Criteria for the safe avoidance of needle sampling in young women with solid breast masses

Criteria for the safe avoidance of needle sampling in young women with solid breast masses
A.J. Maxwell, J.M. Pearson
Clinical Radiology 2010 65;3:218-222

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Nine women with breast cancer, seven with phyllodes, and six with papillomas were found.

No delayed diagnoses in those who had ultrasound would have been made if the following criteria had been applied to avoid needle sampling:

• age less than 25 years
• no known risk factors for breast malignancy
• mass not rapidly enlarging
• smooth discrete mobile mass on clinical examination, or lesion impalpable
• well-defined homogeneously isoechoic or mildly hypoechoic solid mass
• less than 3 cm in greatest dimension
• ovoid shape, aligned parallel to the skin surface
• smooth or gently lobulated contour (two or three lobulations only; no microlobulation
• thin echogenic pseudocapsule
• no calcification
• no acoustic shadowing

Needle sampling could have been safely avoided in approximately two-thirds of the women reviewed below the age of 25 with a solid breast mass

Screening for breast cancer post reduction mammoplasty

Screening for breast cancer post reduction mammoplasty
T.M. Muir, J. Tresham, L. Fritschi, E. Wylie
Clinical Radiology 2010 65;3:198-205

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Postoperative breast changes following reduction mammoplasty do not significantly hinder analysis of the screening mammogram

Lesion size is a major determinant of the mammographic features of ductal carcinoma in situ: findings from the Sloane project

Lesion size is a major determinant of the mammographic features of ductal carcinoma in situ: findings from the Sloane project
A. Evans, K. Clements, A. Maxwell, H. Bishop, A. Hanby, G. Lawrence, S.E. Pinder
Clinical Radiology 2010 65;3:181-184

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Lesion size has a strong influence on the radiological features of calcific DCIS; small, high-grade lesions often show no casting calcifications, whereas casting calcifications are seen in nearly half of large, low-grade lesions. As small clusters of punctate or granular calcifications may represent high-grade DCIS, an aggressive clinical approach to the diagnosis of such lesions is recommended as the adequate treatment of high-grade DCIS will prevent the occurrence of potentially life-threatening high-grade invasive disease

Diagnosis of breast cancer at dynamic MRI in patients with breast augmentation by paraffin or silicone injection

Diagnosis of breast cancer at dynamic MRI in patients with breast augmentation by paraffin or silicone injection
J.H. Youk, E.J. Son, E.-K. Kim, J.-A. Kim, M.J. Kim, J.Y. Kwak, S.M. Lee
Clinical Radiology
Volume 64, Issue 12, December 2009, Pages 1175-1180

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In patients with breasts injected with foreign material, MRI was used to successfully diagnose malignant breast lesions and could be the diagnostic method of choice. Analysis of the morphological and kinetic features at MRI in conjunction with clinical findings is essential.

(Ed..) If the patient has been injected with Silicone rather than paraffin oil, then add silicone suppression sequence to the fat suppression series to distinguish between foci of silicone and

Can breast MRI computer-aided detection (CAD) improve radiologist accuracy for lesions detected at MRI screening and recommended for biopsy in a high-

Can breast MRI computer-aided detection (CAD) improve radiologist accuracy for lesions detected at MRI screening and recommended for biopsy in a high-risk population?
T. Arazi-Kleinman, P.A. Causer, R.A. Jong, K. Hill, E. Warner
Clinical Radiology Volume 64, Issue 12, December 2009, Pages 1166-1174

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The breast MRI CAD system used could not improve the radiologists' accuracy for distinguishing all malignant from benign lesions, due to the poor sensitivity for DCIS detection

Pseudoangiomatous stromal hyperplasia: a study of the mammographic and sonographic features

Pseudoangiomatous stromal hyperplasia: a study of the mammographic and sonographic features
L. Celliers, D.D. Wong, A. Bourke
Clinical Radiology 65 (2010) 145–149

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Although there are emerging patterns associated with PASH on imaging, the features are not sufficiently specific to allow for a prospective diagnosis. Histological confirmation, preferably with core biopsy, should always be considered

(Ed:)
From a BIRADS point of view, on ultrasound these most commonly present as a circumscribed oval solid mass, and therefore benign appearances. The mammographic features are usually more suspicious and therefore more likely to prompt biopsy

Will MRI screening deliver the expected survival advantage in BRCA 1 carriers?

Will MRI screening deliver the expected survival advantage in BRCA 1 carriers?
L.J. Hamilton, A.J. Evans, E.J. Cornford, E.A. Rakha, I.O. Ellis, W.D. Foulkes
Clinical Radiology (2009) 64, 1045-1047

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Magnetic resonance imaging (MRI) screening for breast cancer has greater sensitivity than conventional mammographic screening.1,2 Digital mammography gives maximum sensitivity in younger women with denser breasts.3 Combining MRI with digital mammography is likely to give maximum sensitivity. This additional sensitivity offered by MRI has the potential to identify breast cancer at an earlier stage, when the tumours are smaller in size and are not associated with metastases to regional lymph nodes

It is of vital importance that actual mortality data on a cohort of MRI-screened BRCA1 carriers without prior breast cancer are published to en- able an informed decision on the benefits of MRI screening in this group. Until such mortality data are available, the predicted benefits must remain just that - predictions. We urge caution until such time as prospective survival data are available