This pictorial essay demonstrates the variable appearances of ductal carcinoma in situ on full-fi... more This pictorial essay demonstrates the variable appearances of ductal carcinoma in situ on full-field digital mammography, synthesized mammography, and digital breast tomosynthesis. The spectrum of intercase and intracase variability suggests further refinement of reconstruction algorithms for synthesized mammography may be necessary to maximize early detection of ductal carcinoma in situ.
Ectopic or accessory breasts describe residual breast tissue that fails to regress during normal ... more Ectopic or accessory breasts describe residual breast tissue that fails to regress during normal embryologic development anywhere outside the expected locations. Ectopic breast tissue is seen in 2-6% of the population and is categorized into two types: supernumerary and aberrant breast tissue . The extent of development of this accessory tissue varies from rudimentary to complete with organized glandular and ductal development. Given this, it is possible for the same pathology that affects normally positioned breast tissue to also affect accessory breast tissue.
AJR. American journal of roentgenology, Jan 21, 2016
The purpose of this study was to determine whether additional breast imaging is clinically valuab... more The purpose of this study was to determine whether additional breast imaging is clinically valuable in the evaluation of patients with gynecomastia incidentally observed on CT of the chest. In a retrospective analysis, 62 men were identified who had a mammographic diagnosis of gynecomastia and had also undergone CT within 8 months (median, 2 months). We compared the imaging findings of both modalities and correlated them with the clinical outcome. Gynecomastia was statistically significantly larger on mammograms than on CT images; however, there was a high level of concordance in morphologic features and distribution of gynecomastia between mammography and CT. In only one case was gynecomastia evident on mammographic but not CT images, owing to cachexia. Two of the 62 men had ductal carcinoma, which was obscured by gynecomastia. Both of these patients had symptoms suggesting malignancy. The appearance of gynecomastia on CT scans and mammograms was highly correlated. Mammography perf...
Cellular fibroadenomas (CFA) are difficult to distinguish from phyllodes tumor (PT) at biopsy. Th... more Cellular fibroadenomas (CFA) are difficult to distinguish from phyllodes tumor (PT) at biopsy. This study's purpose was to determine what CFA characteristics were associated with recommendations to follow-up or excise and if the current algorithm was correct. Databases from 2002 to 2014 were reviewed. Mass characteristics and post biopsy recommendations were recorded. 81 CFAs were diagnosed; 19 cellular and 62 with slightly cellular stroma. 21 masses were surgically excised with 2 PTs diagnosed. Larger mass size and increased histologic cellularity were associated with excision recommendation, but only clinical growth was associated with PT.
Objectives. To study factors that predict changes in management with digital breast tomosynthesis... more Objectives. To study factors that predict changes in management with digital breast tomosynthesis (DBT). Methods. The Institutional Review Board approved this HIPAA compliant study. 996 patients had DBT with full field digital mammography (FFDM). Univariate analysis evaluated predictors of management change and cancer detection. Results. DBT changed management in 109 of 996 (11%); 77 (71%) required less imaging. Recalled patients after abnormal FFDM screen were most likely to have management change-25% (24 of 97 patients) compared to 8% (13/163) of symptomatic patients and 10% (72/736) of screening patients (P < 0.001). Dense breasted patients had a higher likelihood of having DBT change management: 13% (68/526) compared to 9% (41/470) (P = 0.03). Of the 996 patients, 19 (2%) were diagnosed with breast cancer. 15 cancers (83%) were seen on FFDM and DBT; 3 (17%) were diagnosed after DBT (0.3%, 95%CI: 0.1-0.9%). One recurrence was in the skin and was not seen on DBT nor was it seen...
PURPOSE/AIM The purpose of this exhibit is to show the viewer examples of elastography of benign ... more PURPOSE/AIM The purpose of this exhibit is to show the viewer examples of elastography of benign and malignant cases; we will show the cases with 2D and elastography and allow the reader to predict the pathology and then discuss the elastography findings. CONTENT ORGANIZATION The cases will be presented in a quiz format. Key points for each case will include the findings on 2D ultrasound and elastography. The answer will include a discussion of the role that elastography may play in such cases. The list of cases includes true positive invasive breast cancers, false negative breast cancers, false positive breast cancers as well as true negatives. We will include breast cancers, papillomas, fibroadenomas and breast cysts. SUMMARY Elastography provides interesting information about a lesions stiffness, but at this time with current technology cannot reliably differentiate benign from malignant disease. One should continue to rely on 2D information when making decisions about whether to...
PURPOSE/AIM The upcoming American Board of Radiology (ABR) Exam of the Future will include up to ... more PURPOSE/AIM The upcoming American Board of Radiology (ABR) Exam of the Future will include up to 110 questions emphasizing physics content. The purpose of this exhibit is to review mammography physics and quality improvement for those taking the new ABR exam and for practicing radiologists. CONTENT ORGANIZATION Similar to the new ABR examination, this exhibit will emphasize images and practical applications. Topics are from the ABR Diagnostic Radiology Core Examination Study Guide (updated 8/5/2011). These include: optimizing film or digital mammograms (target/filter, grid, scatter, radiation dose), recognition and correction of artifacts, digital mammography workstations (equipment parameters and image processing). Quality assurance topics include quality determinants: patient positioning, image processing, optimal technique, and equipment. Mammography Quality Standards Act requirements will be reviewed. The presentation will conclude with an interactive quiz using multiple choice ...
PURPOSE To determine the correlation between dense breasts (DB) and invasive breast cancer progno... more PURPOSE To determine the correlation between dense breasts (DB) and invasive breast cancer prognostic indicators METHOD AND MATERIALS IRB approved retrospective review identified 159 women > 30 who were diagnosed with an invasive breast cancer within 2 years of receiving a mammogram. Density data from the mammogram reports were divided into dense (BI-RADS 3 and 4) and not dense (BI-RADS 1 and 2) categories and correlated with pathological characteristics of the tumors in these women. The pathology characteristics were taken from pathology reports of biopsies and tumor resections and included estrogen, progesterone and her2 receptor status. Additionally, the stage of the tumors was determined using TNM data from the pathology reports. RESULTS Median age at diagnosis for invasive cancer was 61 years (range 33-89). 67/93 (72%) patients in the not dense category and 40/66 (61%) in the dense category were diagnosed with stage 1 cancer. The remaining patients 26/96 (28%) in the not den...
PURPOSE/AIM To describe a systematic protocol for the sonographic assessment of lymph nodes in th... more PURPOSE/AIM To describe a systematic protocol for the sonographic assessment of lymph nodes in the axillary and internal mammary regions, review characteristics of normal lymph node morphology, provide a step-wise technical description for biopsy of abnormal nodes, and discuss potential complications and benefits of ultrasound guided lymph node biopsy. CONTENT ORGANIZATION 1. Overview of anatomy and pathophysiology 2. Indications for sonographic assessment of axillary and internal mammary regions. 3. How to image these regions with ultrasound. 4. Review of criteria for normal lymph node morphology 5. How to core biopsy axillary nodes and aspirate internal mammary nodes, including images of sampled nodes with pathologic correlates. 6. Potential complications. 7. Potential benefits. SUMMARY Ultrasound is presented as a practical and effective means for assessing axillary and internal mammary lymph nodes, and for sampling those which appear abnormal. The indications for sonographic ass...
The purposes of this article are to describe two cases of breast cancer in male-to-female transse... more The purposes of this article are to describe two cases of breast cancer in male-to-female transsexuals and to review eight cases previously reported in the literature. Breast cancer occurs in male-to-female transsexuals who receive high doses of exogenous estrogen and develop breast tissue histologically identical to that of a biologically female breast. This exposure to estrogen results in increased risk of breast cancer. The first patient described is a male-to-female transsexual with screening-detected ductal carcinoma in situ and a family history of breast cancer. The other patient is a male-to-female transsexual with invasive ductal carcinoma that was occult on diagnostic digital mammographic and ultrasound findings but visualized on digital breast tomosynthesis and breast MR images. The analysis of the eight previously reported cases showed that breast cancer in male-to-female transsexuals occurs at a younger age and is more frequently estrogen receptor negative than breast cancer in others born biologically male. Screening for breast cancer in male-to-female transsexuals should be undertaken for those with additional risk factors (e.g., family history, BRCA2 mutation, Klinefelter syndrome) and should be available to those who desire screening, preferably in a clinical trial.
PURPOSE/AIM This exhibit will review the appearance of breast masses on digital breast tomosynthe... more PURPOSE/AIM This exhibit will review the appearance of breast masses on digital breast tomosynthesis (DBT). It will also include a concise review of the key literature supporting the ability of DBT to visualize and characterize benign and malignant masses. CONTENT ORGANIZATION This interactive exhibit will allow the participant to review and test themselves as they view selected tomosynthesis images. Each example/case will include an image with a multiple choice question, followed by an answer slide with visual descriptions, arrows highlighting the key findings in each case, and corresponding videos or conventional mammographic images. A spectrum of benign and malignant masses will be reviewed. Additionally, there will be a concise review of the literature on the ability of DBT to identify and characterize masses. SUMMARY The goal of the educational exhibit is to illustrate a spectrum of masses using DBT. After reviewing this exhibit, the radiologist should have a greater ability to...
PURPOSE/AIM This exhibit will highlight the utility of 3D tomosynthesis as a diagnostic tool for ... more PURPOSE/AIM This exhibit will highlight the utility of 3D tomosynthesis as a diagnostic tool for breast pathology. CONTENT ORGANIZATION This will be an interactive exhibit which will allow the user to review and test themselves as they review selected tomosynthesis images. Each example will include visual descriptions or videos and corresponding conventional imaging, with arrows highlighting the key findings in each case. A spectrum of normal studies as well as a spectrum of benign and malignant masses and calcifications will be reviewed. SUMMARY The goal of the educational exhibit is to demonstrate the imaging spectrum of breast disease using 3D tomosynthesis. This will be done by creating an interactive atlas encompassing a wide spectrum of breast pathology.
This pictorial essay demonstrates the variable appearances of ductal carcinoma in situ on full-fi... more This pictorial essay demonstrates the variable appearances of ductal carcinoma in situ on full-field digital mammography, synthesized mammography, and digital breast tomosynthesis. The spectrum of intercase and intracase variability suggests further refinement of reconstruction algorithms for synthesized mammography may be necessary to maximize early detection of ductal carcinoma in situ.
Ectopic or accessory breasts describe residual breast tissue that fails to regress during normal ... more Ectopic or accessory breasts describe residual breast tissue that fails to regress during normal embryologic development anywhere outside the expected locations. Ectopic breast tissue is seen in 2-6% of the population and is categorized into two types: supernumerary and aberrant breast tissue . The extent of development of this accessory tissue varies from rudimentary to complete with organized glandular and ductal development. Given this, it is possible for the same pathology that affects normally positioned breast tissue to also affect accessory breast tissue.
AJR. American journal of roentgenology, Jan 21, 2016
The purpose of this study was to determine whether additional breast imaging is clinically valuab... more The purpose of this study was to determine whether additional breast imaging is clinically valuable in the evaluation of patients with gynecomastia incidentally observed on CT of the chest. In a retrospective analysis, 62 men were identified who had a mammographic diagnosis of gynecomastia and had also undergone CT within 8 months (median, 2 months). We compared the imaging findings of both modalities and correlated them with the clinical outcome. Gynecomastia was statistically significantly larger on mammograms than on CT images; however, there was a high level of concordance in morphologic features and distribution of gynecomastia between mammography and CT. In only one case was gynecomastia evident on mammographic but not CT images, owing to cachexia. Two of the 62 men had ductal carcinoma, which was obscured by gynecomastia. Both of these patients had symptoms suggesting malignancy. The appearance of gynecomastia on CT scans and mammograms was highly correlated. Mammography perf...
Cellular fibroadenomas (CFA) are difficult to distinguish from phyllodes tumor (PT) at biopsy. Th... more Cellular fibroadenomas (CFA) are difficult to distinguish from phyllodes tumor (PT) at biopsy. This study&amp;amp;amp;amp;amp;amp;#39;s purpose was to determine what CFA characteristics were associated with recommendations to follow-up or excise and if the current algorithm was correct. Databases from 2002 to 2014 were reviewed. Mass characteristics and post biopsy recommendations were recorded. 81 CFAs were diagnosed; 19 cellular and 62 with slightly cellular stroma. 21 masses were surgically excised with 2 PTs diagnosed. Larger mass size and increased histologic cellularity were associated with excision recommendation, but only clinical growth was associated with PT.
Objectives. To study factors that predict changes in management with digital breast tomosynthesis... more Objectives. To study factors that predict changes in management with digital breast tomosynthesis (DBT). Methods. The Institutional Review Board approved this HIPAA compliant study. 996 patients had DBT with full field digital mammography (FFDM). Univariate analysis evaluated predictors of management change and cancer detection. Results. DBT changed management in 109 of 996 (11%); 77 (71%) required less imaging. Recalled patients after abnormal FFDM screen were most likely to have management change-25% (24 of 97 patients) compared to 8% (13/163) of symptomatic patients and 10% (72/736) of screening patients (P < 0.001). Dense breasted patients had a higher likelihood of having DBT change management: 13% (68/526) compared to 9% (41/470) (P = 0.03). Of the 996 patients, 19 (2%) were diagnosed with breast cancer. 15 cancers (83%) were seen on FFDM and DBT; 3 (17%) were diagnosed after DBT (0.3%, 95%CI: 0.1-0.9%). One recurrence was in the skin and was not seen on DBT nor was it seen...
PURPOSE/AIM The purpose of this exhibit is to show the viewer examples of elastography of benign ... more PURPOSE/AIM The purpose of this exhibit is to show the viewer examples of elastography of benign and malignant cases; we will show the cases with 2D and elastography and allow the reader to predict the pathology and then discuss the elastography findings. CONTENT ORGANIZATION The cases will be presented in a quiz format. Key points for each case will include the findings on 2D ultrasound and elastography. The answer will include a discussion of the role that elastography may play in such cases. The list of cases includes true positive invasive breast cancers, false negative breast cancers, false positive breast cancers as well as true negatives. We will include breast cancers, papillomas, fibroadenomas and breast cysts. SUMMARY Elastography provides interesting information about a lesions stiffness, but at this time with current technology cannot reliably differentiate benign from malignant disease. One should continue to rely on 2D information when making decisions about whether to...
PURPOSE/AIM The upcoming American Board of Radiology (ABR) Exam of the Future will include up to ... more PURPOSE/AIM The upcoming American Board of Radiology (ABR) Exam of the Future will include up to 110 questions emphasizing physics content. The purpose of this exhibit is to review mammography physics and quality improvement for those taking the new ABR exam and for practicing radiologists. CONTENT ORGANIZATION Similar to the new ABR examination, this exhibit will emphasize images and practical applications. Topics are from the ABR Diagnostic Radiology Core Examination Study Guide (updated 8/5/2011). These include: optimizing film or digital mammograms (target/filter, grid, scatter, radiation dose), recognition and correction of artifacts, digital mammography workstations (equipment parameters and image processing). Quality assurance topics include quality determinants: patient positioning, image processing, optimal technique, and equipment. Mammography Quality Standards Act requirements will be reviewed. The presentation will conclude with an interactive quiz using multiple choice ...
PURPOSE To determine the correlation between dense breasts (DB) and invasive breast cancer progno... more PURPOSE To determine the correlation between dense breasts (DB) and invasive breast cancer prognostic indicators METHOD AND MATERIALS IRB approved retrospective review identified 159 women > 30 who were diagnosed with an invasive breast cancer within 2 years of receiving a mammogram. Density data from the mammogram reports were divided into dense (BI-RADS 3 and 4) and not dense (BI-RADS 1 and 2) categories and correlated with pathological characteristics of the tumors in these women. The pathology characteristics were taken from pathology reports of biopsies and tumor resections and included estrogen, progesterone and her2 receptor status. Additionally, the stage of the tumors was determined using TNM data from the pathology reports. RESULTS Median age at diagnosis for invasive cancer was 61 years (range 33-89). 67/93 (72%) patients in the not dense category and 40/66 (61%) in the dense category were diagnosed with stage 1 cancer. The remaining patients 26/96 (28%) in the not den...
PURPOSE/AIM To describe a systematic protocol for the sonographic assessment of lymph nodes in th... more PURPOSE/AIM To describe a systematic protocol for the sonographic assessment of lymph nodes in the axillary and internal mammary regions, review characteristics of normal lymph node morphology, provide a step-wise technical description for biopsy of abnormal nodes, and discuss potential complications and benefits of ultrasound guided lymph node biopsy. CONTENT ORGANIZATION 1. Overview of anatomy and pathophysiology 2. Indications for sonographic assessment of axillary and internal mammary regions. 3. How to image these regions with ultrasound. 4. Review of criteria for normal lymph node morphology 5. How to core biopsy axillary nodes and aspirate internal mammary nodes, including images of sampled nodes with pathologic correlates. 6. Potential complications. 7. Potential benefits. SUMMARY Ultrasound is presented as a practical and effective means for assessing axillary and internal mammary lymph nodes, and for sampling those which appear abnormal. The indications for sonographic ass...
The purposes of this article are to describe two cases of breast cancer in male-to-female transse... more The purposes of this article are to describe two cases of breast cancer in male-to-female transsexuals and to review eight cases previously reported in the literature. Breast cancer occurs in male-to-female transsexuals who receive high doses of exogenous estrogen and develop breast tissue histologically identical to that of a biologically female breast. This exposure to estrogen results in increased risk of breast cancer. The first patient described is a male-to-female transsexual with screening-detected ductal carcinoma in situ and a family history of breast cancer. The other patient is a male-to-female transsexual with invasive ductal carcinoma that was occult on diagnostic digital mammographic and ultrasound findings but visualized on digital breast tomosynthesis and breast MR images. The analysis of the eight previously reported cases showed that breast cancer in male-to-female transsexuals occurs at a younger age and is more frequently estrogen receptor negative than breast cancer in others born biologically male. Screening for breast cancer in male-to-female transsexuals should be undertaken for those with additional risk factors (e.g., family history, BRCA2 mutation, Klinefelter syndrome) and should be available to those who desire screening, preferably in a clinical trial.
PURPOSE/AIM This exhibit will review the appearance of breast masses on digital breast tomosynthe... more PURPOSE/AIM This exhibit will review the appearance of breast masses on digital breast tomosynthesis (DBT). It will also include a concise review of the key literature supporting the ability of DBT to visualize and characterize benign and malignant masses. CONTENT ORGANIZATION This interactive exhibit will allow the participant to review and test themselves as they view selected tomosynthesis images. Each example/case will include an image with a multiple choice question, followed by an answer slide with visual descriptions, arrows highlighting the key findings in each case, and corresponding videos or conventional mammographic images. A spectrum of benign and malignant masses will be reviewed. Additionally, there will be a concise review of the literature on the ability of DBT to identify and characterize masses. SUMMARY The goal of the educational exhibit is to illustrate a spectrum of masses using DBT. After reviewing this exhibit, the radiologist should have a greater ability to...
PURPOSE/AIM This exhibit will highlight the utility of 3D tomosynthesis as a diagnostic tool for ... more PURPOSE/AIM This exhibit will highlight the utility of 3D tomosynthesis as a diagnostic tool for breast pathology. CONTENT ORGANIZATION This will be an interactive exhibit which will allow the user to review and test themselves as they review selected tomosynthesis images. Each example will include visual descriptions or videos and corresponding conventional imaging, with arrows highlighting the key findings in each case. A spectrum of normal studies as well as a spectrum of benign and malignant masses and calcifications will be reviewed. SUMMARY The goal of the educational exhibit is to demonstrate the imaging spectrum of breast disease using 3D tomosynthesis. This will be done by creating an interactive atlas encompassing a wide spectrum of breast pathology.
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