Diagnosis and imaging characteristics of a juvenile fibroadenoma in a 2-year-old patient: a case report.

Fibroadenomas are abundantly reported in the literature with several papers documenting the natural progression and clinical outcomes of thousands of cases. Juvenile fibroadenomas (also called cellular fibroadenomas) are frequently characterized by rapid growth, often described as 5-10 cm in size. They constitute approximately 7%-8% of fibroadenomas. They often measure greater than 5 cm. Pathologically, they show similar features to fibroadenomas but can resemble phyllodes. There have been few documented cases of breast masses in early childhood. Furthermore, there are scant radiology publications focused on the imaging features of juvenile fibroadenomas in patients younger than 5 years old. Our patient presented at 2 years of age with a unilateral right breast mass. Two ultrasound examinations were completed over a period of 5 months, and a magnetic resonance imaging was performed prior to surgical intervention. Eventual surgical excision yielded a final pathologic diagnosis of juvenile fibroadenoma. In this report, we will discuss the imaging and pathology of juvenile fibroadenomas, and we will address important differential considerations both from a pathologic and radiologic standpoint.

Evaluation of the "Angelina Jolie Effect" on Screening Mammography Utilization in an Academic Center.

PURPOSE: The aim of this study was to understand the impact on screening mammography at our institution, comparing weekly utilization in the 2 years before and the 2 years after Ms Angelina Jolie disclosed in the New York Times on May 13, 2013, that she had had a prophylactic double mastectomy. METHODS: All 48,110 consecutive screening mammograms conducted at our institution between May 16, 2011, and May 16, 2015, were selected from our electronic medical record system. We used interrupted time series statistical models and graphical methods on utilization data to understand utilization changes before and after Ms Jolie's news. RESULTS: The graphed trend of weekly screening mammogram utilization failed to show changes around the time of interest. Analytical models and statistical tests also failed to show a step change increase or acceleration of utilization around May 2013. However, graphical and time series analyses showed a flattening of utilization in the middle of 2014. CONCLUSIONS: In our well-powered analysis in a large regional breast imaging center, we found no support for the hypothesis that this celebrity news drove increased screening.

Frequencies of Private Mentions and Sharing of Mammography and Breast Cancer Terms on Facebook: A Pilot Study.

BACKGROUND: The most popular social networking site in the United States is Facebook, an online forum where circles of friends create, share, and interact with each other's content in a nonpublic way. OBJECTIVE: Our objectives were to understand (1) the most commonly used terms and phrases relating to breast cancer screening, (2) the most commonly shared website links that other women interacted with, and (3) the most commonly shared website links, by age groups. METHODS: We used a novel proprietary tool from Facebook to analyze all of the more than 1.7 million unique interactions (comments on stories, reshares, and emoji reactions) and stories associated with breast cancer screening keywords that were generated by more than 1.1 million unique female Facebook users over the 1 month between November 15 and December 15, 2016. We report frequency distributions of the most popular shared Web content by age group and keywords. RESULTS: On average, each of 59,000 unique stories during the month was reshared 1.5 times, commented on nearly 8 times, and reacted to more than 20 times by other users. Posted stories were most often authored by women aged 45-54 years. Users shared, reshared, commented on, and reacted to website links predominantly to e-commerce sites (12,200/1.7 million, 36% of all the most popular links), celebrity news (n=8800, 26%), and major advocacy organizations (n=4900, 15%; almost all accounted for by the American Cancer Society breast cancer site). CONCLUSIONS: On Facebook, women shared and reacted to links to commercial and informative websites regarding breast cancer and screening. This information could inform patient outreach regarding breast cancer screening, indirectly through better understanding of key issues, and directly through understanding avenues for paid messaging to women authoring and reacting to content in this space.

JOURNAL CLUB: Scatter Radiation Dose From Digital Screening Mammography Measured in a Representative Patient Population.

OBJECTIVE: The purpose of this study was to quantify the amount of scatter radiation received at the skin surface overlying the thyroid gland, salivary gland, lens of the eye, sternum, and uterus during a routine screening digital mammographic examination measured in a representative patient population. SUBJECTS AND METHODS: The subjects were 207 women without symptoms with varied body mass indexes who underwent annual screening mammography while wearing six optically stimulated luminescence dosimeters placed at the bridge of the nose, right submandibular gland, right and left thyroid lobes, mid sternum, and 2 cm caudal to the umbilicus to assess scatter radiation dose to the skin. RESULTS: The average scatter radiation doses at the skin surface during digital screening mammography in the representative population of women were as follows: overlying the right lobe of the thyroid, 0.24 mGy; left lobe of the thyroid, 0.25 mGy; salivary gland, 0.2 mGy; bridge of the nose, 0.025 mGy; sternum, 0.87 mGy; and umbilicus, 0.011 mGy. The scatter radiation doses at the umbilicus and the bridge of the nose were too low to measure with statistical confidence. Scatter radiation dose increased with increasing body mass index and increasing breast compression thickness. CONCLUSION: Scatter radiation dose at the skin overlying organs of interest is a small fraction of the entrance skin dose to the breast. The low levels of scatter radiation measured do not support delaying clinically indicated mammography during early pregnancy.

Influence of Obesity on Breast Density Reduction by Omega-3 Fatty Acids: Evidence from a Randomized Clinical Trial.

Preclinical data indicate that omega-3 fatty acids (n-3FA) potentiate the chemopreventive effect of the antiestrogen (AE) tamoxifen against mammary carcinogenesis. The role of n-3FA in breast cancer prevention in humans is controversial. Preclinical and epidemiologic data suggest that n-3FA may be preferentially protective in obese subjects. To directly test the protective effect of n-3FA against breast cancer, we conducted a 2-year, open-label randomized clinical trial in 266 healthy postmenopausal women (50% normal weight, 30% overweight, 20% obese) with high breast density (BD; ≥25%) detected on their routine screening mammograms. Eligible women were randomized to one of the following five groups (i) no treatment, control; (ii) raloxifene 60 mg; (iii) raloxifene 30 mg; (iv) n-3FA lovaza 4 g; and (v) lovaza 4 g plus raloxifene 30 mg. The 2-year change in BD, a validated biomarker of breast cancer risk, was the primary endpoint of the study. In subset analysis, we tested the prespecified hypothesis that body mass index (BMI) influences the relationship between plasma n-3FA on BD. While none of the interventions affected BD in the intention-to-treat analysis, increase in plasma DHA was associated with a decrease in absolute breast density but only in participants with BMI >29. Our results suggest that obese women may preferentially experience breast cancer risk reduction from n-3FA administration.

Does a High-Risk Recommendation in Mammography Reports Increase Attendance at a Breast Cancer Risk Assessment Clinic?

PURPOSE: This study evaluates the effectiveness of introducing, in 2012, a standardized recommendation into mammography reports, to recruit women at high risk for breast cancer into our risk assessment clinic. METHODS: The study population was comprised of patients presenting for screening or diagnostic mammography, in 2011 and 2013, who were identified as having a ≥20% lifetime risk for breast cancer. Mammographic reports were assessed for annotations addressing the patients' risk status and referral to a provider at the clinic. The percentage of patients given a high-risk recommendation who did, versus did not, consult a provider at the clinic, within 1 year of their mammogram, was analyzed. RESULTS: A total of 173 patients in 2011, and 241 patients in 2013, were identified as having a ≥20% lifetime risk of developing breast cancer. Of these, 40.5% were given a recommendation to attend our risk assessment clinic in 2011, versus 75.5% in 2013. Despite the overall increase in such recommendations by radiologists, only a modest increase occurred, from 11.4% to 14.3%, in patients that subsequently attended our risk assessment clinic. CONCLUSIONS: Although the number of referrals to our high-risk clinic increased modestly after institution of a standardized reporting recommendation, >85% of patients at high risk, in 2013, did not consult a provider for patients at high risk, regarding their elevated lifetime risk of breast cancer.

Pathologic-radiologic correlation in evaluation of retroareolar margin in nipple-sparing mastectomy.

Nipple-sparing mastectomy (NSM) has recently been increasing in popularity due to a better cosmetic outcome and quality-of-life benefit. The radiologic distance between the tumor and the nipple is independently predictive of nipple-areolar complex involvement and can assist in patient selection for NSM. However, concordance between the preoperative radiologic imaging and histologic evaluation would play a major role in making patient selection for NSM meaningful. We analyzed the pathologic-radiologic correlation for evaluation of retroareolar (RA) margin in NSM. A retrospective histologic and blinded radiologic review of 80 NSM (41 therapeutic and 39 prophylactic) performed on 45 patients was done. Histologically, the cases were divided into positive or close (invasive or in situ carcinoma within 5 mm of the RA margin) and negative (greater than 5 mm from the RA margin). Radiographically, positive cases were defined as suspicious enhancement and/or suspicious findings within 20 mm of the nipple on magnetic resonance imaging (MRI) and/or diagnostic mammography, respectively. Thirty five of 41 (85.4 %) therapeutic cases were concordant. Six cases were discordant, with 2/41 (4.9 %) discordant cases classified as positive at histology, but negative on imaging and 4/41 (9.75 %) discordant cases classified as negative at histology, but positive on imaging. Agreement between pathology and radiology was moderate [kappa coefficient 0.54 (p = 0.0003)].We conclude that there is a significant agreement between histologic and radiologic evaluation for assessment of RA margin and preoperative radiologic imaging; specifically, MRI provides valuable information and should be strongly recommended to help select patients for NSM.

PPV(3) of suspicious breast MRI findings.

RATIONALE AND OBJECTIVES: Magnetic resonance imaging (MRI) characteristics of Breast Imaging Reporting and Data System (BI-RADS) 4 and 5 lesions were evaluated to identify characteristics that may improve the positive predictive value (PPV) of a biopsy. MATERIALS AND METHODS: MRI BI-RADS 4 or 5 breast findings in 101 women who underwent biopsy leading to a diagnosis of cancer within 1 year (PPV3; n = 115 cases) were reviewed. Patient history, lesion morphology, enhancement pattern and kinetics, and T2 characteristics were examined. RESULTS: The PPV3 of all BI-RADS 4 and 5 breast lesions seen on MRI was 22.6% (26 of 115). Excluding lesions with second-look imaging correlates decreased the PPV3 to 11.8% (6/51). Of the MRI-guided biopsies, 20.9% (24 of 115) yielded a high-risk lesion, altering surgical management. MRI lesion type did not significantly affect the PPV3: the PPV3 was 26.3% (15 of 57) for masses, 21.4% (9 of 42) for non mass enhancement (NME) and 12.5% (2 of 16) for suspicious foci. The PPV3 for lesions found on diagnostic MRI in women with newly diagnosed cancer was 30.8% (20 of 65) which was statistically significantly greater compared to a PPV3 of 11.9% (5 of 42) for lesions identified on high-risk screening MRI. CONCLUSIONS: Suspicious MRI findings identified on a second-look examination are more likely malignant than those seen only on MRI. Suspicious MRI findings discovered in patients with concurrent malignancy have a greater PPV3 than those detected on high-risk screening MRIs. However, the type of MRI finding (mass vs. NME vs. foci) does not significantly affect the PPV3 and should not be used as a discriminator for determining biopsy threshold.

Differential impact of body mass index on absolute and percent breast density: implications regarding their use as breast cancer risk biomarkers.

Percent breast density (PBD), a commonly used biomarker of breast cancer risk (BCR), is confounded by the influence of non-dense breast tissue on its measurement and factors, such as BMI, which have an impact on non-dense tissue. Consequently, BMI, a potent BCR factor, is, paradoxically, negatively correlated with PBD. We propose that absolute breast density (ABD) is a more accurate biomarker of BCR. We used a volumetric method to compare the correlation between PBD and ABD with baseline demographics and dietary and physical activity variables in a group of 169 postmenopausal women enrolled in a clinical trial prior to any intervention. As expected, a strong negative correlation between PBD and BMI was observed (Rho = -0.5, p < 5e(-12)). In contrast, we observed a strong, previously not well established, positive correlation of BMI with ABD (Rho = 0.41, p < 2.5e(-8)), which supports the use of ABD as a more accurate indicator of BCR. Correction of PBD by BMI did not frequently provide the same information as ABD. In addition, because of the strong influence of BMI on ABD, many correlations between dietary variables and ABD did not emerge, until adjustment was made for BMI. ABD corrected by BMI should be the gold standard BD measurement. These findings identify the optimal measurement of BD when testing the influence of an intervention on BD as a biomarker of BCR.

Hematoma formation during breast core needle biopsy in women taking antithrombotic therapy.

OBJECTIVE: The purpose of this study was to compare hematoma formation after breast core needle biopsy performed on patients undergoing and those not undergoing concurrent antithrombotic therapy. SUBJECTS AND METHODS: A prospective assessment of core needle biopsies (stereotactic, ultrasound guided, or MRI guided) performed on patients enrolled between September 2011 and July 2012 formed the basis of this study. Postprocedure mediolateral and craniocaudal mammograms were evaluated for the presence and size of hematomas. Patients were clinically evaluated for complications 24-48 hours after the procedure through telephone call or face-to-face consultation. Needle size, type of biopsy, and presence of hematoma and documented complications were correlated with use of antithrombotic agents (including aspirin, warfarin, clopidogrel, and daily nonsteroidal antiinflammatory medications). RESULTS: No clinically significant hematomas or bleeding complications were found. Eighty-nine of 617 (14.4%) non-clinically significant hematomas were detected on postprocedure mammograms. The probability of development of a non-clinically significant hematoma was 21.6% for patients taking antithrombotics and 13.0% for those not taking antithrombotics. Concurrent antithrombotic therapy and larger needle gauge were significant factors contributing to the probability of hematoma formation. The volume of the hematoma was not related to needle gauge or presence of antithrombotic therapy. CONCLUSION: No clinically significant hematomas were found. Because there are potential life-threatening risks to stopping antithrombotic therapy before breast biopsy, withholding antithrombotic therapy for core needle breast biopsy is not recommended because the incidence of non-clinically significant hematoma is low.

Pediatric and adolescent breast masses: a review of pathophysiology, imaging, diagnosis, and treatment.

OBJECTIVE: Pediatric breast masses are relatively rare and most are benign. Most are either secondary to normal developmental changes or neoplastic processes with a relatively benign behavior. To fully understand pediatric breast disease, it is important to have a firm comprehension of normal development and of the various tumors that can arise. Physical examination and targeted history (including family history) are key to appropriate patient management. When indicated, ultrasound is the imaging modality of choice. The purpose of this article is to review the benign breast conditions that arise as part of the spectrum of normal breast development, as well as the usually benign but neoplastic process that may develop within an otherwise normal breast. Rare primary carcinomas and metastatic lesions to the pediatric breast will also be addressed. The associated imaging findings will be reviewed, as well as treatment strategies for clinical management of the pediatric patient with signs or symptoms of breast disease. CONCLUSION: The majority of breast abnormalities in the pediatric patient are benign, but malignancies do occur. Careful attention to patient presentation, history, and clinical findings will help guide appropriate imaging and therapeutic decisions.