Artificial Intelligence for Breast Cancer Screening in Mammography (AI-STREAM): A Prospective Multicenter Study Design in Korea Using AI-Based CADe/x / 한국유방암학회지

Purpose@#Artificial intelligence (AI)-based computer-aided detection/diagnosis (CADe/x) has helped improve radiologists’ performance and provides results equivalent or superior to those of radiologists’ alone. This prospective multicenter cohort study aims to generate real-world evidence on the overall benefits and disadvantages of using AI-based CADe/x for breast cancer detection in a population-based breast cancer screening program comprising Korean women aged ≥ 40 years. The purpose of this report is to compare the diagnostic accuracy of radiologists with and without the use of AI-based CADe/x in mammography readings for breast cancer screening of Korean women with average breast cancer risk. @*Methods@#Approximately 32,714 participants will be enrolled between February 2021 and December 2022 at 5 study sites in Korea. A radiologist specializing in breast imaging will interpret the mammography readings with or without the use of AI-based CADe/x. If recall is required, further diagnostic workup will be conducted to confirm the cancer detected on screening. The findings will be recorded for all participants regardless of their screening status to identify study participants with breast cancer diagnosis within both 1 year and 2 years of screening. The national cancer registry database will be reviewed in 2026 and 2027, and the results of this study are expected to be published in 2027. In addition, the diagnostic accuracy of general radiologists and radiologists specializing in breast imaging from another hospital with or without the use of AI-based CADe/x will be compared considering mammography readings for breast cancer screening.DiscussionThe Artificial Intelligence for Breast Cancer Screening in Mammography (AI-STREAM) study is a prospective multicenter study that aims to compare the diagnostic accuracy of radiologists with and without the use of AI-based CADe/x in mammography readings for breast cancer screening of women with average breast cancer risk. AI-STREAM is currently in the patient enrollment phase.Trial RegistrationClinicalTrials.gov Identifier: NCT05024591

Ultrasonographic Features and the Diagnostic Role of Core Needle Biopsy at Metastatic Breast Cancer in the Thyroid gland: A Case Report

Metastases to the thyroid gland have rarely been reported in clinical settings, and the thyroid gland is an uncommon site for breast carcinoma metastasis. We report a case of a 64-year-old breast cancer patient diagnosed with metastatic breast carcinoma in the thyroid gland after performing ultrasonography (US)-guided core needle biopsy (CNB) and subsequent total thyroidectomy. On US, the thyroid lesion appeared to be mildly enlarged with multiple internal hypoechoic lines and a few microcalcifications without mass formation. Under US-guidance, CNB was performed by targeting the area with microcalcifications and subsequently diagnosed as metastatic breast carcinoma. Total thyroidectomy revealed that the patient had metastatic invasive ductal carcinoma of the breast with lymphatic spread involving both lobes and the isthmus of the thyroid gland. Although the thyroid gland is an uncommon metastatic site, the unusual features of thyroid metastasis can be observed on US; thus, US-guided CNB effectively aids the diagnosis of thyroid metastasis.

Left Upper Lobar Agenesis Associated with Tracheal Trifurcation: A Case Report

Lobar agenesis is a rare congenital anomaly that is characterized by the absence of the lobar pulmonary artery, pulmonary vein, bronchi, and parenchyma. We encountered a unique case of a young male patient with agenesis of the left upper lobe with tracheal trifurcation into three bronchi, all arising at the carinal level. Complex tracheobronchial anatomy was explicitly demonstrated by three-dimensional CT reconstruction and virtual bronchoscopy. Left upper lobar agenesis associated with tracheal trifurcation is an extremely rare anomaly that, to the best of our knowledge, has not been previously reported.

Superficially Palpable Masses of the Scalp and Face: A Pictorial Essay

Palpable lesions of the scalp and face are common in clinical practice. They are usually small and benign, and the lesions tend to be treated simply according to the clinical symptoms. However, radiologic evaluation is often performed to determine the exact type and location of a lesion to ensure appropriate management. Ultrasonography is useful as a primary and definitive modality for evaluating small superficial lesions. CT and MRI are better for characterizing soft tissue features and provide superior soft tissue resolution. This article discusses various lesions and their imaging findings of the scalp and face that may present as superficially palpable masses.

A Pulmonary Sequestered Segment with an Aberrant Pulmonary Arterial Supply: A Case of Unique Anomaly

We presented a rare case of a 64-year-old man with a combined anomaly of the bronchus and pulmonary artery that was detected incidentally. Computed tomography showed a hyperlucent, aerated sequestered segment of the right lower lung with an independent ectopic bronchus, which had no connection to the other airway. The affected segment was supplied by its own aberrant pulmonary artery branch from the right pulmonary trunk. This anomaly cannot be classified with any of the previously reported anomalies.

Non-puerperal mastitis masking pre-existing breast malignancy: importance of follow-up imaging

Mastitis is an inflammatory condition of the breast with common symptoms of pain, swelling, erythema, warmth, and fever. Diagnosis of mastitis is easily made on the basis of typical symptoms and ultrasonographic findings, such as diffusely increased echogenicity of the parenchyma and subcutaneous fat, or skin thickening. However, when it occurs in women middle-aged or older, associated malignancy should be considered. In our cases, we detected irregular hypoechoic malignant masses after the disappearance of inflammatory changes. Therefore, when non-puerperal women have inflammatory signs on their breast, follow-up imaging should be performed. In particular, in the case of persistent or growing palpability after the recovery of breast inflammation, percutaneous core biopsy and short-term follow-up with ultrasonography should be considered to exclude the associated malignancy.

Small-cell neuroendocrine carcinoma of the breast / 대한외과학회지

A small-cell carcinoma is one of the histologic subtypes of primary neuroendocrine carcinomas of the breast. A small-cell carcinoma is a rare entity of the breast and exhibits similar morphologic features as neuroendocrine tumors of the gastrointestinal tract and lung. We present the imaging and pathologic findings of a primary small-cell neuroendocrine carcinoma of the breast. This is the first report of a primary small-cell carcinoma arising from the breast in Korea.

Chronic and Recurrent Subareolar Abscess of the Breast from Underlying Causes

A subareolar abscess is the most common non-puerperal abscess of the breast. The main cause of a subareolar abscess is squamous metaplasia, which obstructs the lactiferous ducts and leads to the stasis of secretions and rupture of the ducts. However, there are other causes of subareolar abscess formation.

Acute Obstructive Cholangitis after Transarterial Chemoembolization: the Effect of Percutaneous Transhepatic Removal of Tumor Fragment

Acute obstructive cholangitis due to the migration of necrotized tumor fragment is a rare complication occurring after a transarterial chemoembolization. The percutaneous tumor removal procedure following percutaneous transhepatic biliary drainage is an appropriate treatment over endoscopic removal for the relief of acute cholangitis in this case. Following this serial management, no invasive hepatocellular carcinoma of the bile duct recurred after two years of follow-up.

Malignant Fibrous Histiocytoma of Chest Wall

Primary malignant fibrous histiocytoma (MFH) of the chest wall is rare. We report a case of primary MFH arising from the chest wall, which was thought to be a metastasis or myeloma. The imaging study revealed a single mass of the chest wall involving a rib. Resection and chest wall reconstruction was done. The histologic diagnosis was storiform-pleomorphic primary MFH. Although MFH of the chest wall is an uncommon pathology, it should be considered in the differentiation of a single bony destructive lesion involving the rib with a soft tissue component.

Brain Metastasis of Breast Cancer: Clinical and Radiologic Findings

PURPOSE: To analyse the clinical and radiologic findings of brain metastasis of breast cancer. MATERIALS AND METHODS: Sixty-one of 1399 patients in whom breast cancer was diagnosed between 1983 and 1999 were affected by brain metastasis. Among these 1399, the stage of the breast cancer, in descending order of frequency, was IIA (n=508), I (n=366), IIB (n=247), IIIA (n=189), IIIB (n=45), 0 (n=33) and IV (n=11). The stage of the 61 brain metastases, similarly ordered, was IIB (12.5%), IIA (3.9%), IIIA (3.1%), IIIB (2.2%) and I (0.8%). In all confirmed breast cancers, the age distribution, in descending order of frequency, was 40 - 49years (n=610), 50 - 59 (n=301), 30 - 39 (n=291), 60 - 69 (n=124), 20 - 29 (n=41), 70 - 79 (n=28), and 80 - 89 (n=4). The age distribution of brain metastasis was 20 -29 (14.6%), 30 - 39 (7.9%), 50 - 59 (4.6%), 40-49 (2.6%) and 60 - 69 (1.6%). Imaging findings were available for 35 of the 61 patients affected by brain metastasis, and symptoms from brain among the 35, analysis of the symptoms of this metastasis, the site of the first distant metastasis to an extracranial or cranial organ, the interval from the diagnosis of breast cancer to brain metastasis, the interval from brain metastasis to death, and the difference in survival time between patients with initial and succeeding brain metastasis was undertaken. Brain CT findings were analysed in 29 cases and MRI findings in eight. RESULTS: The most common symptoms were headache and vomiting. Among the 35 brain metastasis patients for whom imaging findings were available, other systemic metastasis occurred in 22. Initial brain metastasis occurred in the remaining 13, and in seven of these there was also coincident organ metastasis, while six showed only brain metastasis. The most frequent intervals from the diagnosis of breast cancer to brain metastasis were 1 - 2 years(8/35) and 2 - 3years(8/35). Twenty-six of 35 patients died within one year of brain metastasis. Patients in whom this occurred later survived for longer than those in whom it occurred initially. According to CT or MRI, involvement was supratentorial (n=23), infratentorial (n=2) or at both sites (n=10). Twenty-four patients had multiple lesions and 11 had a single lesion. Precontrast CT imaging show the masses were isodense in 23 cases, hyperdense in three, hypodense in two, and calcified in one. In seven of eight patients who underwent MRI, the lesions showed iso signal intensity on T1WI and iso or high signal intensity on T2WI. The most common enhancement pattern was homogeneous nodular (n=20). CONCLUSION: Among breast cancer patients in whom metastis to the brain occurred, those in whom this happened later survived for longer than those in whom it took place initially. In order to delay brain metastasis and prolong survival, screening for the first distant metastasis is therefore important. The metastasis of breast cancer to the brain was mainly multiple. The most frequent location and postcontrast imaging findings were, respectively, the supratentorium and homogeneous nodular enhancement.