Sonographic features of primary breast cancer in men.

OBJECTIVE: The imaging studies of eight men with proven primary breast cancer and preoperative sonography and mammography were reviewed and correlated with final pathology reports. CONCLUSION: There were five cases of invasive breast carcinoma and three cases of ductal carcinoma in situ of the papillary subtype. All three cases of papillary ductal carcinoma in situ showed cystic features on sonography. Most (4/5) invasive cancers were solid on sonography. The appearance of a complex cystic mass in the male breast on sonography should suggest the possibility of malignancy and therefore warrants biopsy.

Society of Breast Imaging residency and fellowship training curriculum.

A recently developed Society of Breast Imaging curriculum for residency training is intended to provide guidance to residents and their mentors, and to practicing radiologists who want to keep up to date in screening, diagnosis, and interventional procedures. The curriculum contains lists of key concepts in 14 subject areas: epidemiology; anatomy; pathology, and physiology; equipment and technique; quality control; interpretation; problem-solving mammography; ultrasound; interventional procedures; reporting and medicolegal aspects; screening; MR imaging; therapeutic considerations; and patient management principles. The curriculum also makes recommendations about residency training, including the number of examinations the resident should interpret, and the time the resident should spend in breast imaging. Recommendations for fellowship training are also discussed.

Primary inflammatory carcinoma of the breast: retrospective review of mammographic findings.

OBJECTIVE: Our goal was to describe the mammographic characteristics of primary inflammatory carcinoma of the breast. MATERIALS AND METHODS: We identified the medical records of 43 women who participated in a chemotherapy protocol for primary inflammatory carcinoma of the breast between 1994 and 1997. Mammograms were available for review in 26 women (age range, 34-78 years; mean age, 56 years). Two radiologists independently reviewed the 26 mammograms obtained before patients underwent treatment. A third observer was the final arbiter when needed. RESULTS: Mammographic findings included skin thickening in 24 patients (92%), diffusely increased density in 21 patients (81%), trabecular thickening in 16 patients (62%), axillary lymphadenopathy in 15 patients (58%), architectural distortion or focal asymmetric density in 13 patients (50%), and nipple retraction in 10 patients (38%). Malignant-appearing calcifications were seen in six patients (23%), and a mass was seen in four patients (15%). CONCLUSION: Diffuse mammographic abnormalities such as skin thickening, increased density, trabecular thickening, and axillary lymphadenopathy are common at presentation in patients with primary inflammatory carcinoma of the breast. Mammographic masses and malignant-appearing calcifications are uncommon manifestations of this disease.

Tubular carcinoma of the breast: mammographic and sonographic features.

OBJECTIVE: The purpose of this study was to define specific mammographic and sonographic features of tubular carcinoma of the breast. MATERIALS AND METHODS: Seventeen pathologically confirmed cases of tubular carcinoma were characterized retrospectively by two radiologists. Mammograms and sonograms were available for all patients. RESULTS: Fifteen of the 17 tubular carcinomas appeared as irregularly shaped masses with spiculated margins on mammography. Sixteen of the 17 masses had central densities. Spicules longer than the diameter of the central lesion were noted in eight (53%) of 15 tubular carcinomas. Eight tubular carcinomas had associated calcifications, with calcifications suspected of being malignant in four cases. On sonography, 15 hypoechoic masses were seen. The margins of the masses on sonography were described as ill-defined in 14 (93%) of the 15 cases. Posterior acoustic shadowing was present in 14 of the 15 cases. CONCLUSION: Tubular carcinomas are usually seen on mammography as irregularly shaped masses with central densities and spiculated margins, and most tubular carcinomas can be identified on sonography as hypoechoic masses with ill-defined margins and posterior acoustic shadowing. Although the mammographic and sonographic features of tubular carcinoma are not sufficiently specific to differentiate tubular carcinomas from radial scars, sonography can be useful for guiding biopsies and evaluating for multifocal and multicentric disease.

Mammographic findings after breast conservation therapy.

Breast conservation therapy for breast cancer involves lumpectomy or segmental mastectomy followed by radiation therapy. Masses, fluid collections, architectural distortion, scarring, edema, skin thickening, and calcifications are posttreatment findings that may mimic or mask local tumor recurrence. Despite the overlap between posttreatment changes and tumor recurrence, the two entities can usually be distinguished by the characteristic mammographic appearances of posttreatment sequelae and by comparing interval findings on successive studies. Postoperative masses and fluid collections slowly diminish in size and usually resolve by 1 year after surgery. Radiation-induced edema gradually resolves; increasing edema may be due to recurrent cancer. Postsurgical scarring usually appears as a poorly marginated soft-tissue mass with interspersed radiolucent areas. Recurrent cancer is usually seen as a mass with no central radiolucent areas. Pleomorphic and granular microcalcifications are important markers for recurrent cancer and can usually be distinguished from the thick, calcified plaques and elongated dystrophic calcifications associated with scarring.

Process mapping in screening mammography.

Successful screening mammography programs aim to screen large numbers of women efficiently and inexpensively. Development of an effective screening mammography program requires skilled personnel, solid infrastructure, and a robust computer system. A group of physicians, technologists, computer support personnel, and administrators carefully analyzed a growing screening mammography program as a series of steps, starting with the request for the examination and ending with the receipt of a hard-copy consultation. The analysis involved a detailed examination of every step and every possible outcome in the screening process. The information gained through process mapping may be used for identification of systemic and personnel problems, allocation of resources, modification of workplace architecture, and design of computer networks. Process mapping is helpful for those involved in designing and improving screening mammography programs. Viewing a process (i.e., obtaining a screening mammogram) as a series of steps may allow for the identification of inefficient components that may limit growth.

MR imaging of the breast for cancer evaluation. Current status and future directions.

This article discusses the current status of clinical feasibility testing and outlines some of the advantages and disadvantages of contrast-enhanced breast MR imaging. A review of imaging parameters includes the dose of paramagnetic contrast agents, two- versus three-dimensional scanning, and postprocessing data analysis with an emphasis on areas for further development. Principles of interpretation for normal tissue, benign lesions, and invasive cancers are summarized including causes of false-positive and false-negative MR imaging interpretations. Future clinical roles for breast MR imaging such as MR imaging-directed biopsies and therapies and MR as a complementary technique to film-screen mammography for selected clinical situations are suggested.

Ductal abnormalities detected with galactography: frequency of adequate excisional biopsy.

OBJECTIVE: Galactography (ductography) is a contrast examination of the mammary ducts performed to identify and localize intraductal growths that may be the cause of spontaneous discharge from the nipple. The objective of this study was to correlate the radiologic-pathologic findings in patients with abnormal findings on galactograms in order to determine how often the biopsy specimens included the lesions seen at galactography. MATERIALS AND METHODS: We retrospectively studied all galactograms with abnormal findings obtained in women who subsequently had biopsy at our institution between 1981 and 1991. Galactograms and tissue specimens from 29 women who had 30 biopsies were included. The standard technique was used to perform galactography. Biopsies were performed by using standard surgical technique for duct excision. The histopathologic findings were retrospectively reviewed by a pathologist to determine whether the biopsy specimens included the lesions seen at galactography. RESULTS: In six (20%) of the 30 biopsies, the lesion shown by galactography was not seen on histopathologic review. In the other 80%, the lesion was successfully identified on histopathologic examination. CONCLUSION: Our finding that the abnormality shown by galactography was not completely excised in one in five cases indicates that greater cooperation between the surgeon, radiologist, and pathologist is essential to ensure that all lesions are properly removed.

Management of mammographic indeterminate lesions. First place winner of the Conrad Jobst Award in the Gold Medal paper competition.

The positive predictive value of mammography in nonpalpable malignancy, only 20 to 25 per cent, could be improved with better mammographic criteria for lesions not requiring biopsy. The outcomes of 89 patients with indeterminate lesions were reviewed to determine whether these lesions could be managed safely by observation rather than biopsy. Indeterminate lesions were defined as 1) tightly clustered, nonlinear calcifications (> 5 within 1 cm of tissue); 2) dominant, well-circumscribed soft-tissue masses (< or = 1 cm2); or 3) asymmetric density. Lesions not immediately undergoing biopsy were followed with frequent-interval mammography. Twenty-two lesions (26%) underwent immediate biopsy, and 2 of these demonstrated carcinoma in situ with microinvasion. Sixty-seven lesions (74%) were observed (median follow-up, 34 months), and 2 (2.5%) proved to be malignant, for an overall malignancy rate of 4.5 per cent. All malignancies were stage I, and the patients remain alive with no evidence of disease (average follow-up, 24 months). Sixty patients were spared unnecessary biopsy, decreasing potential wire-directed biopsies by 25 per cent. The positive predictive value of mammography increased from 21 to 32 per cent over the period. Indeterminate lesions can be safely followed with frequent ipsilateral mammography, reserving biopsy for lesions that progress. Management schemes such as this one can be used to decrease the number of negative wire-directed biopsies.

Abnormalities of the breast caused by biopsy: spectrum of mammographic findings.

It is important for radiologists to be familiar with the spectrum of mammographic abnormalities caused by postbiopsy changes in the breast. Although many breast biopsies leave no residual abnormality, occasionally an atypical manifestation of a biopsy scar may produce a radiologic finding suspicious enough to mandate a biopsy. Problem-solving maneuvers recommended to increase confidence that a change is related to a recent biopsy include (1) skin markers; (2) comparison with preoperative films; (3) correlation with physical examination; (4) tailored mammographic views, including focal spot compression, magnification, and tangential views; and (5) postoperative and follow-up mammograms.

Sensitivity, specificity, predictive value and accuracy of film/screen mammography. A three-year experience.

Mammographic and pathologic findings of 312 breast lesions biopsied at the University of Kentucky Medical Center over a three-year period (Jan 1, 1984 through Dec 31, 1986) were correlated. Each of the 312 mammographic examinations was classified as a true positive, true negative, false positive, or false negative interpretation based on the final pathologic diagnosis. The data on 88 wire directed biopsies for clinically occult mammographic lesions and data on 224 biopsies of palpable lesions performed without wire localization were evaluated separately and in combination. From this data the sensitivity, specificity, predictive value, and accuracy of mammography for detecting breast cancer were calculated. Results of all breast biopsies 1984-1986 gave a sensitivity of 84%, specificity of 59%, positive predictive value of 40%, negative predictive value of 92%, and an accuracy of 65% for film-screen mammography. Wire directed biopsies increased the false positive diagnosis from 22 to 96 but also accounted for the detection of 14 clinically occult breast cancers, of which 84% had negative lymph nodes.