Future Directions in Breast Imaging

Breast cancer imaging has improved dramatically over the last decade, with higher and more uniform quality standards for mammography, the increasing use of sonography and magnetic resonance imaging (MRI), and the widespread availability of imaging-guided percutaneous biopsy for clinically occult disease. This review paper describes the limitations that exist in the current state of the art for breast cancer imaging for detection and diagnosis. Four broad areas of future investigation are described in detail. First, we discuss the use of newer versions of mammography, such as digital mammography, with tomosynthesis and digital subtraction mammography. Secondly, new screening for occult disease might be improved through individualized strategies that stratify by patient risk, for example, through more rigorous screening with new and different tools for women at high risk. Third, the use of tools that might be useful for less invasive therapy of breast cancer with imaging to monitor the efficacy of the therapy is discussed. Finally, we describe the use of imaging to monitor and adjust neoadjuvant chemotherapy regimens in the course of therapy for advanced breast cancers when the risk of death is high

Non-mass breast lesions on ultrasound: final outcomes and predictors of malignancy

Background Breast cancer can present as non-mass lesions (NMLs) on ultrasound. However, knowledge of and understanding about NMLs are scarce. Purpose To retrospectively investigate the final outcomes of sonographic breast NMLs and determine the clinical and radiologic variables associated with malignancy Material and Methods In our radiologic database of breast ultrasound examinations between 2011 and 2014, we found 119 women with 121 NMLs with available histopathologic or sonographic follow-up (over 2 years) data. We collected the clinical variables (patient's age, symptoms, and mammographic density) and histopathologic data as well as radiologic variables (mammographic and ultrasound findings) after retrospective review by two radiologists, the authors of the current paper, in consensus. We classified the ultrasound findings according to distribution (focal, linear or segmental, and regional) and associated features (calcification, architectural distortion, and ductal changes) and analyzed the associations between variables and malignancy using the t test and χ2 test. Results Of the 121 NMLs, 88 (72.7%) were benign and 33 (27.3%) were malignant. Ductal carcinoma in situ (DCIS) (17/33, 51.5%) and invasive ductal cancer with or without DCIS (13/33, 39.4%) comprised the main malignancies, and malignancy was significantly associated with palpability ( P = 0.000). Mammographic findings and sonographic distribution and associated features were significantly different between benign and malignant lesions ( P = 0.000, P = 0.004, and P = 0.001, respectively). Malignant lesions showed more frequent calcifications combined with asymmetry ( P = 0.000) on mammography and linear-segmental distributions ( P = 0.001) and associated calcifications ( P = 0.019) or architectural distortions ( P = 0.015) on ultrasound. Conclusion Breast NMLs on ultrasound showed high risk of malignancy. Symptoms and mammographic and ultrasound findings can be possible predictors of malignancy in NMLs

Dedicated 3D photoacoustic breast imaging

Purpose: To report the design and imaging methodology of a photoacoustic scanner dedicated to imaging hemoglobin distribution throughout a human breast

Invasive Micropapillary Carcinoma of the Breast: MR Imaging Findings

ObjectiveTo analyze the magnetic resonance (MR) imaging findings of invasive micropapillary carcinoma of the breast.Materials and MethodsMR images were retrospectively evaluated in 14 patients (age range: 37-67, mean age: 49 years) with pathologically confirmed invasive micropapillary carcinoma of the breast. The enhancement type (mass/non-mass), shape, margin, contrast enhancement, and time-intensity curve pattern on the dynamic study were correlated with the histopathologic features. Associated findings, such as edema, nipple change, skin change and enlarged axillary lymph nodes were also studied.ResultsThe most common features of the masses were irregular shape (12 of 14 patients, 85.8%) and irregular or spiculated margin (11 of 14 patients, 78.7%). The contrast enhancement was heterogeneous in 11 patients (78.7%), rim enhancement in 2 cases (14.2%), and homogeneous in one patient (7.1%). The predominant kinetic pattern was rapid increase (14 of 14, 100%) in the initial phase and washout (11 of 14, 78.7%) in the delayed phase. Associated non-mass like enhancement was shown in 4 patients, representing ductal carcinoma in situ. MR imaging helped detect additional sites of cancer other than the index lesion in 3 patients (21.4%). Enlarged axillary lymphadenopathy was identified in 7 of the 14 patients (50%).ConclusionInvasive micropapillary carcinoma appears as a mass with an irregular shape, irregular or spiculated margin and heterogeneous enhancement on MR imaging. Though these findings are not specific and are also observed with other breast malignancies, invasive micropapillary carcinoma frequently showed multiple lesions, accompanying non-mass enhancement and axillary lymph node enlargement

Comparison of a Stationary Digital Breast Tomosynthesis System to Magnified 2D Mammography Using Breast Tissue Specimens

RATIONAL AND OBJECTIVES: The objective of this study was to compare the stationary digital breast tomosynthesis (s-DBT) system to a conventional mammography system in a study of breast specimens. Radiologist evaluation of image quality was assessed in a reader study. This study represents the first human tissue imaging with the novel carbon nanotube-based s-DBT device. MATERIALS AND METHODS: Thirty-nine patients, with known breast lesions (Breast Imaging Reporting and Data System 4 or 5) by conventional mammography and scheduled for needle localization biopsy, were recruited under an institutional review board-approved protocol. Specimen images were obtained using a two-dimensional (2D) mammography system with a ×1.8 magnification factor and an s-DBT system without a high magnification factor. A reader study was performed with four breast fellowship-trained radiologists over two separate sessions. Malignancy scores were recorded for both masses and microcalcifications (MCs). Reader preference between the two modalities for MCs, masses, and surgical margins was recorded. RESULTS: The s-DBT system was found to be comparable to magnified 2D mammography for malignancy diagnosis. Readers preferred magnified 2D mammography for MC visualization (P < .05). However, readers trended toward a preference for s-DBT with respect to masses and surgical margin assessment. CONCLUSIONS: Here, we report on the first human data acquired using a stationary digital breast tomosynthesis system. The novel s-DBT system was found to be comparable to magnified 2D mammography imaging for malignancy diagnosis. Given the trend of preference for s-DBT over 2D mammography for both mass visibility and margin assessment, s-DBT could be a viable alternative to magnified 2D mammography for imaging breast specimens

Cosmetic Outcomes for Accelerated Partial Breast Irradiation Prior to Surgical Excision of Early Stage Breast Cancer Using Single Dose Intraoperative Radiotherapy

Determine cosmetic outcome and toxicity profile of intraoperative radiation delivered prior-to tumor excision for patients with early stage breast cancer

Assessing the Standalone Sensitivity of Computer-aided Detection (CADe) with Cancer Cases from the Digital Mammographic Imaging Screening Trial (DMIST)

To assess the sensitivities and false detection rates of two CADe systems when applied to digital or screen-film mammograms in detecting the known breast cancer cases from the DMIST breast cancer screening population

Interpretation of Digital Mammograms: Comparison of Speed and Accuracy of Soft-Copy versus Printed-Film Display

PURPOSE: To compare the speed and accuracy of the interpretations of digital mammograms by radiologists by using printed-film versus soft-copy display. MATERIALS AND METHODS: After being trained in interpretation of digital mammograms, eight radiologists interpreted 63 digital mammograms, all with old studies for comparison. All studies were interpreted by all readers in soft-copy and printed-film display, with interpretations of images in the same cases at least 1 month apart. Mammograms were interpreted in cases that included six biopsy-proved cancers and 20 biopsy-proved benign lesions, 20 cases of probably benign findings in patients who underwent 6-month follow-up, and 17 cases without apparent findings. Area under the receiver operating characteristic curve (Az), sensitivity, and specificity were calculated for soft-copy and printed-film display. RESULTS: There was no significant difference in the speed of interpretation, but interpretations with soft-copy display were slightly faster. The differences in Az, sensitivity, and specificity were not significantly different; Az and sensitivity were slightly better for interpretations with printed film, and specificity was slightly better for interpretations with soft copy. CONCLUSION: Interpretation with soft-copy display is likely to be useful with digital mammography and is unlikely to significantly change accuracy or speed

Cancer Cases from ACRIN Digital Mammographic Imaging Screening Trial: Radiologist Analysis with Use of a Logistic Regression Model

To determine which factors contributed to the Digital Mammographic Imaging Screening Trial (DMIST) cancer detection results