Journal of Breast Imaging最新文献

{"title":"Institutional Review of BI-RADS 5 and BI-RADS 4C Lesions Over 5 Years Following Surgical Excision: Analysis of Radiology-Pathology Correlation.","authors":"Jennie E Brodsky, Maria Ly, Sylvia Jang, Ian S Hagemann, Michelle V Lee","doi":"10.1093/jbi/wbag019","DOIUrl":"10.1093/jbi/wbag019","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the performance of radiologists' radiologic-pathologic (rad-path) assessment in BI-RADS 4C and 5 breast lesions with benign core biopsy pathology.</p><p><strong>Methods: </strong>Institutional pathology records were reviewed, analyzing surgical excision results for benign core biopsies after BI-RADS 4C and 5 assessments from 2019 to 2024, and the rad-path correlation issued by the radiologist prior to excision was recorded. Pathologic diagnoses and imaging data were retrieved from the electronic medical record.</p><p><strong>Results: </strong>A total of 523 BI-RADS 4C and 5 core biopsies were identified during the study period. The malignancy rate following BI-RADS 4C assessment was 74.1% and following BI-RADS 5 assessment was 93.2%. Fifty-one benign image-guided biopsies underwent radiology-pathology correlation analysis. Radiologists categorized 19/51 benign pathology results as radiology-pathology discordant, with an upgrade rate to malignancy of 47.3%, and 32/51 as concordant, with an upgrade rate of 9.4%. All concordant upgrades occurred in high-risk lesions (atypical ductal hyperplasia, papilloma) for which excision had been recommended at the time of concordance assessment. Discordant benign pathology upgraded to malignancy included diagnoses such as dense stromal fibrosis, fibrocystic change, chronic inflammation, atypical ductal hyperplasia, hematoma, and papilloma.</p><p><strong>Conclusion: </strong>Radiologist-performed rad-path correlation is highly reliable for benign BI-RADS 4C and 5 lesions. Radiology-pathology discordant benign biopsies carry a high risk of malignancy and warrant surgical excision. In contrast, radiology-pathology concordant benign results are highly predictive of final benign outcome, particularly when high-risk features are absent. These findings support the essential role of radiologist rad-path correlation in reducing unnecessary surgery and avoiding missed cancers.</p>","PeriodicalId":43134,"journal":{"name":"Journal of Breast Imaging","volume":" ","pages":"540-549"},"PeriodicalIF":1.7,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Lead Interpreting Physician's Essential Guide: Core Responsibilities of the Lead Interpreting Physician Under the Mammography Quality Standards Act and the American College of Radiology Accreditation Standards.","authors":"Adrian A Sanchez, Heather V Garrett, Ria Dave, Debbie L Bennett, Michelle V Lee","doi":"10.1093/jbi/wbag053","DOIUrl":"10.1093/jbi/wbag053","url":null,"abstract":"<p><p>The Mammography Quality Standards Act (MQSA), enacted by Congress in 1992, established nationwide requirements to ensure the safety, consistency, and diagnostic quality of mammography in the United States. Compliance encompasses equipment performance, personnel qualifications, quality assurance and quality control activities, reporting standards, patient notification, and facility certification. Although individual MQSA components are straightforward, the cumulative responsibilities, particularly for the Lead Interpreting Physician (LIP), can be complex. This article provides a comprehensive overview of the MQSA regulatory framework, including the roles of federal and state entities, accreditation bodies, and key personnel essential to maintaining a compliant mammography program. We outline qualification and ongoing training requirements for interpreting physicians, technologists, and medical physicists; describe expectations for annual U.S. Food and Drug Administration (FDA) inspections; and summarize required processes for patient and provider communication, record retention, equipment evaluation, and the facility's annual outcomes audit. The article also reviews the FDA's Enhancing Quality Using the Inspection Program (EQUIP) initiative, which emphasizes continuous clinical image quality improvement, and highlights common reasons for inspection deficiencies. Key considerations for teleradiology, including diagnostic display testing and documentation standards, are discussed, as are updates introduced by the 2023 FDA rule, including mandatory breast density notification. By synthesizing regulatory requirements and practical operational strategies, this article aims to support LIPs and multidisciplinary breast imaging teams in developing efficient, sustainable systems that ensure high-quality mammographic care and ongoing MQSA compliance.</p>","PeriodicalId":43134,"journal":{"name":"Journal of Breast Imaging","volume":" ","pages":"569-580"},"PeriodicalIF":1.7,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fat Necrosis: Correlation of Imaging Findings and Histopathology.","authors":"Preya Shah, Alisha Marie Maltos, Cooper D Rutland, Uzma Waheed","doi":"10.1093/jbi/wbag050","DOIUrl":"10.1093/jbi/wbag050","url":null,"abstract":"<p><p>Fat necrosis is an inflammatory response arising from damage to adipose tissue. Fat necrosis is a commonly encountered benign entity in breast imaging and has a wide spectrum of imaging appearances. Although fat necrosis is most commonly seen after intervention or trauma, it may be idiopathic. Given the overlap in imaging characteristics between fat necrosis and malignancy, understanding the various manifestations of fat necrosis can aid accurate diagnosis and help avoid unnecessary biopsy. We describe the range of imaging characteristics, including both classic benign imaging features and nonspecific features that can look worrisome for malignancy. Finally, we describe the radiologic-pathologic correlation of fat necrosis in the breast since biopsy with pathology is the gold standard for diagnosis in equivocal cases.</p>","PeriodicalId":43134,"journal":{"name":"Journal of Breast Imaging","volume":" ","pages":"556-563"},"PeriodicalIF":1.7,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral Breast Enlargement: A Rare Complication of Central Vein Stenosis in a Hemodialysis Patient Mimicking Inflammatory Breast Cancer.","authors":"Jian-Ling Chen, Yen-Jen Chen, Jane Wang","doi":"10.1093/jbi/wbag012","DOIUrl":"10.1093/jbi/wbag012","url":null,"abstract":"","PeriodicalId":43134,"journal":{"name":"Journal of Breast Imaging","volume":" ","pages":"600-602"},"PeriodicalIF":1.7,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of High-Risk Breast Lesions: A Comprehensive Update.","authors":"Kathryn W Zamora, Miglena K Komforti, Elizabeth B Vorhis, Sona A Chikarmane, Kristen Coffey, Katerina Dodelzon, Madeline Evans, Anne E Kendell, Santo Maimone, Jessica H Porembka, Wenhui Zhou, Manisha Bahl","doi":"10.1093/jbi/wbag034","DOIUrl":"10.1093/jbi/wbag034","url":null,"abstract":"<p><p>High-risk breast lesions (HRLs) encompass a heterogeneous group of pathologies that coexist with an adjacent or synchronous malignancy, confer an increased risk of future breast cancer, or warrant surgical consideration because of upgrade potential or local behavior. Despite their clinical importance, management of HRLs remains variable. The American Society of Breast Surgeons (ASBrS) and the Society of Breast Imaging are collaborating to establish unified, evidence-based guidelines for managing these lesions. While these recommendations are currently in development, this review summarizes the existing literature and current guidance, including ASBrS recommendations, to provide context for multidisciplinary management. The article reviews the histopathologic features, imaging appearance, and management strategies for HRLs, including atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), flat epithelial atypia (FEA), papillomas with and without atypia, radial scar/complex sclerosing lesion (RS/CSL), mucocele-like lesion (MLL), desmoid tumor, and pseudoangiomatous stromal hyperplasia (PASH). Recent literature supports nonoperative management for specific radiologic-pathologic concordant lesions, particularly limited ADH, pure FEA, and pure RS, highlighting the important role of multidisciplinary discussion for personalized care. Lesions such as LCIS subtypes, papilloma with atypia, and MLL with atypia continue to warrant excision due to higher reported upgrade rates to malignancy. Beyond short-term management, HRLs such as ADH, ALH, and LCIS serve as biomarkers of long-term breast cancer risk, informing recommendations for surveillance, risk assessment, and chemoprevention counseling. Achieving a consensus among radiology, pathology, and surgical disciplines is essential to ensure oncologic safety while minimizing overtreatment in the era of precision breast care.</p>","PeriodicalId":43134,"journal":{"name":"Journal of Breast Imaging","volume":" ","pages":"477-494"},"PeriodicalIF":1.7,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining the Role of Postmortem Radiologic-Pathologic Correlation in Breast Arterial Calcification Research.","authors":"Zacharoula Sidiropoulou, Carlos Santos","doi":"10.1093/jbi/wbag056","DOIUrl":"https://doi.org/10.1093/jbi/wbag056","url":null,"abstract":"","PeriodicalId":43134,"journal":{"name":"Journal of Breast Imaging","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Memoriam: Stephen Albert Feig, MD.","authors":"Ellen B Mendelson","doi":"10.1093/jbi/wbag055","DOIUrl":"https://doi.org/10.1093/jbi/wbag055","url":null,"abstract":"","PeriodicalId":43134,"journal":{"name":"Journal of Breast Imaging","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normal and Pathological Incidental Breast Implant Findings on Chest Computed Tomography: What the Radiologist Needs to Know.","authors":"Mira Yuniarti, Nungky Kusumaningtyas, Nina I Sh Supit, Vera Nevyta Tarigan, Jenno Fillano, Callistus Bruce Henfry Sulay, Gilbert Sterling Octavius","doi":"10.1093/jbi/wbag043","DOIUrl":"https://doi.org/10.1093/jbi/wbag043","url":null,"abstract":"<p><p>Breast augmentation and reconstruction using implants are increasingly common, resulting in a growing number of patients with breast implants undergoing chest CT for unrelated clinical indications. Although CT is not considered a primary imaging modality for breast implant evaluation, breast implants and their associated findings are frequently encountered incidentally. These findings may range from normal postoperative appearances and expected findings to degenerative changes and clinically significant complications, many of which may be asymptomatic. This review highlights the spectrum of normal and pathological breast implant findings as visualized on chest CT. Normal appearances include implant position, contour, shell characteristics, and expected postoperative changes such as minimal peri-implant fluid or radial folds. Other implant-related findings, including capsular calcification and internal debris, may mimic or obscure true complications. Pathological conditions discussed include seroma, hematoma, infection, capsular contracture, intracapsular and extracapsular rupture, silicone migration, and retained silicone following explantation. Given the limitations of CT in soft-tissue characterization and the use of ionizing radiation, CT should not be used as a replacement for dedicated breast imaging techniques. However, recognition of abnormal CT features is essential, as these incidental findings may prompt appropriate recommendations for targeted breast imaging with ultrasound or magnetic resonance imaging and guide clinical decision-making. Familiarity with these entities enables radiologists to avoid diagnostic pitfalls, provide accurate interpretations, and contribute meaningfully to patient management when breast implant findings are incidentally detected on CT.</p>","PeriodicalId":43134,"journal":{"name":"Journal of Breast Imaging","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mammogram-Based Artificial Intelligence Risk Assessment in High-Risk Women Undergoing Supplemental Screening with MRI.","authors":"Samuel B Ogunlade, Lian Wang, Anahita Tavana, Santo Maimone, Kristin A Robinson, Kaitlin M Moran, Amie Leon, Andrey P Morozov, Chidi T Nwachukwu, Haley P Letter","doi":"10.1093/jbi/wbag046","DOIUrl":"https://doi.org/10.1093/jbi/wbag046","url":null,"abstract":"<p><strong>Objective: </strong>Current clinical risk models were developed for longer-term breast cancer risk stratification and therefore have limited utility for predicting short-term (1-year) breast cancer risk. This study evaluates the performance of a mammogram-based artificial intelligence (MB-AI) risk model for predicting breast cancer diagnosis within 1 year in high-risk women.</p><p><strong>Methods: </strong>This retrospective case-control study included 340 women who underwent supplemental MRI screening within 1 year following a negative mammogram, of whom 101 (29.7%) developed breast cancer and 239 (70.3%) remained cancer-free during the same interval. Artificial-intelligence-assigned absolute 1-year risk scores, Tyrer-Cuzick (TC) lifetime and 10-year scores, and Gail lifetime and 5-year scores were analyzed. Model discrimination was evaluated using receiver operating characteristic (ROC) curves. Sensitivity, specificity, and predictive values were estimated at optimal cutoffs. Subgroup analyses examined model performance across genetic, menopausal, reproductive, and tumor-based strata.</p><p><strong>Results: </strong>The MB-AI model demonstrated the highest overall discriminative ability (area under the curve [AUC] = 0.812), with strong performance in extremely dense breasts (AUC = 0.976). By comparison, TC lifetime (AUC = 0.625) and Gail lifetime (AUC = 0.668) models showed modest discrimination, while TC 10-year and Gail 5-year models did not discriminate (AUCs ≤0.49). Subgroup analyses showed consistent performance across clinical and pathological categories. The MB-AI model also showed an AUC comparable to that of previously developed AI models.</p><p><strong>Conclusions: </strong>A mammogram-based AI model demonstrated improved performance compared with traditional clinical risk models for predicting breast cancer diagnosis within 1 year in women undergoing supplemental screening. These findings support that AI-based approaches may reflect both short-term risk and early imaging features of occult disease and suggest further investigation of AI as a complement to existing risk stratification strategies.</p>","PeriodicalId":43134,"journal":{"name":"Journal of Breast Imaging","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative MRI versus Ultrasound in Axillary Nodal Staging in Breast Cancer: Additive Role of MRI.","authors":"Firouzeh K Arjmandi, Berat B Ozcan, Tianshen Hu, Anthony Froix, Heather McArthur, Yin Xi, Basak E Dogan","doi":"10.1093/jbi/wbag045","DOIUrl":"https://doi.org/10.1093/jbi/wbag045","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the additive role of breast MRI in axillary nodal staging following a benign axillary US and compare diagnostic performance of US-first versus MRI-first imaging sequences.</p><p><strong>Methods: </strong>This retrospective study included 524 patients with stage I-III breast cancer who underwent preoperative breast MRI and axillary surgery. Imaging assessments were categorized as US-first (n = 367) or MRI-first (n = 157). Diagnostic performance metrics were calculated based on the first modality used to evaluate the axilla. Incremental detection by MRI after benign US was assessed. Associations between false-negative results and clinicopathologic factors were analyzed.</p><p><strong>Results: </strong>US-first patients were younger (51.8 vs 55.2 years, P = 0.002), had larger tumors (37.8 mm vs 26.0 mm, P < 0.001), and higher Ki-67 indices (42.6% vs 33.0%, P < 0.001) compared to MRI-first. Sensitivity for nodal metastasis was higher for US-first (71.7%) than MRI-first (50%, P = 0.01), while MRI-first demonstrated greater specificity (85.6% vs 74.6%, P = 0.02) and negative predictive value (87.0% vs 69.2%, P < 0.001). Among 182 axillae assessed as benign on initial US, MRI identified 24 additional abnormal cases (13.2%), of which 15 were true positives, yielding an incremental detection rate of 8.2%. False-negative results were associated with younger age in both groups and with larger tumor size and multifocality in US-first cases.</p><p><strong>Conclusion: </strong>MRI provided clinically relevant incremental detection of axillary metastases after benign US and demonstrated higher negative predictive value when performed first. False-negative results were more common in patients with younger age, larger tumors, and multifocal disease, highlighting the need to consider these factors when interpreting axillary imaging.</p>","PeriodicalId":43134,"journal":{"name":"Journal of Breast Imaging","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}