3-T breast magnetic resonance imaging in patients with suspicious microcalcifications on mammography

Objective

To investigate the diagnostic value of 3-Tesla (T) breast MRI in patients presenting with microcalcifications on mammography.

Methods

Between January 2006 and May 2009, 123 patients with mammographically detected BI-RADS 3–5 microcalcifications underwent 3-T breast MRI before undergoing breast biopsy. All MRIs of the histopathologically confirmed index lesions were reviewed by two breast radiologists. The detection rate of invasive carcinoma and ductal carcinoma in situ (DCIS) was evaluated, as well as the added diagnostic value of MRI over mammography and breast ultrasound.

Results

At pathology, 40/123 (33 %) lesions proved malignant; 28 (70 %) DCIS and 12 (30 %) invasive carcinoma. Both observers detected all invasive malignancies at MRI, as well as 79 % (observer 1) and 86 % (observer 2) of in situ lesions. MRI in addition to conventional imaging led to a significant increase in area under the receiver operating characteristic (ROC) curve from 0.67 (95 % CI 0.56–0.79) to 0.79 (95 % CI 0.70–0.88, observer 1) and to 0.80 (95 % CI 0.71–0.89, observer 2), respectively.

Conclusions

3-T breast MRI was shown to add significant value to conventional imaging in patients presenting with suspicious microcalcifications on mammography.

Key points

? 3-T MRI is increasingly used for breast imaging in clinical practice. ? On 3-T breast MRI up to 86 % of DCIS lesions are detected. ? 3-T MRI increases the diagnostic value in patients with mammographically detected microcalcifications.     

Can positron emission mammography help to identify clinically significant breast cancer in women with suspicious calcifications on mammography?

Objective

To evaluate the diagnostic accuracy of positron emission mammography (PEM) for identifying malignant lesions in patients with suspicious microcalcifications detected on mammography.

Methods

A prospective, single-centre study that evaluated 40 patients with suspicious calcifications at mammography and indication for percutaneous or surgical biopsy, with mean age of 56.4 years (range: 28-81 years). Patients who agreed to participate in the study underwent PEM with 18F-fluorodeoxyglucose before the final histological evaluation. PEM findings were compared with mammography and histological findings.

Results

Most calcifications (n?=?34; 85.0 %) were classified as BIRADS 4. On histology, there were 25 (62.5 %) benign and 15 (37.5 %) malignant lesions, including 11 (27.5 %) ductal carcinoma in situ (DCIS) and 4 (10 %) invasive carcinomas. On subjective analysis, PEM was positive in 15 cases (37.5 %) and most of these cases (n?=?14; 93.3 %) were confirmed as malignant on histology. There was one false-positive result, which corresponded to a fibroadenoma, and one false negative, which corresponded to an intermediate-grade DCIS. PEM had a sensitivity of 93.3 %, specificity of 96.0 % and accuracy of 95 %.

Conclusion

PEM was able to identify all invasive carcinomas and high-grade DCIS (nuclear grade 3) in the presented sample, suggesting that this method may be useful for further evaluation of patients with suspected microcalcifications.

Key Points

? Many patients with suspicious microcalcifications at mammography have benign results at biopsy. ? PEM may help to identify invasive carcinomas and high-grade DCIS. ? Management of patients with suspicious calcifications can be improved.

     

Cancelled stereotactic biopsy of calcifications not seen using the stereotactic technique: do we still need to biopsy?

Objective

To determine the frequency of cancelled stereotactic biopsy due to non-visualisation of calcifications, and assess associated features and outcome data.

Methods

A retrospective review was performed on 1,874 patients scheduled for stereotactic-guided breast biopsy from 2009 to 2011. Medical records and imaging studies were reviewed.

Results

Of 1,874 stereotactic biopsies, 76 (4 %) were cancelled because of non-visualisation of calcifications. Prompt histological confirmation was obtained in 42/76 (55 %). In 28/76 (37 %) follow-up mammography was performed, and 7/28 subsequently underwent biopsy. Of 27 without biopsy, 21 (78 %) had follow-up. Nine cancers (9/49, 18 %) were found: 6 ductal carcinoma in situ (DCIS), 3 infiltrating ductal carcinoma (IDC). Of 54 patients with either biopsy or at least 2 years’ follow-up, 9 (17 %) had cancer (95 % CI 8–29). Cancer was present in 7/42 (17 %, 95 % CI 7–31 %) lesions that had prompt histological confirmation (DCIS?=?5, IDC?=?2) and in 2/28 (7 %, 95 % CI 0.8–24 %) lesions referred for follow-up (DCIS?=?1, IDC?=?1). Neither calcification morphology (P?=?0.2), patient age (P?=?0.7), breast density (P?=?1.0), personal history (P?=?1.0) nor family history of breast cancer (P?=?0.5) had a significant association with cancer.

Conclusion

Calcifications not visualised on the stereotactic unit are not definitely benign and require surgical biopsy or follow-up. No patient or morphological features were predictive of cancer.

Key points

? Half of cancelled stereotactic biopsies were due to non-visualisation of calcified foci. ? This reflects the improved detection of calcifications by digital mammography. ? Calcifications too faint for the stereotactic technique require alternative biopsy or follow-up ? 17?% of patients with biopsy or at least 2 years’ follow-up had cancer. ? No patient/morphological features were found to aid selection for re-biopsy vs. follow-up.     

Diagnostic performance of dual-energy contrast-enhanced subtracted mammography in dense breasts compared to mammography alone: interobserver blind-reading analysis

Purpose

To analyse the accuracy of dual-energy contrast-enhanced spectral mammography in dense breasts in comparison with contrast-enhanced subtracted mammography (CESM) and conventional mammography (Mx).

Materials and methods

CESM cases of dense breasts with histological proof were evaluated in the present study. Four radiologists with varying experience in mammography interpretation blindly read Mx first, followed by CESM. The diagnostic profiles, consistency and learning curve were analysed statistically.

Results

One hundred lesions (28 benign and 72 breast malignancies) in 89 females were analysed. Use of CESM improved the cancer diagnosis by 21.2 % in sensitivity (71.5 % to 92.7 %), by 16.1 % in specificity (51.8 % to 67.9 %) and by 19.8 % in accuracy (65.9 % to 85.8 %) compared with Mx. The interobserver diagnostic consistency was markedly higher using CESM than using Mx alone (0.6235 vs. 0.3869 using the kappa ratio). The probability of a correct prediction was elevated from 80 % to 90 % after 75 consecutive case readings.

Conclusion

CESM provided additional information with consistent improvement of the cancer diagnosis in dense breasts compared to Mx alone. The prediction of the diagnosis could be improved by the interpretation of a significant number of cases in the presence of 6 % benign contrast enhancement in this study.

Key Points

? DE-CESM improves the cancer diagnosis in dense breasts compared with mammography. ? DE-CESM shows greater consistency than mammography alone by interobserver blind reading. ? Diagnostic improvement of DE-CESM is independent of the mammographic reading experience.     

Dual-energy computed tomography after endovascular aortic aneurysm repair: The role of hard plaque imaging for endoleak detection

Objectives

To assess the diagnostic accuracy of dual-energy computed tomography (DECT) for detection of endoleaks and aneurysm sac calcifications after endovascular aneurysm repair (EVAR) using hard plaque imaging algorithms.

Materials and methods

One hundred five patients received 108 triple-phase contrast-enhanced CT (non-contrast, arterial and delayed phase) after EVAR. The delayed phase was acquired in dual-energy and post-processed using the standard (HPI-S) and a modified (HPI-M) hard plaque imaging algorithm. The reference standard was determined using the triple-phase CT and contrast-enhanced ultrasound. All images were analysed separately for the presence of endoleaks and calcifications by two independent readers; sensitivity, specificity and interobserver agreement were calculated.

Results

Endoleaks and calcifications were present in 25.9 % (28/108) and 20.4 % (22/108) of images. The HPI-S images had a sensitivity/specificity of 54 %/100 % (reader 1) and 57 %/99 % (reader 2), the HPI-M images of 93 %/92 % (reader 1) and 96 %/92 % (reader 2) for detection of endoleaks. For detection of calcifications HPI-S had a sensitivity/specificity of 91 %/99 % (reader 1) and 95 %/97 % (reader 2), the HPI-M images of 91 %/99 % (reader 1) and 91 %/99 % (reader 2), respectively.

Conclusion

Using HPI-M, DECT enables an accurate diagnosis of endoleaks after EVAR and allows distinguishing between endoleaks and calcifications with high diagnostic accuracy.

Key Points

? Dual-energy computed tomography allows the diagnosis of aortic pathologies after EVAR. ? Hard plaque imaging algorithms can distinguish between endoleaks and aneurysm sac calcifications. ? The modified hard plaque imaging algorithm detects endoleaks with high diagnostic accuracy.     

Imaging features of sporadic breast cancer in women under 40 years old: 97 cases

Objectives

To evaluate characteristic features of mammography, ultrasound and magnetic resonance imaging (MRI) of sporadic breast cancer in women <40 years and to determine correlations with pathological and biological factors.

Methods

A retrospective review of radiological, clinicopathological and biological features of sporadic breast cancers for women under 40 years at our institution between 2007-2012 covering 91 patients. Mammography was available for 97 lesions, ultrasound for 94 and MRI for 38.

Results

The most common imaging features were masses, nearly all classified BI-RADS 4 or 5. On mammography microcalcifications alone accounted for 31 %, all suspicious. There were 42.6 % luminal B, 24.5 % luminal A, 19.1 % HER2-enriched and 10.6 % triple-negative (TN) tumours by immunohistochemistry. HER2 overexpression was correlated with the presence of calcifications at mammography (P?=?0.03). TN cancers more often had an oval shape and abrupt interface at ultrasound and rim enhancement on MRI. MRI features were suspicious for all cancers and rim enhancement of a mass was a significant predictor of triple-negative tumours (P?=?0.01).

Conclusions

The imaging characteristics of cancers in patients under 40 years without proven gene mutations do not differ from their older counterparts, but appear correlated to phenotypic profiles, which have a different distribution in young women compared to the general population.

Key Points

? Young women have more luminal B/HER2+ phenotypes than older women. ? The appearance of cancers is correlated with their biological profiles. ? Sporadic breast cancer imaging in young women is generally classified BI-RADS 4/5. ? Triple-negative cancers can be misinterpreted as benign, requiring thorough imaging analysis.     

Percutaneous Image-Guided Cryoablation in Inoperable Extra-abdominal Desmoid Tumors: A Study of Tolerability and Efficacy

Objective

To determine the tolerability, effectiveness and outcomes of percutaneous image-guided cryoablation on inoperable extra-abdominal desmoid tumors.

Methods

Between 2011 and 2012, 13 patients (mean age 39.3 years, range 15–74) with inoperable extra-abdominal desmoid tumors were consecutively treated with cryoablation (17 tumors treated in 17 procedures), including two patients with Gardner syndrome and nine recurrences after surgery. Disease-free survival (DFS) and local control based on RECIST criteria were calculated on prospective clinical and imaging follow-up until 2013.

Results

Cryoablation was performed under ultrasound (n = 8), computed tomography (n = 1), or combined (n = 8) guidance, and under general (n = 15) or local (n = 2) anesthesia. A major complication was observed in one session (5.8 %). Mean follow-up was 11.3 months (6–27 months). Among all the patients treated, eight patients (47 %) presented residual tumors on the first magnetic resonance follow-up, which were asymptomatic. The DFS rate was stable at 82.3 % (95 % confidence interval 0.55–0.94) at 6, 12, and 24 months. The local tumor progression rate was 0 % at 6, 12, and 24 months. Two patients (12 %) presented an in situ recurrence.

Conclusions

Despite high rates of partial ablation, percutaneous image-guided cryoablation appears to be safe and effective for local control for patients with inoperable extra-abdominal desmoid tumors.     

Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme

Objectives

Feasibility studies have shown that contrast-enhanced spectral mammography (CESM) increases diagnostic accuracy of mammography. We studied diagnostic accuracy of CESM in patients referred from the breast cancer screening programme, who have a lower disease prevalence than previously published papers on CESM.

Methods

During 6 months, all women referred to our hospital were eligible for CESM. Two radiologists blinded to the final diagnosis provided BI-RADS classifications for conventional mammography and CESM. Statistical significance of differences between mammography and CESM was calculated using McNemar’s test. Receiver operating characteristic (ROC) curves were constructed for both imaging modalities.

Results

Of the 116 eligible women, 113 underwent CESM. CESM increased sensitivity to 100.0 % (+3.1 %), specificity to 87.7 % (+45.7 %), PPV to 76.2 % (+36.5 %) and NPV to 100.0 % (+2.9 %) as compared to mammography. Differences between conventional mammography and CESM were statistically significant (p?<?0.0001). A similar trend was observed in the ROC curve. For conventional mammography, AUC was 0.779. With CESM, AUC increased to 0.976 (p?<?0.0001). In addition, good agreement between tumour diameters measured using CESM, breast MRI and histopathology was observed.

Conclusion

CESM increases diagnostic performance of conventional mammography, even in lower prevalence patient populations such as referrals from breast cancer screening.

Key Points

? CESM is feasible in the workflow of referrals from routine breast screening. ? CESM is superior to mammography, even in low disease prevalence populations. ? CESM has an extremely high negative predictive value for breast cancer. ? CESM is comparable to MRI in assessment of breast cancer extent. ? CESM is comparable to histopathology in assessment of breast cancer extent.     

Comparison of CT-Guided Percutaneous Biopsy with and Without Registration of Prior PET/CT Images to Diagnose Mediastinal Tumors

Purpose

To compare computed tomography (CT)-guided percutaneous biopsy with and without registration of prior positron emission tomography (PET)/CT images in the diagnosis of mediastinal tumors.

Methods

We performed clinically indicated percutaneous biopsy in 106 patients with mediastinal tumors in the anterior (n = 61), posterior (n = 21), middle (n = 16), and superior mediastinum (n = 8). The final diagnosis was based on surgical outcomes, or imaging findings and the results of at least 6-month follow-up. The patients underwent CT-guided percutaneous biopsy with (group 1, n = 56) or without (group 2, n = 50) registration of prior PET/CT images obtained no more than 22 days earlier. The registered images were used to plan the procedure and help target the tumors.

Results

CT-guided percutaneous needle biopsy yielded adequate samples in 101 of 106 (95 %) patients (group 1, n = 53; group 2, n = 48); in 95 patients (94 %), the diagnosis was confirmed by specific histological typing (group 1, n = 51; group 2, n = 44). The diagnostic accuracy of CT-guided percutaneous biopsy with and without the registration of prior PET/CT images was not statistically different (group 1, 96 %; group 2, 93 %, p = 0.324).

Conclusion

CT-guided percutaneous biopsy is an easy and safe procedure that can provide a precise diagnosis in the majority of mediastinal tumors. PET/CT-guided biopsy yielded no special diagnostic advantages.     

Evaluation of testicular tumour calcification with digital orchiography

Objectives

To analyse the calcification of testicular tumours in the orchiectomy specimens detected by digital orchiography obtained in a full-field digital mammography (FFDM) unit.

Methods

Orchiectomy specimens of 37 consecutive patients were imaged by FFDM. Detected foci of calcification were stratified as: type 1, dense microcalcification; type 2, faint microcalcification; type 3, macrocalcification. Histopathology identified the tumour types, the presence of intratubular germ cell neoplasia (IGCN) and associated calcifications. Orchiography results correlated with the histopathology.

Results

On orchiography, 32/37of the specimens (86 %) had co-existing foci of calcification. Histopathology results revealed foci of calcification in 23/37 (62 %) of orchiectomy specimens. Of the 20 IGCN cases, 80 % presented with calcifications on orchiography. Fifty-six percent (14/25) of type 1, 70 % (12/17) of type 2, and 30 % (2/6) of type 3 foci of calcification were observed in IGCN-positive cases.

Conclusion

This study classifies the morphology of testicular tumour calcification in three main groups by digital orchiography. In half of the testicular cancers, histopathologically proven IGCN is also found in addition to the index tumour. Type 2 foci of microcalcification detected by orchiography may be related to IGCN and may prompt further clinical assessment.

Key Points

? Orchiography can detect and classify calcification in 86?% of testicular cancers. ? Intratubular germ cell neoplasia (IGCN) co-exists in 54?% of testicular cancers. ? Type 2 foci of microcalcification detected by orchiography may be related to IGCN. ? Orchiography may play a possible future role in the diagnosis of testicular IGCN.     

Cytological Sampling Versus Forceps Biopsy During Percutaneous Transhepatic Biliary Drainage and Analysis of Factors Predicting Success

Purpose

To assess the accuracy of cytological sampling and forceps biopsy in obstructing biliary lesions and to identify factors predictive of success.

Methods

Consecutive patients (n = 119) with suspected malignant inoperable obstructive jaundice treated with percutaneous transhepatic biliary drainage during 7 years were included (60 male; mean age 72.5 years). All patients underwent forceps biopsy plus cytological sampling by washing the forceps device in cytological solution. Patient history, procedural and pathological records, and clinical follow-up were reviewed. Statistical analysis included chi-square test and multivariate regression analysis.

Results

Histological diagnosis after forceps biopsy was more successful than cytology: Sensitivity was 78 versus 61%, and negative predictive value was 30 versus 19%. Cytology results were never positive when the forceps biopsy was negative. The cytological sample was negative and forceps sample positive in 2 cases of cholangiocarcinoma, 16 cases of pancreatic carcinoma, and 1 case of benign disease. Diagnostic accuracy was predicted by low bilirubin (p < 0.001), aspartate transaminase (p < 0.05), and white cell count (p ≤ 0.05).

Conclusions

This technique is safe and effective and is recommended for histological diagnosis during PTBD in patients with inoperable malignant biliary strictures. Diagnostic yield is greater when bilirubin levels are low and there is no sepsis; histological diagnosis by way of forceps biopsy renders cytological sampling unnecessary.     

The role of needle biopsy for focal bone lesions with complete fluid-fluid levels on magnetic resonance imaging

Objective

To assess the value of image-guided needle biopsy of bone lesions completely filled with fluid–fluid levels (FFLs) on magnetic resonance imaging (MRI) and the safety of primary surgical curettage.

Materials and methods

The radiology database was searched for all reports containing “fluid level” from 1998 to 2011 and the imaging was reviewed retrospectively. Inclusion criteria were patients with bone lesions completely filled with FFLs on MRI (defined as FFLs on every axial and/or sagittal T2-weighted or Short Tau Inversion Recovery (STIR) sequence). The pathology database was then reviewed for the outcome of needle biopsy (n?=?14) and for the outcome of surgical curettage, either post-biopsy or primary (n?=?52).

Results

There were 53 patients (mean age 18 years; M?=?34, F?=?19). Fourteen patients underwent percutaneous needle biopsy, which was diagnostic in five (36 %) and non-diagnostic in nine (64 %). Fifty-two patients had surgical curettage/resection, which was diagnostic in 50 (96 %) and non-diagnostic in two (4 %). All lesions were benign; 78 % were aneurysmal bone cysts (ABC), 8 % were lesions with ABC change, and 14 % were simple bone cysts.

Conclusions

Our results suggest that patients with bone lesions completely filled with FFLs on MRI are almost certain to be benign, provided that the clinical and radiological features are not atypical. Percutaneous needle biopsy in such cases is unlikely to be of value and these lesions can be safely managed with primary surgical curettage.     

Ct-guided bone biopsy in cancer patients with suspected bone metastases: retrospective review of 308 procedures

Purpose

The authors assessed the adequacy and sensitivity of CT-guided bone biopsy in 308 procedures performed in 286 cancer patients with suspected bone metastases.

Materials and methods

An electronic search of our CT-guided bone biopsy database was retrospectively performed to evaluate the adequacy of samples and, in the event of negative samples, whether the patients had radiological progression at the site of biopsy (false negative). Adequacy and false-negative rate were compared with radiological features, biopsy location, specimen length and complications to assess any statistically relevant association with a multivariate logistic regression model.

Results

A total of 290/308 (94.1 %) samples were adequate. Forty-five patients had normal bone marrow and were followed-up, with evidence of progression at the site of biopsy in 10 cases (false-negative cases); overall sensitivity was 96.7 %. Specimen length was significantly correlated to the probability of an adequate biopsy (p = 0.035) and inversely correlated to the probability to obtain a false-negative result (p = 0.02). We encountered 11/308 (3.5 %) minor complications and no major complications.

Conclusion

CT-guided biopsy of bone lesions in cancer patients allows for a final diagnosis in 94 % of cases. A specimen longer than 1 cm may lead to a significant result in terms of adequacy and sensitivity. Negative biopsies with positive positron emission tomography or magnetic resonance imaging and specimen shorter than 1 cm should be repeated to avoid a false-negative result.     

Short interval follow-up after a benign concordant MR-guided vacuum assisted breast biopsy – is it worthwhile?

Objective

To determine the utility of short-interval follow-up after benign concordant MRI-guided breast biopsy.

Materials and methods

Institutional review board approved, retrospective review of consecutive biopsies performed over 3 years (2007–10) yielded 170 women with 188 lesions that were considered benign concordant. Indication for original study, biopsy results, follow-up recommendations, compliance and outcomes of subsequent MRI and mammography examinations were reviewed.

Results

The most common indication for breast MRI was high-risk screening 119/170 (70 %). Overall, 59 % of lesions (113/188) had follow-up MRI. Of those lesions (n?=?113), 43 % (49/113) presented within 7 months, 26 % (29/113) presented within 8–13 months, 11.5 % (13/113) presented within 14–22 months, and 19 % (22/113) presented after 23 months. At initial follow-up, 37 % of lesions were stable and 61 % were decreased in size. Three lesions were recommended for excision based on follow-up imaging with one malignancy diagnosed 2 years following biopsy. One additional patient had MRI-detected bilateral cancers remote from the biopsy site 3 years after biopsy.

Conclusion

Overall cancer yield of lesions with follow-up MRI was 0.9 % (1/113); no cancers were detected at 6 months. Our data suggests that 6-month follow-up may not be required and that annual screening MRI would be acceptable to maintain a reasonable cancer detection rate.

Key Points

? Follow-up recommendations after benign concordant MRI-guided breast biopsy remain controversial. ? Cancer detection rate was 0.9 % overall with no cancers detected at 6 months. ? Short-interval follow-up after benign concordant MRI-guided breast biopsy may not be necessary.     

Diagnostic accuracy of digital breast tomosynthesis versus digital mammography for benign and malignant lesions in breasts: a meta-analysis

Objective

To evaluate the diagnostic performance of digital breast tomosynthesis (DBT) and digital mammography (DM) for benign and malignant lesions in breasts.

Methods

Document retrieval was conducted on PubMed, EMBASE, the Cochrane Library, Web of Science and Chinese Biomedical Literature Database, etc., from 1950 to June 2013. Metadisc1.4 software was used to analyse the pooled sensitivity, specificity, diagnostic odds ratio (DOR), and positive and negative likelihood ratio. The heterogeneity was assessed using forest plots and the inconsistency index (I²). Before statistical comparison, the area under (AUC) the summary receiver-operating characteristic curve (SROC) of two different diagnostic methods was calculated respectively.

Results

A total of seven studies involving 2,014 patients and 2,666 breast lesions were included. Compared with the gold standard (histological results), the pooled sensitivity and specificity of DBT were 90.0 % and 79.0 %, and for DM they were 89.0 % and 72.0 %, respectively. The pooled positive likelihood ratio of DBT and DM was 3.50 and 2.83; the pooled negative likelihood ratio of DBT and DM was 15 % and 18 %; the pooled DOR for DBT and DM was 26.04 and 16.24, respectively.

Conclusions

Digital breast tomosynthesis has a higher sensitivity and specificity in breast diagnosis than digital mammography.

Key Points

? Digital breast tomosynthesis has high sensitivity and specificity in breast diagnosis. ? DBT appears to have superior diagnostic accuracy relative to digital mammography. ? DBT images were captured at a lower dose than 2D images. ? DBT displays abnormal features of lesions more clearly than DM. ? Digital breast tomosynthesis could become the first choice for assessing breast lesions.     

Digital mammography screening: how many breast cancers are additionally detected by bilateral ultrasound examination during assessment?

Objective

To assess the positive predictive values of incremental breast cancer detection (PPV1) in relation to the mammographic breast density and of performed biopsies (PPV3) resulting from supplemental bilateral physician-performed whole-breast ultrasound (US) at recall of a population-based digital mammography screening programme.

Methods

A total of 2,803 recalled screening participants (50–69 years), who had additional bilateral US with prospectively completed documentation [grading of breast density (ACR 1–4), biopsy recommendation related to US and mammography], were included.

Results

The PPV1 of supplemental cancer detection only by US was 0.21 % (6/2,803) compared to 13.8 % (386/2,803) by mammography. The PPV1 of US-only cancer detection was 0 %, 0.16 % (2/1,220), 0.22 % (3/1,374) and 1.06 % (1/94) for women with breast density of ACR 1, ACR 2, ACR 3 and ACR 4, respectively. The PPV3 of US-only lesion detection was 33.3 % (9/27) compared to 38.0 % (405/1,066) by mammography. The proportion of invasive cancers no larger than 10 mm was 37.5 % (3/8) for US-only detection compared to 38.4 % (113/294) for mammographic detection.

Conclusion

Bilateral ultrasound at recall, in addition to the assessment of screen-detected mammographic abnormalities, resulted in a low PPV of incremental cancer detection only by US, without a disproportional increase of false-positive biopsies.

Key Points

? Bilateral breast ultrasound was assessed in women recalled following digital mammography screening. ? Overall breast cancer detection rate reached the desired level of European guidelines. ? Additional ultrasound-only cancer detection had a low positive predictive value (0.21 %). ? Ultrasound did detect additional unexpected breast cancers in breasts graded ACR 2–4. ? Bilateral breast ultrasound offers little or only marginal benefit in routine screening.     

Performance comparison of single-view digital breast tomosynthesis plus single-view digital mammography with two-view digital mammography

Objective

To determine the performance of combined single-view mediolateral oblique (MLO) digital breast tomosynthesis (DBT) plus single-view cranio-caudal (CC) mammography (MX) compared with that of standard two-view digital mammography.

Methods

A multi-reader multi-case (MRMC) receiver-operating characteristic (ROC) study was conducted, involving six breast radiologists. Two hundred fifty patients underwent bilateral MX and DBT imaging. MX and DBT images with the adjunct of the CC-MX view from 469 breasts were evaluated and rated independently by six readers. Differences in mean areas under the ROC curves (AUCs), mean sensitivity and mean specificity were analysed by analysis of variance (ANOVA) to assess clinical performance.

Results

The combined technique was found to be non-inferior to standard two-view mammography (MX_(CC+MLO)) in mean AUC (difference: +0.021;95 % LCL = ?0.011), but was not statistically significant for superiority (P?=?0.197). The combined technique had equivalent sensitivity to standard mammography (76.2 % vs. 72.8 %, P?=?0.269) and equivalent specificity (84.9 % vs. 83.0 %, P?=?0.130). Specificity for benign lesions was significantly higher with the combination of techniques versus mammography (45.6 % vs. 36.8 %, P?=?0.002).

Conclusion

In this enriched study population, the combination of single-view MLO tomosynthesis plus single-view CC mammography was non-inferior to that of standard two-view digital mammography in terms of ROC curve area, sensitivity and specificity.

Key Points

? Breast tomosynthesis (DBT) has emerged as a valuable adjunct to mammography (MX). ? Combination DBT/MX demonstrated non-inferior clinical performance to standard two-view MX. ? Combination DBT/MX was superior to two-view MX in recognising benign lesions. ? Combination DBT/MX reduced variability compared with two-view MX.     

Image guided radiofrequency thermo-ablation therapy of chondroblastomas: should it replace surgery?

Objective

To assess the safety and effectiveness of image-guided radiofrequency ablation (RF ablation) in the treatment of chondroblastomas as an alternative to surgery.

Materials and Methods

Twelve patients with histologically proven chondroblastoma at our institution from 2003 to date. We reviewed the indications, recurrences and complications in patients who underwent RF ablation.

Results

Twelve patients were diagnosed with chondroblastoma. Out of these, 8 patients (6 male, 2 female, mean age 17 years) with chondroblastoma (mean size 2.7 cm) underwent RF ablation. Multitine expandable electrodes were used in all patients. The number of probe positions needed varied from 1 to 4 and lesions were ablated at 90 °C for 5 min at each probe position. The tumours were successfully treated and all patients became asymptomatic. There were no recurrences. There were 2 patients with knee complications, 1 with minor asymptomatic infraction of the subchondral bone and a second patient with osteonecrosis/chondrolysis.

Conclusion

Radiofrequency ablation appears to be a safe and effective alternative to surgical treatment with a low risk of recurrence and complications for most chondroblastomas. RF ablation is probably superior to surgery when chondroblastomas are small (less than 2.5 cm) with an intact bony margin with subchondral bone and in areas of difficult surgical access.     

Comprehensive assessment of spotty calcifications on computed tomography angiography: Comparison to plaque characteristics on intravascular ultrasound with radiofrequency backscatter analysis

Background

The purpose of the study was to systematically compare calcification patterns in plaques on computed tomography angiography (CTA) with plaque characteristics on intravascular ultrasound with radiofrequency backscatter analysis (IVUS-VH).

Methods and Results

In total, 108 patients underwent CTA and IVUS-VH. On CTA, calcification patterns in plaques were classified as non-calcified, spotty or dense calcifications. Plaques with spotty calcifications were differentiated into small spotty (<1 mm), intermediate spotty (1-3 mm) and large spotty calcifications (≥3 mm). Plaque characteristics deemed more high-risk on IVUS-VH were defined by % necrotic core (NC) and presence of thin cap fibroatheroma (TCFA). Overall, 300 plaques were identified both on CTA and IVUS-VH. % NC core was significantly higher in plaques with small spotty calcifications as compared to non-calcified plaques (20% vs 13%, P = .006). In addition, there was a trend for a higher % NC in plaques with small spotty calcifications than in plaques with intermediate spotty calcifications (20% vs 14%, P = .053). Plaques with small spotty calcifications had the highest % TCFA as compared to large spotty and dense calcifications (31% vs 9% and 31% vs 6%, P < .05).

Conclusion

Plaques with small spotty calcifications on CTA were related to plaque characteristics deemed more high-risk on IVUS-VH. Therefore, CTA may be valuable in the assessment of the vulnerable plaque.