Background: The assessment of breast density is one of the main goals of radiologists because the masking effect of dense fibroglandular tissue may affect the mammographic identification of lesions. The BI-RADS 5th Edition has revised the mammographic breast density categories, focusing on a qualitative evaluation rather than a quantitative one. Our purpose is to compare the concordance of the automatic classification of breast density with the visual assessment according to the latest available classification. Methods: A sample of 1075 digital breast tomosynthesis images from women aged between 40 and 86 years (58 ± 7.1) was retrospectively analyzed by three independent readers according to the BI-RADS 5th Edition. Automated breast density assessment was performed on digital breast tomosynthesis images with the Quantra software version 2.2.3. Interobserver agreement was assessed with kappa statistics. The distributions of breast density categories were compared and correlated with age. Results: The agreement on breast density categories was substantial to almost perfect between radiologists (κ = 0.63–0.83), moderate to substantial between radiologists and the Quantra software (κ = 0.44–0.78), and the consensus of radiologists and the Quantra software (κ = 0.60–0.77). Comparing the assessment for dense and non-dense breasts, the agreement was almost perfect in the screening age range without a statistically significant difference between concordant and discordant cases when compared by age. Conclusions: The categorization proposed by the Quantra software has shown a good agreement with the radiological evaluations, even though it did not completely reflect the visual assessment. Thus, clinical decisions regarding supplemental screening should be based on the radiologist’s perceived masking effect rather than the data produced exclusively by the Quantra software.

Microvascular flow imaging is a new ultrasound technique with better ability than color Doppler imaging to identify small vessels that have slow blood flow, and it permits better evaluation of the features, especially microvascular architecture, of various lesions. We describe a case of inguinal hidradenitis suppurativa in a patient with positive risk factors (young age, female, smoker, and obese), diagnosed by ultrasonography using B-Mode, color Doppler, and finally also with microvascular flow imaging. Our aim is to demonstrate the usefulness of this new technique in characterization of lesions.

Vacuum-assisted breast biopsy (VABB) guided by digital breast tomosynthesis (DBT) represents one of the best instruments to obtain a histological diagnosis of suspicious lesions with no ultrasound correlation or those which are visible only on DBT. After a review of the literature, we retrospectively analyzed the DBT-guided VABBs performed from 2019 to 2022 at our department. Descriptive statistics, Pearson’s correlation and χ² test were used to compare distributions of age, breast density (BD) and early performance measures including histopathology. We used kappa statistics to evaluate the agreement between histological assessment and diagnosis. Finally, we compared our experience to the literature to provide indications for clinical practice. We included 85 women aged 41–84 years old. We identified 37 breast cancers (BC), 26 stage 0 and 11 stage IA. 67.5% of BC was diagnosed in women with high BD. The agreement between VABB and surgery was 0.92 (k value, 95% CI: 0.76–1.08). We found a statistically significant inverse correlation between age and BD. The post-procedural clip was correctly positioned in 88.2%. The post-procedural hematoma rate was 14.1%. No infection or hemorrhage were recorded. When executed correctly, DBT-guided VABB represents a safe and minimally invasive technique with high histopathological concordance, for detecting nonpalpable lesions without ultrasound correlation.

Portal vein thrombosis (PVT) is a common complication of liver cirrhosis and is often the first sign of undetected hepatocellular carcinoma. It is crucial to differentiate malignant from benign thrombosis in determining prognosis and treatment. We describe a case of malignant PVT, detected for the first time by a new ultrasound technology, microvascular flow imaging, which can depict low flow in small vessels.

Background/Objectives: Contrast-enhanced mammography (CEM) has demonstrated high diagnostic accuracy in breast lesion detection and characterization. However, interpretation of enhancement intensity remains largely qualitative and subject to interobserver variability. This study aimed to evaluate the feasibility and reproducibility of a standardized region-of-interest (ROI)-based quantitative approach for enhancement assessment in CEM. Methods: In this single-center prospective study, 22 women undergoing CEM for suspicious findings on conventional breast imaging were enrolled, yielding a total of 27 lesions. Quantitative analysis was performed on recombined mediolateral oblique images acquired in both the early and delayed post-contrast phases. Three radiologists with different levels of experience independently performed ROI measurements using two standardized ellipsoidal ROI sizes (0.1 cm² and 0.2 cm²). ROIs were systematically positioned on the lesion, fibroglandular tissue, subcutaneous fat, and pectoralis major muscle. Relative ROI (rROI) metrics were calculated to reduce variability related to acquisition and post-processing factors. The primary normalized parameter was the lesion-to-parenchyma ratio (nROI). Histopathology served as the reference standard. Results: Of the 27 lesions, eight were benign (29.6%), eight were high-risk/B3 lesions (29.6%), and 11 were malignant (40.7%). Breast density categories were B in 11 lesions (40.7%), C in 13 lesions (48.1%), and D in three lesions (11.1%). Inter-reader reproducibility was good to excellent. Absolute lesion gray-scale values showed excellent agreement, with intraclass correlation coefficient (ICC) values ranging from 0.941 to 0.974, while nROI showed good reproducibility, with ICC values ranging from 0.861 to 0.894. No significant inter-reader differences were observed for normalized ratios. Comparison between ROI sizes showed small but statistically significant early phase differences for nROI, with median values of 1.009 for 0.1 cm² ROIs and 1.005 for 0.2 cm² ROIs (median paired difference −0.002; p = 0.002). Early phase nROI measured with the 0.1 cm² ROI differed significantly across breast density categories, increasing from density B to D (0.996, 1.010, and 1.015, respectively; p = 0.026). Conclusions: Standardized ROI-based quantitative analysis in CEM is feasible, and normalized enhancement ratios showed good inter-reader agreement, suggesting their potential to reduce variability related to subjective visual assessment and technical acquisition factors. Consequently, the proposed method provides a reproducible methodological framework for future larger studies aimed at validating quantitative CEM metrics.