Sora C. Yoon

Objective: This study investigates patient and procedural factors related to complications in lactating patients undergoing image-guided core-needle breast biopsies. Methods: This study identified patients who were breastfeeding and underwent biopsies between December 2012 and February 2024. Imaging findings, procedural details, pathology, 30-day complications, and clinical course were reviewed. Factors associated with complications were investigated using Fisher’s exact test, logistic regression, and the chi-squared test. Results: A total of 97 biopsies were performed in 88 patients who were lactating (median age 33 years, range 21-47). The median postpartum time at biopsy was 4 months (range 0-5 months). The most common biopsy types included 59/97 (60.8%) 14-gauge US, 19/97 (19.6%) 18-gauge US, and 16/97 (16.5%) 9-gauge vacuum stereotactic. Some 6/97 (6.2%) biopsies yielded malignant diagnoses. The 30-day complication rate was 19/88 (21.6%) patients, with 11/88 (12.5%) developing milk fistula, 10/88 (11.4%) developing infection, and 2/88 (2.3%) requiring surgery or hospitalization. Some 9/11 (81.8%) milk fistulas resolved with continued breastfeeding. Biopsies performed near the obstetric delivery date (P = .03) and biopsy sites closer to the nipple (P = .04) were at increased risk for complication. Patients with milk fistula had significantly elevated infection risk (P = .0003; odds ratio = 16). No statistically significant associations were found between milk fistula formation and biopsy needle gauge or total volume of tissue removed at biopsy. Conclusion: A significant portion of patients who are lactating may develop postprocedural complications after core-needle biopsy, but serious complications are infrequent. Biopsy needle gauge is not associated with milk fistula or other complication. Most milk fistulas from core-needle biopsy will resolve without the need to stop breastfeeding.

Radiologists face a range of challenges to maximize the life-saving benefits of screening mammography, including pressure to maintain accuracy, manage heavy workloads, and minimize the risk of fatigue and burnout. This review provides targeted strategies to address these challenges and, ultimately, to improve interpretive performance of screening mammography. Workflow optimizations, including offline vs online and batched vs nonbatched interpretation, interrupted vs uninterrupted reading, and the importance of comparing current mammograms with prior examinations will be explored. Each strategy has strengths, weaknesses, and logistical challenges that must be tailored to the individual practice environment. Moreover, as breast radiologists contend with increasingly busy and hectic working conditions, practical solutions to protect reading environments and minimize distractions, such as the “sterile cockpit” approach, will be described. Additionally, breast radiologists are at greater risk for fatigue and burnout due to rising clinic volumes and an inadequate workforce. Optimizing the approach to reading screens is critical to helping breast imaging radiologists maintain and maximize the benefits of screening mammography, ensure the best outcomes for our patients, and maintain radiologist job satisfaction.

Evaluate the effectiveness of alcohol sclerotherapy in postoperative breast and axillary seromas. This was an IRB-approved retrospective review of consecutive patients from 2017 to 2021. The procedure involves aspiration of seroma fluid, injection of ethanol for 15 to 30 minutes, and then aspiration of the injected ethanol. Following review of the medical record, patient and procedure data were recorded. Success was defined as no recurrence of seroma. Statistical analysis was performed using a chi-square or t-test, as appropriate. Twenty seromas were treated in 19 patients (mean age, 63 years; range, 49–79) following mastectomy (9/20, 45%), lumpectomy (25%, 5/20), axillary nodal dissection (5/20, 25%), or chest wall surgery (1/20, 5%). The mean seroma volume was 146 ± 165 mL. There was a mean of 1.4 prior aspiration attempts (range, 0–3). Mean injected ethanol volume was 39 mL (range, 8–60 mL) for a mean of 26 ± 5 minutes. Seromas recurred in 85% (17/20) of cases, and repeat aspiration was performed in 35% (6/17). The mean recurrence time was 34 ± 29 days. The recurrent seromas were 31% smaller (mean, 80 ± 48 mL). Only a smaller pre-ablation seroma was associated with successful ablation (P < 0.01), as the mean pre-ablation volume was 36 ± 24 mL for successful ablations and 119 ± 56 mL for unsuccessful ablations. There were no post-procedural complications. Single-treatment ethanol sclerotherapy is typically unsuccessful in ablating breast and axillary seromas. Only a smaller pre-ablation seroma size was associated with successful ablation.

To examine time from screening to diagnostic workup, biopsy, and surgery for non-Hispanic White (NHW) and Black women following implementation of a same-day biopsy program. All NHW and Black women with BI-RADS category 0 screening mammogram at Duke University Hospital were identified between August 1, 2020, and August 1, 2021. Patient characteristics were recorded. Time between screening mammogram, diagnostic workup, breast biopsy, surgical consultation, and surgery were recorded. Comparisons were made between NHW and Black women using a multivariable regression model. Diagnostic imaging to biopsy time interval was compared to historical averages before same-day biopsy implementation. There were 2156 women: 69.9% NHW (1508/2156) and 30.1% Black (648/2156). Mean ± standard deviation time from screening to diagnostic imaging overall was 13.5 ± 32.5 days but longer for Black (18.0 ± 48.3 days) than for NHW women (11.5 ± 22.2 days) (P < 0.001). The mean time from diagnostic mammogram to biopsy was 5.9 ± 18.9 days, longer for Black (9.0 ± 27.9 days) than for NHW women (4.4 ± 11.8 days) (P = 0.017). The same-day biopsy program shortened the time from diagnostic imaging to biopsy overall (12.5 ± 12.4 days vs 5.9 ± 18.9 days; P < 0.001), with a significant reduction for NHW women (12.4 ± 11.7 days vs 4.4 ± 11.8 days) (P < 0.001) but not Black women (11.5 ± 9.9 days vs 9.0 ± 27.9 days) (P = 0.527). Disparities exist along the breast imaging pathway. A same-day biopsy program benefited NHW women more than Black women.

Background: Preliminary work has demonstrated that background parenchymal enhancement (BPE) assessed by radiologists is predictive of future breast cancer in women undergoing high‐risk screening MRI. Algorithmically assessed measures of BPE offer a more precise and reproducible means of measuring BPE than human readers and thus might improve the predictive performance of future cancer development.Purpose: To determine if algorithmically extracted imaging features of BPE on screening breast MRI in high‐risk women are associated with subsequent development of cancer.Study Type: Case–control study.Population: In all, 133 women at high risk for developing breast cancer; 46 of these patients developed breast cancer subsequently over a follow‐up period of 2 years.Field Strength/Sequence: 5 T or 3.0 T T₁‐weighted precontrast fat‐saturated and nonfat‐saturated sequences and postcontrast nonfat‐saturated sequences.Assessment: Automatic features of BPE were extracted with a computer algorithm. Subjective BPE scores from five breast radiologists (blinded to clinical outcomes) were also available.Statistical Tests: Leave‐one‐out crossvalidation for a multivariate logistic regression model developed using the automatic features and receiver operating characteristic (ROC) analysis were performed to calculate the area under the curve (AUC). Comparison of automatic features and subjective features was performed using a generalized regression model and the P‐value was obtained. Odds ratios for automatic and subjective features were compared.Results: The multivariate model discriminated patients who developed cancer from the patients who did not, with an AUC of 0.70 (95% confidence interval: 0.60–0.79, P < 0.001). The imaging features remained independently predictive of subsequent development of cancer (P < 0.003) when compared with the subjective BPE assessment of the readers.Data Conclusion: Automatically extracted BPE measurements may potentially be used to further stratify risk in patients undergoing high‐risk screening MRI.Level of Evidence: 3Technical Efficacy: Stage 5J. Magn. Reson. Imaging 2019;50:456–464.