Lawrence W. Bassett

Revision of the American Joint Committee on cancer staging system for breast cancer

PURPOSE To revise the American Joint Committee on Cancer staging system for breast carcinoma. MATERIALS AND METHODS A Breast Task Force submitted recommended changes and additions to the existing staging system that were (1) evidence-based and/or consistent with widespread clinical consensus about appropriate diagnostic and treatment standards and (2) useful for the uniform accrual of outcome information in national databases. RESULTS Major changes included the following: size-based discrimination between micrometastases and isolated tumor cells; identifiers to indicate usage of innovative technical approaches; classification of lymph node status by number of involved axillary lymph nodes; and new classifications for metastasis to the infraclavicular, internal mammary, and supraclavicular lymph nodes. CONCLUSION This revised staging system will be officially adopted for use in tumor registries in January 2003.

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.

Diagnostic Accuracy of Digital versus Film Mammography: Exploratory Analysis of Selected Population Subgroups in DMIST

PURPOSE To retrospectively compare the accuracy of digital versus film mammography in population subgroups of the Digital Mammographic Imaging Screening Trial (DMIST) defined by combinations of age, menopausal status, and breast density, by using either biopsy results or follow-up information as the reference standard. MATERIALS AND METHODS DMIST included women who underwent both digital and film screening mammography. Institutional review board approval at all participating sites and informed consent from all participating women in compliance with HIPAA was obtained for DMIST and this retrospective analysis. Areas under the receiver operating characteristic curve (AUCs) for each modality were compared within each subgroup evaluated (age < 50 vs 50-64 vs >or= 65 years, dense vs nondense breasts at mammography, and pre- or perimenopausal vs postmenopausal status for the two younger age cohorts [10 new subgroups in toto]) while controlling for multiple comparisons (P < .002 indicated a significant difference). All DMIST cancers were evaluated with respect to mammographic detection method (digital vs film vs both vs neither), mammographic lesion type (mass, calcifications, or other), digital machine type, mammographic and pathologic size and diagnosis, existence of prior mammographic study at time of interpretation, months since prior mammographic study, and compressed breast thickness. RESULTS Thirty-three centers enrolled 49 528 women. Breast cancer status was determined for 42,760 women, the group included in this study. Pre- or perimenopausal women younger than 50 years who had dense breasts at film mammography comprised the only subgroup for which digital mammography was significantly better than film (AUCs, 0.79 vs 0.54; P = .0015). Breast Imaging Reporting and Data System-based sensitivity in this subgroup was 0.59 for digital and 0.27 for film mammography. AUCs were not significantly different in any of the other subgroups. For women aged 65 years or older with fatty breasts, the AUC showed a nonsignificant tendency toward film being better than digital mammography (AUCs, 0.88 vs 0.70; P = .0025). CONCLUSION Digital mammography performed significantly better than film for pre- and perimenopausal women younger than 50 years with dense breasts, but film tended nonsignificantly to perform better for women aged 65 years or older with fatty breasts.

In vivo diffusion-weighted MRI of the breast: Potential for lesion characterization

To investigate the potential of apparent diffusion coefficients (ADCs) in characterizing breast lesions in vivo.

Standard for breast conservation therapy in the management of invasive breast carcinoma.

Multidisciplinary guidelines for management of invasive breast carcinoma from the American College of Radiology, the American College of Surgeons, the College of American Pathology, and the Society of Surgical Oncology have been updated to reflect the continuing advances in the diagnosis and treatment of invasive breast cancer. The guidelines provide a framework for clinical decision‐making for patients with invasive breast carcinoma based on review of relevant literature and include information on patient selection and evaluation, technical aspects of surgical treatment, techniques of irradiation, and follow‐up care.

The ACR BI-RADS® Experience: Learning From History

The Breast Imaging Reporting and Data System (BI-RADS) initiative, instituted by the ACR, was begun in the late 1980s to address a lack of standardization and uniformity in mammography practice reporting. An important component of the BI-RADS initiative is the lexicon, a dictionary of descriptors of specific imaging features. The BI-RADS lexicon has always been data driven, using descriptors that previously had been shown in the literature to be predictive of benign and malignant disease. Once established, the BI-RADS lexicon provided new opportunities for quality assurance, communication, research, and improved patient care. The history of this lexicon illustrates a series of challenges and instructive successes that provide a valuable guide for other groups that aspire to develop similar lexicons in the future.

Stereotactic core-needle biopsy of the breast: A report of the Joint Task Force of the American College of Radiology, American College of Surgeons, and College of American Pathologists

A national task force consisting of members from the American College of Radiology, the American College of Surgeons, and the College of American Pathologists examined the issues surrounding stereotactic core-needle biopsy for occult breast lesions. Their report includes indications and contraindications, informed consent, specimen handling, and management of indeterminate, atypical, or discordant lesions.

Standard for the management of ductal carcinoma in situ of the breast (DCIS)

The multidisciplinary guidelines for management of ductal carcinoma in situ of the breast from the American College of Radiology, the American College of Surgeons, the College of American Pathology, and the Society of Surgical Oncology have been updated to take into account continuing advances in the diagnosis and treatment of this disease. The continued growth in mammographic evaluation and technology has resulted in an increase in the diagnosis of ductal carcinoma in situ of the breast (DCIS). The resulting guidelines provide a framework for clinical decision‐making for patients with DCIS based on review of relevant literature, and includes information on patient selection and evaluation, technical aspects of surgical treatment, techniques of irradiation, and follow‐up care.

Magnetic resonance imaging of the posterior cruciate ligament Clinical use to improve diagnostic accuracy

This study was undertaken to determine the accuracy of magnetic resonance image scanning in detecting posterior cruciate ligament injury, and to determine those clinical situations where it can add the most useful information. A retrospective study was conducted on 201 patients who underwent surgery after magnetic resonance scanning of their knees. Two additional pa tients who did not have surgery but had clinical findings grossly positive for posterior cruciate ligament injury were included in the analysis of magnetic resonance imaging accuracy. In all, there were 190 intact and 13 torn posterior cruciate ligaments. In a review of the clinical findings in the 11 patients with surgically docu mented tears, we found that all 11 had positive mag netic resonance scans. In 4 of the 11, magnetic reso nance imaging provided especially useful information regarding the status of the ligament. For the 190 normal ligaments, there were no false-positive scans; for the 13 torn ligaments, there were no false-negative scans. Therefore, specificity and sensitivity estimates for this group were both 100%. Magnetic resonance imaging proved to be an accu rate modality for evaluating the integrity of the posterior cruciate ligament. If used in the proper setting, it can provide useful information for diagnosing posterior cru ciate ligament injuries.

National trends and practices in breast MRI.

OBJECTIVE The objective of our study was to report on the current practices of radiologists involved in the performance and interpretation of breast MRI in the United States. MATERIALS AND METHODS We invited the 1,696 active physician members of the Society of Breast Imaging to participate in a survey addressing whether and how they performed and interpreted breast MRI. Respondents were asked to select one member of their practice to complete the survey. A total of 754 surveys were completed. Every respondent did not reply to every question. RESULTS Contrast-enhanced breast MRI was offered at 557 of 754 (73.8%) practices. Of these, 346 of 553 (62.6%) performed at least five breast MRI examinations per week, and only 56 of 553 (10.1%) performed > 20 per week. Radiologists qualified under the Mammography Quality Standards Act supervised the performance of and interpreted breast MRI in the majority of facilities. Of 552 respondents, breast MRI was interpreted as soft copy with computer-aided detection (CAD) in 280 practices (50.7%), as soft copy without CAD in 261 (47.3%), and as hard copy in 11 (2.0%). Of 551 respondents, 256 (46.5%) never and 207 (37.6%) rarely interpreted breast MRI without correlating mammography or sonography findings. The majority of respondents never (269/561, 48.0%) or rarely (165/561, 29.4%) interpreted breast MRI performed at an outside facility. Screening breast MRI was offered at 359 of 561 (64.0%) practices. Of the practices performing contrast-enhanced examinations, 173 of 557 (31.1%) did not perform MRI-guided interventional procedures. CONCLUSION Contrast-enhanced breast MRI is now widely used in the United States. The information gained from this survey should provide reasonable approaches for the development of professional practice guidelines.