Journal of Breast Imaging

Kellow, Zina; Kulkarni, Supriya; Gordon, Paula B; Seely, Jean M

doi: 10.1093/jbi/wbaf064pmid: 41665986

Screening aims to detect breast cancer before it becomes clinically apparent, enabling identification of tumors when they are smaller and have not yet spread and when treatment options are more effective, less invasive, and more affordable. However, screening mammography has known limitations, with breast density being a primary challenge. Denser breast tissue not only increases the likelihood of cancer but also makes tumors harder to detect due to overlapping tissue. Strong evidence now exists to support updating our previous guidelines to recommend supplemental screening beyond mammography for individuals with American College of Radiology category c or d breast density. Supplemental screening methods, such as MRI, contrast-enhanced mammography (CEM), or US (in that order of preference) can significantly improve cancer detection rates. We recognize that implementing these recommendations across Canada will present challenges. Nevertheless, a collaborative effort among radiologists, health care stakeholders, and policymakers is essential to drive gradual, meaningful improvements in breast cancer detection and outcomes.

Aru, Marco G; Rahbar, Habib; Biswas, Debosmita; Sujichantararat, Suleeporn Y; Dontchos, Brian; Partridge, Savannah C; Kazerouni, Anum S

doi: 10.1093/jbi/wbaf082pmid: 41671073

Breast MRI has evolved over the past several decades into a cornerstone of breast imaging. Historically, dynamic contrast-enhanced (DCE) MRI has served as the foundation of breast MRI protocols for differentiation of benign and malignant lesions and was supplemented by additional sequences to refine diagnostic accuracy. More recently, advanced techniques, such as diffusion-weighted MRI, ultrafast DCE-MRI, and deep learning models, have further expanded capabilities of breast MRI. These innovations, however, have also contributed to substantial variability in breast MRI protocols across institutions. At the same time, the expanding indications for screening and diagnostic breast MRI are driving higher patient volumes, creating operational challenges for breast imaging centers tasked with balancing efficiency, accuracy, and limited resources. This review outlines the key elements and considerations of modern breast imaging protocols, discusses strategies for protocol optimization, and explores emerging technologies and future trends that are shaping the next generation of breast imaging.

Hao, Meng; Poplack, Steven P; Bao, Jean; Tsai, Jacqueline; Liang, Tie; Wong, Jason; Dashevsky, Brittany Z

doi: 10.1093/jbi/wbaf049pmid: 41666006

ObjectiveTo evaluate the utility of SCOUT radar localization (SCOUT) placement at the time of axillary lymph node (LN) biopsy.MethodsA retrospective study was conducted on SCOUT placement during axillary LN core-needle biopsy (CNB) between January 2018 and September 2023. The SCOUT was considered utilized if detected and removed during targeted axillary dissection with or without subsequent axillary LN dissection. Analysis was performed with a Fisher’s exact test and Wilcoxon rank-sum test to determine association of features with either LN disease status or SCOUT utilization.ResultsSCOUT placement was performed in 127 patients during US-guided CNB, with 77% (98/127) malignant and 23% (29/127) benign results. Three patients were lost to follow-up and excluded. SCOUTs placed during LN biopsy were utilized in 70% (87/124) of patients. A total of 104 patients underwent axillary surgery, including 80 malignant and 24 benign CNB specimen cases. The SCOUT-localized node did not take up blue dye or radiotracer in 28% (22/80) of patients with malignant CNB LNs, 86% (19/22) of whom were in postneoadjuvant treatment. SCOUTs were not utilized for 30% (37/124) of patients. Age was a significant predictor of SCOUT utilization, with 87% (40/46) of utilization among patients <50 years old (P <.001). Among the 24 patients with benign CNB specimens who underwent axillary surgery, 25% (6/24) had nodal metastasis, of which 50% (3/6) were within the SCOUT-localized node.ConclusionSCOUTs placed at the time of LN biopsy facilitate detection of the biopsied node and may be particularly beneficial after neoadjuvant treatment and in women <50 years old.

Cao, Yuying; Lu, Amy H; Cecil, Ryan; Abrams, Gordon S; Vargo, Adrienne; Reginella, Ruthane F; Nair, Bronwyn E; Carlin, Beatrice A; Shinde, Dilip D; Ganott, Marie A; Berg, Wendie A; Hartman, Jamie Y; Sumkin, Jules H; Kelly, Amy E; Chough, Denise M;

Gu, Lin; Zuwasti, Ufara; Rigling, McKenna; Berg, Wendie A

doi: 10.1093/jbi/wbaf043pmid: 41661649

ObjectiveTo detail acute and delayed contrast reactions associated with contrast-enhanced mammography (CEM) in a prospective screening trial.MethodsIn an institutional review board–approved protocol from October 2019 through July 2024, women with personal history of breast cancer received up to 3 rounds of annual supplemental screening CEM. Intravenous iopamidol (370 mg/mL) was administered via automated injector. Adverse events within 1 week of contrast administration were recorded.ResultsA total of 1651 women (mean age at entry: 63.2 years) received 3873 contrast injections (1651, 1326, and 896 in years 1, 2, and 3, respectively). Among 3873 injections, we observed 38 (0.98%) contrast reactions in 35 unique participants, including 25/3873 (0.65%) allergic-like reactions (15/1651 [0.91%] in year 1, 7/1326 [0.53%] in year 2, and 3/896 [0.33%] in year 3), 9/3873 (0.23%) physiologic reactions, and 4/3873 (0.10%) other reactions. Of 25 allergic-like reactions, 20 (80%) were cutaneous (hives/rash). One participant had bronchospasm, 1 had scratchy throat, 1 had shortness of breath, 1 sneezed repeatedly, and 1 had watery eyes. Five allergic-like reactions were delayed, including hives in 4 (2 at 1 day, 1 at 2-3 days, and one 7 days later) and watery eyes in 1; 2 physiologic reactions were delayed. Two of 25 reactions were immediate, and imaging was not completed; medication was given to 15/25 (60%). Allergic-like reactions occurred in 14/3328 (0.42%) examinations in women with prior uneventful iodinated contrast exposure, 10/510 (1.96%) among those naïve to contrast (P <.001), and 1 woman with recurrent but initially unreported reaction in year 1. No allergic-like reactions were observed in 34 examinations (19 women) premedicated for prior allergic contrast reaction.ConclusionWe observed a low rate and usually mild severity of adverse reactions to iodinated contrast in CEM with trained staff.

Yan, Howard Z; Liang, Tie; DeMartini, Wendy B; Pittman, Sarah M; Dashevsky, Brittany Z; Rosen, Eric L; Ikeda, Debra M; Waheed, Uzma; Lipson, Jafi A; Poplack, Steven P

doi: 10.1093/jbi/wbaf040pmid: 41666007

Bragg, Ashley C; Legha, Ravinder S; Ding, Qingqing; Yang, Wei-Tse

doi: 10.1093/jbi/wbaf056pmid: 41666009

Metaplastic breast carcinoma (MBC) is a rare and aggressive malignancy pathologically defined by differentiation of the neoplastic epithelium to mesenchymal-like and/or squamous components. Metaplastic breast carcinoma is typically a triple receptor negative invasive breast cancer (TNBC). There are multiple subtypes of MBC, and imaging findings are nonspecific. Classically, MBC presents in postmenopausal women as an enlarging palpable mass. At presentation, MBC is often larger than non-MBC breast cancer, and distant metastases are more common. Axillary nodal involvement is, however, less frequent. Mammography commonly demonstrates a circumscribed oval, round, or lobulated mass with or without calcifications. Spiculated masses and architectural distortion are less common than in non-MBC breast cancer. US often demonstrates a round/oval solid mass with cystic spaces due to necrosis. A T2 hyperintense mass with rim enhancement is often demonstrated on MRI. Imaging findings of MBC can mimic benign tumors, such as phyllodes and non-MBC breast cancers, and radiologists should consider MBC in the differential diagnosis of a mass with these features, especially with a clinical history of a new or enlarging palpable finding. Pathologic diagnosis is important, but accurate diagnosis on core biopsy can be limited due to the heterogeneity of this entity and dependence on sampling the metaplastic component. Data suggest that MBC confers a worse long-term prognosis than non-MBC breast cancers, including other TNBCs.

Garrett, Heather V; Bennett, Debbie L; Fine, Richard E; Bryce, Yolanda

doi: 10.1093/jbi/wbaf038pmid: 41558655

US-guided cryoablation has emerged as a promising minimally invasive treatment modality for breast cancer. With the growing adoption and success of cryoablation as a breast cancer treatment, many of these patients are undergoing routine follow-up imaging. There is a growing body of evidence and literature regarding the expected imaging appearance of the postcryoablation breast. Although there are limited data to provide guidelines for imaging and BI-RADS assessment after cryoablation, radiologists are seeking guidance in this area as they encounter these patients in their practice. Our objective is to provide an overview of the expected imaging findings after breast cryoablation and propose an imaging follow-up algorithm and BI-RADS assessment scheme in this patient population. Based on a review of the literature and the authors’ clinical experience, we propose that patients should have initial imaging at 3 to 6 months after cryoablation. Subsequent surveillance imaging after cryoablation can be performed at 6- or 12-month intervals. Modalities of mammography with or without a contrast-enhanced study (MRI, contrast-enhanced mammography) should be used for follow-up imaging. BI-RADS assessment should be given on these imaging studies to aid in patient tracking and guide future interventions and imaging follow-up. For patients in whom cryoablation is considered a successful and definitive treatment and follow-up imaging shows expected postablation findings with no suspicious abnormalities, BI-RADS 2 assessment is appropriate. For patients in whom cryoablation was considered palliative and/or incomplete, BI-RADS 6 assessment can be given.

Huang, Monica L; Lane, Deanna L; Chang Sen, Lauren Q; Candelaria, Rosalind P; Santiago, Lumarie

doi: 10.1093/jbi/wbaf050pmid: 41558639

Breast cryoablation for the treatment of fibroadenoma and breast cancer is safe and effective, and breast cryoablation performed as an outpatient procedure with local anesthesia alone is well tolerated by patients. Because use of this procedure is increasing, radiologists and proceduralists must understand the postcryoablation breast imaging algorithms, including the rationale for imaging, the appropriate timing for imaging, and appropriate imaging modalities. Radiologists must also be able to differentiate benign, expected posttreatment findings at the ablation zone from findings suggestive of residual, progressing, or recurrent malignancy on mammography, digital breast tomosynthesis, US, MRI, and contrast-enhanced mammography. Finally, radiologists must report postcryoablation breast imaging findings using appropriate descriptors and standardized reporting lexicon. Accurate and standardized reporting of postcryoablation breast imaging findings is important to guide clinical management, facilitate research on imaging findings’ associated risk for malignancy, and permit comparison of radiologist performance and patient outcomes across facilities worldwide.

Ahn, Richard W

doi: 10.1093/jbi/wbaf055pmid: 41558654

Breast imaging plays a unique role in radiology, serving as the gatekeeper for initial imaging evaluation and tissue diagnosis of breast cancers. However, the definitive treatment of nonmetastatic breast cancer remains surgical excision, with radiation and/or chemotherapy based on stage and tumor profile.1 The reemergence of breast cryotherapy, highlighted by the recent 5-year results of the ICE3 trial, has the potential to expand the scope of breast imaging radiologists into the treatment of breast cancers.2 There is also increasing interest in cryoablation for immune potentiation in triple-negative and metastatic breast cancers.3