What’s new in Breast Imaging – August 2020

2 years ago

Chapman, M. C., Hayward, J. H., Woodard, G. A., Joe, B. N., & Lee, A. Y. (2020). The Role of Breast MRI in Detecting Asymptomatic Recurrence After Therapeutic Mastectomy. American Journal of Roentgenology,215(1), 254-261. doi:10.2214/ajr.19.21640


In this retrospective study, researchers sought to establish the utility of breast MRI in identifying asymptomatic disease recurrence in patients who previously underwent therapeutic unilateral mastectomy. Of the 402 breast MRIs reviewed, 395 (98.3%) had benign findings on the mastectomy side. Seven (1.7%) breast MRIs had findings suspicious for malignancy (BI-RADS 4), four of which had biopsy-proven malignancy. The sensitivity and specificity for MRI detection of malignancy on the mastectomy side were 66.7% and 99.2%, respectively. The cancer detection rate for this subset of patients was 10 cancers per 1000 examinations. The authors concluded that the asymptomatic mastectomy side should be included in MRIs of the contralateral breast to evaluate for cancer recurrence after mastectomy.


Berg, W. A., Berg, J. M., Sickles, E. A., Burnside, E. S., Zuley, M. L., Rosenberg, R. D., & Lee, C. S. (2020). Cancer Yield and Patterns of Follow-up for BI-RADS Category 3 after Screening Mammography Recall in the National Mammography Database. Radiology,296(1), 32-41. doi:10.1148/radiol.2020192641


In this retrospective study, researches sought to determine the outcomes of 6-, 12-, and 24-month follow up for BI-RADS 3 lesions, which have an expected malignancy rate of less than 2%. Cases were selected from the National Mammography Database (NMD) and included patients over 25 years old without a personal history of breast cancer. Of the 45,202 selected cases, 3.5% of women underwent biopsy at the time of initial recall, and 4.6% of those biopsied lesions were malignant. After 90 days, 922 patients were seen again, and 78 lesions were biopsied (15% were malignant). Subsequent biopsy-proven cancer yield rates at 6-, 12-, and 24-month follow up were 1.5%, 1.2%, and 1.86%, respectively. Researchers concluded that in the NMD the use of the BI-RADS 3 category is appropriate as the cumulative cancer yield rate over 2 years was 1.86%. Researchers also noted that 57.8% of malignancies were diagnosed before or at 6 months, reinforcing the need for short-term follow up for BI-RADS 3 lesions.


Tan, H., Wu, Y., Bao, F., Zhou, J., Wan, J., Tian, J., . . . Wang, M. (2020). Mammography-based radiomics nomogram: A potential biomarker to predict axillary lymph node metastasis in breast cancer. The British Journal of Radiology,93(1111), 20191019. doi:10.1259/bjr.20191019


In this study, researchers sought to predict axillary lymph node (ALN)  metastasis in breast cancer patients with the use of a radiomics normogram including integrated features from pre-operative digital mammography (MG) and clinical risk factors. A total of 216 patients with pathology-proven breast cancer were divided into primary and validation cohorts. Radiomic features were obtained from craniocaudal views of mammograms. Ninety-five out of 216 patients had pathology-proven ALN metastasis. The radiomics normogram, which included features like progesterone receptor status and molecular subtype, had area under the receiver operator curve values of 0.883 and 0.863 for the two study cohorts. The authors concluded that their mammography-based radiomics normogram is a non-invasive assessment for the prediction of ALN metastasis, which may aid clinicians and patients in pre-operative planning.


Kim, E., Do, S., Yun, J., Park, Y., Park, C., Moon, J., . . . Kook, S. (2020). Preoperative evaluation of mammographic microcalcifications after neoadjuvant chemotherapy for breast cancer. Clinical Radiology,75(8). doi:10.1016/j.crad.2020.03.024i


In this retrospective study, the authors sought to determine the predictive value of pre-operative mammographic microcalcifications representing residual tumor after neoadjuvant chemotherapy (NAC). Patients who had microcalcifications on mammography after completing NAC underwent breast MRI and immunohistochemical analysis. Ninety-six patients were included in the study. Ten patients had pathological complete responses, and residual mammographic microcalcifications were benign. Of the remaining patients, 28.1% of residual microcalcifications were benign, and 61.5% represented in situ or invasive carcinoma. Compared to residual mammographic microcalcifications, MRI was better at predicting residual tumor in all breast cancer subtypes. The authors concluded that in approximately one-third of the study cohort mammographic microcalcifications did not correlate with the residual tumor. However, MRI and molecular subtype were useful predictors of residual tumor after NAC regardless of residual mammographic microcalcification extent.

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