Consensus Meeting of Breast Imaging: BI-RADS® and Beyond

Organizers of medical educational courses are often confronted with questions that are clinically relevant yet trespassing the frontiers of scientifically proven, evidence-based medicine at the point of care. Therefore, since 2007 organizers of breast teaching courses in German language met biannually to find a consensus in clinically relevant questions that have not been definitely answered by science. The questions were prepared during the 3 months before the meeting according to a structured process and finally agreed upon the day before the consensus meeting. At the consensus meeting, the open questions concerning 2D/3D mammography, breast ultrasound, MR mammography, interventions as well as risk-based imaging of the breast were presented first for electronic anonymized voting, and then the results of the audience were separately displayed from the expert votes. Thereafter, an introductory statement of the moderator was followed by pros/cons of two experts, and subsequently the final voting was performed. With ≥75% of votes of the expert panel, an answer qualified as a consensus statement. Seventeen consensus statements were gained, addressing for instance the use of 2D/3D mammography, breast ultrasound in screening, MR mammography in women with intermediate breast cancer risk, markers for localization of pathologic axillary lymph nodes, and standards in risk-based imaging of the breast. After the evaluation, comments from the experts on each field were gathered supplementarily. Methodology, transparency, and soundness of statements achieve a unique yield for all course organizers and provide solid pathways for decision making in breast imaging.

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Current Status of Breast Ultrasound

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2010.07.006 ◽

2011 ◽

Vol 62 (1) ◽

pp. 31-40 ◽

Cited By ~ 9

Author(s):

Anat Kornecki

Keyword(s):

High Risk ◽

Breast Imaging ◽

Breast Ultrasound ◽

Current Status ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Tumour Extension ◽

The Status ◽

High Risk Populations

Ultrasound (US) has a significant role in diagnostic breast imaging. It is most commonly used as an adjunctive test in characterizing lesions detected by other imaging modalities or by clinical examination. US is recognized as the modality of choice in the evaluation of women who are symptomatic and younger than 30 years of age, pregnant, or lactating. Combined mammography and US appear to have a role in screening high-risk populations. The use of standard Breast Imaging Reporting and Data System US lexicon is helpful in guiding the differentiation between benign and malignant sonographic signs. Biopsy is warranted when benign features are absent or for any feature consistent with malignancy, despite other benign findings. Whole breast and axillary US are useful in assessing tumour extension, multifocality, and the status of axillary lymph nodes. US is the modality of choice for guiding interventional breast procedures. The role of US as a guidance tool for nonoperative breast treatment is being investigated.

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The usefulness of F-18 FDG PET/CT-mammography for preoperative staging of breast cancer: comparison with conventional PET/CT and MR-mammography

Radiology and Oncology ◽

10.2478/raon-2013-0031 ◽

2013 ◽

Vol 47 (4) ◽

pp. 390-397 ◽

Cited By ~ 7

Author(s):

Eun-Ha Moon ◽

Seok Tae Lim ◽

Yeon-Hee Han ◽

Young Jin Jeong ◽

Yun-Hee Kang ◽

...

Keyword(s):

Breast Cancer ◽

Tumour Size ◽

Breast Tumour ◽

Initial Assessment ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Mr Mammography ◽

T Stage ◽

Correct Definition ◽

Pet Ct

AbstractBackground. The objective of the study was to compare the diagnostic efficacy of an integrated Fluorine-18 fluorodeoxyglucose (F-18 FDG) PET/CT-mammography (mammo-PET/CT) with conventional torso PET/CT (supine-PET/CT) and MR-mammography for initial assessment of breast cancer patients.Patients and methods. Forty women (52.0 ± 12.0 years) with breast cancer who underwent supine-PET/CT, mammo- PET/CT, and MR-mammography from April 2009 to August 2009 were enrolled in the study. We compared the size of the tumour, tumour to chest wall distance, tumour to skin distance, volume of axillary fossa, and number of metastatic axillary lymph nodes between supine-PET/CT and mammo-PET/CT. Next, we assessed the difference of focality of primary breast tumour and tumour size in mammo-PET/CT and MR-mammography. Histopathologic findings served as the standard of reference.Results. In the comparison between supine-PET/CT and mammo-PET/CT, significant differences were found in the tumour size (supine-PET/CT: 1.3 ± 0.6 cm, mammo-PET/CT: 1.5 ± 0.6 cm, p < 0.001), tumour to thoracic wall distance (1.8 ± 0.9 cm, 2.2 ± 2.1 cm, p < 0.001), and tumour to skin distance (1.5 ± 0.8 cm, 2.1 ± 1.4 cm, p < 0.001). The volume of axillary fossa was significantly wider in mammo-PET/CT than supine-PET/CT (21.7 ± 8.7 cm3vs. 23.4 ± 10.4 cm3, p = 0.03). Mammo-PET/CT provided more correct definition of the T-stage of the primary tumour than did supine-PET/ CT (72.5% vs. 67.5%). No significant difference was found in the number of metastatic axillary lymph nodes. Compared with MR-mammography, mammo-PET/CT provided more correct classification of the focality of lesion than did MR-mammography (95% vs. 90%). In the T-stage, 72.5% of cases with mammo-PET/CT and 70% of cases with MRmammography showed correspondence with pathologic results.Conclusions. Mammo-PET/CT provided more correct definition of the T-stage and evaluation of axillary fossa may also be delineated more clearly than with supine-PET/CT. The initial assessment of mammo-PET/CT would be more useful than MR-mammography because the mammo-PET/CT indicates similar accuracy with MR-mammography for decision of T-stage of primary breast tumour and more correct than MR-mammography for defining focality of lesion.

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Common Current Procedural Terminology Codes in Breast Imaging

Journal of Breast Imaging ◽

10.1093/jbi/wbz063 ◽

2019 ◽

Vol 1 (4) ◽

pp. 334-337

Author(s):

Dana H Smetherman

Keyword(s):

Breast Imaging ◽

Digital Breast Tomosynthesis ◽

Axillary Lymph Nodes ◽

Computer Assisted ◽

Axillary Lymph ◽

Current Procedural Terminology ◽

Imaging Procedures ◽

Breast Tomosynthesis ◽

Computer Assisted Detection ◽

Magnetic Resonance Imaging Mri

Abstract This article reviews the common Current Procedural Terminology (CPT) codes for frequently performed breast imaging procedures. The CPT codes for breast radiology services, including the revised codes for mammography, computer-assisted detection (CAD), breast ultrasound, breast magnetic resonance imaging (MRI), and imaging-guided breast interventional procedures and the new codes for digital breast tomosynthesis (DBT) and marker placement in axillary lymph nodes are outlined. The application of basic CPT coding principles, such as the use of modifiers and the different structure of code families in breast radiology services, is also discussed. CPT codes are updated on an ongoing basis to reflect the evolution of medical practice, and the CPT codes for breast imaging procedures have changed significantly in the past 5 years. These modifications can affect the distribution of work and utilization of resources in radiology departments. A working knowledge of coding practices will facilitate compliance with billing regulations and help ensure breast radiologists are appropriately paid for their work.

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Application of MR Mammography Beyond Local Staging: Is There a Potential to Accurately Assess Axillary Lymph Nodes? Evaluation of an Extended Protocol in an Initial Prospective Study

American Journal of Roentgenology ◽

10.2214/ajr.10.4889 ◽

2011 ◽

Vol 196 (5) ◽

pp. W641-W647 ◽

Cited By ~ 62

Author(s):

Pascal A. T. Baltzer ◽

Matthias Dietzel ◽

Hartmut P. Burmeister ◽

Ramy Zoubi ◽

Mieczyslaw Gajda ◽

...

Keyword(s):

Lymph Nodes ◽

Prospective Study ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Mr Mammography ◽

Local Staging

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Evaluation of the Clinical and Imaging Findings of Breast Examinations in a Tertiary Facility in Ghana

International Journal of Breast Cancer ◽

10.1155/2021/5541230 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Emmanuel Kobina Mesi Edzie ◽

Klenam Dzefi-Tettey ◽

Philip Narteh Gorleku ◽

Adu Tutu Amankwa ◽

Eric Aidoo ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Breast Imaging ◽

Positive Family History ◽

Definitive Treatment ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Imaging Features ◽

Imaging Findings ◽

Duration Of Symptoms

Breast diseases have been one of the major battles the world has been fighting. In winning this fight, the role of medical imaging cannot be overlooked. Breast imaging reveals hidden lesions which aid physicians to give the appropriate diagnosis and definitive treatment, hence this study, to determine the clinical and imaging findings of breast examinations to document the radiologic features in our setting. This cross-sectional retrospective study reviewed the sociodemographics, imaging reports (mammography and ultrasonography with BI-RADS scores and their features), and the clinical data of 425 patients from September 2017 to September 2020 in the Cape Coast Teaching Hospital. 72 solid lesions with their histology reports were also reviewed. Data obtained were organized, coded, and analyzed using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 20.0. The results obtained were presented in appropriate tables and charts. A chi-squared test was employed for associations and statistical significance was specified at p ≤ 0.05 . 63.29% of the patients were married, but only 18.59% had a positive family history of breast cancer. BI-RADS scores 1(57.46%) and 2(27.99%) were the most recurrent findings. The most common BI-RADS 2, 3, 4, and 5 imaging features were benign-looking axillary lymph nodes (66.33%), well-defined solid masses (61.54%), ill-defined solid masses (42.86%), and ill-defined solid masses with suspicious-looking axillary lymph nodes (100.00%), respectively. The most frequent indications were routine screening (49.18%), mastalgia (26.59%), and painless breast masses (19.77%). There was significant association between duration of symptoms and breast cancer ( p value = 0.007 ). In conclusion, routine breast screening and mastalgia were the topmost indications for breast imaging. BI-RADS 1 and 2 were the commonest BI-RADS scores, and benign-looking axillary lymph nodes and simple cysts were the most frequent imaging features for BI-RADS 2 and ill-defined solid masses and suspicious-looking axillary lymph nodes for BI-RADS 4 and 5.

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