Prophylactic breast irradiation reduces background parenchymal enhancement (BPE) on MRI: A secondary analysis.

PURPOSE: We recently showed that prophylactic breast irradiation (PBI) reduces the risk of contralateral breast cancer in BRCA mutation carriers undergoing treatment for early breast cancer. It has been suggested that Background Parenchymal Enhancement (BPE) may be a biomarker for increased risk of breast cancer. METHODS: For participants in the trial we reviewed the MRI prior to enrollment and following radiation treatment and scored the contralateral breast for BPE and density. RESULTS: Significant reduction of BPE was more commonly noted following PBI (p = 0.011) compared to the control group. CONCLUSION: Reduction of BPE by PBI may contribute to its prophylactic effect.

Breast Imaging Utilizing Dedicated Gamma Camera and (99m)Tc-MIBI: Experience at the Tel Aviv Medical Center and Review of the Literature Breast Imaging.

The scope of the current article is the clinical role of gamma cameras dedicated for breast imaging and (99m)Tc-MIBI tumor-seeking tracer, as both a screening modality among a healthy population and as a diagnostic modality in patients with breast cancer. Such cameras are now commercially available. The technology utilizing a camera composed of a NaI (Tl) detector is termed breast-specific gamma imaging. The technology of dual-headed camera composed of semiconductor cadmium zinc telluride detectors that directly converts gamma-ray energy into electronic signals is termed molecular breast imaging. Molecular breast imaging system has been installed at the Department of Nuclear medicine at the Tel Aviv Sourasky Medical Center, Tel Aviv in 2009. The article reviews the literature well as our own experience.

The inter-observer variability of breast density scoring between mammography technologists and breast radiologists and its effect on the rate of adjuvant ultrasound.

PURPOSE: This study assesses the inter-observer variability of mammographic breast density scoring (BDS) between technologists and radiologists and evaluates the effect of technologist patient referral on the load of adjuvant ultrasounds. MATERIALS AND METHODS: In this IRB approved study, a retrospective analysis of 503 prospectively acquired, random mammograms was performed between January and March 2014. Each mammogram was evaluated for BDS independently and blindly by both the performing technologist and the interpreting radiologist. Statistical calculation of the Spearman correlation coefficient and weighted kappa were obtained to evaluate the inter-observer variability between technologists and radiologists and to examine whether it relates to the technologist's seniority or women's age. The effect on the load of adjuvant ultrasounds was evaluated. RESULTS: 10 mammography technologists and 7 breast radiologists participated in this study. BDS agreement levels between technologists and radiologists were in the fair to moderate range (kappa values: 0.3-0.45, Spearman coefficient values: 0.59-0.65). The technologists markedly over-graded the density compared to the radiologists in all the subsets evaluated. Comparison between low and high-density groups demonstrated a similar trend of over-grading by technologists, who graded 51% of the women as having dense breasts (scores 3-4) compared to 27% of the women graded as such by the radiologists. This trend of over grading breast density by technologists was unrelated to the women's age or to the technologists' seniority. CONCLUSION: Mammography technologists over-grade breast density. Technologists' referral to an adjuvant ultrasound leads to redundant ultrasound studies, unnecessary breast biopsies, costs and increased patient anxiety.

Preoperative clinical, mammographic and sonographic assessment of neoadjuvant chemotherapy response in breast cancer.

BACKGROUND: The current methods for pre- and post-chemotherapy examination of the extent of disease in the breast and lymph nodes do not provide sufficiently accurate information and, not infrequently, the surgeon has to re-operate. OBJECTIVES: To correlate the findings between three methods of examination (physical examination, ultrasonography, mammography), all performed by the same oncologic and radiologic team, in patients with locally advanced breast cancer or a tumor/breast tissue ratio that precludes breast-conserving surgery. METHODS: Forty patients (median age 48 years, range 24-73) with locally advanced breast cancer or with a tumor/breast ratio that precluded breast-conserving surgery were evaluated by the same medical team and received neoadjuvant chemotherapy. Surgery was performed in all, and the pathologic specimen was correlated with the results of the other examinations. RESULTS: In the pre-chemotherapy evaluation, the imaging findings of the breast correlated with the physical findings in 78% of the patients and with the axilla examination in 66.7%. In the post-chemotherapy analysis, imaging agreed with the physical findings of the breast in 62.2% and in 76.3% of the axilla. Sonography best detected occult breast disease and axillary lymph nodes but correlated with pathology in only 58% of the patients in diagnosing breast tumor and in 65.8% in diagnosing axillary lymph nodes. Mammography correlated with breast and lymph node pathology in half the patients. CONCLUSIONS: None of the classical methods of post-neoadjuvant chemotherapy evaluations could adequately delineate the actual extent of the disease in the breast and axillary lymph nodes. More exacting techniques of imaging combined with the classical methods are required.