Mona El-Khoury

Breast imaging reporting and data system lexicon for US: interobserver agreement for assessment of breast masses.

PURPOSE To retrospectively evaluate the interobserver agreement of radiologists who used the Breast Imaging Reporting and Data System (BI-RADS) lexicon to characterize and categorize ultrasonographic (US) features of breast masses. MATERIALS AND METHODS No institutional review board approval or patient consent was required. Five breast radiologists retrospectively independently evaluated 267 breast masses (113 benign and 154 malignant masses in 267 patients) by using the BI-RADS US lexicon. Reviewers were blinded to mammographic images, medical history, and pathologic findings. Interobserver agreement was assessed with the Aickin revised kappa statistic. RESULTS Interobserver agreement varied from fair for evaluation of mass margins (kappa = 0.36) to moderate for evaluation of lesion boundary (kappa = 0.48), echo pattern (kappa = 0.58), and posterior acoustic features (kappa = 0.47) to substantial for evaluation of mass orientation (kappa = 0.70) and shape (kappa = 0.64). For small (< or =0.7 cm; n = 49) or malignant (n = 154) masses, low concordance was noted for margin descriptors (kappa = 0.30 and 0.28, respectively) and BI-RADS category (kappa = 0.21 and 0.26, respectively). Overall, only fair agreement was obtained for BI-RADS category (kappa = 0.30). Agreement for subdivisions 4a, 4b, and 4c of BI-RADS category 4 was fair (kappa = 0.33), fair (kappa = 0.32), and poor (kappa = 0.17), respectively. CONCLUSION Reproducibility of US BI-RADS terminology is good except for margin evaluation. A trend toward lower concordance was noted for the evaluation of small masses and malignant lesions. Classification into subdivisions 4a, 4b, and 4c was poorly reproducible.

Tissue Harmonic Imaging, Frequency Compound Imaging, and Conventional Imaging Use and Benefit in Breast Sonography

The purpose of this study was to evaluate different sonographic settings (tissue harmonic, frequency compounding, and conventional imaging) and to determine which setting optimizes breast lesion detection and lesion characterization.

Sonography of Postexcision Specimens of Nonpalpable Breast Lesions: Value, Limitations, and Description of a Method

OBJECTIVE The objective of our study was to retrospectively review our experience regarding the value of sonography in identifying a nonpalpable mass within a surgically excised specimen and in assessing the surgical margins in cases of malignancy. MATERIALS AND METHODS One hundred four lumpectomies were performed in 99 consecutive patients with 131 nonpalpable breast lesions after sonographically guided needle localization. All 104 surgical specimens were scanned on sonography, and 86 specimen radiographs were obtained. Visualization of the lesion on sonography was compared with specimen radiographs and histologic findings. Sonographic margin status was classified as negative (shortest distance between tumor and specimen margin, > 0.2 cm) or positive (shortest distance between tumor and specimen margin, 0.2 cm) and was compared with pathology results. RESULTS Specimen sonography showed 95.4% (125/131) of the excised abnormalities; nonfatty background and a lesion size of greater than 0.5 cm contributed significantly to the success of specimen sonography. Four of six lesions missed on sonography were identified on specimen radiography. Among 81 malignant specimens, sonography identified 38 specimens with positive margins and 43 with negative margins. Pathologic examination revealed eight false-positive and 10 false-negative results (21% false-positive rate and 23.2% false-negative rate). CONCLUSION Specimen sonography is an effective procedure for identifying the presence of the lesion within the specimen; however, it is of limited value in cases of small hypoechoic lesions against a fatty background. Assessment of margins is limited by both false-positive and false-negative results.

Surgical Outcome of Biopsy-Proven Lobular Neoplasia: Is There Any Difference Between Lobular Carcinoma In Situ and Atypical Lobular Hyperplasia?

OBJECTIVE The aims of our study were to determine the frequency of malignancy after surgical excision of biopsy-proven lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH) lesions, to assess any difference between pure LCIS and pure ALH lesions regarding their radiologic presentation and the malignancy upgrade rate after surgical excision, and to evaluate the outcome of lesions that were not excised surgically but were followed up. MATERIALS AND METHODS Radiologic and pathologic records of 14,435 imaging-guided needle biopsies of the breast performed between 2004 and 2008 in three different institutions were retrospectively reviewed. A total of 126 patients (0.9%) had biopsy-proven LCIS or ALH, or both, as the highest-risk lesion. Among the 126 patients, 89 (71%) continued to surgery, and 14 were followed up for more than 24 months. The Mantel-Haensel chi-square test was used for statistical analysis. RESULTS Cancer upgrade was documented in 17 of the 43 LCIS (40%), 11 of the 40 ALH (27%), and two of the six combined ALH and LCIS lesions (33%) surgically excised, for a total malignancy upgrade rate of 34% (30/89). Both LCIS and ALH lesions presented mammographically in most cases as microcalcifications (p = 0.078). None of the 14 patients followed up for a mean period of 51 months showed development of malignancy. CONCLUSION No statistically significant difference was found between mammographic presentation and postsurgical outcome of LCIS versus ALH lesions. Surgical excision of these lesions is recommended as long as no evident criteria are provided to differentiate those that might be associated with an underlying malignancy.

Sonographic Appearance of Invasive Ductal Carcinoma of the Breast According to Histologic Grade

OBJECTIVE The purpose of this study was to compare the efficacy of the sonographic features in the BI-RADS lexicon for predicting malignancy grade of invasive ductal breast carcinoma in women assigned a BI-RADS category of 4 or 5. MATERIALS AND METHODS Two radiologists retrospectively evaluated 299 consecutive cases of grades 1-3 invasive ductal breast carcinoma presenting as a mass in consensus by using the BI-RADS sonographic lexicon. Histologic grade was established on surgical specimens. Effect sizes were calculated via the Goodman and Kruskal tau, an asymmetric measure of strength of nominal association, and results were interpreted in terms of proportional reduction in error. RESULTS Thirty-eight lesions (13%) were grade 1, 153 (51%) were grade 2, and 108 (36%) were grade 3, with the majority of all masses showing an irregular shape (84%) and hypoechoic echotexture (82%). Of the sonographic features examined, malignancy grade was best predicted by posterior acoustics (τ = 0.13, p < 0.001), lesion boundary (τ = 0.05, p < 0.001), and margin (τ = 0.04, p = 0.001). Among grade 3 lesions, there were significantly more lesions with posterior enhancement (53 vs 27.6; adjusted standardized residuals (z(res)) = 7; p < 0.001), abrupt interfaces (68 vs 51.2; z(res) = 4; p < 0.001), and microlobulated margins (12 vs 5.8; z(res) = 3; p = 0.001) than would be expected. CONCLUSION Malignancy grade was slightly to moderately predicted by margin, lesion boundary, and acoustic sonographic features. In particular, grade 3 invasive ductal breast carcinomas were more likely than expected to display microlobulated margins, abrupt interfaces, and posterior enhancement.

Sonographic Features of Breast Carcinoma Presenting as Masses in BRCA Gene Mutation Carriers

The purpose of this study was to review the sonographic features of breast cancer gene BRCA1‐ and BRCA2‐associated breast carcinomas in comparison with “sporadic” breast carcinomas and benign breast masses.

Accuracy of percutaneous core needle biopsy in diagnosing papillary breast lesions and potential impact of sonographic features on their management

To assess retrospectively the accuracy of core needle biopsy in diagnosing papillary breast lesions and evaluate the prediction of malignant papillary lesions based on sonographic features.

Effects of antiperspirant aluminum percent composition and mode of application on mock microcalcifications in mammography.

OBJECTIVE Active ingredients in antiperspirants - namely, aluminum-based complexes - can produce radiopaque particles on mammography, mimicking microcalcifications. The present study was designed to investigate whether the appearance of antiperspirant induced radiopaque particles observed on mammograms is dependent on the percentage of aluminum-based complexes in antiperspirants and/or on their mode of application. METHODS A total of 43 antiperspirants with aluminum-based complex percentages ranging between 16% and 25% were tested. Each antiperspirant was applied to a single use plastic shield and then placed on an ultrasound gel pad, simulating breast tissue. Two experiments were performed, comparing antiperspirants based on (1) their percentage of aluminum-based complexes (20 antiperspirants) and (2) their mode of applications (solid, gel, and roll-on) (26 antiperspirants). Two experienced, blinded radiologists read images produced in consensus and assessed the appearance of radiopaque particles based on their density and shape. RESULTS In experiment 1, there was no statistically significant association between the percent aluminum composition of invisible solid antiperspirants and the density or shape of the radiopaque particles (p-values>0.05). In experiment 2, there was a statistically significant association between the shape of the radiopaque particles and the mode of application of the antiperspirant (p-value=0.0015). CONCLUSIONS Our study suggests that the mammographic appearance of the radiopaque antiperspirant particles is not related to their percent composition of aluminum complexes. However, their mode of application appears to influence the shape of radiopaque particles, solid antiperspirants mimicking microcalcifications the most and roll-on antiperspirants the least.