Faculty Bibliography

OBJECTIVE: Ductal carcinoma in situ (DCIS) typically presents as calcifications which are detected mammographically. Our aim was to evaluate the less common presentations of ductal carcinoma in situ diagnosed by image-guided core biopsy and correlate with histopathologic diagnoses. METHODS AND MATERIAL: Imaging and histopathologic findings were retrospectively reviewed in 11 patients with ductal carcinoma in situ diagnosed at core biopsy that presented as noncalcified radiographic abnormalities. RESULTS: Mammography showed non-calcified, circumscribed nodules, ill-defined nodules and architectural distortion. In two patients, no mammographic abnormality was detected. Sonography showed circumscribed, round or oval, solid masses; irregular, heterogeneous masses; and a tubular structure. Histopathologic diagnoses included multiple architectural subtypes and ranged from low to high nuclear grade. CONCLUSION: Although image-guided core biopsy diagnosis of ductal carcinoma is typically made when sampling calcifications, DCIS can be diagnosed following biopsy of non-calcified masses or distortion. There is no correlation between histopathologic subtype and radiologic appearance

OBJECTIVE: Computerized realistic simulation technology has been used as a training tool in fields such as aviation and military training and in the nuclear power industry. More recently, it has been adapted for use in anesthesia crisis resource management. We describe the effectiveness of a simulation program like that used by anesthesiology departments that we developed to teach radiologists the principles of crisis management. MATERIALS AND METHODS: A mock CT scanner and patient simulator were used to simulate the environment in which radiologists encounter crises. Twenty-four residents attended the training program, four at each half-day session. Two responded to and two observed an initial crisis, after which they attended a lecture and watched a videotape review. The second pair then participated in a different crisis scenario. The scenario order was randomized. All scenarios were videotaped and randomly reviewed by two physicians not involved with the course. The following behavioral qualities of the participating residents were evaluated using a five-point scale, ranging from poor (1) to excellent (5): global assessment, communication skills, use of support personnel, use of resources, and role clarity. Residents then rated the course on a five-point scale using the following criteria: overall course usefulness, attainment of course goals, realism of scenarios, quality of lecture, and quality of videotape review. RESULTS: The trainees who had attended the lecture and watched the videotape review before participating in a scenario consistently scored higher than those who had not in the following areas (score after training/score before training): global assessment, 4.08/2.50; communication skills, 4.09/2.67; use of support personnel, 4.17/3.00; use of resources, 4.00/2.92; and role clarity, 4.17/2.67. Moreover, the participants gave the course the following average ratings: overall usefulness, 4.93; attainment of course goals, 4.78; realism of scenarios, 4.63; quality of lecture, 4.63; and quality of videotape review, 4.85. CONCLUSION: Although the critical assessment of a teaching method is difficult and subjective by nature, the improvement in behavioral performance scores suggests that simulation technology effectively conveyed the principles of crisis management. The course ratings show that the program was well accepted by participants

The success rate with the traditional 14-gauge, core-biopsy, multiple-pass technique was compared with that of a directional vacuum-assisted device in sampling calcification clusters in the breast. Of the 130 focal calcification clusters sampled with the multiple-pass technique, 12 clusters (9.2%) had no particles depicted on radiographs of the specimen. Specimens from all 106 (100%) clusters sampled with the directional, vacuum-assisted instrument contained calcifications at radiography. The directional, vacuum-assisted device improved the ability to percutaneously sample breast calcifications

PURPOSE: To determine whether there are any mammographic and ultrasonographic (US) features of epidermal inclusion cysts of the breast, including heterogeneous microcalcifications, that may be used to preclude unnecessary biopsy. MATERIALS AND METHODS: Clinical history and imaging findings in 15 patients who had undergone surgical excision of an epidermal inclusion cyst were reviewed. RESULTS: In 11 patients, imaging findings of an epidermal inclusion cyst were noted, including 10 patients with mammographic findings, one with US findings only, and seven with mammographic and US findings. The most common mammographic finding (in nine of 10 patients) was an isodense to high-density mass with a circumscribed margin; three circumscribed masses had multiple associated heterogeneous microcalcifications. In the seven patients with corresponding US findings, a circumscribed hypoechoic mass with through transmission was depicted. An additional US feature in six patients was extension of the mass into the dermis. CONCLUSION: Biopsy may be deemed unnecessary if the characteristic US and physical examination findings are present, even in the case of a cyst with heterogeneous microcalcifications

OBJECTIVE. In our institution for the past 4 years, stereotaxic core breast biopsy using a 14-gauge needle has been offered as an alternative to surgical excision. The purpose of this paper is to describe our protocol, results, and lessons learned from our experience. MATERIALS AND METHODS. From August 1991 to July 1995, 388 stereotaxic needle core biopsies of clinically occult, noncalcified, mammographically detected solid masses were performed. In this group, 103 patients underwent subsequent surgical excision. Another 169 have had follow-up examinations 1 year or more after their biopsies. RESULTS. Of the 61 patients diagnosed with a malignant process on core biopsy, all had confirmation on subsequent surgical excision. Forty-one of the 42 core biopsies that showed a benign process were subsequently confirmed on surgical excision. One patient with atypical ductal hyperplasia on core biopsy had ductal carcinoma in situ on surgical excision. Patients with 169 benign masses on core biopsy have been followed for at least 1 year by mammography. Of these women, 110 have been followed for at least 2 years, and no malignant lesions have been found. CONCLUSION. Stereotaxic large-needle core biopsy appears to be an accurate alternative to surgical excision for evaluating a solid breast mass. However, the mammographic appearance, technical quality of the biopsy, and pathologic findings in each patient must be correlated to ensure the highest possible accuracy when using this technique

PURPOSE: To assess the usefulness of the routine supplementary magnification view in patients who have undergone breast conservation therapy. MATERIALS AND METHODS: Four hundred seventy-one mammograms in 392 patients were evaluated. Conventional craniocaudal and mediolateral oblique views were obtained in each patient. After a preliminary interpretation was made, a magnification view of the excision site was evaluated and any additional information was documented. RESULTS: In 115 examinations (24%), the magnification view was considered necessary to better evaluate equivocal or questionable calcifications seen on standard views. In 18 cases (4%), review of the magnification view influenced the decision to perform biopsy. None of the magnification views that were considered unnecessary caused the interpretation made from conventional views to be altered. CONCLUSION: Magnification mammographic views should be obtained in patients who have undergone breast conservation therapy only when considered necessary after review of findings on conventional views

OBJECTIVE. The purpose of this study was to determine the mammographic and sonographic findings of injuries of the breast caused by seat belts in automobile accidents. The imaging findings of such injuries must be differentiated from those of carcinoma, so that inappropriate treatment is avoided. MATERIALS AND METHODS. Five patients who had breast injuries caused by seat belts with shoulder restraints between 1988 and 1993 and who underwent mammography were included in this study. Four of these women had imaging studies done in our department, and one was examined elsewhere. The initial mammograms for four patients were obtained 1-2 months after trauma to the breast. For the fifth patient, the initial study was obtained 13 months after injury. For all women, follow-up examinations were performed from 3 months to 4 years after injury. Two patients also underwent sonography of the breast during the course of their evaluation. RESULTS. At 1-2 months after breast injury caused by a seat belt, mammograms showed thin-walled fat-density cysts in a linear distribution and, in less dense breasts, an associated 2-3-cm band of increased density. The band of increased density was not seen in more dense breasts. These findings correlated with the line of contusion across the breast and resultant fat necrosis, which ultimately led to the formation of lipid cysts. By 3-4 months after the injury, the lipid cysts and contusion were less apparent, and a line of fibrosis had developed. On sonography, the lipid cysts were smoothly marginated; such cysts may be either anechoic or hypoechoic. Parenchymal calcification may develop 3.5-4 years after such an injury. CONCLUSION. Mammograms in women with breast injuries caused by seat belts show areas of contusion, lipid cysts, and parenchymal calcifications occurring in a bandlike distribution corresponding to the path of the seat belt shoulder restraint across the chest. Lipid cysts are seen sonographically as smoothly marginated anechoic or hypoechoic nodules