Initially developed in 1993, the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon serves to standardize breast imaging reports, improve communication with referring physicians, and provide a quality assurance tool. The long-awaited BI-RADS fifth edition consolidates, improves, and expands the lexicon for mammography, breast ultrasonography (US), and breast magnetic resonance (MR) imaging. The new edition has increased the number of imaging examples to nearly 600. The breast MR imaging lexicon is significantly expanded since it first appeared in the fourth edition. New terms have been added to the US lexicon to reflect technologic advances. Minor but important changes have been made to the mammography section. Calcification descriptors in the lexicon are now consolidated into two categories: benign and suspicious. The controversial "intermediate concern" grouping has been eliminated, and a table in the lexicon summarizes the literature supporting the recommendation to biopsy such calcifications. New descriptors such as "developing asymmetry" are illustrated, and abstracts are provided to reference their significance. A generous guidance section is included after the lexicon description for each modality. Useful frequently asked questions are succinctly answered, and the literature to support each answer is included in the reference section for each modality. This review article illustrates and highlights changes to the BI-RADS lexicon and provides readers with a general overview to familiarize them with the fifth edition. (©)RSNA, 2016.

A breast cancer diagnosis can be a life‐changing and stressful experience that can lead to chronic mental health conditions such as posttraumatic stress disorder (PTSD). Greater than one‐third of patients initially diagnosed with PTSD after a diagnosis of breast cancer continue to have persistent or worsening PTSD symptoms after 4 years. An emerging body of literature has indicated several key environmental and biological risk factors for PTSD among survivors of breast cancer. Well‐recognized risk factors include having a history of childhood trauma, being nonwhite, obesity, younger age at the time of diagnosis, diagnosis with a higher stage of breast cancer, and short time since treatment. Of the emerging risk factors related to fear circuitry in the brain, 2 pathways of particular importance are the stress‐driven activation of inflammatory pathways and the long‐term effect of antiendocrine therapies. These central and peripheral responses during and after stress exposure are important because increased fear and anxiety can lead to the maintenance of PTSD and worse patient outcomes. Given the poor outcomes associated with PTSD and the high prevalence of breast cancer in women, more research to identify those women at heightened risk of PTSD after breast cancer is warranted to reduce the number of diagnoses and lessen the negative impact of this chronic mental health condition.

Carcinosarcoma of the pancreas is a rare malignancy with high mortality. Diagnosis is based on pathologic demonstration of adjacent malignant epithelial and mesenchymal tissue. Due to inherent limitations of biopsy sampling, tumor heterogeneity is rarely recognized until definitive surgical resection. A 52-year-old woman presented to the emergency department with diarrhea. Abdominal CT imaging showed a 4.1×4.5 cm mass in the head of the pancreas with intrahepatic and extrahepatic ductal dilation. Endoscopic ultrasound (EUS) confirmed the mass with evidence of superior mesenteric vein involvement. Fine-needle aspiration (FNA) showed adenocarcinoma. After multi-disciplinary tumor board discussion, the patient was treated with four cycles of neoadjuvant of oxaliplatin, irinotecan, fluorouracil, and leucovorin (FOLFIRINOX) followed by 50-55 Gy photon radiation with concurrent capecitabine. Pancreaticoduodenectomy was performed after 6 months of neoadjuvant therapy. Pathologic examination revealed carcinosarcoma of the pancreas, with pathological partial response in the resected tumor. Patient has been disease-free for 15 months. Carcinosarcoma of pancreas is a rare clinical entity. There is no established systemic therapy and only two patients, inclusive of this case, have been treated with neoadjuvant chemotherapy. Here we report a case of pancreatic carcinosarcoma treated with neoadjuvant FOLFIRINOX followed by chemoradiation with pathological partial response. Modern treatment approaches for pancreatic ductal adenocarcinoma (PDAC) could be applied to this rare pathology.

Oropharyngeal squamous cell carcinoma (OPSCC) accounts for over half of all head and neck cancers. Since the 1970s, OPSCC has shifted from an environmentally triggered to virally mediated disease due to a sharp rise in human papillomavirus (HPV)-related SCC. Although a highly effective prophylactic vaccine is available, its current implementation is far below national targets and OPSCC incidence is predicted to further increase by 2045. However, we believe that with prompt action now, we can not only defy these predictions, but effectively eradicate HPV-related OPSCC in these next 20 years. We herein provide an overview of the necessary elements to eliminate this disease: improved primary vaccine uptake, a one-time universal vaccination effort, and implementation of novel therapeutics that have potential to cure existing disease.

Women are at higher risk for developing posttraumatic stress disorder (PTSD) compared to men, yet little is known about the biological contributors to this sex difference. One possible mechanism is differential immunological and neuroendocrine responses to traumatic stress exposure. In the current prospective study, we aimed to identify whether sex is indirectly associated with the probability of developing nonremitting PTSD through pro-inflammatory markers and whether steroid hormone concentrations influence this effect. Female ( n = 179) and male ( n = 197) trauma survivors were recruited from an emergency department and completed clinical assessment within 24 h and blood samples within ∼three hours of trauma exposure. Pro-inflammatory cytokines (IL-6, IL-1[Formula: see text], TNF, IFNγ), and steroid hormone (estradiol, testosterone, progesterone, cortisol) concentrations were quantified in plasma. Compared to men, women had a higher probability of developing nonremitting PTSD after trauma ( p = 0.04), had lower pro-inflammatory cytokines and testosterone ( p’ s<0.001), and had higher cortisol and progesterone ( p’ s<0.001) concentrations. Estradiol concentrations were not different between the sexes ( p = 0.24). Pro-inflammatory cytokines were a significant mediator in the relationship between sex and probability of developing nonremitting PTSD ( p < 0.05), such that men had higher concentrations of pro-inflammatory cytokines which were associated with lower risk of nonremitting PTSD development. This effect was significantly moderated by estradiol ( p < 0.05), as higher estradiol levels in men were associated with higher pro-inflammatory cytokine concentrations and lower risk for developing nonremitting PTSD. The current results suggest that sex differences in the pro-inflammatory cytokine response to trauma exposure partially mediate the probability of developing nonremitting PTSD, and that the protective ability to mount an pro-inflammatory cytokine response in men may depend on higher estradiol levels in the aftermath of trauma exposure.