microcalcifications not associated with mass or distortion detected exclusively by bilateral FFDM. A commercially available CAD system (Second Look, version 7.2) was retrospectively applied to the craniocaudal and mediolateral oblique views in these patients (mean age, 59 years; range, 35–84 years). Breast density, location and mammographic size of the lesion, distribution, and tumour histology were recorded and analysed by using χ2, Fisher exact, or McNemar tests, when applicable. Results When using d-CAD, 71 of 74 malignant microcalcification cases (96%) and 101 of 122 benign microcalcifications (83%) were identified. There was a significant difference ( P < .05) between CAD sensitivity on the craniocaudal view, 91% (68 of 75), vs CAD sensitivity on the mediolateral oblique view, 80% (60 of 75). The d-CAD sensitivity for dense breast tissue (American College of Radiology [ACR] density 3 and 4) was higher (97%) than d-CAD sensitivity (95%) for nondense tissue (ACR density 1 and 2), but the difference was not statically significant. All 28 malignant calcifications larger than 10 mm were detected by CAD, whereas the sensitivity for lesions small than or equal to 10 mm was 94%. Conclusions D-CAD had a high sensitivity in the depiction of asymptomatic breast cancers, which were seen as microcalcifications on FFDM screening, with a sensitivity of d-CAD on the craniocaudal view being significantly better. All malignant microcalcifications larger than 10 mm were detected by d-CAD.

The aim of this study was to evaluate the presence of clinically and mammographically occult disease using breast MRI in a cohort of cancer patients undergoing contralateral prophylactic mastectomy (CPM) and the utmost indication of axillary assessment (sentinel node biopsy (SLNB)) for this side. A retrospective review of patients with unilateral invasive breast cancer or ductal carcinoma in situ (DCIS) from institutional MRI registry data (2004–2010) was conducted. Characteristics of patients undergoing CPM with breast MRI obtained less than 6 month before surgery were evaluated. A total of 2322 consecutive patients diagnosed with DCIS or stage I to III infiltrating breast cancer underwent preoperative breast MRI. Of these, 1376 patients (59.2%) had contralateral clinical breast exam and mammography without abnormalities; and 116 patients (4.9%) underwent CPM (28 excluded patients had breast MRI more than 6 months before CPM). The mean age of the 88 patients was 49 years (range 28–76 years). Two (2.3%) DCIS identified on surgical pathology specimen were not depicted by MRI and the 5 mm T1N0 invasive cancer (1.1%) was identified on MRI. Preoperative MRI showed 95% accuracy to demonstrate absence of occult disease with negative predicted value (NPV) of 98% (95% CI: 91.64–99.64%). Occult disease was present in 3.4% of CPM. MRI accurately identified the case of invasive cancer in this cohort. The high negative predictive value suggests that MRI can be used to select patients without consideration of SLNB for the contralateral side.

OBJECTIVE. The purpose of this study was to describe the sonographic appearance and histopathologic basis of those malignancies of the breast that show nonenhancement on MRI.CONCLUSION. Breast malignancies with suspicious features on sonography may not be detected on MRI due to nonenhancement of the lesions. In such cases, we suggest the use of tissue sampling to differentiate between benign and malignant breast lesions.

Fat necrosis is a cause of palpable breast lesions. Sonography is commonly used before mammography in young patients with palpable lumps. We describe a case of isoechoic breast fat necrosis that was detected because of extension to the skin. We are unaware of other reports of an isoechoic appearance of fat necrosis.

The purpose of this study was to evaluate the performance of a direct computer-aided detection (d-CAD) system integrated with full-field digital mammography (FFDM) in assessment of amorphous calcifications.From 1438 consecutive stereotactic-guided biopsies, FFDM images with amorphous calcifications were selected for retrospective evaluation by d-CAD in 122 females (mean age, 56 years; range, 35-84 years). The sensitivity, specificity, accuracy and false-positive rate of the d-CAD system were calculated in the total group of 124 lesions and in the subgroups based on breast density, mammographic lesion distribution and extension. Logistic regression analysis was used to stratify the risk of malignancy by patient risk factors and age.The d-CAD marked all (36/36) breast cancers, 85% (11/13) of the high-risk lesions and 80% (60/75) of benign amorphous calcifications (p0.01) correctly. The sensitivity, specificity and diagnostic accuracy for the combined malignant and "high-risk" lesions was 96, 80 and 86%, respectively. The likelihood of malignancy was 29%. There was no significant difference between the marking of fatty or dense breasts (p0.05); however, d-CAD marks showed differences for small (7 mm) lesions (p=0.02) and clustered calcifications (p=0.03). The false-positive rate of d-CAD was 1.76 marks per full examination.The d-CAD system correctly marked all biopsy-proven breast cancers and a large number of biopsy-proven high-risk lesions that presented as amorphous calcifications. Given our 29% likelihood of malignancy, imaging-guided biopsy appears to be a reasonable recommendation in cases of amorphous calcifications marked by d-CAD.

To evaluate the frequency of diagnosis of high-risk lesions at MRI-guided vacuum-assisted breast biopsy (MRgVABB) and to determine whether underestimation may be predicted. Retrospective review of the medical records of 161 patients who underwent MRgVABB was performed. The underestimation rate was defined as an upgrade of a high-risk lesion at MRgVABB to malignancy at surgery. Clinical data, MRI features of the biopsied lesions, and histological diagnosis of cases with and those without underestimation were compared. Of 161 MRgVABB, histology revealed 31 (19%) high-risk lesions. Of 26 excised high-risk lesions, 13 (50%) were upgraded to malignancy. The underestimation rates of lobular neoplasia, atypical apocrine metaplasia, atypical ductal hyperplasia, and flat epithelial atypia were 50% (4/8), 100% (5/5), 50% (3/6) and 50% (1/2) respectively. There was no underestimation in the cases of benign papilloma without atypia (0/3), and radial scar (0/2). No statistically significant differences (p > 0.1) between the cases with and those without underestimation were seen in patient age, indications for breast MRI, size of lesion on MRI, morphological and kinetic features of biopsied lesions. Imaging and clinical features cannot be used reliably to predict underestimation at MRgVABB. All high-risk lesions diagnosed at MRgVABB require surgical excision.

Granular cell tumours (GCTs) are uncommon, usually benign neoplasms that can mimic malignancy on breast imaging. GCTs can originate anywhere in the body but are most frequently found in the head and neck area, particularly in the oral cavity. When occurring in the breast, as occurs in 5-8% of all cases of GCT, the clinical presentation is similar to that of a primary breast carcinoma. We report a case of granular cell tumour of the breast presenting as a suspicious lesion on breast imaging, and review the MRI features of GCTs.

56 Background: Mammographic breast density is a significant risk factor for breast cancer. Women with extremely dense breasts are at 4-to-6 times the risk of developing breast cancer than women with primarily fatty breast tissue. Electrical Breast Densitometry (EBD) is a new technique that assesses breast density. EBD is non-ionizing, fast, has low cost per test ($20-$30) and may help in breast cancer risk assessment in the primary care setting. Methods: This study evaluated the feasibility of the EBD in an IRB-approved pilot study of 20 patients. The study used a custom-made self-adhesive electrode (SenoSENSE Medical Systems, Toronto, Canada) interfaced to an off-the-shelf impedance meter (Bodystat 1500, Bodystat, Isle of Man, UK) with a customized cable. On the same day as the subject’s scheduled mammogram, impedance measurements were acquired for each breast. Mammogram densities were scored by a trained radiologist using standard BiRADS breast density categories 1 to 4. Results: A high correlation coefficient was observed (Pearson correlation coefficient >0.80) between breast density determined by the EBD and the BiRADS breast density score. In addition a statistically significant difference was observed between dense categories (BiRADS 3,4) and fatty categories (BiRADS 1,2) (p0.95) was observed between EBD measurements on the left and right breasts. Previous studies have reported a left/right correlation of 0.89 for blinded mammography readers. Conclusions: These results suggests that the EBD measure may be less variable than mammographic estimates of density. The results of the study suggest that Electrical Breast Densitometry is a promising technique for the assessment of breast density and the ability to aid in evaluation of breast cancer risk. It can be reasonably deployed at primary care facilities.