Computer-aided detection in direct digital full-field mammography: initial results

For the first time, full-field digital mammography (FFDM) allows computer-aided detection (CAD) analysis of directly acquired digital image data. The purpose of this study was to evaluate a CAD system in patients with histologically correlated breast cancer depicted with FFDM. Sixty-three cases of histologically proven breast cancer detected with FFDM (Senographe 2000D, GE Medical Systems, Buc, France) were analyzed using a CAD system (Image Checker V2.3, R2 Technology, Los Altos, Calif.). Fourteen of these malignancies were characterized as microcalcifications, 37 as masses, and 12 as both. The mammographic findings were categorized as BI-RADS 3 (n=5), BI-RADS 4 (n=17) and BI-RADS 5 (n=40). The sensitivity for malignant lesions and the rate of false-positive marks per image were calculated. The sensitivity and its 95% confidence interval (CI) were estimated. The sensitivity of the CAD R2 system in breast cancer seen on FFDM was 89% for microcalcifications [CI_95%=(70%; 98%)] and 81% for masses [CI_95%=(67%; 91%)]. As expected, the detection rate was higher in lesions categorized as BI-RADS 5 (37 of 40) compared with lesions categorized as BI-RADS 4 (11 of 17). In the group categorized as BI-RADS 3 the detection rate was 4 of 5 lesions; however, this group was very small. The rate of false-positive marks was 0.35 microcalcification marks/image and 0.26 mass marks/image. The overall rate of false-positive marks was 0.61 per image. CAD based on FFDM provides an optimized work flow. Results are equivalent to the results reported for CAD analysis of secondarily digitized image data. Sensitivity for microcalcifications is acceptable and for masses is low. The number of false-positive marks per image should be reduced. Electronic Publication     

Usefulness and limitations of the Japan Mammography Guidelines for the categorization of microcalcifications

Background  The Japan Mammography Guidelines, referred to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS), are intended to standardize the terminology in mammographic reports and the assessment of findings and to recommend action to be taken. The Japan Mammography Guidelines have explicit guidelines for the categorization of microcalcifications. The purpose of this study was to assess the positive predictive value (PPV) of each categorization of microcalcifications according to the decision table proposed by the Japan Mammography Guidelines according to BI-RADS morphology and distribution parameters and the pathologic outcome. Methods  A retrospective review was performed of 101 non-palpable screening mammography-detected microcalcification lesions without mass that had stereotactic vacuum-assisted breast biopsy (SVAB). This study was approved by our institutional review board, and informed consent was obtained for all SVAB. We classified microcalcification lesions according to the decision table. Histological findings were reviewed. Results  In calcification morphology, all 32 punctate morphology microcalcifications, regardless of distribution, were benign (100%), whereas 25% (9/36) amorphous morphology microcalcifications, 67% (14/21) pleomorphic morphology microcalcifications and 92% (11/12) linear morphology microcalcifications were malignant. For calcification distribution, 28% (15/55) cluster distribution microcalcifications, 40% (17/43) segmental distribution microcalcifications and 67% (2/3) linear distribution microcalcifications were malignant. Features with high positive PPV showed segmental or linear distribution of linear morphology (100%, respectively), segmental distribution of pleomorphic morphology (100%) and cluster distribution of linear morphology (80%). The PPV for cluster punctate, cluster amorphous, cluster pleomorphic and cluster linear microcalcifications was 0, 21, 50 and 80%, respectively. The PPV for segmental punctate, segmental amorphous, segmental pleomorphic and segmental linear microcalcifications was 0, 27, 100 and 80%, respectively. The PPV for linear amorphous and linear linear microcalcifications was 50 and 100%. Conclusions  The decision table proposed by the Japan Mammography Guidelines according to BI-RADS morphology and distribution parameters is useful, but continued development of the decision table to improve standardization in mammographic interpretation is needed.     

Diagnosis and Management of Benign,Atypical, and Indeterminate Breast Lesions Detected on Core Needle Biopsy

Imaging abnormalities detected by mammographic screening often lead to diagnostic evaluations, with suspicious abnormalities subjected to image-guided core needle biopsy (CNB) to exclude malignancy. Most CNBs reveal benign pathological alterations, termed benign breast disease (BBD). Adoption of CNB presents challenges with pathologic classification of breast abnormalities and management of patients with benign or atypical histological findings. Patient management and counseling after CNB diagnosis of BBD depends on postbiopsy determination of radiologic-pathologic concordancy. Communication between radiologists and pathologists is crucial in patient management. Management is dependent on the histological type of BBD. Patients with concordant pathologic imaging results can be reassured of benign biopsy findings and advised about the future risk of developing breast cancer. Surgical consultation is advised for patients with discordant findings, symptomatic patients, and high-risk lesions. This review highlights benign breast lesions that are encountered on CNB and summarizes management strategies. For this review, we conducted a search of PubMed, with no date limitations, and used the following search terms (or a combination of terms): atypical ductal hyperplasia, atypical hyperplasia, atypical lobular hyperplasia, benign breast disease, cellular fibroepithelial lesions, columnar cell lesions, complex sclerosing lesion, core needle biopsy, fibroadenomas, flat epithelial atypia, lobular carcinoma in situ, lobular neoplasia, mucocele-like lesions, phyllodes tumor, pseudoangiomatous stromal hyperplasia, radial scar, and vascular lesions. The selection of references included in this review was based on study relevance and quality. We used additional articles culled from the bibliographies of retrieved articles to examine the published evidence for risk factors of BBD.     

Breast Density and Breast Cancer Risk: A Practical Review

New legislation in several states requiring breast density notification in all mammogram reports has increased awareness of breast density. Estimates indicate that up to 50% of women undergoing mammography will have high breast density; thus, with increased attention and high prevalence of increased breast density, it is crucial that primary care clinicians understand the implications of dense breasts and are able to provide appropriate counseling. This review provides an overview of breast density, specifically by defining breast density, exploring the association between breast density and breast cancer risk, both from masking and as an independent risk factor, and reviewing supplemental screening options as part of a larger framework for counseling patients with dense breasts.     

超声引导下导丝定位在触诊阴性的BI-RADS IV类及以上乳腺病变中的应用

目的 探讨超声引导下导丝定位在触诊阴性的BI-RADS Ⅳ类及以上乳腺病变中的临床价值及应用技巧。方法 回顾性分析我院2015 年1 月~2017 年6 月150 例女性患者,临床触诊阴性且超声提示BI-RADS Ⅳ类及以上,术前通过超声引导下导丝定位,选择合理的穿刺点,定位针尽可能与皮肤垂直,术中沿导丝切除病灶。结果 150 例患者共检出BI-RADS Ⅳ类及以上乳腺病灶157 枚,超声引导下导丝定位成功率100%,手术切除率100%。病理证实良性病例数100 例,病灶107 枚,恶性病例数50 例,病灶50 枚。良性病例行区段切除,恶性病例其中31例实施保乳手术,19 例实施乳腺癌改良根治术。恶性病例穿刺点均一并手术切除,且未有因穿刺点选择不当而影响手术切口选择的病例。结论 术前超声引导下导丝定位可以精准切除触诊阴性的BI-RADS Ⅳ类及以上乳腺病变。定位针尽可能与皮肤垂直,合理选择进针点,可以快速准确的切除病灶,又不会影响恶性病例后续手术切口的选择。     

UE联合BI-RADS诊断乳腺肿块良恶性的价值

目的探讨超声弹性成像技术(UE)联合乳腺影像学报告与数据系统(BI-RADS)诊断乳腺肿块良恶性的价值。方法选取我院就诊的120例乳腺肿块患者为研究对象,均行乳腺超声检查,并以病理结果为金标准。比较UE评分、BI-RADS分级及UE评分联合BI-RADS分级诊断乳腺肿块良恶性的SE、SP、PPV、NPV。结果病理结果显示120例乳腺肿瘤患者的148个肿块病灶中,共有良性病灶83个,恶性病灶65个。UE评分显示恶性病灶69个,BI-RADS分级显示恶性病灶70个,联合诊断出恶性病灶62个。UE评分联合BI-RADS分级诊断的SP、PPV、NPV相比UE评分、BI-RADS分级诊断均较高。结论 UE评分联合BIRADS分级诊断乳腺肿块良恶性的临床效果显著,值得临床应用。     

微血管成像技术探查BI-RADS 4类乳腺肿块内穿支血管的价值

目的 探讨SMI在探查BI-RADS 4类乳腺肿块穿支血管的价值.方法 对已行常规超声检查且诊断为BI-RADS 4类的48个乳腺肿块,分别行PD、ADF及SMI检查,比较三种血流显像技术对乳腺肿块内穿支血管显示的差异.结合病理结果,分析SMI对BI-RADS 4类乳腺肿块中穿支血管的诊断价值.结果 SMI对乳腺肿块内穿支血管显示数量与PD、ADF相比均存在显著性差异(P=0.00),PD与ADF之间不存在显著差异(P＞0.05).SMI对BI-RADS分类校正前后曲线下面积分别为0.70和0.82,相比有统计学差异(P＜0.05).结论 对于BI-RADS 4类乳腺肿块,SMI能够提高乳腺肿块良恶性鉴别诊断的准确度.