Jiyon Lee

The Relationship of Mammographic Density and Age: Implications for Breast Cancer Screening

OBJECTIVE Breast density is increasingly recognized as an independent risk factor for the development of breast cancer, because it has been shown to be associated with a four- to sixfold increase in a womans risk of malignant breast disease. Increased breast density as identified on mammography is also known to decrease the diagnostic sensitivity of the examination, which is of great concern to women at increased risk for breast cancer. Dense tissue has generally been associated with younger age and premenopausal status, with the assumption that breast density gradually decreases after menopause. However, the actual proportion of older women with dense breasts is unknown. The purpose of this study was to examine the relationship between age and breast density, particularly focusing on postmenopausal women. MATERIALS AND METHODS All screening mammograms completed at the New York University Langone Medical Center in 2008 were retrospectively reviewed. Analysis of variance and descriptive analyses were used to evaluate the relationship between patient age and breast density. RESULTS A total of 7007 screening mammograms were performed. The median age of our cohort was 57 years. Within each subgroup categorized by decade of age, there was a normal distribution among the categories of breast density. There was a significant inverse relationship between age and breast density (p < 0.001). Seventy-four percent of patients between 40 and 49 years old had dense breasts. This percentage decreased to 57% of women in their 50s. However, 44% of women in their 60s and 36% of women in their 70s had dense breasts as characterized on their screening mammograms. CONCLUSION In general, we found an inverse relationship between patient age and mammographic breast density. However, there were outliers at the extremes of age. A meaningful proportion of young women had predominantly fatty breasts and a subset of older women had extremely dense breasts. Increased density renders mammography a less sensitive tool for early detection. Breast density should be considered when evaluating the potential benefit of extended imaging for breast cancer screening, especially for women at increased risk for the disease.

Is breast MRI helpful in the evaluation of inconclusive mammographic findings

OBJECTIVE The purpose of this study was to evaluate the usefulness of MRI of the breast in cases in which mammographic or sonographic findings are inconclusive. MATERIALS AND METHODS We retrospectively reviewed images from 115 MRI examinations of the breast performed from 1999 to 2005 for the indication of problem-solving for inconclusive findings on a mammogram. Forty-eight of the 115 women (41.8%) were at high risk. We discerned whether sonography or MRI was used as an adjunctive tool and correlated the findings with those in the pathology database. RESULTS The equivocal findings most frequently leading to MRI were asymmetry and architectural distortion. No suspicious MRI correlate was found in 100 of 115 cases (87%). These cases were found stable at follow-up mammography or MRI after a mean of 34 months. Fifteen enhancing masses (13%) that corresponded to the mammographic abnormality were seen on MR images. All masses identified at MRI were accurately localized for biopsy, and six malignant lesions were identified. Four of six malignant tumors were seen in one mammographic view only; two were seen on second-look ultrasound images. MRI had a sensitivity of 100% and compared with mammography had significantly higher specificity (91.7% vs 80.7%, p = 0.029), positive predictive value (40% vs 8.7%, p = 0.032), and overall accuracy (92.2% vs 78.3%, p = 0.0052). Eighteen incidental lesions (15.7%) were detected at MRI, and all were subsequently found benign. CONCLUSION We found breast MRI to be a useful adjunctive tool when findings at conventional imaging were equivocal. Strict patient selection criteria should be used because of the high frequency of incidental lesions seen on MR images.

The relationship of breast density in mammography and magnetic resonance imaging in high-risk women and women with breast cancer

PURPOSE To evaluate the relationship between mammographic breast density (MBD), background parenchymal enhancement (BPE), and fibroglandular tissue (FGT) in women with breast cancer (BC) and at high risk for developing BC. METHODS Our institutional database was queried for patients who underwent mammography and MRI. RESULTS Four hundred three (85%) had BC and 72 (15%) were at high risk. MBD (P=.0005), BPE (P<.0001), and FGT (P=.02) were all higher in high-risk women compared to the BC group. CONCLUSIONS Higher levels of MBD, BPE and FGT are seen in women at higher risk for developing BC when compared to women with BC.

Mentorship in Radiology

Mentoring is an extremely important component of academic medicine, including radiology, yet it is not specifically emphasized in radiology training, and many academic radiology departments in the United States, Canada, and elsewhere do not have formal mentoring programs for medical students, residents, fellows, or junior faculty. The purpose of this article is to overview the current status of mentorship in radiology, to discuss the importance of mentorship at multiple levels and its potential benefits in particular, as well as how to conduct a successful mentor-mentee relationship. The literature on mentorship in radiology and in academic medicine in general is reviewed.

Practical and illustrated summary of updated BI-RADS for ultrasonography

The American College of Radiology released the fifth edition of the Breast Imaging-Reporting and Data System (BI-RADS) in 2014 (copyright 2013), which includes the expanded second edition of the ultrasound BI-RADS lexicon. This review provides a practical summary of the updated lexicon, including selective illustrations with original clinical images, a discussion of overarching concepts, and examples of current clinical applications.