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  • Radiology in Public Focus

    October 01, 2013

    Press releases were sent to the medical news media for the following articles appearing in recent issues of Radiology.

    Photomicrograph of surgical specimen
    (Click to enlarge) Image in a 48-year-old woman with nipple discharge. Photomicrograph of surgical specimen (H-E stain; original magnification, 3200) reveals small papilloma, which was fully excised

    (Radiology 2013;269;2:InPress) ©RSNA, 2013.
    All rights reserved. Printed with permission.

    Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ at Core Breast Biopsy: Use of Careful Radiologic-Pathologic Correlation to Recommend Excision or Observation

    When careful radiologic-pathologic correlation is conducted in the setting of a breast core biopsy with atypical lobular hyperplasia or lobular carcinoma in situ, some women can be safely triaged to observation, according to new research.

    Kristen A. Atkins, M.D., of the University of Virginia in Charlottesville, and colleagues examined 50 cases of atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) from 49 women aged 40-73 years (mean age, 59 years) devoid of any additional lesion that required excision. Researchers performed detailed radiologic-pathologic analysis while blinded to subsequent follow-up information, comparing all biopsy-related images with the histologic findings at core biopsy and designating each core biopsy finding as concordant or discordant.

    Of the 43 benign concordant core biopsy findings, none were upgraded at surgery or extended follow-up. Of the seven discordant biopsy findings, two were upgraded to ductal carcinoma in situ at surgery; none of the cases were upgraded at follow-up.

    “Focused and complete radiologic-pathologic correlation may obviate excisional biopsy in patients with benign concordant biopsy findings,” the authors write.

    Sonogram shows a BI-RADS category 3 lesion
    (Click to enlarge) Sonogram shows a BI-RADS category 3 lesion (arrow) in a woman aged 43 years at 1-year follow-up. At 2-year follow-up, the lesion had suspicious changes and was reclassified as a BI-RADS category 4a solid lesion. The lesion was not detected with mammography in either year. At biopsy, the lesion was determined to be an 18-mm invasive lobular cancer.

    (Radiology 2013;269;3:InPress) ©RSNA, 2013.
    All rights reserved. Printed with permission.

    Probably Benign Lesions at Screening Breast US in a Population with Elevated Risk: Prevalence and Rate of Malignancy in the ACRIN 6666 Trial

    Breast Imaging Reporting and Data System (BI-RADS) category 3 lesions are common at screening ultrasound and have a low malignancy rate, new research shows. For that reason, a recommendation of yearly diagnostic follow-up for BI-RADS category 3 le¬sions detected at screening US may be appropriate, according to researchers.

    Richard G. Barr, M.D., Ph.D., of Radiology Consultants, Youngstown, Ohio, and colleagues analyzed data from the American College of Radiology Imaging Network (ACRIN) trial 6666, in which both annual mammography and ultrasound screenings were performed on women with dense breasts at 21 sites around the country.

    BI-RADS Category 3 lesions were discovered in nearly 20 percent of 2,662 participants over three years of screening and accounted for 25 percent of 2,916 ultrasound-detected lesions other than simple cysts. The malignancy rate of BI-RADS
    category 3 lesions was 0.8 percent (six of 745 lesions; 95 percent confidence interval [CI]: 0.3 percent, 1.7 percent).

    “Since BI-RADS Category 3 lesions have a low malignancy rate and since only 0.1 percent of lesions had suspicious changes at short-interval follow-up and another 0.1 percent showed a suspicious change at 1-year follow-up, both of which were node-negative invasive cancers, a recommendation of yearly follow-up for BI-RADS category 3 lesions may be appropriate,” the authors write.

    Screening Mammography Recall Rate: Does Practice Site Matter?

    Practice setting, which may be influenced by patient or institutional factors, can significantly affect a radiologist’s recall rate in screening mammography, according to new research.

    Jason Rothschild, M.D., of Alpert Medical School of Brown University, Rhode Island Hospital in Providence, and colleagues reviewed data between May 2008 and September 2011 for five radiologists with expertise in breast imaging who interpreted mammograms at a community office practice and an academic referral hospital. Both sites utilized full-field digital mammography and batch screening interpretation.

    Researchers interpreted 74,297 screening mammograms between both sites. The total number of patients recalled was 5,799, for an overall recall rate of 7.8 percent. At 6.9 percent, the recall rate at the community site was significantly lower than the hospital rate of 8.6 percent. The data suggest that patient population factors may affect recall rates at different institutions.

    “Being cognizant of the effect of practice site on screening mammography recall rate may help radiologists improve practice by assessing conditions and performance at sites where recall rates are high,” according to researchers.

    Adjusted ORs and 9 percent CIs of recall for digital breast tomosynthesis
    (Click to enlarge) Adjusted ORs and 9 percent CIs of recall for digital breast tomosynthesis plus mammography versus conventional digital mammography alone according to age and breast density.

    (Radiology 2013;269;2:InPress) ©RSNA, 2013. All rights reserved. Printed with permission. 

    Comparison of Tomosynthesis Plus Digital Mammography and Digital Mammography Alone for Breast Cancer Screening

    Breast tomosynthesis reduces screening mammography recall rates, particularly for younger women and women with dense breasts, without significant changes in cancer detection, according to new research.

    In a retrospective study, Brian M. Haas, M.D., of Yale University School of Medicine in New Haven, Conn., and colleagues reviewed screening recall rates and cancer detection rates in two groups: women who received conventional digital mammography alone and those who received tomosynthesis in addition to mammography. Of the 13,158 patients who underwent screening mammography, 6,100 received tomosynthesis.

    The cancer detection rate was 5.7 per 1,000 in patients receiving tomosynthesis, compared with 5.2 per 1,000 in patients receiving mammography alone. The addition of tomosynthesis resulted in a 30 percent reduction in the overall recall rate, from 12 percent for mammography alone to 8.4 percent in the tomosynthesis group.

    “The greatest benefit from the reduced recall rates are realized by younger women and those with dense breasts, which could potentially increase compliance with screening mammography in two very sensitive patient populations,” the authors write.

    Media Coverage of RSNA

    Radiology September coverIn July, 1,127 RSNA-related news stories were tracked in the media. These stories reached an estimated 578 million people.
    Print and broadcast coverage included Sun-Sentinel, WPIX-TV (New York), KCBS-TV (Los Angeles), KCAL-TV (Los Angeles), WBBM-TV (Chicago), WGCL-TV (Atlanta) and WBAL-TV (Baltimore).
    Online coverage included Yahoo! Health, U.S. News & World Report, MSN.com, WebMD and Examiner.com.

    Read coverage of RSNA in these media:

    RadiologyInfo.org Posts New “Your Radiologist Explains” Videos

    Visit RadiologyInfo.org, RSNA and ACR’s jointly-sponsored public information website, to view recently posted “Your Radiologist Explains” video presentations, including:

    • Inferior Vena Cava Filter Placement and Removal
    • Transjugular Intrahepatic Portosystemic Shunt

    October and November Public Information Activities Focus on Breast and Lung Cancer Awareness

    To highlight National Breast Cancer Awareness Month in October and National Lung Cancer Awareness Month in November, RSNA is distributing public service announcements (PSAs) focusing on the importance of regular screening mammograms and the symptoms, risk factors and possible treatment options related to lung cancer. RSNA is also distributing the “60-Second Checkup” audio program focusing on the use of 3D mammography for better breast cancer detection and CT screening to help reduce lung cancer deaths.

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