Digital Breast Tomosynthesis With Synthetic Mammography: Are We Missing Calcifications That Matter?

OBJECTIVE: To determine whether there are differences in the biopsy outcomes for suspicious calcifications detected with screening mammography using the digital breast tomosynthesis and synthetic 2D (DBT/SM) technique compared to calcifications detected using the full-field digital (DM) technique. METHODS: This retrospective study was IRB approved. The records for all stereotactic biopsies performed for suspicious calcifications detected on screening mammograms using DM in 2011-2014 and DBT/SM in 2017-2020 were reviewed. We collected patient, imaging, and pathology data from the breast imaging database and from retrospective review of a subset of mammograms. The biopsy outcome results were categorized as benign, benign with upgrade potential (BWUP), and malignant based on final pathology. Frequencies and proportions of outcomes were calculated and compared using Mann-Whitney U tests and Wilcoxson signed-rank tests with P-values and 95% confidence intervals (95% CIs). RESULTS: From 2011 to 2014 (DM), 1274 stereotactic biopsies of calcifications yielded 74.2% (945/1274) benign, 11.5% (147/1274) BWUP, and 14.3% (182/1274) malignant outcomes. From 2017 to 2020 (DBT/SM), 1049 stereotactic biopsies yielded 65.2% (684/1049) benign, 15.6% (164/1049) BWUP, and 19.2% (201/1049) malignant outcomes. With DBT/SM, benign biopsy outcomes decreased (9.0%, 95% CI 0.87-11.53, P < 0.05), whereas malignant biopsy outcomes increased (4.9%, 95% CI 0.94-8.36, P < 0.05). There was no significant difference in BWUP biopsy outcomes and total biopsy rates between techniques (P > 0.05). CONCLUSION: Calcifications detected with screening DBT/SM technique were significantly more likely to be malignant than those found using DM. These results support using the DBT/SM technique without obtaining concurrent DM images.

Mixed and Purely Hyperechoic Breast Masses: A Radiologic-Pathologic Review.

Breast US is a mainstay of modern-day breast imaging, especially in the diagnostic and interventional realm. The BI-RADS atlas described six echo patterns relative to the subcutaneous mammary fat: anechoic, hypoechoic, complex cystic and solid, isoechoic, heterogeneous, and hyperechoic. Hyperechoic breast masses demonstrate increased echogenicity relative to subcutaneous mammary fat or equal to fibroglandular tissue. Pathologically, the hyperechoic pattern at breast US results from the intermingling of different components: adipose tissue, fibrous tissue or stroma, secretions, blood or vascularity, and calcifications. Most hyperechoic masses are benign, especially homogeneously hyperechoic masses. However, hyperechogenicity does not exclude malignancy. Two echo patterns have been identified in hyperechoic malignant lesions, including those with a hypoechoic center and hyperechoic rim known as the rim pattern and a mass with hyperechoic areas distributed through the mass known as a dispersed pattern. This article aims to illustrate the echogenic patterns of breast lesions and various benign and malignant hyperechoic breast lesions with radiologic-pathologic correlation and to increase awareness of heterogeneously hyperechoic breast lesions as a manifestation of malignancy.

Project to Improve the Transcription of Clinical Order Information into a Radiology Information System.

CONTEXT: Inaccurate and incomplete imaging order information presented to interpreting radiologists is a persistent problem in many radiology settings. Computerized Physician Order Entry processes in clinic-based settings are often inconsistent, and radiology transcription clerks continue to play a critical role in transmitting accurate content and information from referring physician orders to the radiology information system. (RIS) The purpose of this quality improvement project was to a) identify common transcription areas of deficient RIS imaging order information and b) test outcomes from an intervention to improve the content and concordance of transcribed patient information entered into the RIS. METHODS: A random convenience sample of 500 outpatient radiographic orders were categorized according to degree and quality of concordance between the transcribed patient information documented in the RIS and the corresponding original imaging order information. During Phase I, the authors used a root-cause analysis to determine the possible etiologies for discordance between the information in original imaging orders and the information transcribed into the RIS. The intervention that was delivered included a short education session with radiology transcription clerks with placement reminder posters at transcription workstations. During Phase 2, a second random sample was obtained following the intervention, with data collection and analyses replicating the process from Phase I. A set of inferential comparisons were conducted using chi-square tests to examine for statistical significance. RESULTS: There was an overall 44% decrease in transcription discordance (p < 0.001), and the number of cases with perfectly concordant RIS order indication documentations increased by 21% (p < 0.001). A total of 34% of transcriptions from Phase I were partially discordant due to an inadequate imaging study indication, compared to 15% during Phase II (p < 0.001). There was also a 22% increase in the number of completely concordant transcriptions free of grammatical errors (p < 0.001). CONCLUSIONS: A short education session with radiology transcription clerks along with placement of reminder posters may significantly improve both the concordance and quality of transcribed imaging order information presented to interpreting radiologists using the RIS.