Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience

Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience
A.J. Maxwell
Clinical Radiology (2009) 64, 801-806

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The findings suggests that vacuum-assisted removal is a satisfactory alternative to surgery for the majority of patients, but that particular attention should be paid to ensuring complete lesion removal in view of the relatively high recurrence rate in this series

The Royal College of Radiologists Breast Group breast imaging classification

The Royal College of Radiologists Breast Group breast imaging classification
A.J. Maxwell, N.T. Ridley, G. Rubin, M.G. Wallis, F.J. Gilbert, M.J. Michell

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Standardisation of the classification of breast imaging reports will improve communication between the referrer and the radiologist and avoid ambiguity, which may otherwise lead to mismanagement of patients. Following wide consultation, the Royal College of Radiologists Breast Group has produced a scoring system for the classification of breast imaging. This will facilitate audit and the development of nationally agreed standards for the investigation of women with breast disease.

This five-point system is as follows:

1. normal
2. benign findings
3. indeterminate/probably benign findings
4. findings suspicious of malignancy
5. findings highly suspicious of malignancy

It is recommended that this be used in the reporting of all breast imaging examinations in the UK

NB (Ed) : There are no definitions or lexicon associated with this classification, which renders it less than it could have been, and allows significant variability in reporting, particularly category 2 and 3 findings. These are important differences with the BIRADS classification which will hinder the comparison of data between the US/Europe and the UK

Mammographically non-calcified ductal carcinoma in situ: sonographic features with pathological correlation in 35 patients

Mammographically non-calcified ductal carcinoma in situ: sonographic features with pathological correlation in 35 patients
B. Mesurolle, M. El-Khoury, K. Khetani, N. Abdullah, L. Joseph, E. Kao
Clinical Radiology 64( 6) 2009: 628-636

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Ultrasonographically detected radiographically non-calcified DCIS commonly displays an irregular shape, microlobulated margins, and complex echotexture, giving a “pseudomicrocystic” appearance. Microlobulated margins and “pseudomicrocystic” echotexture seem to be associated with a cancerization of the lobules

Risk–benefit analysis of preoperative breast MRI in patients with primary breast cancer

Risk–benefit analysis of preoperative breast MRI in patients with primary breast cancer
K.C. Siegmann, A. Baur, U. Vogel, B. Kraemer, M. Hahn, C.D. Claussen
Clinical Radiology 2009 64(4): 403-413

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119 patients undergoing pre-operative MRI of the breasts. The findings changed management in 48 patients (40.3%). The change in clinical management and patient benefit were independent of BD and TT (p > 0.05).
The percentage of additional biopsies of benign lesions was 10.1%

NB No difference in outcome between tumour types (rather unexpected)

Patient satisfaction and efficacy of vacuum-assisted excision biopsy of fibroadenomas

Patient satisfaction and efficacy of vacuum-assisted excision biopsy of fibroadenomas
P. Thurley, A. Evans, L. Hamilton, J. James, R. Wilson
Clinical Radiology (2009) 64; 4:381-385

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VAB excision is well-tolerated, safe, and popular with a high initial success rate for fibroadenomas. Bruising and pain are common the week after the procedure

Prediction of the presence of invasive disease from the measurement of extent of malignant microcalcification on mammography and DCIS

Prediction of the presence of invasive disease from the measurement of extent of malignant microcalcification on mammography and ductal carcinoma in situ grade at core biopsy
E.A.M. O'Flynn, J.C. Morel, J. Gonzalez, N. Dutt, D. Evans, R. Wasan, M.J. Michell
Clinical Radiology 64, Issue 2, February 2009, Pages 178-183

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Risk of invasion associated positively with -

increased cluster size

Cluster size DCIS (mm)	Total cases	Invasive cases	Non-invasive cases
<11	136	27 (20%)	109 (81%)
11–30	131	40 (31%)	91 (69%)
31–60	95	33 (35%)	62 (65%)
>60	40	18 (45%)	22 (55%)
Total	402	118 (29%)	284 (71%)

Increasing DCIS Grade

DCIS grade	All cases	Invasive cases	Non-invasive cases
Low	31	4 (13%)	27 (87%)
Intermediate	103	26 (25%)	77 (75%)
High	239	86 (36%)	153 (64%)
Unclassified	3	1 (33%)	2 (67%)
Unknown	26	1 (4%)	25 (96%)
Total	402	118 (29%)	284 (71%)

Allows risk of invasion to be objectively estimated pre-operatively, and therefore an informed decision made about whether SLNB should be performed at the same time as definitive surgery

Does computer-aided detection have a role in the arbitration of discordant double-reading opinions in a breast-screening programme?

Does computer-aided detection have a role in the arbitration of discordant double-reading opinions in a breast-screening programme?
J.J. James, E.J. Cornford
Clinical Radiology (2009) 64, 46 - 51

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The main effect of CAD acting as an arbitrator of discordant double-reading opinions is to increase
the recall rate, significantly above what is found when arbitration is performed by an independent third reader. Using CAD as an arbitrator may be an option to deal with discordant double-reading opinions when no other method of consensus or arbitration is available