1. Review of false negative cases (small size and masking with enhancing parenchyma - Chicago)
2. Despite the use of pre-op MRI, no increase in Mastectomy conversion rate (San Diego)
3. MR CAD - great for IDC but only 50% for DCIS (Toronto)
4. Small cancers (<5mm)>
5. Kinetics good for mass enhancement BUT NOT non-mass like enhancement (Chicago)
6. Value of MRI in work up of lobular Ca (Nice)
7. MR in occult metastatic malignancy - neg exam means treat axilla only (Milan)
8. MR Galactography - initial experience (Erlangen)
HIGH RISK SCREENING Session -
Wendy Berg presented 2 papers with the early results of the ACRIN 6666 trial
When added to mammography in the high risk setting, the diagnostic sensitivity of screening increases. The second paper showed the serious downside with a large proportion of false positive screens with additional unnecessary biopsies.
Increased workload/demand for breast MRI as a result of the 2007 American Cancer Society guidelines on screening high risk women, similar to the October 2006 UK NICE guidelines
It was shown that in the USA, current units could theoretically cope with the increased numbers of screening examinations 2-3 per week, without additional investment.
BREAST INTERVENTIONAL PAPERS -
1. Axillary US in SLNB (Korea) - including US localisation to prevent technical failure of SLNB or false -ve when tumour filed with malignancy
2. Radiofrequency ablation of breast cancer and assessment of ablation zone (Glasgow) - Safe and effective in achieving cell death with CE US to assess immediate response
3. Cryoablation vs radiofrequency ablation of small breast cancer: measurement with 3T MRI imaging ( Rome) - US guided ablation feasible and reliable. CE MRI ideal method to quantify procedure efficacy
4. US mammotome excision of low risk benign lesions (Korea) - can replace surgical excision for low risk benign lesions
5. US mammotome excision of benign intraduct mass for treatment of nipple discharge (Korea)
6. US mammotome excision of benign papillary masses (Korea) - to preclude surgical biopsy
More interventional papers given on Wednesday morning -
1. Is surgical excision of core biopsy proven benign papillomas necessary? (Durham, NC) - close imaging FU is all they do in their practice.
2. Underestimation of papillary lesions by core: correlation with surgical excision ( Scottsville, NY) - 6% underestimate by core. 91% of lesions were identified as atypical
3. Follow-up rather than excision for papillary lesions with VAB (Philadelphia, PA) - 11g VAB can be safely followed rather than having surgical excision
4. How many calcs for diagnosis in VAB for non-mass calcifications? (Korea) - 6 or more cores should be obtained
5. Impact of 10g Vacora and 9G Suros ATEC biopsy for MRI guided biopsy (Bonn, Germany) - Lesions sampled at VAB reduced the chances of localisation biopsy
6. 8G vs 11G needle diagnostic accuracy for stereo cores (Boston, MA) - improvement of over 90% by using 8G for calcs
7. False -ve rate for 14G core biopsy (Korea) - accurate method for diagnosing cancer
8. Clip displacement following VAB, comparison of conventional and gel markers(Vienna, Austria) - SenoRX clips cw Micromark clips. Displacement of up to 20mm with conventional clips. Conventional clips should no longer be used.
9. Diagnostic accuracy of 14G core biopsy for Phyllodes tumours (Korea) - tendency to UNDERSAMPLE.
RSNA Breast Imaging - Ultrasound
1. US screening of women with personal history of breast cancer: Cancer detection in the contralateral breast (Korea) - US can detect mammographically occult cancers - increased from 4 to 9 cancers in 1314 women
2. Breast Ca staging using cortical thickness of axillary lymph nodes at ultrasound (Boston, MA) - Maximum cortical thickness of >3mm (compared with Nottingham Criteria of 2mm) is a simple and accurate sonographic criterion (US + FNAC/core gave sensitivity of 91%, specificity of 100%, PPV 100%, NPV 72%)
3. 3D US for the identification and diagnosis of breast cancer (Peoria, IL) - SomoVu 3D reconstruction enabled visualization of mammo occult and MR occult lesions
4. US screening of mastectomy site for detection of non-palpable recurrent cancer (Korea) - some recurrences visible when non-palpable
5. Reproducibility of tool for breast ultrasound assessment and reporting (San Diego, CA)
6. Adjunct diagnostic value of US in patients with suspected ductal breast disease (Rome, Italy) - Important role in the diagnosis of benign focal masses and duct ectasia. Can replace galactography
7. Elasticity imaging of the breast: results of a multi-center trial (Korea) - high sensitivity in characterizing malignant breast lesions. Variability in specificity between centers requires standardization of the technique
8. US Elastography of breast lesions associated with suspicious microcalcifications detected at mammography (Korea) - Malignant calcifications have less strain (HARDER) than benign calcifications
9. Inter and Intra-observer agreement in interpretation of US elastography (Korea) - Interobserver agreement was moderate to substantial and intraobserver agreement was substantial to perfect for the visual assessment of strain images
1. Adding tomosynthesis to FFDM reduces callbacks by 43%, regardless of breast density (Boston)
2. Comparison of Tomosynthesis and FFDM in an OP symptomatic setting (Amsterdam) - No differences found between the 2 techniques in their population
3. Tomosynthesis vs conventional: comparison of breast mass detection and characterisation (Ann Arbor) - More masses detected by tomosynthesis. Better margin assessment but same malignancy rating
4. Comparison of FDDM and SFM within a population based UK screening programme (Barts, London) - Similar recall rates, cancer detection and PPV. FFDM detects larger invasive tumours in the 50-60 age group
5. Digital monitor zooming vs magnificaton FFDM ( Korea) - Better quality of image and increased confidence of diagnosis of radiologists when using magnification rather than simple magnification
6. Improved diagnostic accuracy with contrast enhanced FFDM (Berlin)
7. Technical recall rates FFDM vs SFM (Houston) - digital significantly LOWER TR rate regardless of whether there were prior mammograms available
RSNA Mixed Papers -
1. Comparison of Mammo, US and MRI in evaluation of DCIS extent (Korea) - MRI better correlate with pathology
2. Correlation between Mammo and US findings of node -ve IDC (Korea) - HER2 +ve correlated with segmental microcalcs with a mass on US
3. Performance of electrical impedance device to detect cancer in women (Charleston) - HEDA breast scan has a better diagnostic accuracy for breast cancer detection than mammography in women under 50 yrs and small breasts, but no difference with normal sized breasts.
RSNA Breast Imaging - Mammography
1. Assessment of microcalcifications with large core biopsy (VAB) in a screening population (Weisbaden, Germany) - biopsy of all clusters of microcalcification lead to an improvement in their benign/malignant ratio through increased detection of DCIS
2. Coronary Artery Calcification on mammograms ? correlates with coronary artery disease? (Staten Island, NY) - No correlate with C.A.Disease, but with age only
3. Mammo features post Mammosite therapy (Norfolk, VA) - 7x more likely to get seromas and 3.3x to get fat necrosis compared with whole breast irradiation
4. Single dilated duct at Mammography - outcomes (San Francisco, CA) - Rare finding with a greater than 2% chance of malignancy. Should be called a BIRADS 4A rather than a 3 assessment
5. Breast density evaluations from mammograms and central tomosynthesis projections (Philadelphia, PA) - Correlation better with tomosynthesis
6. LCD vs CRT displays for digital mammography calcs and masses (Korea) - Comparable performance, but LCDs better than CRT for microcalcifications - non significant
RSNA Breast Imaging - Computer Aided Detection
1. CAD of malignant and benign clustered microcalcifications in temporal pairs of mammograms and it's effect on Radiologists characterization performance (Ann Arbor, MI) - increased diagnostic accuracy when using interval change analysis
2. CAD review of false -ve FFDM exams on priors (Korea) - CAD correctly identified 34 0f 46 (73%) of retrospectively visible lesions and 14 of 14 (100%) of actionable lesions
3. Critical analysis of studies measuring the effectiveness of CAD in screening (Chicago, IL) - while each individual study is small, the aggregate of studies indicate that performance is comparable to double reading by radiologists
4. An inductive CAD system using genetic algorithms for detection of calcification on mammograms (Orinda, CA) - CAD teaching itself and learning from it's mistakes
5. US CAD into clinical practice: and observational study (Chicago, IL) - cautious optimism using CADx
6. Independent US CAD BI RADS assessment of breast lesions (Philadelphia, PA) - Initial study showed significant improvement in the hands of trained users
7. MRI detected suspicious findings: comparison of kinetic feature measurement using CAD in benign and malignant lesions (Seattle, WA) - ONLY delayed kinetics categorized by the most suspicious type of enhancement were significantly different between B/M. In keeping with MRI BI RADS recommendation of reporting the most suspicious kinetic curve. Any washout enhancement was assoc with malignancy in nearly 50%, entirely persistent with 13.3%
8. Application of CAD in MRM: do we really need whole lesion time curve distribution analysis? (Jena, Germany) - Higher diagnostic accuracy for curve distribution data after application of a statistical regression model compared to semi-automatic detected 'most suspect curve' type
SPOTLIGHT PAPER
Triple Negative breast cancers - imaging appearances
Researchers at University of Pennsylvania Medical Center in Philadelphia have found data on triple negative cancers that may help clinicians diagnose and characterize them earlier.
Udoetuk and Conant compared the imaging features and clinical presentations of triple negative cancers with those of other breast cancers through an imaging trial of 284 women from March 2002 to March 2006. Each participant received a battery of imaging tests, including a bilateral film-screen mammogram, digital mammogram, whole-breast ultrasound, contrast-enhanced MRI, and a whole-body PET scan. The mean age of study participants was 50.
Triple-negative cancers were found to have some particular clinical characteristics, as compared to non-triple negative cancers:
The group determined that, when they excluded lesions that were palpable by the woman herself or by her doctor, and looked only at symptoms such as breast pain and nipple discharge, women with TN cancer were four times as likely to have those symptoms as women with non-TN cancers, Udoetuk said. And the TN cancers were more advanced
TN cancer tumors were characterized by round or oval masses by either MR or ultrasound scans in 18.5% of the women with this type of cancer, versus 4% of women with non-TN cancers