Tc-99m sestamibi scintimammography in the mammographically dense breast.

PURPOSE: The mammographically dense breast or the "difficult-to-interpret mammogram" poses significant clinical and diagnostic imaging concerns. From our experience using Tc-99m sestamibi mammography in more than 650 patients, we share our experience in a pictorial manner and include suggested indications and limitations of this exciting new technique. Examples of Tc-99m sestamibi imaging in six patients with mammographically dense breasts are presented. MATERIALS AND METHODS: All patient examinations were ordered clinically for various indications. Comparison radiographic mammography and, when available, confirmatory pathologic analysis were also done. The examples were chosen from our experience with more than 650 patients at two university hospitals and one outpatient imaging center. RESULTS: Of the six examples presented, four had cancer, one had fibrosis after chemotherapy for ductal cell carcinoma, and one had no evidence of cancer. Tc-99m sestamibi imaging showed no increased uptake in the one patient with no tumor and various degrees of uptake in the other five patients. CONCLUSIONS: Six examples from our clinical experience show the usefulness of Tc-99m sestamibi imaging in patients with mammographically dense breasts. The ability to identify a malignancy or its absence supports the continued use of this procedure in these patients.

Lumbar agenesis with sacral sparing: a case report.

Caudal agenesis or caudal regression syndrome refers to a spectrum of malformations involving the lower spine, which can result in significant progressive or permanent neurologic defects. Caudal agenesis is frequently associated with other congenital anomalies of the axillary skeleton, hindgut and genitourinary systems. Described in this paper is a patient who presented with multiple clinical and radiographic findings consistent with caudal agenesis. This case is unique in that there is total absence of the lumbar vertebral column with an intact spinal cord and bony sacrum.

Bilateral renal masses after local Bacillus Calmette-Guerin therapy for postcystectomy ureteral cancer.

Bacillus Calmette-Guerin was administered through the ileal conduit of a 63-year-old man with upper tract recurrence of transitional cell carcinoma. Subsequent computed tomography showed bilateral renal masses, which were granulomatous at pathologic examination. The bacilli likely reached the kidneys via proven ileoureteral reflux. Patients with reflux may benefit from antituberculous prophylaxis.

The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories.

OBJECTIVE: The purpose of the study was to assess the positive predictive value of mammographic features and final assessment categories described in the Breast Imaging Reporting and Data System (BI-RADS) for lesions on which biopsies have been performed. SUBJECTS AND METHODS: We prospectively evaluated 492 impalpable mammographically detected lesions on which surgical biopsy (as opposed to percutaneous biopsy) was performed. Each lesion was classified according to BI-RADS descriptors for masses (margins and shape) and calcifications (morphology and distribution) and was categorized by the BI-RADS final assessment categories as category 3 ("probably benign"), category 4 ("suspicious abnormality"), or category 5 ("highly suggestive of malignancy"). Mammographic and pathologic findings were reviewed. RESULTS: Carcinoma was present in 225 (46%) of 492 lesions. For the 492 lesions subject to biopsy, BI-RADS final assessment categories were category 3 in eight lesions (2%), category 4 in 355 (72%), and category 5 in 129 (26%). The features with highest positive predictive value for carcinoma were spiculated margins (81%), irregular shape (73%), linear calcification morphology (81%), and segmental or linear calcification distribution (74% and 68%, respectively). Carcinoma was present in 105 (81%) of 129 category 5 lesions compared with 120 (34%) of 355 category 4 lesions (p < .001). The frequency of carcinoma was higher in category 5 than in category 4 lesions for all mammographic lesion types and all interpreting radiologists. CONCLUSION: The standardized terminology of the BI-RADS lexicon allows quantification of the likelihood of carcinoma in an impalpable breast lesion. The features with highest positive predictive value--spiculated margins, irregular shape, linear morphology, and segmental or linear distribution--warrant designation of a lesion as category 5.

Lymphoma arising in Paget's disease.

We present a case of lymphoma arising in pagetoid bone. The malignant potential of pagetoid bone is well known; however, primary lymphomatous involvement is extremely rare and has only been suggested in a few cases.