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Li-Fraumeni syndrome (LFS) is an inherited autosomal-dominant tumor-predisposition disorder caused by germline mutations in the TP53 tumor suppressor gene. Since patients with LFS are likely to develop therapy-related cancers, radiation therapy should be avoided if breast cancer is found in these individuals. Herein, we present a case of secondary breast cancer in an LFS patient after radiation and chemotherapy for the first diagnosed breast sarcoma.

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Male breast cancer is rare, accounting for approximately 1% of breast cancers. Metastasis from extra-mammary malignancy to the breast in men is extremely rare. The most common primary tumors that metastasize to the breast in male are prostate, lung, stomach, colorectal cancer, melanoma, and sarcoma. To our knowledge, only a few cases of bladder cancer presenting with metastasis to the male breast have been reported, and metastasis with infiltration rather than mass is extremely rare. We report imaging findings on mammography and ultrasonography in a 59-year-old male with bladder cancer metastatic to the breast.

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Purpose: The purpose of our study was to evaluate digital breast tomosynthesis as a breast cancer screening modality for women with gynecologic cancer. Materials and Methods: This retrospective study included patients with underlying gynecologic malignancies who underwent screening digital breast tomosynthesis for breast cancer. The cancer detection rate, recall rate, sensitivity, specificity, and positive predictive value (PPV) were calculated. PPV1 was defined as the percentage of all positive screening exams that have a tissue diagnosis of cancer within a year. PPV2 was defined as the percentage of all diagnostic exams (and Breast Imaging Reporting and Data System category 4, 5 from screening setting) with a recommendation for tissue diagnosis that have cancer within a year. PPV3 was defined as the percentage of all known biopsies actually performed that resulted in a tissue diagnosis of cancer within the year. For each case of screen-detected cancer, we analyzed the age, type of underlying gynecologic malignancy, breast density, imaging features, final Breast Imaging Reporting and Data System assessment, histologic type, T and N stages, molecular subtype, and Ki-67 index. Results: Among 508 patients, 7 with breast cancer were identified after a positive result. The cancer detection rate was 13.8 per 1000 screening exams, and the recall rate was 17.9%. The sensitivity was 100%, and the specificity was 83.2%. The false negative rate was 0 per 1000 exams. The PPV1, PPV2, and PPV3 were 7.7, 31.8, and 31.8, respectively. Conclusion: Digital breast tomosynthesis may be a promising breast cancer screening modality for women with gynecologic cancer, based on the high cancer detection rate, high sensitivity, high PPV, and high detection rate of early-stage cancer observed in our study.

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BACKGROUND: Soft tissue calcification is common in patients with secondary hyperparathyroidism who have received long-term treatment with hemodialysis. However, calcifications in the breast parenchyma are not common. We report a case of a woman with dystrophic breast calcifications from secondary hyperparathyroidism. CASE REPORT: A 65-year-old woman presented with a palpable mass in her right breast which she had discovered 1 month ago. She had a medical history of end-stage renal disease. Mammography and ultrasound revealed large dystrophic calcifications in both breasts. Core needle biopsy was performed for calcifications in the right breast, and the pathologic diagnosis was dystrophic calcification in the stroma from secondary hyperparathyroidism. CONCLUSION: Reviewing our case will contribute to a fast and correct diagnosis in patients with dystrophic breast calcifications and lab results indicating secondary hyperparathyroidism, and will help discriminate these benign lesions from malignancies.

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Purpose To investigate the value of the combined use of elastography and color Doppler ultrasonography (US) with B-mode US for evaluation of screening US-detected breast masses in women with dense breasts. Materials and Methods This prospective, multicenter study included asymptomatic women with dense breasts who were referred for screening US between November 2013 and December 2014. Eligible women had a newly detected breast mass at conventional B-mode US screening, for which elastography and color Doppler US were performed. The following outcome measures were compared between B-mode US and the combination of B-mode US, elastography, and color Doppler US: area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), and the number of false-positive findings at screening US. Results Among 1021 breast masses (mean size, 1.0 cm; range, 0.3-3.0 cm) in 1021 women (median age, 45 years), 68 were malignant (56 invasive). Addition of elastography and color Doppler US to B-mode US increased the AUC from 0.87 (95% confidence interval [CI]: 0.82, 0.91) to 0.96 (95% CI: 0.95, 0.98; P < .001); specificity from 27.0% (95% CI: 24.2%, 29.9%) to 76.4% (95% CI: 73.6%, 79.1%; P < .001) without loss in sensitivity (95% CI: -1.5%, 1.5%; P > .999); and PPV from 8.9% (95% CI: 7.0%, 11.2%) to 23.2% (95% CI: 18.5%, 28.5%; P < .001), while avoiding 67.7% (471 of 696) of unnecessary biopsies for nonmalignant lesions. Conclusion Addition of elastography and color Doppler US to B-mode US can increase the PPV of screening US in women with dense breasts while reducing the number of false-positive findings without missing cancers. © RSNA, 2017 Online supplemental material is available for this article.

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PURPOSE: The purpose of this study is to compare the visibility of microcalcifications of digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) using breast specimens. MATERIALS AND METHODS: Thirty-one specimens' DBT and FFDM were retrospectively reviewed by four readers. RESULTS: The image quality of microcalcifications of DBT was rated as superior or equivalent in 71.0% by reader 1, 67.8% by reader 2, 64.5% by reader 3, and 80.6% by reader 4. The Fleiss kappa statistic for agreement among readers was 0.31. CONCLUSIONS: We suggest that image quality of DBT appears to be comparable with or better than FFDM in terms of revealing microcalcifications.

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OBJECTIVE: To evaluate the diagnostic performance of shear-wave elastography (SWE) for the differential diagnosis of breast papillary lesions. METHODS: This study was an institutional review board-approved retrospective study, with a waiver of informed consent. A total of 79 breast papillary lesions in 71 consecutive women underwent ultrasound and SWE prior to biopsy. Ultrasound features and quantitative SWE parameters were recorded for each lesion. All lesions were surgically excised or excised using an ultrasound-guided vacuum-assisted method. The diagnostic performances of the quantitative SWE parameters were compared using the area under the receiver operating characteristic curve (AUC). RESULTS: Of the 79 lesions, six (7.6%) were malignant and 12 (15.2%) were atypical. Orientation, margin, and the final BI-RADS ultrasound assessments were significantly different for the papillary lesions (p < 0.05). All qualitative SWE parameters were significantly different (p < 0.05). The AUC values for SWE parameters of benign and atypical or malignant papillary lesions ranged from 0.707 to 0.757 (sensitivity, 44.4-94.4%; specificity, 42.6-88.5%). The maximum elasticity and the mean elasticity showed the highest AUC (0.757) to differentiate papillary lesions. CONCLUSION: SWE provides additional information for the differential diagnosis of breast papillary lesions. Quantitative SWE features were helpful to differentiate breast papillary lesions.

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PURPOSE: To evaluate the diagnostic performances of preoperative 3-T breast MRI for predicting nipple-areolar complex (NAC) involvement. MATERIALS AND METHODS: We analyzed the predictors of NAC involvement in breast cancer, with diagnostic performances. RESULTS: Among the 403 patients, 43 cases were surgically confirmed for NAC involvement. For predicting NAC involvement, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 60.5%, 87.5%, 36.6%, 94.9%, and 84.6%, respectively. Continuity to NAC, unilateral enhancement of NAC and thickening of NAC were significant magnetic resonance findings predictive of NAC involvement. CONCLUSIONS: Preoperative 3-T breast MRI is a useful method to predict NAC involvement in breast cancer patients.

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PURPOSE: To compare the diagnostic performances of digital breast tomosynthesis (DBT) and ultrasound for the dense breasts with category 0 at conventional digital mammography. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board, and informed consent was waived. Among the 1103 patients who underwent screening digital mammography at our institution, 769 (69.7%) patients had dense breasts. Of the 769 patients, 229 (29.8%) lesions were categorized as 0. DBT, breast ultrasound and digital mammography were performed in 108 (47.2%) patients. BI-RADS final assessments for DBT and ultrasound were recorded. Categories 1-3 were clinically considered as benign, and categories 4 and 5 were clinically considered as malignant. The diagnostic performances of breast ultrasound and DBT were correlated with final pathologic reports or follow-up images. RESULTS: Among 108 lesions, 17 (15.7%) were malignant and 91 (84.3%) were benign. Sensitivity was 100% for both ultrasound (17/17) and DBT (17/17) and negative predictive value was also 100% for both ultrasound (49/49) and DBT (74/74). Specificity and positive predictive value for ultrasound were 53.9% (49/91) and 28.8% (17/59), respectively. Specificity and positive predictive value for DBT were 81.3% (74/91) and 50% (17/34), respectively. DBT showed higher diagnostic accuracy than that of breast ultrasound (DBT: 84.3%, 91/108; ultrasound: 61.1%, 66/108; p<0.001). The benign biopsy rate of DBT (50%, 17/34) was lower than that of ultrasound (71.2%, 42/59). CONCLUSION: DBT showed better diagnostic performance than breast ultrasound for dense breasts with category 0. DBT may reduce the benign biopsy rate and short term follow-up.

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OBJECTIVE: To evaluate the additional role of shear-wave elastography (SWE) in differential diagnosis of complex cystic and solid breast lesions. MATERIALS AND METHODS: From January 2013 to November 2013, 140 complex cystic and solid breast lesions from 139 consecutive patients were performed ultrasound and SWE prior to biopsy. BI-RADS ultrasound final assessment and SWE parameters were recorded for each lesion. Histopathologic diagnosis was used as the reference standard. RESULTS: Among the 140 lesions, 30 lesions (21.4%) were malignant. The mean maximum elasticity (Emax) of malignant lesions (184.3 kPa) was significantly higher than that of benign lesions (45.5 kPa) (P<0.001). Homogeneity of elasticity and color pattern were significantly different from malignancy and benign lesions (P<0.05). Emax with cutoff value at 108.5 kPa showed Az value of 0.968 (95% CI, 0.932-0.985) with sensitivity of 86.7% and specificity of 97.3%. Using this cutoff value, false-positive rate was 2.7% and false-negative rate was 13.3%. By applying an Emax value of 108.5 kPa or less as a criterion for downgrading BI-RADS category 4a lesions to category 3 lesions, 103/123 (83.7%) lesions could be downgraded to category 3 lesions. CONCLUSION: Additional use of SWE could reduce unnecessary benign biopsies in complex cystic and solid breast lesions.

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BACKGROUND: Reduction mammoplasty and mastopexy (breast lift surgery) are becoming increasingly common procedures. Knowledge of characteristic mammographic findings and imaging findings of breast cancer are important to interpret mammography in this population. METHODS: Patients undergoing a mammography examination between March 2006 and March 2012 were consecutively included. Seventy mammography examinations in 39 patients after reduction mammoplasty and 22 mammography examinations in 19 patients after mastopexy were reviewed and analyzed retrospectively. We compared the frequency of each characteristic mammographic finding between reduction mammoplasty and mastopexy. We also analyzed imaging findings of breast cancer in this population. RESULTS: The most frequent mammographic finding of the reduction mammoplasty was nipple elevation (84.3 %). Other findings included retraction of the lower breast (80 %), thickening of the skin (78.6 %), downward shifting of the glandular tissue (47.1 %), retroareolar fibrotic band (42.9 %), and areolar skin calcification or lipid cyst (35.7 %). The most frequent mammographic finding of mastopexy was thickening of the skin (72.7 %). Other mastopexy findings included elevation of nipple (68.2 %), areolar skin calcification or lipid cyst (36.4 %), retraction of lower position (31.8 %), and retroareolar fibrotic band (31.8 %). Downward shifting of glandular tissue and retraction of the lower portion have statistically lower frequency in mastopexy cases (P < 0.05). Two breast cancers were diagnosed in reduction mammoplasty cases. One was missed and one was detected but difficult to diagnose using mammography. CONCLUSION: Although mammography alone is not sufficient for breast screening after reduction mammoplasty, it may be possible to use mammography for postoperative follow-up after mastopexy only. So, operators should recognize that after reduction mammoplasty it will be hard to detect early breast cancer.

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BACKGROUND: The aim of this paper is to evaluate the ultrasonographic features of spontaneous breast tumor infarction. METHODS: The pathologic information system database of the Department of Radiology was retrospectively searched. Between 2009 and 2011, nine cases in eight patients were pathologically confirmed as spontaneous breast tumor infarctions. Mammographic images and the ultrasonographic images were acquired. Two other radiologists analyzed the mammographic and ultrasonographic findings. RESULTS: Most common features were oval, indistinct, heterogeneously hypoechoic mass with posterior enhancement. All lesions were classified as C4 (suspicious finding) except one case. CONCLUSION: Spontaneous breast tumor infarction should be included in the differential diagnoses of hetereogeneously hypoechoic suspicious solid lesions mimicking malignancy.

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BACKGROUND: To evaluate the location of tumor relapse and imaging modality for detection according to the breast cancer subtype: luminal A, luminal B, HER2 positive luminal B, nonluminal HER2 positive, and triple negative. MATERIALS AND METHODS: A total of 1244 patients with breast cancer with known estrogen receptor (ER), progesterone receptor (PR), Ki-67 and human epidermal growth factor receptor 2 (HER2), who underwent breast surgery from 2009 to 2012 were analyzed. Patients were classified into the following categories: luminal A (n=458), luminal B (n=241), HER2 positive luminal B (n=227), nonluminal HER2 positive (n=145) and triple negative (n=173). A total of 105 cases of relapse were detected in 102 patients: locoregional recurrence (n=46), recurrence in the contralateral breast (n=28) and distant metastasis (n=31). Comparison of proportions was used to determine the difference between subtypes. RESULTS: Relapse rates by subtypes are as follows: luminal A 23 of 458 (5.02%), luminal B 19 of 241 (7.88%), HER2 positive luminal B 15 of 227 (6.61%), nonluminal HER2 postive 19 of 145 (13.10%) and triple negative 29 of 173 (16.76%). Luminal A tumors had the lowest rate of recurrence and had significantly lower recurrence rate in comparison with nonluminal HER2 postive (p=0.0017) and triple negative subtypes (p<0.0001). Compared with all other subtypes except nonluminal HER2 positive, triple negative tumors had the highest rate of tumor recurrence (p<0.01). Triple negatives were most likely to develop contralateral recurrence against all subtypes (p<0.05). Detection rate of locoregional and contralateral tumor recurrence were 28.3% on mammography (n=17/60). CONCLUSIONS: Luminal A tumors are associated with a low risk of recurrence while triple negative lesions have a high risk. In case of triple negative tumors, the contralateral breast has much more recurrence as compared with all other subtype. In terms of detection rates, breast USG was the best modality for detecting tumor recurrence, compared with other modalities (p<0.05). Subtyping of breast tumors using a molecular gene expression panel can identify patients who have increased risk of recurrence and allow prediction of locations of tumor recurrence for each subtype.

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BACKGROUND: The computer-aided detection (CAD) system on mammography has the potential to assist radiologists in breast cancer screening. The purpose of this study is to evaluate the diagnostic performance of the CAD system in full-field digital mammography for detecting breast cancer when used by dedicated breast radiologist (BR) and radiology resident (RR), and to reveal who could benefit the most from a CAD application. METHODS: We retrospectively chose 100 image sets from mammographies performed with CAD between June 2008 and June 2010. Thirty masses (15 benign and 15 malignant), 30 microcalcifications (15 benign and 15 malignant), and 40 normal mammography images were included. The participating radiologists consisted of 7 BRs and 13 RRs. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for total, normal plus microcalcification and normal plus mass both with and without CAD use for each reader. We compared the diagnostic performance values obtained with and without CAD use for the BR and RR groups, respectively. The reading time reviewing one set of 100 images and time reduction with CAD use for the BR and RR groups were also evaluated. RESULTS: The diagnostic performance was generally higher in the BR group than in the RR group. Sensitivity improved with CAD use in the BR and RR groups (from 81.10 to 84.29% for BR; 75.38 to 77.95% for RR). A tendency for improvement in all diagnostic performance values was observed in the BR group, whereas in the RR group, sensitivity improved but specificity, PPV, and NPV did not. None of the diagnostic performance parameters were significantly different. The mean reading time was shortened with CAD use in both the BR and RR groups (111.6 minutes to 94.3 minutes for BR; 135.5 minutes to 109.8 minutes for RR). The mean time reduction was higher for the RR than that in the BR group. CONCLUSIONS: CAD was helpful for dedicated BRs to improve their diagnostic performance and for RRs to improve the sensitivity in a screening setting. CAD could be essential for radiologists by decreasing reading time without decreasing diagnostic performance.

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Ultrasound (US) elastography is a valuable imaging technique for tissue characterization. Two main types of elastography, strain and shear-wave, are commonly used to image breast tissue. The use of elastography is expected to increase, particularly with the increased use of US for breast screening. Recently, the US elastographic features of breast masses have been incorporated into the 2nd edition of the Breast Imaging Reporting and Data System (BI-RADS) US lexicon as associated findings. This review suggests practical guidelines for breast US elastography in consensus with the Korean Breast Elastography Study Group, which was formed in August 2013 to perform a multicenter prospective study on the use of elastography for US breast screening. This article is focused on the role of elastography in combination with B-mode US for the evaluation of breast masses. Practical tips for adequate data acquisition and the interpretation of elastography results are also presented.

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BACKGROUND: While many studies have shown that hormones can influence background parenchymal enhancement (BPE) in breast magnetic resonance imaging (MRI), only few have directly address the effect of radiotherapy. The purpose of this study was to evaluate the impact of radiotherapy on BPE in breast MRI. MATERIALS AND METHODS: A retrospective search identified 62 women with unilateral breast cancer who had a breast MRI both before and after radiotherapy following breast-conserving surgery. In our study, we assumed that systemic therapy affected both breasts equivalently. We rated the level of BPE of both breasts using a four- point categorical scale. A change in the level of BPE prior to and after treatment was compared in the diseased and contralateral breasts. RESULTS: All patients received a 4256 to 6480 cGy dose of whole breast radiotherapy over 3-7 weeks. The mean timing of the follow-up study was 6.6 months after completion of radiotherapy. Although the BPE showed a decrease in both breasts after treatment, there was a significant reduction of BPE in the irradiated breast compared with the contralateral breast (1.18 versus 0.98 average reduction in BPE level, p=0.042). CONCLUSIONS: Radiotherapy is associated with decrease in BPE with MRI.

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BACKGROUND: Early detection of breast cancer reduces mortality. Therefore, diagnosis of ductal carcinoma in situ (DCIS) is important. PURPOSE: To compare the sensitivities of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and breast-specific gamma imaging (BSGI) in pathologically proven calcified and non-calcified DCIS. MATERIAL AND METHODS: Thirty-five patients with pathologically diagnosed DCIS from 1 June 2009 through 31 December 2011, underwent a protocol involving both breast MRI and BSGI. Each image was assessed by a separate dedicated breast radiologist. All lesions were divided into two groups; with or without microcalcifications on mammograms. In cases without microcalcifications, we recorded the mass, asymmetry, or negative findings on mammography. On MRI, the enhancement pattern was categorized as mass or non-mass-like enhancement. On BSGI, the uptake pattern was analyzed. The histopathological features of the lesions were obtained. Statistical analysis of the sensitivity of each modality was performed using McNemar's test. RESULTS: Thirty-five women with a mean age of 48 years (range, 26-69 years) were enrolled in the study. The total sensitivities of MRI and BSGI in the 35 cases were 91.4% (32 of 35 DCIS) and 68.6% (24 of 35 DCIS), respectively. Eighteen cases with DCIS displayed microcalcifications on mammography, while 17 cases did not. Of these 17 cases without microcalcifications on mammography, 88.2% (15 of 17 DCIS) were detected by MRI and 52.9% (9 of 17 DCIS) by BSGI. Of 18 cases with microcalcifications on mammography, 94.4% (17 of 18 DCIS) were detected by MRI and 83.3% (15 of 19 DCIS) by BSGI. CONCLUSION: MRI showed a higher sensitivity for the detection of calcified and non-calcified DCIS and is more helpful than BSGI in cases without microcalcifications on mammography.

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PURPOSE: The purpose of this study was to categorize the morphologic and kinetic features of enhancing lesions in breasts with interstitial mammoplasty using dynamic contrast-enhanced magnetic resonance imaging and to assess factors predictive of breast cancer. MATERIALS AND METHODS: We retrospectively reviewed the clinical and radiological data of 21 enhancing lesions in 19 patients with interstitial mammoplasty, who underwent breast magnetic resonance imaging and biopsy or an operation in our hospital from September 2008 to July 2012. These lesions were sorted by morphological and kinetic features and final assessment category according to the BI-RADS lexicon. RESULTS: Nine cases were confirmed to be ductal carcinoma in situ (n = 2) and invasive ductal carcinoma (n = 7), and the remaining 12 cases were fibrocystic disease (n = 2), fibroadenoma (n = 2), fat necrosis (n = 1), foreign body granuloma (n = 3) and silicone mastitis (n = 1). Common features of malignancy included irregular shape (50.0%), spiculated margins (75.0%), heterogeneous enhancement (50.0%) and type III kinetic pattern (87.5%). The correlations of margins and kinetic curve pattern with benignity and malignancy approached statistical significance (p = 0.02, respectively). We found no correlation for shape (p = 0.33) or internal enhancement (p = 0.42) between lesion types. The malignancy rate of enhancing lesions was 42.8% (9/21). The sensitivity and specificity of dynamic contrast-enhanced magnetic resonance imaging were 100% and 16.67%, respectively. The positive predictive value, negative predictive value and accuracy of magnetic resonance imaging were 47.38%, 100% and 52.38%. Overall inter-observer agreement for the kinetic curve pattern was good (κ = 0.67). Moderate agreement was seen in describing the shape, margin, enhancement and assessing the final category (κ = 0.59, 0.46, 0.58 and 0.49, respectively). CONCLUSION: Dynamic contrast-enhanced magnetic resonance imaging had a high sensitivity, negative predictive value for the prediction of breast cancer but a low specificity due to features of foreign body-related lesions that mimicked malignant lesions. The significant predictive factors for malignancy were margins, kinetic curve pattern and final assessment category. Overall inter-observer agreement for the kinetic curve pattern was good.

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Post-transplantation lymphoproliferative disorders (PTLDs) are a heterogeneous group of diseases that represent serious complications following immunosuppressive therapy for solid organ or hematopoietic-cell recipients. In contrast to B-cell PTLD, T-cell PTLD is less frequent and is not usually associated with Epstein Barr Virus infection. Moreover, to our knowledge, isolated T-cell PTLD involving the breast is extremely rare and this condition has never been reported previously in the literature. Herein, we report a rare case of isolated T-cell PTLD of the breast that occurred after a patient had been treated for allogeneic peripheral blood stem cell transplantation due to acute myeloblastic leukemia.

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OBJECTIVE: The aim of this study is to evaluate the clinical characteristics and ultrasonographic findings of band-like interposing fat as well as to identify additional approaches for its diagnosis. MATERIALS AND METHODS: This study included 26 confirmed cases of band-like interposing fat from June 2008 to June 2010. A retrospective analysis was performed to evaluate the clinical characteristics and ultrasonographic findings in these cases. Five radiologists analyzed the ultrasonographic findings, which correlated with the mammographic and MRI findings when available, according to Breast Imaging Reporting and Data System classification. RESULTS: None of the 26 patients had any symptoms. In 92.3% of the patients, the lesion was located in the upper outer quadrant of the breast. The mean distance of the lesion from the nipple was 2.4 ± 0.7 cm (1.1-4.5). The mean depth of the lesion from the skin was 1.3 ± 0.3 cm (0.8-2.1). The mean maximal length of the lesion was 0.8 ± 0.4 cm (0.3-1.8). The following were the most frequent ultrasonographic findings of lesions: irregular shape, not parallel orientation, indistinct margins, abrupt interface, hypoechogenicity, no posterior feature, no calcification, and presence of vascularity. The most frequent BI-RADS category was 4a. There were no suspicious findings on the mammography or MRI. CONCLUSION: Ultrasonographic findings may lead to misclassification of band-like interposing fat as a malignancy. A better understanding of the clinical and ultrasonographic characteristics of band-like interposing fat would facilitate its differentiation from a true mass.

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