Authors:Phillips J; Fein-Zachary V, Slanetz P. Abstract: Contrast-enhanced mammography (CEM) is a promising new imaging modality that uses a dual-energy acquisition to provide both morphologic and vascular assessment of breast lesions. Although no official BI-RADS lexicon exists, interpretation entails using the mammographic BI-RADS lexicon in combination with that for breast MRI. CEM has comparable performance to breast MRI, with sensitivity of 93–100% and specificity of 80–94%. Currently FDA approved for diagnostic imaging, this technology can be helpful in determining disease extent in patients with newly diagnosed breast malignancy, monitoring response to neoadjuvant therapy, identifying mammographically occult malignancies, and diagnostic problem-solving. Studies are ongoing about its role in screening, especially in women with dense breasts or at elevated risk. There are some challenges to successful implementation into practice, but overall, patients tolerate the study well, and exam times are less than the full breast MRI protocol. PubDate: Wed, 13 Mar 2019 00:00:00 GMT
Authors:Kopans D. Abstract: The field of Breast Imaging evolved because a fairly small number of dedicated individuals realized the lifesaving potential of detecting breast cancer earlier. They persevered despite persistent efforts to curtail screening. From the first attempts to produce X-ray images of the breast to magnetic resonance and digital breast tomosynthesis, investigators have worked continuously to develop better ways to detect breast cancer at a time when cure is possible, while working continuously to preserve access for women to screening. Consequently, the death rate from breast cancer has declined by more than 40%. Therapy has improved, but therapy saves lives when breast cancers are treated early. PubDate: Wed, 13 Mar 2019 00:00:00 GMT
Authors:Butler R; Conant E, Philpotts L. Abstract: Digital breast tomosynthesis (DBT) is increasingly recognized as a superior breast imaging technology compared with 2D digital mammography (DM) alone. Accumulating data confirm increased sensitivity and specificity in the screening setting, resulting in higher cancer detection rates and lower abnormal interpretation (recall) rates. In the diagnostic environment, DBT simplifies the diagnostic work-up and improves diagnostic accuracy. Initial concern about increased radiation exposure resulting from the DBT acquisition added onto a 2D mammogram has been largely alleviated by the development of synthesized 2D mammography (SM). Continued research is underway to reduce artifacts associated with SM, and improve its comparability to DM. Breast cancers detected with DBT are most often small invasive carcinomas with a preponderance for grade 1 histology and luminal A molecular characteristics. Recent data suggest that higher-grade cancers are also more often node negative when detected with DBT. A meta-analysis of early single-institution studies of the effect of DBT on interval cancers has shown a modest decrease when multiple data sets are combined. Because of the greater conspicuity of lesions on DBT imaging, detection of subtle architectural distortion is increased. Such findings include both spiculated invasive carcinomas and benign etiologies such as radial scars. The diagnostic evaluation of architectural distortion seen only with DBT can pose a challenge. When no sonographic correlate can be identified, DBT-guided biopsy and/or localization capability is essential. Initial experience with DBT-guided procedures suggests that DBT biopsy equipment may improve the efficiency of percutaneous breast biopsy with less radiation. PubDate: Wed, 13 Mar 2019 00:00:00 GMT
Authors:Pham R; Constantinou N, Plecha D. Abstract: Healthcare systems are constantly expanding and gaining new territories. This growth is met with challenges in the organization and delivery of quality health care services to a large geographical area. The need for provider and staff coverage at the new sites often outpaces the rate at which additional providers and staff are hired. The need for new technology, equipment, and administrative support to oversee the new sites may also lag. The overall result could compromise patient experience at these outlying locations. The breast imaging division at University Hospitals Cleveland Medical Center (UHCMC) instituted many changes to support UHCMC’s continual growth while focusing on consistent quality of care and optimal patient experience. Changes included adoption of the hub-and-spoke organization-design model and incorporation of the integrated practice unit (IPU) concept. In the hub-and-spoke organization-design model, full services are offered at a central hub, with additional limited services provided at the peripheral spoke sites. The IPU is a dedicated team of clinical and nonclinical personnel providing the full care cycle centered on a specific medical condition such as breast health. The breast imaging hubs and spokes are incorporated into the breast health IPUs to provide uniform quality care across a large health system. The purpose of this article is to describe how the breast imaging division, functioning as members of the breast care IPU, utilized the hub-and-spoke concept to provide quality breast imaging services throughout the expanding health system. PubDate: Wed, 13 Mar 2019 00:00:00 GMT
Authors:Singer T; Lourenco A, Baird G, et al. Abstract: ObjectiveTo evaluate radiologists’ supplemental screening recommendations for women with dense breasts, at average, intermediate, or high risk of breast cancer, and to determine if there are differences between their recommendations for their patients, their friends and family, and themselves.MethodsThis is an anonymous survey of Society of Breast Imaging (SBI) members. Demographics, knowledge of breast density as a risk factor, and recommendations for screening with digital breast tomosynthesis (DBT), ultrasound (US), and magnetic resonance imaging (MRI) in women with dense breasts, at average, intermediate, or high- risk of breast cancer were assessed. The likelihood of their recommending the screening test for their patients, their family and friends, and themselves was assessed on a Likert scale from 0 to 4 (0 = “not at all likely” to 4 = “extremely likely”).ResultsThere were 295 responses: 67% were women, and breast imaging comprised 95% of their practice. Among participants, 53% correctly answered the question on relative risk of breast cancer when comparing extremely dense versus fatty breasts, and 57% when comparing heterogeneously dense versus scattered breasts. US is recommended at a relatively low rate (1.0–1.4 on the 0–4 scale), regardless of risk. DBT is recommended at a relatively high rate (2.5–3.0 on the 0–4 scale), regardless of risk status. MR is recommended mainly for those at high risk (3.6 on the 0–4 scale). Radiologists were more likely to recommend additional imaging for themselves than for their patients and their family and friends.ConclusionFor women with dense breasts, radiologists are “somewhat likely” to recommend US and “likely” to “very likely” to recommend DBT regardless of risk group. They are “very likely” to recommend MRI for high-risk groups. PubDate: Wed, 13 Mar 2019 00:00:00 GMT
Authors:Greenstein C; Adam N, Glass E, et al. Abstract: A 59-year-old asymptomatic female from India who had recently traveled to the U.S. had a screening mammogram performed. Additional evaluation, including diagnostic views and ultrasound, was performed for a focal asymmetry in the upper outer quadrant of the left breast (Figure 1). PubDate: Wed, 13 Mar 2019 00:00:00 GMT
Authors:Daugherty M; Niell B. Abstract: ObjectiveThe purpose of this study is to evaluate the utility of routine axillary ultrasound surveillance in asymptomatic T1 or T2 breast cancer patients with 1 to 2 positive axillary nodes that did not undergo axillary lymph node dissection.MethodsA retrospective review of our institutional database identified axillary and breast ultrasound examinations performed between February 1, 2011, and August 31, 2017, in asymptomatic T1 or T2 breast cancer patients with 1 to 2 positive axillary nodes that did not undergo axillary lymph node dissection. From the electronic medical record, patient demographics, imaging data, pathology results, and surgical reports were extracted. Positive predictive values (PPVs) 2 and 3 and cancer detection rate (CDR) were calculated with exact 95% confidence intervals (CIs).ResultsAn average of 2.1 surveillance examinations was performed in 77 unique patients, yielding 160 total examinations. For 7 patients, 7 biopsies were recommended, and 5 biopsies were performed. No malignancy was diagnosed, yielding a PPV2 of 0% (0/7) (95% CI = 0% to 35%); PPV3 of 0% (0/5) (95% CI = 0% to 45%), and CDR of zero per 1000 (0/160) examinations (95% CI = 0 to 19).ConclusionGiven the low frequency of axillary recurrence, routine axillary surveillance ultrasound in women with T1 or T2 breast cancers and 1 to 2 positive lymph nodes would be expected to have a low incremental CDR compared to clinical evaluation alone. Axillary surveillance ultrasound should not be routinely recommended or performed. PubDate: Wed, 13 Mar 2019 00:00:00 GMT
Authors:Pisano E. Abstract: Breast cancer screening is unfortunately still controversial, despite substantial and very convincing evidence of its benefits (1–3), most recently, including a paper demonstrating a 47% greater reduction in risk of death among women in Sweden who participated in screening compared with those who did not (4). In addition, National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results Program data demonstrate that breast cancer deaths in women have fallen 43% since regular mammography screening began in the 1980s (5). PubDate: Sat, 02 Mar 2019 00:00:00 GMT
Authors:Grimm L; Enslow M, Ghate S. Abstract: ObjectiveThe purpose of this study was to determine the malignancy rate of solitary MRI masses with benign BI-RADS descriptors.MethodsA retrospective review was conducted of all breast MRI reports that described a mass with a final BI-RADS assessment of 3, 4, or 5, from February 1, 2005, through February 28, 2014 (n = 1510). Studies were excluded if the mass was not solitary, did not meet formal criteria for a mass, or had classically suspicious BI-RADS features (e.g., washout kinetics, and spiculated margin). The masses were reviewed by 2 fellowship-trained breast radiologists who reported consensus BI-RADS mass margin, shape, internal-enhancement, and kinetics descriptors. The T2 signal was reported as hyperintense if equal to or greater than the signal intensity of the axillary lymph nodes. Pathology results or 2 years of imaging follow-up were recorded. Comparisons were made between mass descriptors and clinical outcomes.ResultsThere were 127 women with 127 masses available for analysis. There were 76 (60%) masses that underwent biopsy for an overall malignancy rate of 4% (5/127): 2 ductal carcinoma in situ (DCIS) and 3 invasive ductal carcinoma. The malignancy rate was 2% (1/59) for T2 hyperintense solitary masses. The malignancy rate was greater than 2% for all of the following BI-RADS descriptors: oval (3%, 3/88), round (5%, 2/39), circumscribed (4%, 5/127), homogeneous (4%, 3/74), and dark internal septations (4%, 2/44).ConclusionT2 hyperintense solitary masses without associated suspicious features have a low malignancy rate, and they could be considered for a BI-RADS 3 final assessment. PubDate: Mon, 25 Feb 2019 00:00:00 GMT
Authors:Dahl D; Huynh P. Abstract: The health care industry has seen many changes in recent years. Gradually, the traditional volume-based fee-for-service health care system is being replaced by the patient-centered, value-based, pay-for-performance model. In response to this, the American College of Radiology has developed an initiative coined Imaging 3.0: a blueprint to help guide our profession through this transition in health care delivery. Radiologists are an integral part of the health care system, and they greatly affect patient care; however, we have progressively become less visible as a specialty. It is time that we, as radiologists, broaden our role in patient care. As breast radiologists, we are uniquely qualified to usher in this new era of medicine. We have the skill set to provide comprehensive breast care. We are actively involved in early breast cancer detection, pre-imaging patient-care decisions, imaging work-ups, diagnosis, care coordination, treatment, and follow-up. We have set the gold standard for concise structured reporting and follow-up recommendations with the American College of Radiology Breast Imaging Reporting and Data System lexicon, which offers value to our clinician colleagues. Our broad knowledge and role in breast conditions, patient relationships, and other noninterpretive skills offers personalized care and expertise that allows for the best, safest, most cost-effective, and efficient service for the patient and health care industry. Our comprehensive care provides direct interaction and education, decreases radiation exposure, and saves patients time and money. It also benefits the health care industry by improving throughput, reducing waste, and eliminating inefficiencies in the system. As breast radiologists, we are uniquely qualified to usher in this new era of radiology. PubDate: Mon, 25 Feb 2019 00:00:00 GMT
Authors:Mainiero M; Parikh J. Abstract: Burnout is a psychological syndrome created by chronic job stress, and it is typified by emotional exhaustion, depersonalization, and feelings of decreased personal accomplishment. In physicians, burnout occurs at alarming rates, and it is on the rise. High burnout rates are ubiquitous in radiology across multiple subspecialties. We know of no study specifically examining burnout among breast imaging radiologists, but given the rates across multiple specialties in radiology, we must assume that a significant portion of breast imaging radiologists also experience burnout. As breast imaging increases in volume and complexity, we must find new ways of practicing that help achieve a healthy work environment. PubDate: Mon, 25 Feb 2019 00:00:00 GMT
Authors:Golding L; Nicola G. Abstract: Breast imaging radiologists are considered by many to be leaders among diagnostic radiologists in the transition to value-based care. Many strategies for success in the changing healthcare landscape are exemplified by the day-to-day practice of breast imaging, including well-developed quality measures, standardized accepted best practices and terminology, and a prominent role in communicating with patients and coordinating care. Further development of these strategies will be important for continued success in both the Merit-Based Incentive Payment System and in alternative payment models. PubDate: Mon, 25 Feb 2019 00:00:00 GMT
Authors:Loving V. Abstract: The US health care industry is increasingly shifting to a value seeking mindset. The breast imaging value chain elucidates how breast imaging radiologists generate and deliver value to their customers, who include both patients and referring health care providers. The breast imaging value chain can be used by radiologists to improve operational effectiveness and to plan new value creation strategically. The overarching goals are increased customer satisfaction and successful practices. PubDate: Mon, 25 Feb 2019 00:00:00 GMT
Authors:Harvey J. Abstract: Breast imaging is a relatively young subspecialty of radiology. The Society of Breast Imaging was founded in 1985 by several radiologists with a passion for reducing the burden of breast cancer on women and men. At that time, the use of screening mammography was not uniformly embraced in the U.S. Over the following decades, members of the society built upon the science of screening, advocated for support of screening within the U.S. health care system, and educated and engaged the public to partake in screening. In this inaugural issue of the Journal of Breast Imaging, we celebrate our past with an article on the history of screening by Dr. Daniel Kopans. Screening remains an important part of breast imaging, even as the methods of how we screen evolve. Each issue of JBI will have an article on an aspect of screening, such as overdiagnosis, screening women in their 40s, and measures beyond mortality in screening outcomes. PubDate: Mon, 07 Jan 2019 00:00:00 GMT
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