Nilgün Güldoğan

We aimed to determine the value of standalone and supplemental automated breast ultrasound (ABUS) in detecting cancers in an opportunistic screening setting with digital breast tomosynthesis (DBT) and compare this combined screening method to DBT and ABUS alone in women older than 39 years with BI‐RADS B‐D density categories. In this prospective opportunistic screening study, 3466 women aged 39 or older with BI‐RADS B‐D density categories and with a mean age of 50 were included. The screening protocol consisted of DBT mediolateral‐oblique views, 2D craniocaudal views, and ABUS with three projections for both breasts. ABUS was evaluated blinded to mammography findings. Statistical analysis evaluated diagnostic performance for DBT, ABUS, and combined workflows. Twenty‐nine cancers were screen‐detected. ABUS and DBT exhibited the same cancer detection rates (CDR) at 7.5/1000 whereas DBT + ABUS showed 8.4/1000, with ABUS contributing an additional CDR of 0.9/1000. Standalone ABUS outperformed DBT in detecting 12.5% more invasive cancers. DBT displayed better accuracy (95%) compared to ABUS (88%) and combined approach (86%). Sensitivities for DBT and ABUS were the same (84%), with DBT + ABUS showing a higher rate (94%). DBT outperformed ABUS in specificity (95% vs. 88%). DBT + ABUS exhibited a higher recall rate (14.89%) compared to ABUS (12.38%) and DBT (6.03%) ( p < .001). Standalone ABUS detected more invasive cancers compared to DBT, with a higher recall rate. The combined approach showed a higher CDR by detecting one additional cancer per thousand.

To compare images generated by synthetic diffusion-weighted imaging (sDWI) with those from conventional DWI in terms of their diagnostic performance in detecting breast lesions when performing breast magnetic resonance imaging (MRI). A total of 128 consecutive patients with 135 enhanced lesions who underwent dynamic MRI between 2018 and 2021 were included. The sDWI and DWI signals were compared by three radiologists with at least 10 years of experience in breast radiology. Of the 82 malignant lesions, 91.5% were hyperintense on sDWI and 73.2% were hyperintense on DWI. Of the 53 benign lesions, 71.7% were isointense on sDWI and 37.7% were isointense on DWI. sDWI provides accurate signal intensity data with statistical significance compared with DWI (P < 0.05). The diagnostic performance of DWI and sDWI to differentiate malignant breast masses from benign masses was as follows: sensitivity 73.1% [95% confidence interval (CI): 62-82], specificity 37.7% (95% CI: 24-52); sensitivity 91.5% (95% CI: 83-96), specificity 71.7% (95% CI: 57-83), respectively. The diagnostic accuracy of DWI and sDWI was 59.2% and 83.7%, respectively. However, when the DWI images were evaluated with apparent diffusion coefficient mapping and compared with the sDWI images, the sensitivity was 92.68% (95% CI: 84-97) and the specificity was 79.25% (95% CI: 65-89) with no statistically significant difference. The inter-reader agreement was almost perfect (P < 0.001). Synthetic DWI is superior to DWI for lesion visibility with no additional acquisition time and should be taken into consideration when conducting breast MRI scans. The evaluation of sDWI in routine MRI reporting will increase diagnostic accuracy.

The aim of this study was to evaluate efficiency of time use for radiologists and operational costs of automated breast ultrasound (ABUS) versus handheld breast ultrasound (HHUS). This study was approved by the Institutional Review Board, and informed consent was waived. One hundred and fifty-three patients, aged 21–81 years, underwent both ABUS and HHUS. The time required for the ABUS scanning and radiologist interpretation and the combined scanning and interpretation time for HHUS were recorded for screening and diagnostic exams. One-Way ANOVA test was used to compare the methods, and Cohen Kappa statistics were used to achieve the agreement levels. Finally, the cost of the methods and return of interest were compared by completing a cost analysis. The overall mean ± standard deviation examination time required for ABUS examination was 676.2±145.42 seconds while mean scan time performed by radiographers was 411.76±67.79 seconds, and the mean radiologist time was 234.01±81.88 seconds. The overall mean examination time required for HHUS was 452.52±171.26 seconds, and the mean scan time and radiologist time were 419.62±143.24 seconds. The reduced time translated into savings of 7.369 TL/month, and savings of 22% in operational costs was achieved with ABUS. The radiologist’s time was reduced with ABUS in both screening and diagnostic scenarios. Although a second-look HHUS is required for diagnostic cases, ABUS still saves radiologists time by enabling a focused approach instead of a complete evaluation of both breasts. Thus, ABUS appears to save both medical staff time and operational costs.

Background/Aim: Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign mesenchymal proliferative breast lesion. The literature contains little information on the radiological results of this uncommon tumor. In this study, we aim to define the radiologic findings of PASH through our institutional experience. Materials and Methods: Patients with PASH of the breast reported in the surgical database of our institution from 2020 to 2023 were retrospectively reviewed. PASH was detected in 11 female patients among the patients who underwent a total of 2172 breast tru-cut biopsies. Nine patients whose imaging studies could be recalled from the picture archiving systems (PACS) were included in the study. BI-RADS, 5th edition, was used to analyze and classify radiologic findings. Results: The median age of cases was 41 (range 22–53). Our single-center incidence was found to be 0.5%. Considering the sonographic findings, all of the lesions had an oval shape. On mammography, they were defined as focal asymmetry or circumscribed masses. An MRI was available in three cases. All three cases were hypointense on T1-weighted sequences and hyperintense on T2-weighted sequences. They displayed type 1 or type 2 enhancement curves in the dynamic contrast-enhanced images. No diffusion restriction was detected. Conclusion: In this study, tumor-forming PASH were generally circumscribed oval hypoechoic solid masses with minimal vascularity and no posterior acoustic features on ultrasound. On mammography, calcification, architectural distortion, or spiculation were not present in any of the cases. MRI findings were t2 hyperintensity, type 1–2 enhancement kinetics, and no diffusion restriction. In all imaging modalities, the imaging characteristics point to a benign lesion.

Objectives: Our study aimed to investigate the sensitivity of the abbreviated magnetic resonance imaging (MRI) in the detection of tumors in breast cancer patients. Methods: Patients who underwent breast MRI between March 2018 and October 2021 were reviewed retrospectively. Patients with a histologic diagnosis of breast malignancy were included in the study. Patients who underwent a biopsy or an interventional procedure before the MRI examination and who received neoadjuvant chemotherapy were excluded from the study. Abbreviated MR protocol included a pre-contrast T1-weighted, 1st minute contrast-enhanced T1-weighted, and 1st minute subtracted series. Additionally, 2nd minute post-contrast series were evaluated. Results: A total of 83 lesions with a histologic diagnosis of breast cancer were evaluated in 81 patients. The mean age of the patients included in the study was 51.08 years (range: 27-79 years). Seventy-four of the 83 breast lesions showed contrast enhancement in the 1st minute contrast-enhanced images and subtraction images (sensitivity 89.1%). When missed cases were re-evaluated all of them were visible in the second-minute contrast-enhanced series. Conclusions: In this study, malignant lesions could be detected with high-sensitivity abbreviated MRI protocol and the addition of second-minute contrast-enhanced series to the protocol significantly improve lesion detection. We believe that MRI with the abbreviated MRI protocol can be used for screening purposes in high-risk women with dense breasts.

Purpose The aim of the study is to compare prone with supine breast magnetic resonance imaging (MRI) in terms of breast tumor location, size, shape, and tumor-to-tumor distances in multifocal lesions to improve image-based guidance for surgical planning. Methods A retrospective analysis was conducted on 75 lesions in 50 patients with pathologically proven breast cancer who underwent MRI in prone and supine positions between December 2019 and December 2020. The transverse, anteroposterior, and craniocaudal dimensions (in millimeters) of the tumor in the x-, y-, and z-axes were measured. Distances from the center of the tumor to the chest wall and the adjacent skin were measured on transverse and reformatted sagittal images. In cases where multifocal lesions were present, the transverse, anteroposterior, and craniocaudal distances between the tumor centers in the x-, y-, and z-axes were measured. Differences between measurements in supine and prone MRI were evaluated with the Mann-Whitney U and the Wilcoxon tests. P values of less than 0.05 were considered to indicate a statistically significant difference. Results The analysis revealed 31 MRIs with 1 and 20 with multifocal lesions. The x-axis dimension of the lesions in prone and supine positions did not significantly differ (P = 0.198) between the 2 positions. A significant difference in the y- and z-axes dimensions was observed between the prone and supine position (P = 0.00 for both). The distance from the tumor to the chest wall and the adjacent skin showed significant difference (P = 0.00 for both). For multifocal lesions, the distance between the lesions showed a significant difference on the y-axis (P = 0.00). Conclusions This study showed a significant difference in the tumor size, location, and tumor-to-tumor distances due to change of patient position, from the standard prone MRI to the supine position in the operating room, resulting in distortion, spatial repositioning, and convergence of the lesions. Supine MRI may be considered in providing a less extensive surgery.

Objectives: To provide demographical and pathological characteristics of breast cancer patients diagnosed in a tertiary clinic with opportunistic screening and diagnostic workup and compare the results with the available national and global breast cancer statistics.Methods: Clinical and pathological data of breast cancer patients diagnosed in our tertiary breast clinic between March 14, 2017 and February 28, 2020 have been entered into a database and analyzed retrospectively. Results were analyzed and compared with the national and global statistics.Results: The total number of patients included in this study were 137 and the number of tumors was 145. Sixty-four (46.7%) patients were detected in screening. All of the patients were female. The mean age was 51.8 years. Eighteen (13.1%) patients were young females (< 40 years), 55 (40.1%) were in 40-49 years, 26 (18.9%) in 50-59 years, 24 (17.5%) in > 60-69 years, 14 (10.2%) in > 70 years. Of the invasive cancers, 100 (79.4%) were invasive ductal, 15 (11.9%) invasive lobular, 6 (4.8%) pleomorphic lobular, 4 (3.2%) papillary, and 1 (0.8%) tubular cancer. Distribution of stages were: 13.1% stage 0, 38.6% stage I, 29.6% stage II, 10.3% stage III, and 8.2% stage IV. The mean tumor diameter was 26.6 mm. Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER-2) were positive in 82.5%, 61.9% and 15.8% of the tumors respectively.Conclusions: Results of this study are in accordance with the latest results of the National Breast cancer database, a project governed by the Turkish Federation of Breast Disease Societies (TMHDF), considering the tumor size, age distribution, histologic subtype analysis, receptor status. However, the percentage of early-stage tumors was higher in this study.