A recent study was conducted to evaluate the diagnostic characteristics of sonographic surveillance for detection of metachronous contralateral breast cancer in patients with a history of breast cancer surgery, in order to determine whether sonography in addition to mammography might be justified in terms of time and cost.

The results, published in the American Journal of Roentgenology indicate that while annual screening sonography in addition to mammograhy may be useful for the discovery of metachronous contralateral cancers, the time and cost involved may not be justified.

The Study
Over a 1-year retrospective period, patients who had undergone surgery for biopsy-proven breast malignancy were identified.

Those who had sonographic evaluation in addition to mammographic evaluation were included in the study. Patients had undergone bilateral whole breast sonography in addition to mammography every 6 months for the first 2 years and then annually thereafter. Exclusion criteria included a history of bilateral breast cancer surgery.

Methodology
1256 Asian women (mean age, 50 years) were included in the study. Over the follow-up period, the contralateral breast was classified as a BI-RADS 1 or 2 93.6% of the time. A BI-RADS 3 category was assigned to 3.8%, category 4 to 2.3%, and category 5 to 0.3%.

One radiologist reviewed the reports of the imaging studies and documented the BI-RADS category. The images were not reread.

Those classified as BI-RADS 1 or 2 were considered negative. BI-RADS categorization of 3, 4, or 5 were only included if they were referring to the breast contralateral to the surgical breast.

In other words, the originally reported BI-RADS was re-categorized to assess only the contralateral breast. The final diagnosis of each patient was determined based on tissue diagnosis at a follow-up time of ≥1 year.
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Results
Overall, 46 biopsies were performed. When tissue diagnosis was compared with BI-RADS category, the positive-predictive value (PPV) was 41.0%.

One cancer was missed, resulting in a false-negative rate of 0.06%.Of patients who continued sonographic adjuvant surveillance for >2 years, a 0.4% false-negative rate was revealed.

Two cases of biopsy-proven contralateral metachronous breast cancer were found on sonography and not detected on mammography.

Annual screening sonography may be useful for the discovery of metachronous contralateral cancers.

Reviewer’s Comments
The authors do not comment extensively on the finding that only 2 cancers discovered on sonography were also mammographically occult. For the remaining cases of metachronous cancer, the mammogram was judged to be positive as well.

Although a significant tool for those 2 cases, does it truly justify the time and cost of performing sonographic surveillance in addition to mammographic surveillance in a patient with otherwise no complaints?

On the other hand, those with a history of breast cancer, or any symptoms, might certainly consider having both sonography and mammography to rule out any chance of a false negative.

Author: Basil Hubbi, MD
Reference:
Kim MJ, Kim E-K, et al. Sonographic Surveillance for the Detection of Contralateral Metachronous Breast Cancer in an Asian Population. AJR; 2009; 192 (January): 221-228.

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A recent study was conducted to assess the mammographic appearance of breast cancer exhibiting a basal phenotype, and to determine whether these features facilitate earlier detection of these tumors, which tend to have a poor prognosis.

Methodology
Over a 12-year period, invasive breast cancers that were recorded in women <=70 years of age were identified.

Those cancers identified on pathology to be of the basal phenotype were noted.

Of those, mammographic features were recorded, including qualification of a mass as well-defined, ill-defined, or spiculated.

Also, architectural distortion, focal asymmetry, or microcalcifications were identified.

If >1 finding was present, the nondominant characteristics were also included in the descriptions.

Five experienced breast imagers, who were blinded to the pathology results, recorded the mammographic features.

The data sets were combined to identify cases where mammographic appearance at screening detection was recorded, and the breast tumor was classified as having basal or nonbasal phenotype.

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Results
356 screening-detected cases of invasive breast cancer with basal phenotype were identified, and 309 had the nonbasal phenotype.

For both types, the dominant mammographic feature was a mass with either ill-defined or spiculated margins.

Basal-phenotype tumors were significantly more likely to appear as ill-defined masses on mammograms.

Nonbasal-phenotype tumors were significantly more likely than basal tumors to exhibit marginal spiculation.

Comedo calcification was seen more frequently with basal tumors as well.

When tumor grade was taken into account, these findings persist, showing that differences in mammographic appearance are not simply due to tumor grade.

Conclusions
In the assessment of characteristics of basal-phenotype breast tumors, these tumors are less likely to have spiculation, more likely to manifest as an ill-defined mass, and more likely to be found in association with comedo calcification.

Breast tumors with basal phenotype have a different mammographic appearance than nonbasal tumors and may explain the good prognostic value of mammographic spiculation.

Reviewer’s Comments
This article is interesting in that it acts to correlate mammographic findings with actual histology, with the idea that basal-phenotype tumors are more aggressive. How will this affect everyday practice?

Regardless of mammographic findings suggesting more aggressive tumors, the lesions will still be subjected to the same algorithm of imaging workup, followed by biopsy, and ultimately surgery and/or neoadjuvant therapy as per true findings at pathology.

Author: Basil Hubbi, MD

Reference:
Luck AA, Evans AJ, et al. Breast Carcinoma With Basal Phenotype: Mammographic Findings. AJR; 2008; 191 (August): 346-351

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P.S. As any diagnostician knows, experience is key in detecting disease. So is keeping up to date with the latest technologies, techniques, and procedures, in the hopes of gaining the best patient outcomes.

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Radiology Daily was launched to help you stay on top of your CME requirements, bringing you the latest news on Emergency Radiology. This is news you can use in your practice to stay on the cutting edge, or even ahead of the curve.

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Every professional caregiver has dedicated themselves to a lifetime of learning.

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A recent study was conducted to evaluate the diagnostic characteristics of sonographic surveillance for detection of metachronous contralateral breast cancer in patients with a history of breast cancer surgery, in order to determine whether sonography in addition to mammography might be justified in terms of time and cost.

The results, published in AJR, indicate that while annual screening sonography in addition to mammography may be useful for the discovery of metachronous contralateral cancers, the time and cost involved may not be justified.

The Study
Over a 1-year retrospective period, patients who had undergone surgery for biopsy-proven breast malignancy were identified. Those who had sonographic evaluation in addition to mammographic evaluation were included in the study. Patients had undergone bilateral whole breast sonography in addition to mammography every 6 months for the first 2 years and then annually thereafter. Exclusion criteria included a history of bilateral breast cancer surgery.

Methodology
1256 Asian women (mean age, 50 years) were included in the study. Over the follow-up period, the contralateral breast was classified as a BI-RADS 1 or 2 93.6% of the time. A BI-RADS 3 category was assigned to 3.8%, category 4 to 2.3%, and category 5 to 0.3%.

One radiologist reviewed the reports of the imaging studies and documented the BI-RADS category. The images were not reread.

Those classified as BI-RADS 1 or 2 were considered negative. BI-RADS categorization of 3, 4, or 5 were only included if they were referring to the breast contralateral to the surgical breast.

In other words, the originally reported BI-RADS was re-categorized to assess only the contralateral breast. The final diagnosis of each patient was determined based on tissue diagnosis at a follow-up time of ≥1 year.
[text_ad]

Results
Overall, 46 biopsies were performed. When tissue diagnosis was compared with BI-RADS category, the positive-predictive value (PPV) was 41.0%.

One cancer was missed, resulting in a false-negative rate of 0.06%.Of patients who continued sonographic adjuvant surveillance for >2 years, a 0.4% false-negative rate was revealed.

Two cases of biopsy-proven contralateral metachronous breast cancer were found on sonography and not detected on mammography.

Annual screening sonography may be useful for the discovery of metachronous contralateral cancers.

Reviewer’s Comments
The authors do not comment extensively on the finding that only 2 cancers discovered on sonography were also mammographically occult. For the remaining cases of metachronous cancer, the mammogram was judged to be positive as well.

Although a significant tool for those 2 cases, does it truly justify the time and cost of performing sonographic surveillance in addition to mammographic surveillance in a patient with otherwise no complaints?

On the other hand, those with a history of breast cancer, or any symptoms, might certainly consider having both sonography and mammography to rule out any chance of a false negative.

Author: Basil Hubbi, MD
Reference:
Kim MJ, Kim E-K, et al. Sonographic Surveillance for the Detection of Contralateral Metachronous Breast Cancer in an Asian Population. AJR; 2009; 192 (January): 221-228.

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The invaluable Special Report Advances in Spine Imaging, tells you what you need to know about better spine imaging using the latest technology.

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Keeping current on new medical technology and procedures is time-consuming, but essential to your professional career.

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[headline_style_3r deck="Obstetric Ultrasound CME just got a little easier..." headline="A Free Special Report From Radiology Daily is available for you to download now: Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma " subheadline="Claim your free copy from Oakstone Medical Publishing, the reliable source for continuing medical education, musculoskeletal imaging courses and reports on the latest musculoskeletal imaging research." headlinetext="" ]
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Dear concerned radiology professional,

If you’re a practising radiologist, radiology resident or internist, you know how far Obstetric Ultrasound has advanced in recent years—even in the past few months, with newer and better imaging and more effective techniques emerging all the time.

So, what’s a busy radiologist to do?

First and foremost, stay on top of the latest research, and your CME requirements, particularly those Obstetric Ultrasound courses that address the latest technology and how to use it correctly and safely, as well as how to interpret your findings to aid in treatment decisions in the hope of the best patient outcome.

Radiology Daily was launched to help you stay on top of your CME requirements, bringing you the latest news on Obstetric Ultrasound. This is news you can use in your practice to stay on the cutting edge, or even ahead of the curve.

Radiology Daily, from Oakstone Medical Publishing, which produces the landmark Practical Reviews in Radiology, brings you the latest news in the world of radiology from over 40 journals around the globe.

Practical Reviews in Radiology brings you peer-reviewed article abstracts–essential reading for anyone in the field of radiology who wants to keep current with the latest research and findings, and meet their CME requirements at the same time.

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Every professional caregiver has dedicated themselves to a lifetime of learning.

You hunger for knowledge…for advanced skills…for tools that promote patient health…

Your goal is always the same:

You want to detect and diagnose disease more quickly and efficiently, in its earliest stages, when treatment is likely to be less difficult and cure is more probable.

This invaluable Special Report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma, brings you invaluable advice on how to detect and diagnose these three main women’s health concerns.

In this special report, you will learn:

• How to Identify Ectopic Pregnancy:
• Who is at risk;
• The main reasons for ectopic pregnancies;
• The 4 key observations to detect normal pregnancy on ultrasound and rule out ectopic pregnancy;
• Evaluating ovarian masses on ultrasound;
• Why size matters when it comes to ovarian masses;
• How to approach ovarian masses in pre-menopausal women;
• How to approach ovarian masses in post-menopausal women;
• The main ovarian masses you will encounter on ultrasound;
• The main types of ovarian cysts;
• The characteristic appearance on a sonograph of the main types of ovarian cysts;
• How to approach ovarian masses if you locate them on ultrasound;
• Which types of ovarian cysts can be ruled benign upon ultrasound;
• Why practice is key when it comes to evaluating ovarian masses on ultrasound;
• Evaluating endometrial thickness with ultrasound;
• What is considered normal endometrial thickness in pre-menopausal women;
• Evaluating endometrial thickness in postmenopausal women;
• How your evaluation should differ if bleeding is present;
• Why it is important to identify atrophic endometrium with ultrasound;
• The appearance of endometrial carcinoma on ultrasound;
• Why focal thickenings of the endometrium are also important;
• The difference in appearance on ultrasound between endometrial polyps and submucous myomas.
• Further resources and suggested reading;
• And more…

Oakstone Medical Publishing is your reliable source for Obstetric Ultrasound CME.

Claim your copy of our free special report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma now, and download in minutes.

Simply click on the button below. We will send you a download link to your copy of this free report, and notify you by email whenever we post new information about Obstetric Ultrasound and Obstetric Ultrasound CME courses to the Radiology Daily website.

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" button="http://radiologydaily.com/wp-content/themes/oakstone/images/buttons/click_to_get_your_special_report.gif" ]

Your time is very valuable.

Keeping current on new medical technology and procedures is time-consuming, but essential to your professional career.

So we’ve distilled the most important facts about Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma into a fast-reading report of only about 2,500 words.

Why not invest the next 10 minutes in gaining a deeper understanding of the latest techniques for MRI imaging of the knee?

Best of all, you’ll also get a free subscription to Radiology Daily‘s email service, to keep you abreast of every new article we post at the site on the topics of the most interest to you.

There are 13 Radiology Daily topics in all, news you can use to add to your knowledge of the rapidly changing world of radiology and stay on top of your CME requirements. You can easily unsubscribe from Radiology Daily at any time with a couple of mouse clicks. It couldn’t be easier.

To get your copy of the free Special Report Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma right now, plus register for your free copy of the Radiology Daily newsletter, simply fill in your details below.

With kind regards,

Don Deye, M.D.
Medical Director

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" button="http://radiologydaily.com/wp-content/themes/oakstone/images/buttons/click_to_get_your_special_report.gif" ]

P.S. As any radiologist knows, when it comes to Obstetric Ultrasound, experience is key in detecting and treating disease. So is keeping up to date with the latest technologies, techniques, and procedures, in the hopes of gaining the best patient outcomes.

If you agree, I’m sure you’ll want to read Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma. Just enter your email address, download your free report, and start reading in minutes.

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" button="http://radiologydaily.com/wp-content/themes/oakstone/images/buttons/click_to_get_your_special_report.gif" ]

Monitoring radiation doses on children should not be overlooked. One recent study measured the dosage for infants undergoing full-body digital testing.

Two units—a Shimadzu radiography unit and a Lodox Statscan—were utilized.

The Shimadzu unit is a conventional radiography unit. The Lodox Statscan is a linear slit scanner. In general, the effective doses measured from the Statscan unit were considerably lower than those measured on the Shimadzu unit at both hospitals where testing occurred.

These results correlated with prior studies, however, the exception was the effective doses from the chest scans on the Statscan unit, which were not lower than in other studies.

The effective doses on the Statscan unit for the AP abdomen and AP pelvis exams were considerably lower than the results in most of the other studies. In particular, the effective doses for the standard trauma imaging protocol were less than half the dose from the Shimadzu unit.

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In conclusion, the doses for most of the standard radiographic examinations were considerably lower than those from the computer radiography system.

It is clear that radiation safety, particularly in children, is always being advanced.

With new technology such as the Statscan, more options are becoming available, although cost and availability will surely limit its widespread use for some time to come.

Author: Basil Hubbi, MD
Reference: Maree GJ, Iriving BJ, Hering ER. Paediatric Dose Measurement in a Full-Body Digital Radiography Unit. Pediatr Radiol 2007; 37 (October): 990–997.

Minkowski Functionals: Quantitative Classification of Breast Parenchymal Density

A recent study was conducted to test the hypothesis that spatial distribution of x-ray attenuation values in digital mammograms can be analyzed quantitatively by using topologic techniques based on Minkowski functionals.

Minkowski functionals are described as a set of topographic descriptors used in an algorithm for quantitative imaging processors.

The study concluded that Minkowski functionals are a novel reproducible approach to quantitatively classify breast parenchymal density.

The Study

Digital mammograms of 100 women performed over a 1-year period at a single institution were randomly chosen. Those that had prior breast surgery, known malignant disease, or breast implants were excluded.

Methodology
A 512- x 512-pixel region of interest was drawn on each of the mammograms in an area of the breast where the density pattern was homogeneous.

Subsequently, 2 experienced radiologists classified the parenchymal pattern within these regions of interest as normal, involution atrophy, or fibrosis based on predetermined qualitative definitions for each category.

Subsequently, quantitative density measurements were performed by first using mean, median, and 20th percentile values of gray-level intensity.

Subsequently, mathematic topology using Minkowski functional spectra analysis as described in a prior publication by Michielsen et al was used. Both quantitative methods were compared with the predetermined radiologist classifications as the standard.

Results
Minkowski functionals are a novel reproducible approach to quantitatively classify breast parenchymal density.

Mean, median, and 20th percentile gray-level intensity for normal breast tissue was 90 ± 9, 91 ± 8, and 68 ± 18, respectively. The mean, median, and 20th percentile gray-level intensity for involution was 84±7, 83 ± 7, and 75 ± 6, respectively, and for fibrosis, the mean, median, and 20th percentile gray-level intensity was 90 ± 8, 89 ± 9, and 73 ± 10, respectively.

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Using the qualitative classification as a standard, with the parameters obtained from gray-level histograms, only 37% to 66% of cases were classified correctly.

Comparatively, discriminant models of the spectral information of the Minkowski functionals exhibited a rate of correct classification of 76% to 83%.

Reviewer’s Comments
The heavy use of statistical analysis and technical descriptors in this study belie the potential this may have on the future of breast imaging by way of computer-aided detection.

We may see this kind of information resurface at a later date, when this approach to categorizing the density of breast tissue trickles down the industry path.

Author: Basil Hubbi, MD

Reference:

Boehm HF, Schneider T, et al. Automated Classification of Breast Parenchymal Density: Topologic Analysis of X-Ray Attenuation Patterns Depicted With Digital Mammography. AJR; 2008;191 (December): W275-W282

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