Inflammatory breast disease: A pictorial essay with radiological-pathological correlation.

Inflammatory conditions of the breast are an important group of diseases that can mimic breast carcinoma on clinical and radiological grounds. This pictorial essay presents the radiological and pathological features of some of these entities.

BreastScreen-based mammography screening in women with a personal history of breast cancer, Western Australian study.

OBJECTIVE: To evaluate mammography screening outcomes in women with a personal history of breast cancer (PHBC), who have an increased risk of recurrent or new breast cancer, relative to women without PHBC. DESIGN, SETTING AND PARTICIPANTS: Retrospective study of 713,191 screening mammograms from two groups of women - those with versus those without PHBC - who participated in the BreastScreen WA program in Western Australia between 1997 and 2006. MAIN OUTCOME MEASURES: Cancer detection rate (CDR), recall to assessment rate, recall positive predictive value (PPV) for cancer, and distribution of cancer characteristics within and between the two groups. RESULTS: Screening detected 4125 breast cancers: CDR per 10,000 screens was significantly higher in women with PHBC (95.5; 95% CI, 78.3-112.7) than in women without PHBC (57.2; 95% CI, 55.4-58.9). Recall to assessment rate per 10,000 screens was lower in women with PHBC (385.2; 95% CI, 350.6-419.8) than in women without PHBC (504.9; 95% CI, 499.7-510.2). Recall PPV was higher for women with PHBC (24.8%; 95% CI, 21.0%-28.9%) than those without PHBC (11.2%; 95% CI, 10.9%-11.6%). Cancer characteristics were consistent with early detection (most were smaller than 2 cm and node-negative) and were similarly distributed in both groups, except for tumour grade, with PHBC women having fewer low-grade cancers and slightly more high-grade cancers than women without PHBC. CONCLUSIONS: The relative rate of cancer detection between women with PHBC and women without PHBC who attended an Australian population-based breast screening program was similar to estimates from international studies. Recall rates were within national standards. Screen-detected cancers had similar characteristics in both groups, except for tumour grade. These data support national integration of mammography screening for women with PHBC into BreastScreen, although evaluation of interval cancers will be necessary.

New diagnostic techniques for breast cancer detection.

Breast imaging has made huge advances in the last decade, and along with newer techniques to diagnose primary breast cancer, many novel methods are being used and look promising in detecting distant metastasis, recurrent disease and assessing response to treatment. Full-field digital mammography optimizes the lesion-background contrast and gives better sensitivity, and it is possible to see through the dense tissues by altering computer windows; this may be particularly useful in younger women with dense breasts. The need for repeat imaging is reduced, with the added advantage of reduced radiation dose to patients. Computer-aided detection systems may help the radiologist in interpretation of both conventional and digital mammograms. MRI has a role in screening women at high risk for breast cancer. It also aids in cancer management by assessing response to treatment and can help in deciding appropriate surgery by providing accurate information on the extent of the tumor. Newer diagnostic techniques such as sestamibi scans, optical imaging and molecular diagnostic techniques look promising, but need more investigation into their use. Their roles will appear clearer in coming years, and they may prove to be of help in further investigating lesions that are indeterminate on standard imaging. Other upcoming techniques are contrast-enhanced mammography and tomosynthesis. These may give additional information in indeterminate lesions, and when used in screening they aid in reducing recall rates, as shown in recent studies. PET/computed tomography has a role in detecting local disease recurrence and distant metastasis in breast cancer patients.