Contrast-Enhanced In-Phase Dixon Sequence: Impact on Biopsy Clip Detection on Breast MRI.

BACKGROUND. Identification of breast biopsy clips using conventional MRI sequences may be challenging. A contrast-enhanced in-phase Dixon sequence may have greater conspicuity for areas of susceptibility compared with standard clinical sequences. OBJECTIVE. The purpose of this article is to compare detection of breast biopsy clips on MRI between the contrast-enhanced in-phase Dixon sequence and three routine clinical sequences. METHODS. This retrospective study included 164 patients (mean age, 50.3 years) with a total of 281 breast biopsy clips who underwent contrast-enhanced breast MRI between January 2, 2019, and April 16, 2020. Three radiologists, blinded to the clip location and sequence used, independently annotated biopsy clip locations on three clinical sequences (T1-weighted non-fat-suppressed [NFS], STIR, and first phase from dynamic contrast-enhanced T1-weighted fat-suppressed [FS]) and on a contrast-enhanced in-phase Dixon sequence and then recorded confidence scores (1-4 scale). A study coordinator used all available imaging and reports to localize clips on MRI, which served as the reference standard. A physicist measured clip CNR. Sequences were compared using the McNemar test and two-tailed Wilcoxon signed rank tests. RESULTS. Among the three readers, pooled sensitivity and PPV were 78.2% and 96.2% for T1-weighted NFS, 26.6% and 92.7% for STIR, 61.7% and 95.9% for contrast-enhanced T1-weighted FS, and 85.1% and 95.1% for contrast-enhanced in-phase Dixon sequence. Pooled sensitivity was higher for contrast-enhanced in-phase Dixon sequence than for the other sequences (all p < .05); pooled PPV was not significantly different between contrast-enhanced in-phase Dixon and the other sequences (all p > .05). Mean confidence scores (pooled across readers for true-positive assessments) and mean CNR were 3.0 ± 0.9 (SD) and 1.21 ± 0.61 for T1-weighted NFS, 1.7 ± 0.9 and 0.57 ± 0.69 for STIR, 2.5 ± 1.0 and 0.54 ± 0.61 for contrast-enhanced T1-weighted FS, and 3.5 ± 0.8 and 4.05 ± 2.6 for the contrast-enhanced in-phase Dixon sequence. Pooled mean confidence scores and CNR were higher for contrast-enhanced in-phase Dixon than for the other sequences (all p < .001). CONCLUSION. Compared with clinical sequences, the contrast-enhanced in-phase Dixon sequence had higher sensitivity for detecting breast biopsy clips on MRI and higher reader confidence and CNR, without change in PPV. CLINICAL IMPACT. The contrast-enhanced in-phase Dixon sequence may help address a current challenge in clinical breast MRI interpretation.

Racial Disparities in Breast Imaging Wait Times Before and After the Implementation of a Same-Day Biopsy Program.

OBJECTIVE: To examine time from screening to diagnostic workup, biopsy, and surgery for non-Hispanic White (NHW) and Black women following implementation of a same-day biopsy program. METHODS: All NHW and Black women with BI-RADS category 0 screening mammogram at Duke University Hospital were identified between August 1, 2020, and August 1, 2021. Patient characteristics were recorded. Time between screening mammogram, diagnostic workup, breast biopsy, surgical consultation, and surgery were recorded. Comparisons were made between NHW and Black women using a multivariable regression model. Diagnostic imaging to biopsy time interval was compared to historical averages before same-day biopsy implementation. RESULTS: There were 2156 women: 69.9% NHW (1508/2156) and 30.1% Black (648/2156). Mean ± standard deviation time from screening to diagnostic imaging overall was 13.5 ±â€…32.5 days but longer for Black (18.0 ±â€…48.3 days) than for NHW women (11.5 ±â€…22.2 days) (P < 0.001). The mean time from diagnostic mammogram to biopsy was 5.9 ±â€…18.9 days, longer for Black (9.0 ±â€…27.9 days) than for NHW women (4.4 ±â€…11.8 days) (P = 0.017). The same-day biopsy program shortened the time from diagnostic imaging to biopsy overall (12.5 ±â€…12.4 days vs 5.9 ±â€…18.9 days; P < 0.001), with a significant reduction for NHW women (12.4 ±â€…11.7 days vs 4.4 ±â€…11.8 days) (P < 0.001) but not Black women (11.5 ±â€…9.9 days vs 9.0 ±â€…27.9 days) (P = 0.527). CONCLUSION: Disparities exist along the breast imaging pathway. A same-day biopsy program benefited NHW women more than Black women.

Role of digital breast tomosynthesis in the evaluation of focal breast pain.

RATIONAL AND OBJECTIVE: To investigate the utility of digital breast tomosynthesis (DBT) in the evaluation of focal breast pain, considering breast density and breast cancer risk. METHODS: Ninety-one cases of focal breast pain evaluated with DBT and ultrasound (US) from 12/30/2014 to 11/9/2017 with 2-year follow-up were identified. Exclusion criteria were non-focal, axillary, or radiating pain; palpable or skin changes; pregnancy or lactation; and history of ipsilateral cancer, trauma, or infection. Demographic data, Tyrer-Cuzick Score (TCS), medical history, breast density, imaging results, and pathology were recorded. Descriptive statistics were reported. RESULTS: Eighteen percent (16/91) of cases demonstrated findings, all benign. Of these, 6% (1/16) were detected by DBT only, 88% (14/16) by US only, and 6% (1/16) by DBT and US. US resulted in 3 benign biopsies. Ninety-nine percent (75/76) of cases with no findings at the site of pain on US also had no findings on DBT. Ninety-eight percent (89/91) of cases with no cancer detected at the site of pain on US also did not have cancer on DBT. DBT detected 2 incidental cancers not associated with pain. DBT and US agreed that there was no finding at the site of pain in 82% (75/91) of cases. A high degree of agreement between DBT and US was seen when stratified by breast density and TCS. CONCLUSION: DBT may be appropriate for the evaluation of focal pain. Low breast cancer incidence was observed at the site of focal pain across all mammographic breast densities and breast cancer risks.

Optimal efficient imaging time for identification of sentinel lymph node with Tc-99m Tilmanocept in breast cancer patients.

We determined the optimal imaging time for axillary lymph node (LN) visualization following Tc-99m Tilmanocept in breast cancer patients to establish imaging guidelines that can allow for a reliable and efficient yet high yield study prior to surgery. Retrospective analysis in 651 patients who underwent lymphoscintigraphy, comparing LN visualization on immediate, 15-minute, and 90-minute delayed imaging after injection of Tc-99m Tilmanocept. Statistical analysis was performed using McNemar's test, kappa coefficient, and Pearson Chi-square test. Five hundred and six patients had either immediate or immediate and 90-minute delayed imaging. Of these patients, 203 (40.1%) had both immediate and 90-minute delayed images. Of these 203 patients, 54 (26.6%) had ≥1 lymph node(s) identified immediately and 196 (96.6%) had ≥1 lymph node(s) identified at 90 minutes (P<0.0001). A kappa coefficient of .0256 was observed (95% CI: .0058-.0453). One hundred and forty-five additional patients had 15-minute delayed imaging. Of these patients, 117 (80.7%) had ≥1 lymph node(s) identified, which was significantly fewer compared to the number of patients with ≥1 lymph node(s) detected at 90 minutes (P<0.0001). Ninety-minute delayed imaging is optimal for identifying sentinel lymph node(s) following Tc-99m Tilmanocept injection in breast cancer patients.