Follow-up of palpable circumscribed noncalcified solid breast masses at mammography and US: can biopsy be averted?

PURPOSE: To determine whether palpable noncalcified solid breast masses with benign morphology at mammography and ultrasonography (US) can be managed similarly to nonpalpable probably benign lesions (Breast Imaging Reporting and Data System [BI-RADS] category 3)-that is, with periodic imaging surveillance-and to determine whether biopsy can be averted in these lesions. MATERIALS AND METHODS: No institutional review board approval or patient consent was required. This retrospective analysis, based on final imaging reports, included 152 patients (age range, 28-77 years; mean age, 48.3 years) with 157 palpable noncalcified solid masses that were classified as probably benign at initial mammography and US. Of 152 patients, 108 underwent follow-up with mammography and US (6-month intervals for 2 years, then 12-month intervals). The remaining 44 patients underwent surgical or needle biopsy after initial imaging. Lesions were analyzed at initial and follow-up examinations. Statistical analysis included Student t test and corresponding exact 95% confidence intervals. RESULTS: In 108 patients who underwent follow-up only, 112 lesions were palpable. In 102 (94.4%) of 108 patients, masses remained stable during follow-up. Lesions were followed for at least 2 years (mean, 4.1 years; range, 2-7 years). In six (5.6%) patients, palpable lesions increased in size during follow-up; these lesions were benign at subsequent open biopsy. No breast carcinoma was diagnosed in the 44 patients with 45 palpable lesions who underwent biopsy after initial imaging. Of 157 lesions, no malignant tumors were observed (exact one-sided 95% confidence interval: 0%, 1.95%). CONCLUSION: The data strongly suggest that palpable noncalcified solid breast masses with benign morphology at mammography and US can be managed similarly to nonpalpable BI-RADS category 3 lesions, with short-term follow-up (6-month intervals for 2 years). More data, based on a larger series, are required to determine whether this conclusion is correct.     

BI-RADS categorisation of 2708 consecutive nonpalpable breast lesions in patients referred to a dedicated breast care unit

Objectives

To determine the malignancy rate of nonpalpable breast lesions, categorised according to the Breast Imaging Reporting and Data System (BI-RADS) classification in the setting of a Breast Care Unit.

Methods

All nonpalpable breast lesions from consecutive patients referred to a dedicated Breast Care Unit were prospectively reviewed and classified into 5 BI-RADS assessment categories (0, 2, 3, 4, and 5).

Results

A total of 2708 lesions were diagnosed by mammography (71.6%), ultrasound (8.7%), mammography and ultrasound (19.5%), or MRI (0.2%). The distribution of the lesions by BI-RADS category was: 152 in category 0 (5.6%), 56 in category 2 (2.1%), 742 in category 3 (27.4%), 1523 in category 4 (56.2%) and 235 in category 5 (8.7%). Histology revealed 570 malignant lesions (32.9%), 152 high-risk lesions (8.8%), and 1010 benign lesions (58.3%). Malignancy was detected in 17 (2.3%) category 3 lesions, 364 (23.9%) category 4 lesions and 185 (78.7%) category 5 lesions. Median follow-up was 36.9?months.

Conclusion

This pragmatic study reflects the assessment and management of breast impalpable abnormalities referred for care to a specialized Breast Unit. Multidisciplinary evaluation with BI-RADS classification accurately predicts malignancy, and reflects the quality of management. This assessment should be encouraged in community practice appraisal.     

BI-RADS categorization as a predictor of malignancy.

PURPOSE: To determine the positive predictive value (PPV) of the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) categories 0, 2, 3, 4, and 5 by using BI-RADS terminology and by auditing data on needle localizations. MATERIALS AND METHODS: Between April 1991 and December 1996, 1,400 mammographically guided needle localizations were performed in 1,109 patients. Information entered into the mammographic database included where the initial mammography was performed (inside vs outside the institution), BI-RADS category, mammographic finding, and histopathologic findings. A recorded recommendation was available for 1,312 localizations in 1,097 patients, who composed the study population. RESULTS: The 1,312 localizations yielded 449 (34%) cancers (139 [31%] were ductal carcinoma in situ [DCIS]; 310 [69%] were invasive cancers) and 863 (66%) benign lesions. There were 15 (1%) category 0 lesions; the PPV was 13% (two of 15 lesions). There were 50 (4%) category 2 lesions; the PPV was 0% (0 of 40 lesions). There were 141 (11%) category 3 lesions; the PPV was 2% (three of 141 lesions). The three cancers in this group were all non-comedotype DCIS. There were 936 (71%) category 4 lesions; the PPV was 30% (279 of 936 lesions). There were 170 (13%) category 5 lesions; the PPV was 97% (165 of 170 lesions). CONCLUSION: Placing mammographic lesions into BI-RADS categories is useful for predicting the presence of malignancy. Perhaps, most important, a lesion placed into BI-RADS category 3 is highly predictive of benignity, and short-term interval follow-up as an alternative to biopsy would decrease the number of biopsies performed in benign lesions.     

Ergebnisse nach Verwendung der BI-RADS®-Kategorien an 1777 klinischen Mammographien

PURPOSE: The purpose of our study was to evaluate the results after using the BI-RADS categories in clinical mammography, especially in the BI-RADS 0 and BI-RADS 3 categories. MATERIAL AND METHODS: During 1 year clinical mammograms were performed in 1,777 patients. The assessment reported by radiologists was based on the American College of Radiology using BI-RADS categories. In BI-RADS 0 and BI-RADS 3 categories additional examinations, histopathological results, und follow-up results were reported. RESULTS: Of 1,777 mammograms, 135 (4.1%) were classified into the BI-RADS 0 category. In 60 of 67 (90%) findings categorized as BI-RADS 0, MR mammography was performed and the results of the mammograms were ultimately classified into the BI-RADS 2 category. In 18 of 135 (13.3%) patients with BI-RADS 0 no further examinations were done. In 113 of 1,777 (3.4%) mammograms were classified into the BI-RADS 3 category. In 11 of 113 (9.7%) patients with BI-RADS 3 histopathology was done. A follow-up mammogram after 6 months was done only in 24 of 102 (23%) patients. In 21 of 102 (18.5%) patients with BI-RADS 3 follow-up mammograms were not performed. CONCLUSIONS: Not all patients with mammographic lesions in the BI-RADS 0 category avail themselves of further diagnostic work-up. Therefore in BI-RADS 0 category lesions, additional work-up should be performed directly after mammography during the same consultation. In some cases of BI-RADS 0 category, MR mammography is able to resolve the problem. Therefore the indication for MR mammography should be more commonly used.     

MR imaging in probably benign lesions (BI-RADS category 3) of the breast

PURPOSE: To investigate the role of dynamic magnetic resonance (MR) imaging in the evaluation of probably benign lesions (BI-RADS category 3) and its contribution to patient management. MATERIALS AND METHODS: Dynamic breast MR imaging was performed in 56 lesions assessed as probably benign in mammography of 43 patients. In MR imaging, T2-weighted turbo spin echo (TSE) with fat suppression sequence followed by pre- and post-contrast T1-weighted 3D-FLASH sequences were used. MR imaging findings were scored using 0-2 point criterion scale. The lesions were divided into five groups according to their total score (0 point: group 1, negative; 1-2 points: group 2, benign; 3 points: group 3, probably benign; 4-5 points: group 4, suspicious for malignancy; 6-8 points: group 5, highly suggestive of malignancy). Histopathologic verification of lesions in group 4 and above was obtained. Lesions in group 3 were either biopsied or followed up by mammography or MR imaging. Lesions in group 1-2 were followed by mammography of 6-month intervals for 2 years. The sensitivity, specificity, accuracy, and positive and negative predictive values of MR imaging in the determination of malignancy in BI-RADS category 3 lesions were calculated. RESULTS: Fifty-six findings (45 mass, 9 breast tissue, 2 focal enhancement) in 43 patients were detected in MR imaging. According to their total score, 41 lesions (73.2%) and breast tissue had 0 point (group 1); 10 lesions (17.8%) had 1-2 points (group 2); 2 lesions (3.6%) had 3 points (group 3); 2 lesions (3.6%) had 4 and 5 points (group 4); and 1 lesion (1.8%) had 6 points (group 5). Ten lesions (of six in groups 1 and 2, one in group 3, three in groups 4 and 5) were histopathologically confirmed. Out of 10 lesions, only 1 (1.8%) with 4 points in group 4 was diagnosed as invasive ductal carcinoma. Other lesions followed with mammography or MR imaging did not change. The sensitivity, specificity, accuracy, positive and negative predictive values of MR imaging in the determination of malignancy in BI-RADS category 3 lesions were calculated as 100, 96.4, 96.4, 33.3, and 100%, respectively. CONCLUSION: In the evaluation of BI-RADS category 3 lesions, dynamic MR imaging does not provide additional information with low positive predictive value similar to that of short interval mammography follow-up.     

Stereotactic vacuum-assisted breast biopsy: results, follow-up and correlation with radiological suspicion

PURPOSE: The purpose of this study was to assess the accuracy and clinical usefulness of stereotactic vacuum-assisted biopsy (VAB) for diagnosing suspicious, nonpalpable, only mammographically detectable breast lesions. MATERIALS AND METHODS: We retrospectively evaluated the results of percutaneous stereotactic VAB with 11-gauge needles performed over a period of 34 months on 228 nonpalpable suspicious breast lesions detectable on mammography only [Breast Imaging Reporting and Data System (BI-RADS) 3: 25.9%; BI-RADS 4: 67.1%; BI-RADS 5: 7%]. The imaging histological concordance was ascertained for each lesion. In cases of discordance, repeat biopsy or surgical excision were recommended; in cases of benign lesions, we urged a follow-up of at least 6 months and for borderline and malignant lesions a surgical excision. We also evaluated concordance between VAB results and subsequent examinations (surgical excision or followup). RESULTS: VAB demonstrated 123 (54%) benign lesions (with six cases of imaging-histological discordance), 26 (11.4%) borderline lesions and 79 (34.6%) malignant lesions. We obtained a suitable post-VAB mammographic or histological evaluation for 78 benign lesions, 17 borderline lesions and 76 malignant lesions, with one (1.3%) false negative (FN) case, two (11.8%) underestimations of borderline lesions, 14 (18.4%) underestimations of malignant lesions and no (0%) false positive cases. We did not observe any postbiopsy complications or scars. CONCLUSIONS: Percutaneous histological VAB with an 11-gauge needle proved to be, as reported in previous studies, a reliable method for diagnosing nonpalpable, mammographically detectable only breast lesions, with an underestimation rate lower than core biopsy and a FN rate similar to that of surgical biopsy, without any significant complications.     

结合MRI和X线分类对乳腺X线筛查为BI-RADS 4类肿块的处理体会

目的:评价结合MRI和X线分类对乳腺X线筛查为BI-RADS 4类肿块的良恶性评估价值,探讨BI-RADS 4类肿块新的处理建议.方法:X线筛查为BI-RADS 4a类(105个)、4b类(42个)和4c类(19个)的151例共166个乳腺肿块,在活检前行MRI.动态增强结合扩散加权成像(DWI)进行MRI BI-RADS分类.结合X线与MRI分类提出新的良恶性评估法.统计X线与MRI诊断乳腺癌的敏感度、特异度及诊断符合率;绘制两者的ROC曲线,Z检验比较曲线下面积;统计结合MRI和X线的新的良恶性评估法发现乳腺癌的敏感性、诊断符合率和对良性病变检出率.结果:2名X线诊断医师和2名MRI诊断医师的BI-RADS分类的Kappa值分别为0.70和0.76,一致性较好.166个肿块,恶性41个,占24.7％.X线BI-RADS 4a类105个:恶性12个,MRI分类为4、5类12个;良性93个,MRI为2、3类81个.X线BI-RADS 4b类42个:恶性16个,MRI分类为4、5类15个;良性26个,MRI为2、3类16个.X线BI-RADS 4c类19个:恶性13个,MRI分类为4、5类12个;良性6个,MRI为3类2个.X线诊断敏感度、特异度为70.7％、74.4％,诊断符合率为73.5％.MRI诊断敏感度、特异性及诊断符合率为95.1％、79.2％和83.1％.X线及MRI诊断乳腺癌的ROC曲线下面积分别为0.749及0.927,两者差异有统计学意义(Z=2.282,P＜0.05).新的良恶性评估法发现乳腺癌的敏感度为100％,诊断符合率为77.7％,良性病变检出率为53.0％.结论:MRI对乳腺X线筛查为BI-RADS 4类肿块有较高的诊断价值.结合X线及MRI分类进行新的良恶性评估,能减少良性肿块不必要的活检.     

Contrast-enhanced MR mammography for evaluation of the contralateral breast in patients with diagnosed unilateral breast cancer or high-risk lesions

PURPOSE: To prospectively evaluate accuracy of gadobenate dimeglumine-enhanced magnetic resonance (MR) mammography for depiction of synchronous contralateral breast cancer in patients with newly diagnosed unilateral breast cancer or high-risk lesions, with histologic analysis or follow-up as reference. MATERIALS AND METHODS: The study had ethics committee approval; all patients provided written informed consent. One hundred eighteen consecutive women (mean age, 52 years) with unilateral breast cancer or high-risk lesions and negative findings in the contralateral breast at physical examination, ultrasonography, and conventional mammography underwent gadobenate dimeglumine-enhanced 1.5-T MR mammography. Transverse three-dimensional T1-weighted gradient-echo images were acquired before and at 0, 2, 4, 6, and 8 minutes after gadobenate dimeglumine administration (0.1 mmol per kilogram body weight). Breast Imaging Reporting and Data System (BI-RADS) was used to categorize breast density and the level of suspicion for malignant contralateral breast lesions. Results were compared with histologic findings. Sensitivity, specificity, accuracy, and positive and negative predictive values for contrast-enhanced MR mammography were evaluated. RESULTS: Contrast-enhanced MR mammography revealed contralateral lesions in 28 (24%) of 118 patients. Twenty-four lesions were detected in patients with dense breasts (BI-RADS breast density category III or IV). Lesions in eight (29%) of 28 patients were BI-RADS category 4; patients underwent biopsy. Lesions in 20 (71%) patients were BI-RADS category 5; patients underwent surgery. At histologic analysis, 22 lesions were confirmed as malignant; six lesions were fibroadenomas. No false-negative lesions were detected; none of the fibroadenomas were BI-RADS category 5. The sensitivity, specificity, accuracy, and positive and negative predictive values of contrast-enhanced MR mammography for depiction of malignant or high-risk contralateral lesions were 100%, 94%, 95%, 79%, and 100%, respectively. Follow-up findings (12-24 months) confirmed absence of contralateral lesions in 90 of 118 patients with negative contrast-enhanced MR mammographic findings in the contralateral breast. CONCLUSION: Contrast-enhanced MR mammography is accurate for detection of synchronous contralateral cancer or high-risk lesions in patients with newly diagnosed breast cancer or high-risk lesions.     

Frequency of malignancy in lesions classified as probably benign after dynamic contrast-enhanced breast MRI examination

PURPOSE: To determine the chance of malignancy in lesions classified as "probably benign" by dynamic magnetic resonance imaging (MRI), in a heterogeneous population. MATERIALS AND METHODS: Reports from 473 patients, from March 1994 to March 2002, who underwent breast MRI were retrospectively reviewed. A total of 79 patients (17%) had lesions classified as probably benign after the MRI, which required further imaging follow-up. We evaluated subsequent MRI, mammographic reports, and clinical follow-up in these patients and established the frequency of malignancy in this group. RESULTS: MRI classified probably benign lesion were diagnosed in 79 women because of focal or diffuse mild enhancement and benign dynamic enhancement curves in the area of the mammographic abnormality, or because of the presence of microcalcifications on the mammogram, or because of incidental enhancing lesions. Two-year radiographic and/or clinical follow-up was available in 68 women. On follow-up, four women (6%) were diagnosed with cancer between 14 and 18 months after the initial MRI. CONCLUSION: Patients with a lesion assessed as probably benign by dynamic contrast enhanced MRI have a higher chance of malignancy than patients with probably benign lesions (Breast Imaging Reporting and Data System category 3, BI-RADS 3) seen on mammography. These patients should be informed of the increased risk of cancer and be given the option of biopsy or close follow-up.     

A multicenter study for the evaluation of the diagnostic efficiency of mammography and echography in nonpalpable breast neoplasms]

The Breast Section of the Italian Society of Radiology set up a cooperative study which included 17 Departments of Radiology and Breast Diagnosis in order to evaluate the diagnostic accuracy of US versus mammography in nonpalpable breast lesions. From January 1, 1989 to december 31, 1990, 400 nonpalpable breast lesions (142 benign lesions, 59 in situ and 199 infiltrating carcinomas) were detected by mammography and/or US; they had questionable/suspicious findings which called for further investigation by means of cytology and/or histology. US proved much less sensitive in non-palpable carcinomas than mammography (49.2% vs 93.8%), also in younger women, and failed to detect 50% of the benign/malignant nonpalpable lesions identified by mammography. US sensitivity was directly related to lesion diameter and probe frequency: 38.7% in infiltrating carcinomas < or = 5 mm vs 56.8% in those > 10 mm; 12% in the patients examined with a 5-MHz probe vs 57.7% in those examined with a > or = 7.5-MHz probe. Furthermore, the most significant US patterns of nonpalpable lesion were irregular contours, posterior attenuation and irregular internal echoes, while an irregular skin line and Cooper ligaments had no significant relation with carcinoma. Thus, breast US cannot be used as a screening test on asymptomatic patients not even on young women with radiologically dense breasts. On the contrary, US performed with high-frequency probes is useful in the assessment of nonpalpable lesions identified by mammography, and allows, in many cases, US-guided cytology and preoperative localization.     

Contrast-enhanced MR imaging in patients with BI-RADS 3-5 microcalcifications

PURPOSE: The aim of this study was to evaluate the role of magnetic resonance imaging (MRI) in patients with microcalcifications classed as Breast Imaging Reporting and Data Systems (BI-RADS) 3-5. MATERIALS AND METHODS: Fifty-five patients with mammographic microcalcifications classified as BI-RADS categories 3, 4 or 5 underwent MRI and biopsy with stereotactic vacuum-assisted biopsy (VAB). Our gold standard was microhistology in all cases and histology with histological grading in patients who underwent surgery. Patients with a microhistological diagnosis of benign lesions underwent mammographic follow-up for at least 12 months. MRI was performed with a 1.5-Tesla (T) unit, and T1 coronal three-dimensional (3D) fast low-angle shot sequences were acquired before and after injection of paramagnetic contrast agent (0.1 mmol/kg). MRI findings, according to the Fisher score, were classified into BI-RADS classes. In patients with cancer who underwent surgery, we retrospectively compared the extension of the mammographic and MRI findings with histological extension. RESULTS: Histology revealed 26 ductal in situ cancers (DCIS) and ductal microinvasive cancers (DCmic), three atypical ductal hyperplasias (ADH) and 26 benign conditions. Histological grading of the 26 patients with cancer revealed four cases of G1, 11 cases of G2 and 11 cases of G3. If we consider mammographic BI-RADS category 3 as benign and BI-RADS 4 and 5 as malignant, mammography had 77% sensitivity, 59% specificity, 63% positive predictive value (PPV), 74% negative predictive value (NPV) and 67.2% diagnostic accuracy. If we consider MRI BI-RADS categories 1, 2 and 3 as benign and 4 and 5 as malignant, MRI had 73% sensitivity, 76% specificity, 73% PPV, 76% NPV and 74.5% diagnostic accuracy. As regards disease extension, mammography had 45% sensitivity and MRI had 84.6% sensitivity. CONCLUSION: Mammography and stereotactic biopsy still remain the only techniques for characterising microcalcifications. MRI cannot be considered a diagnostic tool for evaluating microcalcifications. It is, however, useful for identifying DCIS with more aggressive histological grades. An important application of MRI in patients with DCIS associated with suspicious microcalcifications could be to evaluate disease extension after a microhistological diagnosis of malignancy, as it allows a more accurate presurgical planning.     

Nonpalpable breast masses: evaluation by US elastography.

OBJECTIVE: To compare the diagnostic performances of conventional ultrasound (US) and US elastography for the differentiation of nonpalpable breast masses, and to evaluate whether elastography is helpful at reducing the number of benign biopsies, using histological analysis as a reference standard. MATERIALS AND METHODS: Conventional US and real-time elastographic images were obtained for 100 women who had been scheduled for a US-guided core biopsy of 100 nonpalpable breast masses (83 benign, 17 malignant). Two experienced radiologists unaware of the biopsy and clinical findings analyzed conventional US and elastographic images by consensus, and classified lesions based on degree of suspicion regarding the probability of malignancy. Results were evaluated by receiver operating characteristic curve analysis. In addition, the authors investigated whether a subset of lesions was categorized as suspicious by conventional US, but as benign by elastography. RESULTS: Areas under the ROC curves (Az values) were 0.901 for conventional US and 0.916 for elastography (p = 0.808). For BI-RADS category 4a lesions, 44% (22 of 50) had an elasticity score of 1 and all were found to be benign. CONCLUSION: Elastography was found to have a diagnostic performance comparable to that of conventional US for the differentiation of nonpalpable breast masses. The authors conclude that BI-RADS category 4a lesions with an elasticity score of 1 probably do not require biopsy.     

Columnar cell lesions of the breast: mammographic and US features

OBJECTIVES: Columnar cell lesions are being encountered with increasing frequency in breast biopsies performed. The purpose of our study was to determine whether columnar cell lesions of the breast have any distinctive imaging characteristics. MATERIALS AND METHODS: We retrospectively reviewed our institutional database for all records of breast pathology obtained in a 17-month period. Columnar cell lesion was diagnosed in 53 lesions and 12 of these 53 lesions contained columnar cell lesions as the sole histopathologic findings. These 12 lesions in nine patients made up our study population. They included columnar cell change (n=4), columnar cell hyperplasia (n=5), and columnar cell hyperplasia with atypia (n=3). RESULTS: All nine patients underwent mammography and sonography within 1 month of each other. Of the mammograms in nine patients, nine lesions (75%) appeared as clustered amorphous or indistinct (n=5), fine pleomorphic (n=3), or round (n=1) microcalcifications. The tenth lesion showed a focal mass without microcalcifications and the remaining two lesions showed no abnormal findings. At sonography, not-circumscribed masses were depicted in six lesions and microcalcifications were visible in four lesions, of which three lesions were concurrent with masses. There were no sonographically focal lesions in the remaining five. Overall 11 lesions were classified as BI-RADS category 4 (92%) and one as category 3. Of the three lesions with atypia, two were classified as category 4a and one was classified as category 4c, and they showed no distinct imaging appearance from those without atypia. CONCLUSION: Columnar cell lesions usually present as nonpalpable, clustered indeterminate or suspicious microcalcifications on mammography. They are indistinguishable from other causes of suspicious microcalcifications such as atypical ductal hyperplasia or ductal carcinoma in situ and require needle biopsy or excisional biopsy for diagnosis.     

The negative predictive value of electrical impedance scanning in BI-RADS category IV breast lesions

OBJECTIVES: We sought to prospectively assess the value of electrical impedance scanning (EIS) in discriminating benign from malignant lesions classified as BI-RADS category IV in mammography in comparison with ultrasound (US), with a special focus on negative prediction. MATERIALS AND METHODS: EIS was performed on 128 BI-RADS category IV lesions in 121 women (mean, 51.8 years). The newly developed EIS software 2.67 calculates a BI-RADS-like level of suspicion (LOS) on a 5-grade scale. LOS 1, 2, and 3 were considered negative; LOS 4 and 5 were considered positive. Histopathologic results were obtained in all lesions. RESULTS: Histology proved 37 lesions malignant, 91 benign. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of EIS compared with US were 94.6%, 74.7%, 80.5%, 60.3%, 97.1% versus 90.5%, 33.8%, 47.2%, 29.7%, 92.0%, respectively. In 43 lesions sized < or = 10 mm, EIS demonstrated better sensitivity, specificity, accuracy, PPV, and NPV of 100%, 83.3%, 90.7%, 82.6%, and 100%, respectively. Although NPV was also high, US showed no sufficient results in 39 (30.5%) lesions because of microcalcifications. Receiver operating curve analysis revealed best results for a combined use of US and EIS. CONCLUSIONS: With a NPV of 97.1% of EIS in BI-RADS category IV breast lesions, a negative result in these lesions could be firm indication to manage them as BI-RADS-category III and refer patients for a 6-month short-interval follow-up rather than performing a biopsy. The best adjunctive diagnostic performance can be achieved by a combination of US and EIS. Costs and patient morbidity could be minimized.     

数字乳腺X线摄影:男性乳腺疾病诊断的推荐检查可行性分析

目的 基于敏感性、特异性等指标的评价,探讨数字乳腺X线摄影及超声对男性乳腺病变的诊断价值.方法 选取79例行乳腺X线摄影检查的男性乳腺肿块病例,部分病例同时行超声检查(62例).乳腺病灶评价依据2013版BI-RADS,通过2位高年资乳腺放射医师对征象进行分析后作出BI-RADS分类,并将BI-RADS 4a类以上定义...     

Mammography in 53,803 women from the New Hampshire mammography network

PURPOSE: To describe measures of mammography performance in a geographically defined population and evaluate the interpreter's use of the Breast Imaging Reporting and Data System (BI-RADS). MATERIALS AND METHODS: Mammographic data from 47,651 screening and 6,152 diagnostic examinations from November 1, 1996, to October 31, 1997, were linked to 1,572 pathologic results. Mammographic outcomes were based on BI-RADS assessments and recommendations reported by the interpreting radiologist. The consistency of BI-RADS recommendations was evaluated. RESULTS: Screening mammography had a sensitivity of 72.4% (95% CI: 66.4%, 78.4%), specificity of 97.3% (95% CI: 97.25%, 97.4%), and positive predictive value of 10.6% (95% CI: 9.1%, 12.2%). Diagnostic mammography had higher sensitivity, 78.1% (95% CI: 71.9%, 84.3%); lower specificity, 89.3% (95% CI: 88.5%, 90.1%); and better positive predictive value, 17.1% (95% CI: 14.5%, 19.8%). The cancer detection rate with screening mammography was 3.3 per 1,000 women, with a biopsy yield of 22.4%, whereas the interval cancer rate was 1. 2 per 1,000. Nearly 80% of screening-detected invasive malignancies were node negative. The recall rate for screening mammography was 8. 3%. Ultrasonography was used in 3.5% of screening and 17.5% of diagnostic examinations. BI-RADS recommendations were generally consistent, except for probably benign assessments. CONCLUSION: The sensitivity of screening mammography in this population-based sample is lower than expected, although other performance indicators are commendable. BI-RADS "probably benign" assessments are commonly misused.     

Breast US in patients who had microcalcifications with low concern of malignancy on screening mammography

PURPOSE: To review ultrasound (US) findings in patients who have suspicious microcalcifications with low concern of malignancy (BI-RADS category 4A) on screening mammography and to evaluate helpful findings in differentiating benign and malignant lesions. MATERIALS AND METHODS: Between August 2005 and July 2006, 192 patients showed microcalcifications only, without mass or associated density, on screening mammography. Among them, we selected 82 patients who had microcalcifications with low concern of malignancy (category 4A) that were pathologically confirmed by surgical excision after wire localization (n=23) or biopsy (n=59). Breast US was performed in 37/82 cases and we analyzed the US findings for the calcification areas in these patients, evaluating the findings with benign or malignant pathological results. We correlated US findings with mammographic calcifications using mammography-guided 2D-localization for the calcifications before US examination. RESULTS: There were 12 malignant lesions (32.4%) including 3 invasive ductal carcinomas (IDC), one microinvasive ductal carcinoma (MIDC), 8 ductal carcinoma in situ (DCIS) and 25 benign lesions (67.6%) including 2 atypical ductal hyperplasias (ADH). IDC showed calcifications within heterogeneous hypoechoic parenchyma or calcifications within complex hypoechoic masses of taller-than-wide shape on US. One MIDC showed calcifications within heterogeneous hypoechoic parenchyma and six DCIS showed negative findings, or calcifications with a small nodule, or only calcifications on US. The most common positive US finding in benign lesions was cysts with calcifications. In 24/37 cases (64.8%) with negative US findings, 18 (75%) were benign lesions and 6 (25%) were DCIS. CONCLUSION: In patients with category 4A microcalcifications without associated findings on screening mammography, negative US findings had a high rate of benign results (18/24, 75%). Visible calcifications within heterogeneous hypoechoic parenchyma or mass on US increased the probability of malignancy.     

Nonpalpable breast lesions: stereotaxic fine-needle aspiration cytology

The authors reviewed the accuracy of stereotaxic fine-needle aspiration cytology in prediction of the presence of cancer. Seventy-four nonpalpable breast cancers and 144 benign lesions were studied. The rate of obtaining an inadequate sample was 8.1% for cancers and 20.8% for benign lesions. None of the cytology reports were false-positive, whereas the accuracy of cytologic atypia in prediction of cancer was 72%. Sensitivity and specificity after 1 year of follow-up were 83.8% and 96.6%, respectively, with atypia reports being assumed positive. In patients strongly suspected of having cancer at mammography, the decision to perform biopsy must be independent of the cytologic report, as false-negative cytologic findings are expected. In patients with a low suspicion at mammography, abnormal cytologic findings were the determining factor for a request for biopsy of six cancers and of two benign lesions. Negative cytologic results contributed to the recommendation of follow-up of two lesions that turned out to be malignant. At the authors' institution, the benign-to-malignant biopsy ratio of nonpalpable lesions was greatly reduced after stereotaxic cytologic study became available; the rate of detection of subclinical cancer remained almost unaffected.     

Screening US in Patients with Mammographically Dense Breasts: Initial Experience with Connecticut Public Act 09-41

Purpose: To determine performance and utilization of screening breast ultrasonography (US) in women with dense breast tissue who underwent additional screening breast US in the 1st year since implementation of Connecticut Public Act 09-41 requiring radiologists to inform patients with heterogeneous or extremely dense breasts at mammography that they may benefit from such examination. Materials and Methods: Informed consent was waived for this institutional review board-approved, HIPAA-compliant retrospective review of 935 women with dense breasts at mammography who subsequently underwent handheld screening and whole-breast US from October 1, 2009, through September 30, 2010. Results: Of 935 women, 614 (65.7%) were at low risk, 149 (15.9%) were at intermediate risk, and 87 (9.3%) were at high risk for breast cancer. Of the screening breast US examinations, in 701 (75.0%), results were classified as Breast Imaging Reporting and Data System (BI-RADS) category 1 or 2; in 187 (20.0%), results were classified as BI-RADS category 3; and in 47 (5.0%), results were classified as BI-RADS category 4. Of 63 aspirations or biopsies recommended and performed in 53 patients, in nine, lesions were BI-RADS category 3, and in 54, lesions were BI-RADS category 4. Among 63 biopsies and aspirations, three lesions were malignant (all BI-RADS category 4, diagnosed with biopsy). All three cancers were smaller than 1 cm, were found in postmenopausal patients, and were solid masses. One cancer was found in each risk group. In 44 of 935 (4.7%) patients, examination results were false-positive. Overall positive predictive value (PPV) for biopsy or aspirations performed in patients with BI-RADS category 4 masses was 6.5% (three of 46; 95% confidence interval [CI]: 1.7%, 19%). Overall cancer detection rate was 3.2 cancers per 1000 women screened (three of 935; 95% CI: 0.8 cancers per 1000 women screened, 10 cancers per 1000 women screened). Conclusion: Technologist-performed handheld screening breast US offered to women in the general population with dense breasts can aid detection of small mammographically occult breast cancers (cancer detection rate, 0.8-10 cancers per 1000 women screened), although the overall PPV is low. ? RSNA, 2012.     

Histologic work-up of non-palpable breast lesions classified as probably benign at initial mammography and/or ultrasound (BI-RADS category 3)

Purpose

To determine the accuracy of a probably benign assessment of non-palpable breast lesions (BI-RADS category 3) at mammography and/or ultrasound with immediate histological work-up.

Materials and methods

Stereotactic or ultrasound guided core needle breast biopsy (NBB) was performed to evaluate 288 lesions, which were prospectively assessed as BI-RADS category 3. Imaging findings included 195 masses, 73 calcification cases, 16 focal asymmetries, and four architectural distortion cases. After NBB, patients underwent either open surgical biopsy (OSB) (n = 204) or mammographic follow-up (n = 84) for at least 24 months. Histological results of NBB were compared with those of OSB.

Results

Three of the 288 lesions (1.0%) proved to be malignant at histological work-up, two of them were ductal carcinoma in situ (DCIS) and one of them was an invasive carcinoma. NBB revealed invasive carcinoma in 1/288 (0.35%) and atypical ductal hyperplasia (ADH) in 13/288 (4.5%) lesions. OSB revealed DCIS in 2/204 (1%) and invasive carcinoma in 1/204 (0.5%) lesions. The two DCIS were underestimated as ADH by NBB. The remaining 285 (99%) lesions proved to be benign at OSB or remained stable during follow-up.

Conclusion

Confirmed by tissue diagnosis, the low likelihood of malignancy of prospectively assessed probably benign lesions is below the 2% threshold established for BI-RADS category 3. Imaging follow-up is a safe and effective alternative to immediate histological work-up for such lesions.