The authors report 38 consecutive cases of histologically proved breast radial scars (RSs) detected at mammography. In a retrospective review of mammograms in 30 matched cases of nonpalpable RS and nonpalpable scirrhous cancer, the characteristic mammographic features of RS were confirmed: (a) the absence of a central opacity, often substituted by a radiolucent area; (b) the presence of multiple elongated thin spicules radiating from the center of the lesion; (c) the infrequency of any palpable finding, even for superficial lesions of relatively large size. Microcalcifications with aspecific structure were found in the lesions on mammograms of 14 of the 38 cases and in 24 of the histologic specimens. The typical mammographic features of RS were not specific to RS, being present in a minority of cancer cases. For two blinded readers, sensitivity was 86.7% and 76.7% and specificity was 78% and 80%, respectively. Although some specific mammographic features may suggest the presence of RS, the final differential diagnosis from scirrhous cancer should be based on histologic evidence, and surgical biopsy should be advised for any stellate lesion detected at mammography.

Independent double reading results in only a modest increase in the detection of cancers and therefore may not be cost effective.

The clinical use of breast magnetic resonance (MR) imaging is increasing, especially for applications requiring paramagnetic contrast-agent injection. This document presents a synthetic list of acceptable indications with potential advantages for women according to evidence from the literature and the expert opinion of the panel that developed this statement. We generally recommend that breast MR imaging be performed in centres with experience in conventional breast imaging [mammography and ultrasonography (US)] and needle-biopsy procedures (under stereotactic or US guidance) as well as in breast MR imaging and second-look US for findings not revealed by conventional imaging performed before MR imaging. In our opinion, there is no evidence in favour of breast MR imaging as a diagnostic tool to characterise equivocal findings at conventional imaging when needle-biopsy procedures can be performed, nor for the study of asymptomatic, non-high-risk women with negative conventional imaging. After a description of technical and methodological requirements, we define the indications and limitations of breast MR imaging for surveillance of high-risk women, local staging before surgery, evaluation of the effect of neoadjuvant chemotherapy, breast previously treated for carcinoma, carcinoma of unknown primary syndrome, nipple discharge and breast implants.

The observation that a high proportion of families with BRCA1 alterations from Central-Eastern Tuscany harbours a limited number of founder mutations can have significant impact on clinical management of at risk subjects from this area. In addition, the identification of a large set of families carrying an identical mutation that predisposes to breast and ovarian cancer provides unique opportunities to study the effect of other genetic and environmental factors on penetrance and disease phenotype.

The authors evaluated ultrasound (US)-guided fine-needle aspiration cytology (FNAC) in 270 patients with suspicious findings at mammography. FNAC with a 10-MHz transducer and real-time scanner was performed when a lesion seen mammographically was unequivocally depicted at US. The needle was inserted with variable obliquity to the scanning plane. Stereotaxically guided FNAC was performed when lesions were not visible at US. High suspicion at mammography and positive cytologic reports led to surgical biopsy. Of the 270 lesions, 120 (44.4%) were visible at US. Opacities were the most frequently visualized lesions. Inadequate samplings were most frequently reported for opacities with smooth margins. Differences in accuracy and inadequacy rate between the two modalities were not significant. Cancer was surgically confirmed in 86 of 110 cases. The other 160 lesions were considered benign, and mammographic follow-up in 120 has shown no change. Because FNAC with US guidance was faster and less expensive, it is recommended as the technique of choice in lesions detectable with US.