Scientific Session 1 â Breast Imaging: Mammography

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Scientific Session 6—Breast Imaging: Interventional ProceduresMondaytion with radiologists recommending biopsy was significantly associatedwith higher levels of prebiopsy anxiety (r = –0.48, p = 0.01). Prebiopsyanxiety was not associated with patient sociodemographic characteristics,history of anxiety or depression, or recommending radiologist’slevel of experience. Following biopsy, women’s anxiety significantlydecreased (paired t = –5.94, p < 0.001). Better communication with radiologistsperforming biopsy (mean ± SD = 61.1 ± 5.4; range, 49–65) wasassociated with lower postbiopsy anxiety (r = –0.40, p = 0.04). Biopsiesperformed by a resident or fellow with the attending radiologist trendedtoward greater anxiety postbiopsy (r = 0.30, p = 0.12).Conclusion: Patient perception of poorer communication with radiologistswas associated with higher levels of anxiety before and after breast biopsy.These results highlight the importance of patient-radiologist communication.045. Radioactive Seed Localization of Nonpalpable Breast Lesions:Initial ExperienceWynn, R. 1 *; Rao, R. 1 ; Evans, W. 1 ; Liberman, L. 2 1. University of TexasSouthwestern, Dallas, TX; 2. Memorial Sloan-Kettering Cancer Center,New York, NYAddress correspondence to R. Wynn (ralph.wynn@utsouthwestern.edu)Objective: To evaluate performance and success of preoperative 125 I radioactiveseed localization (RSL) as an alternative to wire localization fornonpalpable breast lesions.Materials and Methods: In compliance with HIPAA, we retrospectivelyreviewed records of preoperative RSLs at our center from January 2010through September 2010. RSLs were performed by placing 125 I-containingradioactive titanium seeds under mammographic or ultrasound guidance.Medical records were reviewed to assess needle biopsy (NB) history,NB/surgical pathology, seed retrieval, and complications. Preoperative,RSL, and specimen images were reviewed to identify imaging targets.Data were recorded in a spreadsheet and 95% CI calculated.Results: Sixty-six lesions in 56 patients had RSL. Fifty-nine (89%) of 66 lesionshad prior NB, with a clip placed in 37 (63%). Guidance for RSL wasultrasound in 34 of 66 (52%) and mammography in 32 (48%). Imaging targetwas mass in 37 (56%; 15 with clip); calcifications in 12 (18%, 6 with clip);clip only in 16 (24%), and hematoma in one (2%). Specimen radiographsconfirmed lesion retrieval in 65 cases with discrete imaging targets; in onetargeted hematoma, NB and surgical pathology were concordant, with NBchanges in surgical specimen. In 59 lesions that had NB, NB and surgical pathologywere concordant in 50 (85%; benign in 10, high risk in 11, and cancerin 29). The remaining nine lesions (15%) included two high-risk lesions upgradedto ductal carcinoma in situ (DCIS) at surgery, one high-risk lesion withbenign findings at surgery, and six cancers removed at NB with no residualcancer at surgery. In these nine cases, specimen radiographs confirmed imagingtarget retrieval and NB histology changes were seen in surgical specimens.All 66 localized lesions were successfully excised; lesion retrieval ratewas 100% (95% CI, 95–100%). Final histology in 66 lesions was benign in13 (20%), high risk in 13 (20%), and cancer in 40 (60%; 26 invasive and 14DCIS). All seeds were retrieved for disposal by radiation safety personnel. Nocomplications occurred; complication rate was 0% (95% CI, 0–5%).Conclusion: RSL can be a safe, successful alternative to preoperativewire localization for nonpalpable breast lesions, even during an institution’searly experience. In our initial study, we found 100% lesion retrieval,100% seed retrieval, and no complications.046. Excisional Biopsy Upgrade Rate of Lobular NeoplasiaDiagnosed on Breast Core BiopsyNiell, B.*; Specht, M.; Gerade, B.; Rafferty, E. Massachusetts GeneralHospital, Boston, MAAddress correspondence to B. Niell (bniell@partners.org)Objective: The appropriate management of lobular neoplasia identifiedon percutaneous core biopsies remains controversial. Published upgraderates following surgical excision range from 1% to 28%, depending uponthe adequacy of percutaneous sampling, radiologic-pathologic concordance,and potential confounding factors that may influence the selectionof patients undergoing surgical excision at centers in which excisionalbiopsy of lobular neoplasia is not routinely performed.Materials and Methods: Our study retrospectively identified patients fromDecember 2005 to March 2010 with lobular neoplasia (atypical lobular neoplasiaor lobular carcinoma in situ) as the highest risk lesion on core biopsy.Per institutional policy, surgical excision was recommended for each patient.An upgrade from the core biopsy result of lobular neoplasia was defined as excisionalbiopsy pathology that demonstrated ductal carcinoma in situ (DCIS),invasive ductal carcinoma (IDC), or invasive lobular carcinoma (ILC).Results: Between November 2005 and March 2010, 4276 percutaneousbreast biopsies were performed, with 52 patients (1.2%) demonstratinglobular neoplasia as the highest risk lesion on core biopsy. Of those 52patients, 48 patients (92%) underwent surgical excision. Overall upgraderate on excisional biopsy was 16.7% (eight of 48 patients), with the highestrisk lesion on excisional biopsy pathology as follows: DCIS (two of48 patients, 4.2%), IDC (two of 48 patients, 4.2%), and ILC (four of 48patients, 8.3%). Pleomorphic lobular carcinoma in situ (LCIS) or LCISwith necrosis on core biopsy accounted for two of the four patients upgradedto ILC on excisional biopsy. After excluding patients with discordantradiologic-pathologic results on core biopsy, the upgrade rate ofexcisional biopsy was 12% (5 of 42 patients).Conclusion: Lobular neoplasia on core biopsy warrants routine recommendationof excisional biopsy given the high upgrade rate to DCIS,IDC, or ILC. To our knowledge, this is the first study evaluating the upgraderate of lobular neoplasia in which all patients with a core biopsyresult of lobular neoplasia were referred for excisional biopsy. Our studymay therefore be less prone to the potential bias in the existing literaturewherein only subsets of patients were referred for excision due toradiologic-pathologic discordance, other high-risk lesions on core biopsypathology, or other potential confounders.047. Outcome at Surgical Excision of Biopsy-Proven LobularNeoplasia: Is There Any Difference Between Lobular Carcinoma InSitu and Atypical Lobular Hyperplasia?Bessissow, A. 1 *; Ibrahim, N. 1 ; El Khoury, M. 2 ; Lalonde, L. 2 ; Mesurolle,B. 1 ; Trop, I. 2 ; Lisbona, A. 3 1. McGill University Health Center,Montreal, Canada; 2. Centre Hospitalier Universitaire de Montréal,Montreal, Canada; 3. Jewish General Hospital, Montreal, CanadaAddress correspondence to M. El Khoury (elkhourymona@yahoo.fr)A18*Will present paper
MondayScientific Session 6—Breast Imaging: Interventional ProceduresObjective: To evaluate the outcome of biopsy proven lobular neoplasia.Materials and Methods: Multiinstitutional retrospective review of allpercutaneous breast biopsies performed between 2000 and 2008 yielded126 patients with a lobular neoplasia lesion as the highest risk lesion. Thebiopsy was performed with a 14-gauge core needle in four patients and avacuum-assisted device in 122 patients of which 65 were with a 14-gaugeneedle and 57 with an 11-gauge needle. The 126 patients were dividedinto groups depending on the biopsy results: lobular carcinoma in situ(61/126, 48.4%), atypical lobular hyperplasia (56/126, 44.4%), or both(9/126, 7.1%). Of these, 89 of 126 (70.6%) patients underwent surgery,among them 43 patients with LCIS lesions, 40 patients with ALH and sixwith both LCIS and ALH lesions. Results were compared with histologicfindings at surgery or mammographic follow-up.Results: Microcalcifications were the most frequent mammographic presentationfound in 106/126 (84.1%) patients, followed by architectural distortions(17/126; 13.5%) and masses (3/126; 2.4%). Of the 43 LCIS lesionsexcised, 17 of 43 (39.5%) were upgraded either to ductal carcinoma in situ(DCIS) (six of 43 [13.9%]), invasive lobular carcinoma (ILC) (10 of 43[23.2%]), or invasive ductal carcinoma (IDC) (one of 43 [2.3%]). Elevenof 40 (27.5%) ALH lesions excised were upgraded either to DCIS (7/40[17.5%]), ILC (3/40 [7.5%]), or IDC (1/40 [2.5%]). Two of six of combinedLCIS and ALH lesions were upgraded to DCIS (22.2%). Of the 37 patientswho did not have surgery, 16 were lost to follow-up and the remaining 22lesions remained stable at mammographic follow-up. Upgrade to malignancywas more frequent when the biopsy was performed with 14-gaugeneedles (21/69 [30.4%]) compared with 11-gauge (9/57 [15.7%]).Conclusion: Underestimation of malignancy may occur when lobularneoplasia is found on percutaneous biopsies. Subsequent surgical excisionis indicated for all these lesions even if only atypical lobular hyperplasiawas the highest risk lesion found.048. Breast Dynamic Contrast-Enhanced MRI: The Influence ofPostcontrast Scan Duration on Assessment of Delayed Phase LesionKineticsWieseler, K.M. 1 *; Partridge, S.C. 2 ; Gutierrez, R. 2 ; Strigel, R. 1 ; Peacock,S. 2 ; Lehman, C. 2 1. University of Washington, Seattle, WA; 2. SeattleCancer Care Alliance, Seattle, WAAddress correspondence to K. Wieseler (kmw116@uw.edu)Objective: Breast dynamic contrast-enhanced (DCE) MRI scanning protocolsvary widely, with little consensus on the appropriate temporal resolutionor minimum length of postcontrast scanning. The purpose of thisstudy was to compare delayed-phase lesion kinetics using postcontrastscan durations of 4.5 and 7.5 minutes.Materials and Methods: Following institutional review board approval,a retrospective review was performed on 103 consecutive breast lesions(BI-RADS 3, 4, 5, or 6) identified in 93 women from April 2004to October 2005. All subjects underwent DCE MRI with 90-secondtemporal resolution and five postcontrast timepoints. Delayed-phase lesionkinetics were assessed using computer-aided evaluation software.Percentages of persistent, plateau, and washout enhancement within eachlesion were compared between 4.5 and 7.5 minutes after contrast injectionby paired t test. Delayed phase kinetic assessments of predominantcurve type (single curve type constituting the largest percentage of thelesion; washout, plateau, or persistent enhancement) and worst lookingcurve (single most suspicious kinetic type) were compared by chi-squareand Fisher exact test, respectively.Results: The study included 74 malignant and 29 benign lesions. At 7.5minutes, there was a significant increase in the percentage of washout enhancementcompared to 4.5 minutes, both for benign (mean, +5%, p = 0.01)and malignant (mean, +11%, p < 0.0001) lesions. The predominant curvetype assessment changed significantly between the 4.5- and 7.5-minute timepoints for malignant lesions only (p = 0.0004), with 18 of 74 malignanciesexhibiting a shift from plateau to washout as the predominant curve type.There were no significant differences between time points in worst curve assessmentsfor either benign (p = 0.46) or malignant lesions (p = 0.23).Conclusion: Changing the final postcontrast time point for evaluationof breast lesions produced significant differences in delayed phase enhancementpatterns. A greater number of malignancies demonstrated apredominantly washout pattern at 7.5 minutes than at 4.5 minutes aftercontrast injection.049. Outcome of Radial Scars Diagnosed at MRI-Guided Vacuum-Assisted Breast BiopsyMercado, C. 1 ; Kellel, M. 2 ; Pysarenko, K. 1 *; Moy, L. 1 ; Toth, H. 1 ;Cangiarella, J. 1 ; Guth, A. 1 1. New York University School of Medicine,New York, NY; 2. No Institutional AffiliationAddress correspondence to C. Mercado (cecilia.mercado@nyumc.org)Objective: The purpose of this study is to investigate the upgrade rate of radialscars when diagnosed on MRI-guided vacuum-assisted breast biopsy.Materials and Methods: A retrospective review of 30 patients with radialscars diagnosed at MRI-guided vacuum-assisted biopsy was performed.Cases accompanied by malignancy were excluded. All lesions were surgicallyexcised. The imaging features and histologic findings on vacuumassistedbreast biopsy and at subsequent surgical excision were assessedand compared.Results: Thirty-one cases of radial scars in 30 patients (mean age, 56years; range, 41–74 years) were identified. The MRI characteristics forthe 31 lesions were mass in 22, non-masslike enhancement (NMLE) ineight, and focus in one. The lesion size ranged from 3 mm to 38 mm(mean, 12 mm). Among 31 lesions, histology at vacuum-assisted biopsywas radial scar in 21, and radial scar with high-risk lesion (atypicalductal hyperplasia [ADH], atypical lobular hyperplasia [ALH], lobularcarcinoma in situ [LCIS] or flat epithelial atypia [FEA]) in 10. Of the 21lesions yielding radial scar at vacuum-assisted biopsy, surgery revealedductal carcinoma in situ (DCIS) in two (2/21, 10%) and a high-risk lesion(ADH, ALH, or LCIS) in four (4/21, 19%). Of the 10 lesions yieldingradial scar with high-risk lesion at MRI vacuum-assisted biopsy, surgicalexcision revealed a high-risk lesion in six (6/10, 60%).Conclusion: No invasive cancers were associated with radial scars in ourseries. However, surgical excision is recommended for all radial scarsbecause the upgrade rate to DCIS occurred in 6% of all cases (2/31) andin 10% of radial scar without atypia (2/21). The incidence of identifyinga high-risk lesion (ADH, ALH, or LCIS) in radial scars is also high withan upgrade rate of 19% (4/21).*Will present paperA19
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Scientific Session 27—Pediatric I
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Scientific Session 1 â Breast Imaging: Mammography