Jessica H. Hayward

Magnetic resonance enterography and wireless capsule endoscopy in the evaluation of patients with inflammatory bowel disease.

BACKGROUND Magnetic resonance enterography (MRE) is increasingly used in children due to growing concerns of radiation. OBJECTIVE To determine the performance of MRE, imaging findings were compared to wireless capsule endoscopy (WCE) and histology results in children with/or suspected inflammatory bowel disease (IBD). MATERIALS AND METHODS Pathology and WCE reports were retrospectively reviewed in 23 patients who had MRE. RESULTS The sensitivity of MRE was 75.0% while the sensitivity of WCE was 77.8%. CONCLUSION MRE and WCE are complementary techniques in evaluation of the small bowel in IBD.

Improving Screening Mammography Outcomes Through Comparison With Multiple Prior Mammograms

OBJECTIVE The objective of the present study is to evaluate the effect of comparison with multiple prior mammograms on the outcomes of screening mammography relative to comparison with a single prior mammogram. MATERIALS AND METHODS We retrospectively analyzed 46,288 consecutive screening mammograms performed at our institution for 22,792 women. We divided these examinations into three groups: those interpreted without comparison with prior mammograms, those interpreted in comparison with one prior examination, and those interpreted in comparison with two or more prior examinations. For each group, we determined the rate of examination recall. We also calculated the positive predictive value of recall (i.e., positive predictive value level 1 [PPV1]) and the cancer detection rate (CDR) for both the group of examinations compared with a single prior mammogram and the group compared with multiple prior mammograms. Generalized estimating equations with the logistic link function were used to determine the relative odds ratio of recall as a function of the number of comparisons, with adjustment made for age as a confounding variable. The Fisher exact test was performed to compare the PPV1 and the CDR in the different cohorts. RESULTS The recall rate for mammograms interpreted without comparison with prior examinations was 16.6%, whereas that for mammograms compared with one prior examination was 7.8% and that for mammograms compared with two or more prior examinations was 6.3%. After adjustment was made for age, the odds ratio of recall for the group with multiple prior examinations relative to the group with a single prior examination was 0.864 (95% CI, 0.776-0.962; p = 0.0074). Statistically significant increases in the PPV1 of 0.05 (p = 0.0009) and in the CDR of 2.3 cases per 1000 examinations (p = 0.0481) were also noted for mammograms compared with multiple prior examinations relative to those compared with a single prior examination. CONCLUSION Comparison with two or more prior mammograms resulted in a statistically significant reduction in the screening mammography recall rate and increases in the CDR and PPV1 relative to comparison with a single prior mammogram.

Follow-up outcomes after benign concordant MRI-guided breast biopsy

OBJECTIVE To evaluate outcomes of benign concordant magnetic resonance imaging (MRI)-guided breast biopsy. METHODS We retrospectively reviewed 611 consecutive MRI-guided breast core biopsies at our institution from 2005 to 2012. Benign concordant cases with MRI follow-up constituted the study group. Lesion appearance on follow-up MRI was assessed and the false-negative rate was calculated. RESULTS Eighty-four lesions in 68 women underwent benign concordant MRI-guided biopsy with subsequent MRI follow-up. Mean time to first follow-up MRI was 10.5 months. Two false negatives were identified on follow-up at 8 and 26 months. CONCLUSIONS We report a false-negative rate of MRI-guided breast biopsy of 2.4%.

Microcalcifications Detected at Screening Mammography: Synthetic Mammography and Digital Breast Tomosynthesis versus Digital Mammography

Purpose To compare the performance of two-dimensional synthetic mammography (SM) plus digital breast tomosynthesis (DBT) versus conventional full-field digital mammography (FFDM) in the detection of microcalcifications on screening mammograms. Materials and Methods In this retrospective multireader observer study, 72 consecutive screening mammograms recalled for microcalcifications from June 2015 through August 2016 were evaluated with both FFDM and DBT. The data set included 54 mammograms with benign microcalcifications and 18 mammograms with malignant microcalcifications, and 20 additional screening mammograms without microcalcifications used as controls. FFDM alone was compared to synthetic mammography plus DBT. Four readers independently reviewed each data set and microcalcification recalls were tabulated. Sensitivity and specificity for microcalcification detection were calculated for SM plus DBT and for FFDM alone. Interreader agreement was calculated with Fleiss kappa values. Results Reader agreement was kappa value of 0.66 (P < .001) for FFDM and 0.63 (P < .001) for SM plus DBT. For FFDM, the combined reader sensitivity for all microcalcifications was 80% (229 of 288; 95% confidence interval [CI]: 74%, 84%) and for malignant microcalcifications was 92% (66 of 72; 95% CI: 83%, 97%). For SM plus DBT, the combined reader sensitivity for all microcalcifications was 75% (215 of 288; 95% CI: 69%, 80%) and for malignant microcalcifications was 94% (68 of 72; 95% CI: 86%, 98%). For FFDM, the combined reader specificity for all microcalcifications was 98% (78 of 80; 95% CI: 91%, 100%) and for malignant microcalcifications was 98% (78 of 80; 95% CI: 91%, 100%). For SM plus DBT, combined reader specificity for all microcalcifications was 95% (76 of 80; 95% CI: 88%, 99%) and for malignant microcalcifications was 95% (76 of 80; 95% CI: 88%, 99%). Mixed-effects model concluded no differences between modalities (-0.03; 95% CI: -0.08, 0.01; P = .13). Conclusion Relative to full-field digital mammography, synthetic mammography plus digital breast tomosynthesis had similar sensitivity and specificity for the detection of microcalcifications previously identified for recall at screening mammography.

Role of MR Imaging for the Locoregional Staging of Breast Cancer

Breast MR imaging has been shown to identify unsuspected sites of cancer in the ipsilateral breast in 16% of women with newly diagnosed breast cancer. Breast MR imaging identifies occult cancer in the contralateral breast in 3% to 5% of women. Early evidence suggests that the added value of MR imaging for staging may be attenuated in women who also undergo tomosynthesis, particularly those with nondense breasts. Breast MR imaging is complementary to ultrasound imaging in evaluating regional nodal basins. Ongoing prospective randomized clinical trials should clarify the impact of preoperative breast MR imaging on clinical outcomes.

Tuberculosis mastitis presenting as bilateral breast masses

Tuberculosis mastitis can be a challenging diagnosis, often presenting with clinical and imaging findings that are suspicious for malignancy. We present a case of a 49-year-old female with a breast mass initially diagnosed as idiopathic granulomatous mastitis. Failure to respond to standard treatments, development of new breast masses, and discovery of a concurrent ulcerating thigh rash with similar histologic findings as the breast masses prompted further investigation, which ultimately lead to the diagnosis of tuberculosis mastitis. There was rapid resolution of both breast and skin symptoms after initiation of empiric drug therapy.

Paraneoplastic neurologic syndrome as a presentation of underlying breast malignancy

While breast cancer most commonly presents as a screen‐detected mammographic finding or a breast symptom, in very rare instances it may first present as a paraneoplastic neurologic syndrome (PNS; Surg Case Rep, 2015;1:59; Ann Neurol 2004;56:715). Fewer than 1% of breast cancer patients have PNS, and an even smaller percentage initially present with neurologic symptoms (J Neurol Neurosurg Psychiatry, 2004;75:ii43). We report a case series of three patients who presented with neurological disorders suspicious for PNS, and were subsequently found to have underlying breast cancer. We follow this with a discussion of key clinical features of management considerations in paraneoplastic syndromes secondary to breast malignancy.

Enhancing Your Acoustics: Ultrasound Image Optimization of Breast Lesions

A general understanding of ultrasound physics relative to image optimization is essential when performing breast ultrasound examinations and in accurately interpreting images of the breast. Appropriate technique is crucial to achieve accurate lesion characterization and is emphasized in the second edition of the American College of Radiology Breast Imaging Reporting and Data System for ultrasound (2013). This pictorial essay reviews clinically relevant ultrasound physics to best characterize breast lesions for guiding the clinician to the proper diagnosis. Differences in chosen parameters on ultrasound imaging can create variability in the appearance of breast lesions.