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.

With a lifetime risk of 1 in 8, breast cancer continues to be a major concern for women and their physicians. The optimal treatment of the disease depends on the stage of the cancer at diagnosis, which is typically assessed using medical imaging. However, currently employed imaging systems for breast tumor measurement rarely agree perfectly. Our group developed an Intraoperative Photoacoustic Screening (iPAS) soft tissue scanner featuring high bulk tissue sensitivity, a clinically compatible scan-time of 6 min, imaging depths greater than 2 cm and the capability to visualize whole breast tumors based on their lipid, rather than hemoglobin, profile. Here, we report on the first clinical experience with breast cancer patients by comparing tumor-measurement using iPAS, preoperative dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) and gold-standard pathology. Tumor size was measured volumetrically for iPAS and DCE-MRI, and separately using maximum diameters for pathology, DCE-MRI and iPAS. Comparisons were performed using Pearson's correlation coefficients, and the non-parametric Wilcoxon signed-rank test. Twelve consecutive patients were included in the study, contingent on pathologically documented invasive carcinoma. iPAS volumetric tumor size was positively correlated to DCE-MRI (Pearson's r = 0.78, p = 0.003) and not significantly different (Wilcoxon, p = 0.97). In comparison to pathology, tumor diameters given by iPAS were positively correlated (Pearson's r = 0.87, p = 0.0002) and significantly different (Wilcoxon, p = 0.0015). The results indicated that volumetric-measurement of invasive breast tumors with iPAS is similar to that of DCE-MRI. On the other hand, tumor diameter measurements were less reliable. Beyond enhancing surgical specimen examination, an extension of this technology to diagnostic imaging promises a new perspective on tumor assessment, potentially improving our current understanding and treatment of breast cancer.

OBJECTIVE. The purpose of this article is to determine the utility of repeat mammography, compared with targeted ultrasound and previous mammogram, in the assessment of an interval palpable breast lump found within 1 year after a negative mammogram study. MATERIALS AND METHODS. Women who were examined for a new palpable lump with mammography and targeted ultrasound between January 2005 and December 2012, who also had a negative mammogram within the previous 6–12 months, were included. The following data were collected: age, mammographic findings, change from previous mammogram, ultrasound findings, BI-RADS category, and biopsy results. RESULTS. A total of 618 palpable lumps in 612 women (mean [± SD] age, 55.9 ± 11.2 years) were included in this study. In 314 of 618 cases (50.8%), a sonographic finding or mammographic change, or both was detected in the region of the palpable lump. Ultrasound detected a finding in 311 cases (50.3%), whereas repeat mammography detected a change in only 80 (12.9%) cases (p <...

To determine the effect of dose fractionation and time delay post-neoadjuvant stereotactic ablative radiotherapy (SABR) on dynamic contrast-enhanced (DCE)-MRI parameters in early stage breast cancer patients. DCE-MRI was acquired in 17 patients pre- and post-SABR. Five patients were imaged 6-7 days post-21 Gy/1fraction (group 1), six 16-19 days post-21 Gy/1fraction (group 2), and six 16-18 days post-30 Gy/3 fractions every other day (group 3). DCE-MRI scans were performed using half the clinical dose of contrast agent. Changes in the surrounding tissue were quantified using a signal-enhancement threshold metric that characterizes changes in signal-enhancement volume (SEV). Tumour response was quantified using Ktrans and ve (Tofts model) pre- and post-SABR. Significance was assessed using a Wilcoxin signed-rank test. All group 1 and 4/6 group 2 patients' SEV increased post-SABR. All group 3 patients' SEV decreased. The mean Ktrans increased for group 1 by 76% (p = 0.043) while group 2 and 3 decreased 15% (p = 0.028) and 34% (p = 0.028), respectively. For ve, there was no significant change in Group 1 (p = 0.35). Groups 2 showed an increase of 24% (p = 0.043), and Group 3 trended toward an increase (23%, p = 0.08). Kinetic parameters measured 2.5 weeks post-SABR in both single fraction and three fraction groups were indicative of response but only the single fraction protocol led to enhancement in the surrounding tissue. Our results also suggest that DCE-MRI one-week post-SABR may be too early for response assessment, at least for single fraction SABR, whereas 2.5 weeks appears sufficiently long to minimize confounding acute effects.