Objective: To determine the added value of digital breast tomosynthesis (DBT) in the assessment of lesions detected by contrast-enhanced mammography (CEM). Material and methods: A retrospective study was conducted in a tertiary university medical center. All CEM studies including DBT performed between January 2016 and December 2020 were included. Lesions were categorized and scored by four dedicated breast radiologists according to the recent CEM and DBT supplements to the Breast Imaging Reporting and Data System (BIRADS) lexicon. Changes in the BIRADS score of CEM-detected lesions with the addition of DBT were evaluated according to the pathology results and 1-year follow-up imaging study. Results: BIRADS scores of CEM-detected lesions were upgraded toward the lesion’s pathology with the addition of DBT (p > 0.0001), overall and for each reader. The difference in BIRADS scores before and after the addition of DBT was more significant for readers who were less experienced. The reason for changes in the BIRADS score was better lesion margin visibility. The main BIRADS descriptors applied in the malignant lesions were spiculations, calcifications, architectural distortion, and sharp or obscured margins. Conclusions: The addition of DBT to CEM provides valuable information on the enhancing lesion, leading to a more accurate BIRADS score.

The study investigates the potential link between gynecomastia and breast cancer in males carriers pf high risk breast cancer genes using mammography data between 2016 and 2023. Stratification by carriers status, breast cancer diagnosis, and gynecomastia presence reveals that carriers shows a higher likelihood of cancer diagnosis in cases of gynecomastia ( P < .05), suggesting a noteworthy association deserving further study. Introduction: The recommendations for annual mammography for male carriers with gynecomastia are controversial. This study investigated the potential link between gynecomastia and breast cancer in male carriers. Patients and Methods: The database of a tertiary medical center was retrospectively searched for all male patients who underwent at least 1 digital mammography study from 2016 to 2023. Known carriers of a pathogenic variant in a high-risk breast- cancer gene were identified. Patients were stratified by carrier status, diagnosis of breast cancer, and diagnosis of gynecomastia. Data on demographics, hormone profile, and pathology results were compared. Results: The cohort included 446 men of whom 82 were known carriers. Gynecomastia was diagnosed by mammography in 251 patients: 239/364 noncarriers (66%) and 12/82 carriers (15%) ( P < .0001). Breast cancer was found in 21/364 noncarriers (6%) and 6/82 carriers (7%) ( P < .6), and in 10/251 patients with gynecomastia (4%) and 17/193 (9%) without gynecomastia ( P < .05). Among patients without gynecomastia, the number of breast cancer cases was similar in carriers and noncarriers ( P = .3). Among patients with gynecomastia, the rate of breast cancer was higher in carriers ( P < .08). On logistic regression analysis, the effect of gynecomastia on carriers was significant ( P = .02). The odds ratio for a breast cancer diagnosis was 5.8 in the presence of gynecomastia (95% CI, 1.1-31, P < .04) and 0.52 in the absence of gynecomastia (95% CI, 0.2-1.7, P < .3). Conclusion: Gynecomastia may be associated with an increased risk of breast cancer in carriers. Larger studies are needed to determine whether and when to screen male carriers.

OBJECTIVE:Contrast-enhanced imaging, including magnetic resonance imaging and, more recently, contrast-enhanced digital mammography (CEM), is indicated for the precise diagnosis of invasive lobular carcinoma (ILC). The aim of our study was to further validate the use of CEM for evaluation of extent of disease in ILC cases, with digital breast tomosynthesis (DBT) as an adjunct. METHODS:A retrospective, institutional review board approved study was conducted in a tertiary medical center. All CEM examinations performed on ILC patients between 2017 and 2023 were reread by 2 dedicated breast radiologists. Clinical data and pathology reports were retrieved from electronic medical records. The longest diameter of the enhancing lesion was correlated to pathology findings. In addition, for each case, the readers provided brief commentary on the added value of DBT. RESULTS:Twenty-four CEM examinations were evaluated. The subjects in the study cohort were on average older than expected for ILC patients (74 vs 63 years) and were unable to undergo breast magnetic resonance imaging due to advanced age and comorbidities. Three subjects were treated with neoadjuvant therapy and thus were excluded from the correlation to pathology analysis. Enhancing lesions, ranging from 4-75 mm, strongly correlated to pathology results, with statistical significance. This was demonstrated for mass and nonmass lesions ( r  = 0.94, P  < 0.001 and r  = 0.99, P  = 0.002, respectively). For most lesions (17/24, 71%), readers remarked that the addition of DBT allowed for improved characterization of lesion margins, mainly detecting architectural distortion. CONCLUSIONS:When compared with the pathology findings, ILC was accurately diagnosed and assessed using CEM. The addition of DBT was reported by the interpreting radiologists as a valuable adjunct for margin analysis.

Purpose: To demonstrate the feasibility of cystic duct emholization and chemical gallbladder ablation as an alternative to cholecystectomy in high-risk patients with calculous cholecystitis who Were not candidates for surgery. Materials and Methods: This prospectixe study included 10 patients with acute cholccystitis (7 males and 3 females ) aged 70-91 years (average age, 81.6 years) between 2013 and 2019. A cholecystostomy catheter was inserted during the acute phase. followed by cystic duct coil emholization performed via the existing drainage tube tract. Once asymptomatic, 3% aethoxysklcrol was injected into the gallbladder. and the drain was removed upon sonographic confirmation that the gallbladder remained contracted. Each phase of the procedure vas performed with an interval of 2-3 weeks. Clinical, cholangiographic, and sonographic data were collected before and after drain removal at 1-month follow-up. Results: Cystic duct embolization was technically successful in all patients. with no immediate post-procedure complications. Gallbladder ahlation performed in 10 patients was technically successful in all of them (median follow-up. 11 months). One patient required repeat ahlation at 14 months. and the prolonged biliary excretions of 1 other patient ceased only at 8 months. Conclusions: Cystic duct emholization with gallbladder ahlation is a feasible procedure for patients in whom cholecystectomy is contraindicated.

Introduction: Tubular adenomas are rare benign epithelial neoplasms of the breast resembling fibroadenomas on both imaging and pathology. We aimed at characterizing and differentiating these lesions on contrast enhanced mammography and MRI.Material and methods: Out of all percutaneous breast biopsies performed at the Rabin medical center between the years 2010-2019, five cases which also had contrast-based imaging including contrast enhanced mammography and MRI were retrieved. Morphology and enhancement patterns of the lesions were analyzed by two dedicated breast radiologists.Results: The contrast imaging characteristics of all lesions were enhancing masses measuring 4-17 mm. The shape of the lesions was oval, borders well circumscribed, on both CEM and MRI. CEM revealed marked homogenous enhancement. MRI enhancement patterns of the small tumors showed homogenous enhancement, whereas the larger mass showed a more heterogeneous enhancement. Kinetic curves on MRI were of rapid marked enhancement.Conclusion: Tubular adenomas diverge pathologically from known enhancement patterns of fibroadenomas.

OBJECTIVE The objective of this study was to identify radiological and clinical factors associated with early mortality in malignant superior vena cava syndrome (SVCS). MATERIALS AND METHODS Chest computed tomography studies of 127 patients with malignancy-associated SVCS were retrospectively reviewed. Involvement of SVC and tributaries, pleural and pericardial effusions, pulmonary artery involvement, and ancillary findings were documented. Univariate and multivariate models determined associations between radiological and clinical variables, and 30-day mortality. RESULTS Thirty-day mortality rate was 16.5% (n = 21). Factors associated with 30-day mortality on univariate analysis included age, cancer stage, SVCS clinical severity, left jugular vein obstruction, number of involved veins, pulmonary arteries involvement, and presence of pleural effusions. Age, SVCS clinical severity, number of veins involved, and pleural effusions were positively associated with 30-day mortality on multivariate analysis. CONCLUSIONS Selected clinical and radiological variables are associated with early death in malignant SVCS. These factors may identify a subgroup of patients who may benefit from treatment escalation.

Anticoagulation is often used in superior vena cava syndrome (SVCS) associated with cancer (i.e malignant SVCS), even without thrombosis, but its effect on outcomes has not been reported. We aimed to determine factors and outcomes associated with thrombosis and anticoagulation in malignant SVCS. Patients with malignant SVCS diagnosed on computerized tomography (CT) were retrospectively included, indexed at diagnosis and followed for 6 months using medical records. The cohort included 183 patients with malignant SVCS of which 153 (84%) were symptomatic. Thirty of the 127 patients (24%) with a reviewable baseline CT had thrombosis of the SVC or tributaries at diagnosis. Patients with baseline thrombosis more often had symptomatic SVCS (p < 0.01). 70% (21/30) of patients with thrombosis and 52% (49/97) of those without thrombosis at baseline received anticoagulation, most often at therapeutic doses. Thrombosis occurred in 5/39 patients with anticoagulation (13%) compared to 2/18 (11%) of those without, during follow-up (p = 0.85). Anticoagulation was associated with a reduction in risk of SVC stent placement during follow-up that did not reach statistical significance (HR 0.47, 95% CI 0.2–1.13, p = 0.09). Major bleeding occurred in 7 (4%) patients, six of whom received anticoagulation (four therapeutic and two intermediate dose). Neither thrombosis nor anticoagulation affected survival. Anticoagulation is commonly used as primary prevention but its benefit remains to be proven. The role of reduced-dose anticoagulation in non-thrombotic malignant SVCS should be prospectively assessed.