Rate of radial scars by core biopsy and upgrading to malignancy or high-risk lesions before and after introduction of digital breast tomosynthesis.

PURPOSE: Radial scars (RS) commonly present mammographically as architectural distortions, but these lesions may be associated with non-invasive and invasive breast cancer. Digital breast tomosynthesis (DBT) has resulted in higher detection rates of architectural distortion particularly in patients with dense breast tissue. We hypothesized that rates of clinically relevant lesions confirmed surgically would be lower in patients who received DBT imaging compared with those who received standard digital breast imaging. METHODS: We performed a retrospective review of 223 patients diagnosed with pure RS by core biopsy and surgical excision before and after DBT was introduced. The rate of upgrading to malignancy or high-risk lesion was evaluated. Demographics, biopsy type, and histologic data were analyzed. Univariable logistic regression analysis was used to identify variables that may be associated with upgrading. RESULTS: The rate of identifying RS increased from 0.04-.13% (P < 0.0001) with DBT imaging. The upgrade rate on surgical specimen to invasive or non-invasive cancer was similar before and after DBT; 6% versus 3%, as were findings of a high-risk lesion; 12% versus 22%. No predictive factors were identified for patients upgraded to malignant neoplasms or high-risk lesions. CONCLUSIONS: The likelihood of identifying RS has increased with DBT imaging, but rates of upgrading to a malignant neoplasm or high-risk lesion were similar to those before DBT. Although the rate of upgrading to malignancy after DBT was low, an excisional biopsy should be considered as 22% of patients were upgraded to high-risk lesions. These patients are candidates for chemoprevention and/or high-risk surveillance.

Breast cyst recurrence after postaspiration injection of air.

Breast cysts are a common cause of breast pain, lumps, and patient anxiety. Older studies incidentally reported a decrease in cyst recurrence when air was injected for diagnostic purposes after aspiration. The purpose of this study was to determine the incidence of cyst recurrence after ultrasound-guided aspiration and injection of air for therapeutic purposes. In this study, we retrospectively reviewed 113 cysts aspirated in 90 women; 88 had air injected for therapeutic purposes after aspiration, and 25 did not. Subsequent mammograms and sonograms were reviewed (mean follow-up 21 months, range of 8-36 months) to assess for recurrence. Demographic and imaging features were not different between the two study groups. Of the 88 cysts that had air injected after aspiration, 14 recurred (16%) compared with 20 of 25 cysts (80%) that did not have air injected following aspiration. Cyst recurrence correlated with air injection, but did not correlate with cyst size, menopausal status, or use of hormone replacement therapy. Only one patient complained of pain, and no complications occurred. The injection of air into cysts following aspiration may be useful for therapeutic purposes.

Process involved in reading imaging studies: workflow analysis and implications for workstation development.

Software development for imaging workstations has lagged behind hardware availability. To guide development and to analyze work flow involved in interpretation of cross-sectional imaging studies, we assessed the cognitive and physical processes. We observed the performance and interpretation of body computed tomography (CT scans and recorded the events that occurred during this process. We studied work flow using a bottleneck analysis. Twenty-four ofa total of 54 cases (44%) involved comparing the images with those of prior scans. Forty-seven of 54 scans (87%) were viewed using windows other than soft tissue, or compared with precontrast scans. In 46 cases (85%), the interpretation stopped to return to a previous level for review. Measurement of lesions was performed in 24 of 54 (44%) cases, and in 15 (63%)of these cases, measurements were taken of lesions on old studies for comparison. Interpretation was interrupted in 14 of 54 cases (26%) by referring clinicians desiring consultation. The work flow analysis showed film folder retrieval by the film room to be the bottleneck for interpretation by film. For picture archiving and communication system (PACS) reading,the CT examination itself proved to be the bottleneck. We conclude that workstations for CT interpretation should facilitate movement within scans, comparison with prior examinations, and measuring lesions on these scans. Workstation design should consider means of optimizing time currently not used between interpretation sessions, minimizing interruptions and providing more automated functions currently requiring physician interaction.