Antithrombotic Therapy and Hematoma Risk during Image-guided Core-Needle Breast Biopsy.

Background For image-guided core-needle breast biopsy (CNBB), it remains unclear whether antithrombotic medication should be withheld because of hematoma risk. Purpose To determine hematoma risk after CNBB in patients receiving antithrombotic medication and to stratify risk by antithrombotic type. Materials and Methods This HIPAA-compliant retrospective study included US-, stereotactic-, or MRI-guided CNBBs performed across six academic and six private practices between April 2019 and April 2021. Patients were instructed to continue antithrombotic medications, forming two groups: antithrombotic and nonantithrombotic. Hematomas were defined as new biopsy-site masses with a diameter of 2 cm or larger on postprocedure mammograms. Hematomas were considered clinically significant if management involved an intervention other than manual compression. Patient age, type of antithrombotic medication, practice type, image guidance modality, needle gauge and type, and outcome of pathologic analysis were recorded. Multivariable logistic regression analysis was used to analyze variables associated with hematomas. Results A total of 3311 biopsies were performed in 2664 patients (median age, 60 years; IQR, 48-70 years; 2658 women). The nonantithrombotic group included 2788 biopsies, and the antithrombotic group included 523 biopsies (328 low-dose aspirin, 73 full-dose antiplatelet drugs, 51 direct oral anticoagulants, 36 warfarin, 32 daily nonsteroidal anti-inflammatory drugs, three heparin or enoxaparin). The antithrombotic group had a higher overall hematoma rate (antithrombotic group: 49 of 523 biopsies [9.4%], nonantithrombotic group: 172 of 2788 biopsies [6.2%]; P = .007), but clinically significant hematoma rates were not different (antithrombotic group: two of 523 biopsies [0.4%], nonantithrombotic group: one of 2788 biopsies [0.04%]; P = .07). At multivariable analysis, age (odds ratio [OR], 1.02; 95% CI: 1.01, 1.03; P < .001), 9-gauge or larger needles (OR, 2.1; 95% CI: 1.28, 3.3; P = .003), and full-dose antiplatelet drugs (OR, 2.5; 95% CI: 1.29, 5.0; P = .007) were associated with higher hematoma rates. US guidance (OR, 0.26; 95% CI: 0.17, 0.40; P < .001) and 10-14-gauge needles (OR, 0.53; 95% CI: 0.36, 0.79; P = .002) were predictive of no hematoma. Conclusion Because clinically significant hematomas were uncommon, withholding antithrombotic medications before core-needle breast biopsy may be unnecessary. Postbiopsy hematomas were associated with full-dose antiplatelet drugs, patient age, and 9-gauge or larger needles. No association was found with other types of antithrombotic medication. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Chang and Yoen in this issue.

Socioeconomic deprivation is not associated with reduced survival of lung transplant recipients.

BACKGROUND: Important risk factors for long-term survival of lung transplant (LT) recipients are infection, acute graft rejection (AR) and chronic lung allograft dysfunction (CLAD). Socioeconomic deprivation (SED) is associated with increased graft failure rate after heart and kidney transplantation, but has not been investigated in LT recipients. The aim of this study was to evaluate an association between LT recipients' SED status and development of AR, CLAD, and long-term survival. METHODS: This was a retrospective cohort study. Over a 23 y period, 233 patients were identified from the Auckland City Hospital Lung Transplant Registry, Auckland, New Zealand. All patients were divided into two groups according to the 2013 New Zealand Deprivation Index Score. RESULTS: The incidence of AR in the higher SED group was 34.0/100 person-y (95% confidence interval [CI]: 24.7-46.7/100 person-y) and in the lower SED group 40.2/100 person-y (95% CI: 33.5-48.3/100 person-y) (P = 0.373). The incidence of CLAD in the higher SED group was 10.7/100 person-y (95% CI: 6.2-18.4/100 person-y) and 9.3 (6.9-12.5/100 person-y) in the lower SED group (P = 0.645). Mortality in the higher SED group was 12.9/100 person-y (95% CI: 9.2-17.9/100 person-y) and 12.4/100 person-y (95% CI: 10.0-15.3/100 person-y) in the lower SED group (P = 0.834). CONCLUSIONS: SED status of LT recipients in New Zealand has no negative effect on development of AR, CLAD, and patients' survival.

Imaging of hepatocellular carcinoma after treatment with yttrium-90 microspheres.

OBJECTIVE: Yttrium-90 radioembolization is an emerging therapy for unresectable hepatocellular carcinoma (HCC). Although therapeutic response based on size has been evaluated in numerous studies, necrosis has been used as a criterion of response in only a few studies. The purpose of our study was to describe the imaging features of HCC after 90Y treatment and to compare size criteria (World Health Organization [WHO] and Response Evaluation Criteria in Solid Tumors [RECIST]) with necrosis criteria and combined criteria (RECIST and necrosis) for assessment of response. MATERIALS AND METHODS: CT images of 42 patients with 76 90Y-treated HCC lesions were analyzed. We used four response criteria: WHO size, RECIST size, necrosis, and combined criteria (RECIST and necrosis). Imaging features of treated lesions included both nodular and peripheral rim enhancement. Survival was assessed with the Kaplan-Meier method. RESULTS: The response rate was 23% according to RECIST criteria, 26% according to WHO criteria, 57% according to necrosis criteria, and 59% according to combined criteria. Response according to necrosis and combined criteria was detected earlier than response according to size criteria alone. Ten responding lesions initially increased in size. After therapy, enhancing peripheral nodules increased in size in 10 lesions, decreased in size in two lesions, and disappeared in two lesions. Twenty-one of 25 lesions with thin rim enhancement after 90Y administration responded to treatment. The median survival times were 660 and 236 days for Okuda stage I and Okuda stage II disease, respectively. CONCLUSION: Use of combined size and necrosis criteria may lead to more accurate assessment of response to 90Y therapy than use of size criteria alone. Imaging features after 90Y treatment, including size, necrosis, peripheral enhancing nodules, and thin rim enhancement, are described.

Response of liver metastases after treatment with yttrium-90 microspheres: role of size, necrosis, and PET.

OBJECTIVE: Yttrium-90 radioembolization is an emerging treatment for liver malignancies. The purpose of this study was to evaluate the imaging response of liver metastases to 90Y microspheres based on size and necrosis criteria using CT and comparing the results to PET and to describe imaging features related to 90Y therapy. MATERIALS AND METHODS: We reviewed the imaging studies of 42 patients with unresectable liver metastases treated with lobar radioembolization with 90Y. CT response was determined using traditional size criteria (World Health Organization [WHO] and Response Evaluation Criteria in Solid Tumors [RECIST]), necrosis criteria, and combined criteria (RECIST and necrosis). We compared the response on CT with the response on PET. Complications of treatment were assessed. RESULTS: The response rate was 19% (8/42) by WHO criteria, 24% (10/42) by RECIST, 45% (19/42) by necrosis criteria, and 50% (21/42) by combined criteria. Stabilization of lesion size occurred in 50% of patients. Necrosis and combined criteria identified responders earlier than RECIST and WHO criteria. Seven responders by combined criteria had an increase in lesion size on initial follow-up and would have been considered nonresponders. PET scans were obtained in 23 patients (33 treated lobes). PET detected significantly more responses to treatment (21/33, 63%) than CT using RECIST (2/33, 6%) or combined criteria (8/33, 24%) (p < 0.05, McNemar test). Complications of treatment included radiation cholecystitis (10 patients, 23%) and liver edema (18 patients, 42%). CONCLUSION: The use of necrosis and size criteria on CT and correlation with PET may improve the accuracy of assessment of response to 90Y treatment in patients with liver metastases and detect response earlier than standard size criteria.

Digital and screen-film mammography: comparison of image acquisition and interpretation times.

OBJECTIVE: The objective of our study was to compare acquisition times and interpretation times of screening examinations using screen-film mammography and soft-copy digital mammography. MATERIALS AND METHODS: Technologist study acquisition time from examination initiation to release of the screenee was measured for both screen-film and digital mammography (100 cases each) in routine clinical practice. The total interpretation time for screening mammography was also measured for 183 hard-copy screen-film cases and 181 soft-copy digital cases interpreted by a total of seven breast imaging radiologists, four experienced breast imagers, and three breast imaging fellows. RESULTS: Screening mammography acquisition time averaged 21.6 minutes for screen-film and 14.1 minutes for digital, a highly significant 35% shorter time for digital than screen-film (p < 10(-17)). The average number of images per case acquired with digital mammography was higher than that for screen-film mammography (4.23 for screen-film, 4.50 for digital; p = 0.047). The total interpretation time averaged 1.4 minutes for screen-film mammography and 2.3 minutes for digital mammography, a highly significant 57% longer interpretation time for digital (p < 10(-11)). In addition, technical problems delaying interpretation were encountered in none of the 183 screen-film cases but occurred in nine (5%) of the 181 digital cases. CONCLUSION: Compared with screen-film mammography, the use of digital mammography for screening examinations significantly shortened acquisition time but significantly increased interpretation time. In addition, more technical problems were encountered that delayed the interpretation of digital cases.

Incorporating new imaging models in breast cancer management.

Mammography is the only screening test proven to decrease breast cancer morbidity and mortality. Although mammography is an effective screening tool, it does have limitations, particularly in women with dense breasts. New imaging techniques are emerging to overcome these limitations and enhance cancer detection, improving patient outcome. Digital mammography, computer aided detection, breast ultrasound and breast magnetic resonance imaging (MRI) are frequently used adjuncts to mammography in today's clinical practice. Recent studies have shown that these techniques can enhance the radiologist's ability to detect cancer and assess disease extent, which is crucial in treatment planning and staging. Positron emission tomography (PET) also plays an important role in staging breast cancer and monitoring treatment response. Other modalities such as tomosynthesis and MR lymphangiography show promise in overcoming the problems related to dense breast tissue and the lack of noninvasive methods to assess lymph node status. Imaging-guided, minimally invasive therapies are also emerging as alternatives to surgical biopsy for breast lesions. As imaging techniques improve, the role of imaging will continue to evolve with the goal remaining a decrease in breast cancer morbidity and mortality.