Papillary lesions of the breast: imaging findings and diagnostic challenges

Papillary breast lesions encompass a wide spectrum of pathologies ranging from benign lesions, such as solitary intraductal papilloma, to the uncommon papillary carcinoma. These lesions have various clinical presentations and diverse radiological features. Differentiating benign and malignant papillary lesions based on imaging features may often be difficult. Other benign and malignant pathologies can also mimic papillary lesions on imaging, and tissue diagnosis is essential. Imaging plays an important role in lesion identification, assessment of extent, tissue sampling, and follow-up. Surgical excision has been recommended for all papillary lesions due to an increased incidence of high-risk lesions and neoplasia even with percutaneous, biopsy-proven benign papillomas. This review looks at papillary breast lesions from the radiologists’ standpoint and discusses the clinical, imaging, and pathological features of these lesions, as well as the role of imaging in their evaluation

Correct determination of the enhancement curve is critical to ensure accurate diagnosis using the Kaiser score as a clinical decision rule for breast MRI

10.1016/j.ejrad.2021.109630European Journal of Radiology13810963

External Validation of a Risk Stratification Score for B3 Breast Lesions Detected at Ultrasound Core Needle Biopsy

Objective: The aim of this study was to externally validate the feasibility and robustness of a risk-stratification score for B3 lesions based on clinical, pathological, and radiological data for improved clinical decision making. Methods: 129 consecutive histologically confirmed B3 lesions diagnosed at ultrasound-guided biopsy at our institution were included in this retrospective study. Patient- and lesion-related variables were independently assessed by two blinded breast radiologists (R1, R2), by assigning each feature a score from 0 to 2 (maximum sum-score of 5). Sensitivity, specificity, positive and negative predictive values were calculated at two different thresholds (≥1 and 2). Categorical variables were compared using Chi-squared and Fisher exact tests. The diagnostic accuracy of the score to distinguish benign from malignant B3 lesions was assessed by receiver operating characteristic (ROC) analysis. Results: Surgery was performed on 117/129 (90.6%) lesions and 11 of these 117 (9.4%) lesions were malignant. No cancers were found at follow-up of at least 24 months. Area under the ROC-curve was 0.736 (R1) to 0.747 (R2), with no significant difference between the two readers (p = 0.5015). Using a threshold of ≥1, a sensitivity, specificity, PPV, and NPV of 90%/90% (R1/R2), 39%/38% (R1/R2), 11%/12% (R1/R2) and 97%/98% (R1/R2) were identified. Both readers classified 47 lesions with a score ≤1 (low risk of associated malignancy). Of these, only one malignant lesion was underdiagnosed (Ductal carcinoma in situ-G1). Conclusions: In our external validation, the score showed a high negative predictive value and has the potential to reduce unnecessary surgeries or re-biopsies for ultrasound-detected B3-lesions by up to 39%

Infiltrative pattern of metastatic invasive lobular breast carcinoma in the abdomen: a pictorial review

10.1186/s13244-021-01120-4Insights into Imaging12118

Classification of CT Findings in 200 patients with unexplained weight loss.

<p>Classification of CT Findings in 200 patients with unexplained weight loss.</p

Baseline characteristics of patients (n = 200).

<p>Baseline characteristics of patients (n = 200).</p

Association between positive CT scan findings and baseline patient variables using univariate logistic regression.

<p>Association between positive CT scan findings and baseline patient variables using univariate logistic regression.</p

True positive category 1 scan—findings highly suspicious for organic etiology.

<p>(A) Axial CT scan of an 80 year old male demonstrates bowel wall thickening of the sigmoid colon (arrow) suspicious for underlying malignancy. (B) Multiple hypodense hepatic lesions are consistent with metastases (arrowheads).</p

False positive category 2 scan–findings indeterminate for possible organic etiology and require further workup.

<p>Axial CT scan of a 74 year old male which demonstrates wall thickening of the rectosigmoid junction (arrow). Follow-up colonoscopy demonstrated no suspicious lesion at the rectosigmoid junction.</p

Deep Learning Systems for Pneumothorax Detection on Chest Radiographs: A Multicenter External Validation Study

10.1148/ryai.2021200190Radiology: Artificial Intelligence3