Current controversies in breast cancer screening.

Multiple large-scale, randomized controlled trials throughout the world have demonstrated screening mammography significantly reduces a woman's risk of dying from breast cancer. Despite the known mortality reduction, the perceived harms of mammography are weighed against the known value. Multiple national guidelines have moved away from recommending all women have annual screening mammograms beginning at age 40. Instead, many now encourage women at average risk for developing breast cancer to engage in shared decision-making with their providers, carefully weighing the perceived harms against the known benefits of mammography. These factors should be incorporated into the decision about when to begin and how often to screen. This paradigm shift has been particularly controversial as it relates to women in the 40-49-year age group, considering their incidence of breast cancer and therefore derived benefit of screening is lower, yet the breast cancers that do occur tend to be more aggressive and often require intensive therapy. Thus, debates ensue over the appropriate age at which to begin screening for breast cancer, how often screening should occur, and when to stop.

Cystic neutrophilic granulomatous mastitis: The Cleveland Clinic experience with diagnosis and management.

Granulomatous mastitis is an uncommon inflammatory disease that typically presents with painful breast lesions. Recent publications have brought to light a specific subset of granulomatous mastitis patients with a distinct histological pattern of disease termed, "cystic neutrophilic granulomatous mastitis" (CNGM). Although many cases of granulomatous lobular mastitis have been thought to be idiopathic, this rare subset of an uncommon disease has been linked to infections with Corynebacterium species. Herein, a cohort of CNGM patients from a large, tertiary care, North-American, academic medical center is presented. Correlative demographic, clinical, radiographic, pathologic, microbiologic, management, and outcomes data are provided. Collaborative communication between specialists to accurately diagnose and manage these patients is essential to decreasing potential morbidity.

Breast Cancer Screening and Diagnosis, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology.

The NCCN Guidelines for Breast Cancer Screening and Diagnosis have been developed to facilitate clinical decision making. This manuscript discusses the diagnostic evaluation of individuals with suspected breast cancer due to either abnormal imaging and/or physical findings. For breast cancer screening recommendations, please see the full guidelines on NCCN.org.

Change in adrenal mass size as a predictor of a malignant tumor.

OBJECTIVE: To assess the value of adrenal mass absolute growth, growth rate, and percentage growth rate on serial imaging for distinguishing benign from malignant adrenal masses. METHODS: We retrospectively reviewed the Cleveland Clinic medical record data on 136 adrenalectomies or biopsies in 132 patients with 2 imaging studies performed more than 2 months apart (during 1997 to 2008). RESULTS: There were 111 benign (81.6%) and 25 malignant (18.4%) adrenal masses. With use of receiver operating characteristic curve analysis, all 3 aforementioned growth measures showed similar levels of discrimination for the entire study group as well as for the subgroups with 3 to 12 months of follow-up (n = 75 masses) and noncontrast computed tomography Hounsfield units >10 or not reported (n = 111 masses). After adjustment for other factors, the 3 growth measures remained statistically significant predictors of a malignant tumor. The absolute growth cutoff value of 0.8 cm had the highest sum of sensitivity and specificity of 72% and 81.1%, respectively. We could not identify an adrenal mass growth cutoff value to provide 100% sensitivity or specificity to confirm or exclude the presence of a malignant lesion. In 3 patients with metastatic lesions, no growth or a decrease in mass size during a period of 4 to 36 months was observed. CONCLUSION: In this study, the largest with surgical histopathology findings as the "gold standard" for diagnosis, change in adrenal mass size was a significant predictor of a malignant tumor. Nevertheless, we could not identify an adrenal mass growth cutoff value for reliable confirmation or exclusion of a malignant lesion. Change in adrenal mass size should be used in conjunction with other imaging and clinical characteristics when surgical resection is being considered.

CT histogram analysis in pathologically proven adrenal masses.

OBJECTIVE: The purpose of this article is to evaluate a histogram analysis method for distinguishing adrenal adenomas from metastases, pheochromocytomas, and adrenocortical carcinomas on CT. MATERIALS AND METHODS: A pathology database was searched, and 335 adrenalectomies from 1995 to 2002 were identified. CT images were available for retrospective review in 187 patients (93 males, 94 females; age range, 15-84 years; mean age, 55.2 years) with 208 adrenal masses. This included 112 adenomas in 104 patients, 48 metastases in 39 patients, 40 pheochromocytomas in 36 patients, and eight adrenocortical carcinomas in eight patients. Histogram analysis was performed using a circular region of interest for mean attenuation, number of pixels, number of negative pixels (< 0 H), and percentage of negative pixels by two interpreters. Areas of necrosis were excluded from measurements. Observer agreement was calculated. RESULTS: In 72 of 76 (94.7%) and 63 of 72 (87.5%) adenomas, respectively, interpreters found attenuation values greater than 10 H contained negative pixels on unenhanced CT scans. None of the enhanced adenomas had mean attenuation less than or equal to 10 H, but 24 (38.7%) and 28 (45.2%), respectively, had negative pixels. Negative pixels were present in unenhanced and enhanced metastases, pheochromocytomas, and carcinomas. Using a 5% or 10% negative pixel threshold value to diagnose adenoma improved specificity but diminished sensitivity. Specificity for a 10% negative pixel threshold was approximately 88% for unenhanced CT scans and 99% for enhanced CT scans, with sensitivities of 71% and 12%, respectively. CONCLUSION: Although specificity for the diagnosis of adenomas on enhanced CT scans with histogram analysis was high when a 10% negative pixel threshold was used, low sensitivity likely limits clinical usefulness.