Barbara Monsees

Breast Cancer Screening With Imaging: Recommendations From the Society of Breast Imaging and the ACR on the Use of Mammography, Breast MRI, Breast Ultrasound, and Other Technologies for the Detection of Clinically Occult Breast Cancer

Screening for breast cancer with mammography has been shown to decrease mortality from breast cancer, and mammography is the mainstay of screening for clinically occult disease. Mammography, however, has well-recognized limitations, and recently, other imaging including ultrasound and magnetic resonance imaging have been used as adjunctive screening tools, mainly for women who may be at increased risk for the development of breast cancer. The Society of Breast Imaging and the Breast Imaging Commission of the ACR are issuing these recommendations to provide guidance to patients and clinicians on the use of imaging to screen for breast cancer. Wherever possible, the recommendations are based on available evidence. Where evidence is lacking, the recommendations are based on consensus opinions of the fellows and executive committee of the Society of Breast Imaging and the members of the Breast Imaging Commission of the ACR.

Mammographically detected breast cancer. Benefits of stereotactic core versus wire localization biopsy.

OBJECTIVE The authors evaluated the differences between stereotactic core needle biopsy (SCNBx) and needle localization surgical biopsy (NLBx) in cost and treatment course for patients with mammographically detected breast cancer. SUMMARY BACKGROUND DATA Stereotactic core needle breast biopsy is a reproducible and reliable alternative to surgical biopsy for histologic diagnosis of mammographic lesions. METHODS Records from 52 consecutive patients with invasive breast cancer diagnosed by SCNBx (n = 21) or NLBx (n = 31) over 2 years were reviewed. Episode-of-care costs were extracted from the Barnes Hospital billing system database. RESULTS At the time of excision, surgical margins were statistically more frequently positive in patients treated with NLBx (55%) than patients treated with SCNBx (0%, p < 0.0001). Furthermore, patients in the NLBx group undergoing breast conservation surgery required re-excision more frequently (74%) than those in the SCNBx group (0%, p = 0.001). There were no complications in either group after the diagnostic procedure. All SCNBx results were correct in the diagnosis of invasive breast cancer. The median cost of SCNBx was approximately

Professional and economic factors affecting access to mammography: a crisis today, or tomorrow? Results from a national survey.

1000 less than the median cost of NLBx. This cost difference was carried through the definitive procedure, whether it was breast conservation or mastectomy. CONCLUSIONS This study shows the advantage of SCNBx to diagnose breast cancer and definitive operative care at a single procedure. The preoperative diagnosis of breast cancer eliminated positive operative margins and procedures to re-excise breast tissue. The use of SCNBx also saved approximately

THE MAMMOGRAPHY QUALITY STANDARDS ACT: An Overview of the Regulations and Guidance

1000 per patient compared with the use of NLBx. Our data suggest that SCNBx is the diagnostic procedure of choice for mammographically detected cancers.

Scientific Presentation Award: The combination of axillary ultrasound and ultrasound-guided biopsy is an accurate predictor of axillary stage in clinically node-negative breast cancer patients

Objective data and anecdotal reports have suggested that access to mammography may be declining because of facility closures and difficulty in recruiting and retaining radiologists and radiologic technologists. To gain insight into the practice patterns, use of emerging technologies, and concerns of breast imagers in current practice, the Society of Breast Imaging (SBI) conducted a national survey of breast imaging practices in the U.S.

Learn, Share, and Live: Breast Cancer Education for Older, Urban Minority Women

The MQSA has imposed a set of federal regulations on every facility and radiologist that performs or interprets mammograms. Because annual inspections and paperwork are somewhat burdensome, many hope that in the future the process of FDA inspections might be streamlined for facilities with good track records and few, if any, findings at inspection. This would serve to reduce facility inconvenience and the costs of regulatory compliance without compromising patient care and outcomes. Currently, however, although not all personnel are required to be familiar with the regulations, key individuals should be conversant with the rules, FDA guidance, and methods that the facility has devised to comply with the regulations.

Pathologic Outcomes of Nonmalignant Papillary Breast Lesions Diagnosed at Imaging-guided Core Needle Biopsy

BACKGROUND The study aim was to determine the accuracy of axillary ultrasound (AUS) and fine-needle aspiration biopsy (FNAB)/needle core biopsy in axillary breast cancer staging. METHODS We reviewed 256 patients with clinically node-negative breast cancer who underwent AUS +/- FNAB/needle core biopsy. AUS-guided FNAB/needle core biopsy was compared with histopathology to determine sensitivity, specificity, negative predictive value, and positive predictive value. RESULTS AUS-guided FNAB/needle core biopsy and final pathology were positive in 72 of 256 patients (28%). In 125 of 256 cases (49%), the AUS and final pathology were negative. Two of 110 patients had a false-positive FNAB (1.8%); both received neoadjuvant chemotherapy. Nine patients (8%) had a false-negative FNAB/needle core biopsy; the median size of lymph node metastasis was 3 mm. The sensitivity and specificity of AUS-guided FNAB/needle core biopsy was 71% and 99%, respectively, with a negative predictive value of 84% and a positive predictive value of 97%. CONCLUSIONS AUS-guided FNAB/needle core biopsy is accurate in predicting the status of the axilla in 70% of clinically node-negative breast cancer patients. This technique is minimally invasive with a low complication rate and can obviate the need for staged lymph node procedures.

Effect of Transition to Digital Mammography on Clinical Outcomes

Among older urban minority women, for whom breast cancer risk is high and the propensity to be screened is low, both social support and breast cancer knowledge have been linked to mammography use. The authors describe a theory-based breast cancer education program implemented via an existing informal network for low-income urban elderly coordinated by a social service agency. The program is both structured and flexible. Core education sessions include delineated content and methods and are led by health professionals. Participants choose from a variety of follow-up activities to promote screening within their community. Pre and posttests administered among 80 program attendees in two sites indicate significant improvement in knowledge (p < .001). Program attendees in each site also planned and participated in follow-up activities to promote screening among their peers. Learn, Share, and Live seems to be an effective program for promoting breast cancer screening among older, urban, primarily minority women.

The impact of breast MRI on surgical decision-making: Are patients at risk for mastectomy?

PURPOSE To determine the upstage rate from nonmalignant papillary breast lesions obtained at imaging-guided core needle biopsy (CNB) and if there are any clinical, imaging, or pathologic features that can be used to predict eventual upstaging to malignancy. MATERIALS AND METHODS This retrospective case review was institutional review board approved and HIPAA compliant, with a waiver of informed consent. A database search (from January 2001 to March 2010) was performed to find patients with a nonmalignant papillary breast lesion diagnosed at CNB. Of the resulting 128 patients, 86 (67%) underwent surgical excision; 42 (33%) patients were observed with imaging, for a median observation time of 4.1 years (range, 1.0-8.6 years). Chart review was performed to determine pertinent features of each case. RESULTS Fourteen of 128 patients were subsequently found to have malignancy at excision, for an upstage rate of 11%. Nine (7%) of the 128 patients were subsequently found to have atypia at excision. Comparisons between patients with upstaged lesions and patients whose lesions were not upstaged demonstrated patients with upstaged lesions to be slightly older (65 vs 56 years, P=.01), more likely to have a mass than calcifications at imaging (P=.03), and to have had less tissue obtained at biopsy (three vs five cores obtained, P=.02; 14- vs 9-gauge needle used, P<.01; no vacuum assistance used, P<.01). Most strongly predictive of eventual malignancy, however, was whether the interpreting pathologist qualified the benign diagnosis at CNB with additional commentary (P<.01). CONCLUSION Given the substantial upstage rate (11%) of papillary lesions diagnosed at imaging-guided CNB, surgical excision is an appropriate management decision; however, careful evaluation in concert with an expert breast pathologist may allow for observation in appropriately selected patients.

Calcaneal and pelvic fractures: Diagnostic evaluation by three-dimensional computed tomography scans

PURPOSE To determine the effect of transition to digital screening mammography on clinical outcome measures, including recall rate, cancer detection rate, and positive predictive value (PPV). MATERIALS AND METHODS Institutional review board approval and the need for informed consent were waived for this HIPAA-complaint study. Practice audit data were obtained for three breast imaging radiologists from 2004 to 2009. These data were sorted by time period into the following groups: baseline (2004-2005), digital year 1 (2007), digital year 2 (2008), and digital year 3 (2009). The χ(2) and Fisher exact tests were used to assess differences in proportions among and between years. Clinical outcomes based on lesion type from 2004 to 2008 were also compared. Computer-aided detection was used. RESULTS The three radiologists interpreted 32 600 screen-film mammograms and 33 879 digital mammograms. Recall rates increased from 6.0% at baseline to 7.1% in digital year 1 (P < .0001) and continued to increase in subsequent years to 8.5%. The cancer detection rate increased from 3.3 at baseline to 5.3 in digital year 1 (P = .0061), and it remained higher than that at baseline in subsequent years. PPV after screening mammogaphy (PPV(1)) increased from 5.6% at baseline to 7.5% in digital year 1 and returned to baseline levels in digital year 3. In contrast, PPV after biopsy (PPV(3)) decreased from 44.5% at baseline to 30.3% in digital year 3 (P = .0021). From 2004 to 2008, 3444 patients with 3493 lesions were recalled. The percentage of recalls for calcifications increased from 13.8% at baseline to a peak of 23.9% in digital year 1 and 17.9% in digital year 2. Both PPV(1) and PPV(3) decreased for calcifications after the digital transition. CONCLUSION Recall rate and cancer detection rate increase for at least 2 years after the transition to digital screening mammography. PPV(3) is significantly reduced after digital transition, primarily in patients with microcalcifications.