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The Journal of the American Osteopathic... Dec 2017Breast masses and nipple discharge are common symptoms that lead women to seek medical care. Many of the findings on subsequent examination are benign. When evaluating a... (Review)
Review
Breast masses and nipple discharge are common symptoms that lead women to seek medical care. Many of the findings on subsequent examination are benign. When evaluating a patient who presents with breast masses or nipple discharge, it is useful to take a holistic approach to evaluating the patient, including a detailed history, structural and directed physical examination, and, if indicated, laboratory studies, diagnostic imaging, and biopsy. The goal of this review is to assist physicians in understanding the evaluation, diagnosis, and management of benign breast conditions.
Topics: Breast; Breast Diseases; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Mastitis; Nipple Discharge
PubMed: 29181518
DOI: 10.7556/jaoa.2017.147 -
Plastic and Reconstructive Surgery Nov 2018It has been two centuries since Petrus Camper identified superficial fascia and over 175 years since Sir Astley Cooper wrote his book on the anatomy of the breast. In... (Observational Study)
Observational Study
BACKGROUND
It has been two centuries since Petrus Camper identified superficial fascia and over 175 years since Sir Astley Cooper wrote his book on the anatomy of the breast. In the 1990s, Ted Lockwood taught us the importance of the superficial fascia layers in body contouring procedures he pioneered. These descriptions, however, fail to explain the three-dimensional fascial system in the breast. The authors set out to discover and describe a theory of superficial fascia structures responsible for breast shape.
METHODS
The nature of the superficial fascia system that surrounds the breast and its attachments to the chest were studied in 12 cadaver breast dissections and in clinical cases of both cosmetic and reconstructive breast procedures.
RESULTS
The authors found a three-dimensional, closed system of fascia and fat surrounding the corpus mammae, which attaches to the skin by means of specialized vertical cutaneous ligaments, or Cooper ligaments, and which attaches to the chest wall by means of a three-dimensional zone of adherence at the breast's periphery.
CONCLUSIONS
The breast is shaped by a three-dimensional, fibrofatty fascial system. Two layers of this system surround the corpus mammae and fuse together around it, and anchor it to the chest wall in a structure we have called the circummammary ligament.
Topics: Breast; Cadaver; Dissection; Fascia; Fasciotomy; Female; Humans; Medical Illustration
PubMed: 30511967
DOI: 10.1097/PRS.0000000000004948 -
European Radiology Jun 2022Breast density is an independent risk factor for the development of breast cancer and also decreases the sensitivity of mammography for screening. Consequently, women...
Breast density is an independent risk factor for the development of breast cancer and also decreases the sensitivity of mammography for screening. Consequently, women with extremely dense breasts face an increased risk of late diagnosis of breast cancer. These women are, therefore, underserved with current mammographic screening programs. The results of recent studies reporting on contrast-enhanced breast MRI as a screening method in women with extremely dense breasts provide compelling evidence that this approach can enable an important reduction in breast cancer mortality for these women and is cost-effective. Because there is now a valid option to improve breast cancer screening, the European Society of Breast Imaging (EUSOBI) recommends that women should be informed about their breast density. EUSOBI thus calls on all providers of mammography screening to share density information with the women being screened. In light of the available evidence, in women aged 50 to 70 years with extremely dense breasts, the EUSOBI now recommends offering screening breast MRI every 2 to 4 years. The EUSOBI acknowledges that it may currently not be possible to offer breast MRI immediately and everywhere and underscores that quality assurance procedures need to be established, but urges radiological societies and policymakers to act on this now. Since the wishes and values of individual women differ, in screening the principles of shared decision-making should be embraced. In particular, women should be counselled on the benefits and risks of mammography and MRI-based screening, so that they are capable of making an informed choice about their preferred screening method. KEY POINTS: • The recommendations in Figure 1 summarize the key points of the manuscript.
Topics: Breast; Breast Density; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening
PubMed: 35258677
DOI: 10.1007/s00330-022-08617-6 -
Journal of Translational Medicine Aug 2023Over the last five decades, breast density has been associated with increased risk of developing breast cancer. Mammographically dense breasts are considered those... (Review)
Review
Over the last five decades, breast density has been associated with increased risk of developing breast cancer. Mammographically dense breasts are considered those belonging to the heterogeneously dense breasts, and extremely dense breasts subgroups according to the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS). There is a statistically significant correlation between the increased mammographic density and the presence of more glandular tissue alone. However, the strength of this correlation is weak. Although the mechanisms driving breast density-related tumor initiation and progression are still unknown, there is evidence suggesting that certain molecular pathways participating in epithelial-stromal interactions may play a pivotal role in the deposition of fibrillar collagen, increased matrix stiffness, and cell migration that favor breast density and carcinogenesis. This article describes these molecular mechanisms as potential "landscapers" for breast density-related cancer. We also introduce the term "Breast Compactness" to reflect collagen density of breast tissue on chest CT scan and the use of breast stiffness measurements as imaging biomarkers for breast cancer screening and risk stratification.
Topics: Humans; Female; Radiology; Breast Neoplasms; Breast; Tomography, X-Ray Computed; Risk Factors
PubMed: 37649088
DOI: 10.1186/s12967-023-04457-0 -
The British Journal of Radiology May 2022While breast hematomas are common, their imaging features are often underrecognized or mistaken for other conditions.Diagnosis of acute hematomas is generally easy when... (Review)
Review
While breast hematomas are common, their imaging features are often underrecognized or mistaken for other conditions.Diagnosis of acute hematomas is generally easy when associated with a recent history of breast trauma, surgery, or percutaneous biopsy. However, minor trauma might not always be remembered, and breast hematoma might have longlasting imaging manifestations when associated with fat necrosis. Also, because of the increasing use of breast MRI and FDG-PET/CT, breast hematomas are increasingly detected as incidentalomas and may mimic malignancies.Conversely, breast hematomas may also be associated with authentic malignant processes.In this pictorial review, we present the natural history of breast hematomas, their various imaging features, as well as their differential diagnoses, highlighting the situations requiring histopathological correlation.
Topics: Breast; Hematoma; Humans; Multimodal Imaging; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography
PubMed: 35195443
DOI: 10.1259/bjr.20210514 -
Asian Pacific Journal of Cancer... Feb 2022Breast surgery requires a high aesthetic outcome and should be individualized according to anthropometric breast and body characteristics. This study aimed to measure...
OBJECTIVES
Breast surgery requires a high aesthetic outcome and should be individualized according to anthropometric breast and body characteristics. This study aimed to measure the anthropometric parameters and volume of Vietnamese female breasts and their application in breast surgery.
SUBJECTS AND METHODS
A cross-sectional descriptive study enrolled 240 women treated at Vietnam National Cancer Hospital aged 18 to 78 years old. The measurements were obtained with the patient sitting upright in the anatomic position based on key landmarks and breast volume was also assessed. Differences in breast anthropometric measurements and breast volume were compared between groups of age, BMI, and the number of children. The correlation between breast volume calculated by anthropometric method and surgical specimen volume was evaluated to determine the accuracy of this method.
RESULTS
The mean values of the right and left breast volumes are less statistically different. Mean breast volume of the right breast and left breast were 396.1±182.3ml and 399.4±182.2ml, respectively. The proportion of breast ptosis increased with age (p=0.027), Body mass index (p<0.0001), and the number of children (p=0.004). The most important factor affecting the size and shape of the breast was body mass index (BMI). Mastectomy specimen volume and breast volume calculated by the anthropometric method are highly correlated with r=0.966.
CONCLUSIONS
The results of this study should be applied in clinical practice in breast surgery for Vietnamese women.
.Topics: Adolescent; Adult; Age Factors; Aged; Anatomic Landmarks; Anthropometry; Asian People; Body Mass Index; Breast; Cross-Sectional Studies; Female; Gravidity; Humans; Mastectomy; Middle Aged; Organ Size; Pregnancy; Sitting Position; Vietnam; Young Adult
PubMed: 35225480
DOI: 10.31557/APJCP.2022.23.2.665 -
European Journal of Radiology Nov 2022Contrast-enhanced mammography (CEM) is a promising vascular-based breast imaging technique with high diagnostic performance in detecting breast cancer. Dual-energy... (Review)
Review
Contrast-enhanced mammography (CEM) is a promising vascular-based breast imaging technique with high diagnostic performance in detecting breast cancer. Dual-energy acquisition using low and high energy x-ray spectra following intravenous iodinated contrast injection provides both anatomic and functional information in the same examination. The low-energy images are equivalent to standard digital mammography and the post-processed recombined images depict enhancement analogous to contrast-enhanced breast magnetic resonance imaging (MRI). Thus, CEM has the potential to detect abnormal morphologic features as well as neovascularity associated with breast cancer. Since its emergence in 2011, CEM has consistently demonstrated superior performance compared with standard mammography and mammography plus ultrasound, particularly in women with dense breasts, with high sensitivity approaching that of MRI, supporting its use as a cost-effective diagnostic and screening tool. CEM has been primarily used in the diagnostic setting to evaluate patients with screening abnormalities or with symptomatic breasts, to perform preoperative staging of newly diagnosed breast cancer, and to evaluate response to neoadjuvant chemotherapy. More recently, CEM has been performed to screen women who have an intermediate to high lifetime risk of developing breast cancer. In addition to its high diagnostic performance, CEM is less expensive and more accessible than MRI and potentially better tolerated by patients. Minor drawbacks to CEM include a slightly increased radiation dose compared with standard mammography and a low risk for contrast allergy reaction. The aim of this study is to review the background, current literature, and future applications of CEM in breast cancer screening.
Topics: Female; Humans; Breast Neoplasms; Early Detection of Cancer; Mammography; Breast; Contrast Media; Magnetic Resonance Imaging
PubMed: 36108478
DOI: 10.1016/j.ejrad.2022.110513 -
RoFo : Fortschritte Auf Dem Gebiete Der... Nov 2022Breast MRI is the most sensitive method for the detection of breast cancer and is an integral part of modern breast imaging. On the other hand, interpretation of breast... (Review)
Review
BACKGROUND
Breast MRI is the most sensitive method for the detection of breast cancer and is an integral part of modern breast imaging. On the other hand, interpretation of breast MRI exams is considered challenging due to the complexity of the available information. Clinical decision rules that combine diagnostic criteria in an algorithm can help the radiologist to read breast MRI by supporting objective and largely experience-independent diagnosis.
METHOD
Narrative review. In this article, the Kaiser Score (KS) as a clinical decision rule for breast MRI is introduced, its diagnostic criteria are defined, and strategies for clinical decision making using the KS are explained and discussed.
RESULTS
The KS is based on machine learning and has been independently validated by international research. It is largely independent of the examination technique that is used. It allows objective differentiation between benign and malignant contrast-enhancing breast MRI findings using diagnostic BI-RADS criteria taken from T2w and dynamic contrast-enhanced T1w images. A flowchart guides the reader in up to three steps to determine a score corresponding to the probability of malignancy that can be used to assign a BI-RADS category. Individual decision making takes the clinical context into account and is illustrated by typical scenarios.
KEY POINTS
· The KS as an evidence-based decision rule to objectively distinguish benign from malignant breast lesions is based on information contained in T2w und dynamic contrast-enhanced T1w sequences and is largely independent of specific examination protocols.. · The KS diagnostic criteria are in line with the MRI BI-RADS lexicon. We focused on defining a default category to be applied in the case of equivocal imaging criteria.. · The KS reflects increasing probabilities of malignancy and, together with the clinical context, assists individual decision making..
CITATION FORMAT
· Baltzer PA, Krug KB, Dietzel M. Evidence-Based and Structured Diagnosis in Breast MRI using the Kaiser Score. Fortschr Röntgenstr 2022; 194: 1216 - 1228.
Topics: Humans; Female; Breast; Magnetic Resonance Imaging; Mammography; Breast Neoplasms; Radiography; Retrospective Studies
PubMed: 35613905
DOI: 10.1055/a-1829-5985 -
Breast Cancer (Tokyo, Japan) May 2018In 2017, breast cancer became the most commonly diagnosed cancer among women in the US. After lung cancer, breast cancer is the leading cause of cancer-related mortality... (Review)
Review
In 2017, breast cancer became the most commonly diagnosed cancer among women in the US. After lung cancer, breast cancer is the leading cause of cancer-related mortality in women. The breast consists of several components, including milk storage glands, milk ducts made of epithelial cells, adipose tissue, and stromal tissue. Mammographic density (MD) is based on the proportion of stromal, epithelial, and adipose tissue. Women with high MD have more stromal and epithelial cells and less fatty adipose tissue, and are more likely to develop breast cancer in their lifetime compared to women with low MD. Because of this correlation, high MD is an independent risk factor for breast cancer. Further, mammographic screening is less effective in detecting suspicious lesions in dense breast tissue, which can lead to late-stage diagnosis. Molecular differences between dense and non-dense breast tissues explain the underlying biological reasons for why women with dense breasts are at a higher risk for developing breast cancer. The goal of this review is to highlight the current molecular understanding of MD, its association with breast cancer risk, the demographics pertaining to MD, and the environmental factors that modulate MD. Finally, we will review the current legislation regarding the disclosure of MD on a traditional screening mammogram and the supplemental screening options available to women with dense breast tissue.
Topics: Biomarkers, Tumor; Breast; Breast Density; Breast Neoplasms; Early Detection of Cancer; Epithelial Cells; Extracellular Matrix Proteins; Female; Fibroblasts; Humans; Mammography; Risk Factors
PubMed: 29651637
DOI: 10.1007/s12282-018-0857-5 -
Diagnostic and Interventional Radiology... 2017High social awareness of breast diseases and the rise in breast imaging facilities have led to an increase in the detection of even rare benign and malignant breast... (Review)
Review
High social awareness of breast diseases and the rise in breast imaging facilities have led to an increase in the detection of even rare benign and malignant breast lesions. Breast lesions are associated with a broad spectrum of imaging characteristics, and each radiologic imaging technique reflects different characteristics of them. We aimed to increase familiarity of the radiologist with these uncommon lesions as well as correlate histopathologic findings with the radiologic imaging features of the tumors. Histopathologic examination is necessary in the evaluation of such breast lesions, particularly when radiologic images are not definitive for a specific diagnosis.
Topics: Breast; Breast Diseases; Female; Humans; Mammography
PubMed: 28508760
DOI: 10.5152/dir.2017.16085