Symptomatic complicated cysts generally warrant aspiration. All clustered microcysts were benign, but further study is required. Cystic lesions with thick indistinct walls and/or thick septations (> or =0.5 mm), intracystic masses, and predominantly solid masses with eccentric cystic foci should be examined at biopsy; 18 of 79 of such complex cystic lesions proved malignant in this series.

Inter- and intraobserver variability in mammographic interpretation is substantial for both feature analysis and management. Continued development of methods to improve standardization in mammographic interpretation is needed.

Statistically significant differences with various biopsy devices are seen in the breast tissue yield and in fragmentation.

PurposeAs the breast cancer survivor population increases, the topic of screening these women for recurrences is increasingly relevant. In our institution, we use both breast MRI and mammography in the surveillance of breast cancer survivors, although little data exists on the use of MRI in this setting. We present a retrospective analysis of our experience and compare the sensitivity and specificity of MRI vs. mammography in this setting.MethodsWe identified women under 65 with a history of breast cancer and at least one follow-up MRI performed along with a mammogram done within 6 months of the MRI. We compared the outcomes of MRI and mammography in terms of biopsies performed as well as in detection of new cancers.ResultsOf 617 charts reviewed, 249 patients met inclusion criteria, with 571 paired MRI/mammogram results. There were 27 biopsies performed due to MRI findings alone, 10 done due to mammographic findings alone, and 15 done based on abnormalities seen on both imaging modalities. There were 8 malignancies identified based on an abnormal MRI, 3 detected on both MRI and mammography, and none identified via mammography alone. Overall, MRI had a sensitivity of 84.6% (the 95% CI 54.6–98.1) and a specificity of 95.3% (the 95% CI 93.3–96.9); mammography a sensitivity of 23.1% (the 95% CI 5.0–53.8), and a specificity of 96.4% (the 95% CI 94.5–97.8).ConclusionsBreast MRI is a useful surveillance modality in breast cancer survivors and may be more sensitive at detecting recurrences than mammography alone in this population.

OBJECTIVE. Our objectivewas to determinethe predictivevalueof specimenradiography for large core (14-gauge) needle biopsy of noncalcified breast masses. SUBJECTS AND METHODS. Eighty-four biopsiesof 83 breastmassesyielded 403specimens. Specimens showing dense material on specimen radiography were predicted to be diagnostic;specimensshowingintermediate-or low-densitymaterial were predictedto be nondiagnostic. Specimenradiographicand histopathologic findingswere correlatedfor each specimen using vital dyes to mark individual specimens. RESULTS. Of the403 specimens, 307 (76%) containeddiagnosticmaterialrepresentativeof the lesion, with a specific diagnosis achieved for 82 (99%) of 83 lesions (62 benign, 20 ma lignant). Of the 293 passescontaining dense material, 268 (9 1%) proved to be diagnostic; I 1 (18%) of 62 specimenscontainingonly low-densitymaterialprovedto be diagnostic.Of the 25 (9%) of 293 specimens containing radiographically dense but nondiagnostic material, I 8 (72%) showed focal fibrosis and had missed the lesion; 15 (83%) of 18 such specimenswere obtained in dense parenchyma. The positive predictive value of specimen radiography was I3 ( 100%) of 13 in fatty breasts; 77 (96%) of 80 in breasts with minimal scattered fibroglandular elements; 91 (94%) of 97 in heterogeneously dense breasts; and 35 (70%) of 50 in breasts with extremely dense parenchyma. Of the 16 lesions sampled stereotactically, specimen radi ography helped assessthe inadequacy of initial sampling in three (19%). In six (9%) of 68 sonographically guided biopsies, only one or two specimens could be obtained; specimen ra diographyhelpeduspredictwhethermaterialwasadequatefor diagnosis. CONCLUSION. Radiography of corespecimens obtainedfrom noncalcified breastmassesaccurately reveals the adequacy of sampling unless the breast parenchyma is extremely dense.Such immediate assessment can help ensureadequatematerial from lesions that are difficult to biopsyandcantherebyimprovethediagnostic yieldoflarge coreneedlebreastbiopsy.