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journal club discussion guide

May 2023

1. Preoperative Breast MRI: Current Evidence and Patient Selection  (JBI 2023)

  • What are the current indications for pMRI in the setting of a new breast cancer?

  • How does pMRI impact ILC staging?

  • Discuss some of the major MRI trials impacting surgical outcomes. 

  • In which particular subsets of IDC evaluation is pMRI particularly helpful?

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2. Pure Mucinous Carcinoma of the Breast: Radiologic-Pathologic Correlation (JBI 2023)

  • How is mucinous cancer different from typical IDC in clinical presentation?

  • What are the typical imaging presentation features of mucinous carcinoma?

  • What is a mucocele like lesion?

  • Is there axillary involvement commonly in these patients? What are the treatment options?

April 2023

1. Screening Breast MRI and the Science of Premenopausal Background Parenchymal Enhancement (JBI 2021)

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2. Influence of Menstrual Cycle Timing on Screening Breast MRI Background Parenchymal Enhancement and Diagnostic Performance in Premenopausal Women (JBI 2019)

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Questions for Discussion

  • What is the normal presentation of BPE on MRI?

  • How can BPE be quantitatively measured?

  • What does the data reveal regarding LMP and BPE?

  • How does BPE impact outcomes?

  • What does BPE suggest about breast cancer risk?

  • What does your practice currently do?

  • How will this information change your practice?

March 2023

1. Supplemental Breast Cancer Screening in Women with Dense Breasts and Negative Mammography: A Systematic Review and Meta-Analysis (Radiology 2023)

  • What is the purpose of this study? 

  • What is the target patient population? 

  • Why do women with dense breasts benefit from supplemental screening? 

  • What are the pros and cons of the various methods of supplemental breast cancer screening? 

  • How were studies selected for this meta-analysis? 

  • What supplemental screening modalities were evaluated? 

  • Review the primary and secondary outcomes that were measured. 

  • For which outcomes was MRI shown to be superior? 

  • For which outcomes show no difference? 

  • What are the limitations of this study? 

  • What are potential future directions? 

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2. Ultrasound as the Primary Screening Test for Breast Cancer: Analysis From ACRIN 6666 (JNCI, 2016)

  • What is the purpose of this study? 

  • What is the patient population studied? 

  • What modalities are compared in this study? 

  • How were patients screened with mammogram and ultrasound? 

  • Review the outcomes that were measured. 

  • While US and mammogram detected a similar number of cancers, cancers with what characteristics were more likely to be detected by US? 

  • What are the limitations of this study?

February 2023

1. Beyond Breast Density: Risk Measures for Breast Cancer in Multiple Imaging Modalities (Radiology, 2023)

  • How do the 4th and 5th editions of BIRADS vary in regards to classifying risk categories based on breast density for DM and DBT?

  • What is area-based percent density? Total dense volume?

  • Which risk assessment models use breast density?

  • How is breast parenchymal complexity measured?

  • Review deep learning models and ability to predict risk.

  • How might ultrasound be better at determining risk than mammography?

  • What is the proposed relationship between BPE and cancer risk on MRI?

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2. An Analysis of Cancer Center–Provided Rideshare Utilization for Radiation Therapy (JACR 2023)

  • An Analysis of Cancer Center–Provided Rideshare Utilization for Radiation Therapy (JACR 2023)

  • What is the purpose of this study?

  • How were patients chosen for a rideshare?

  • What is a geospatial analysis?

  • What is the Area Deprivation Index?

  • Review the results. What the characteristics of patients who used rideshare services?

  • How might this study impact your practice?​

January 2023

1. Contrast-Enhanced Mammography Versus MRI in the Evaluation of Neoadjuvant Therapy Response in Patients With Breast Cancer: A Prospective Study (AJR)

  • What was the purpose of this prospective study?

  • How was pathologic complete response (pCR) defined on imaging?

  • Review the key differences in sensitivity and specificity differences for pCR detection in post neoadjuvant therapy patients between MRI and CEM.

  • Discuss the role of delayed CEM in detection of residual DCIS post neoadjuvant therapy

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2. Contrast-enhanced Mammography: A Guide to Setting Up a New Clinical Program (JBI)

  • How does CEM work?

  • What are the contrast related risks associated with CEM? In which groups of patients should contrast administration be avoided?

  • Which patients may benefit from a CEM study? Discuss the common initial indications for the exam when setting up as a new modality in a practice.

  • What is a recombined-only imaging finding on CEM? How do radiologists navigate this circumstance?

December 2022

1. Comparison of Abbreviated Breast MRI vs Digital Breast Tomosynthesis for Breast Cancer Detection Among Women With Dense Breasts Undergoing Screening. JAMA. 2020 (Scientific)

  • Why is this study being pursued?

  • Review eligibility requirements? Why are women with hx of contrast-enhanced imaging or screening ultrasound excluded?

  • Review the study methodology.

  • What are the primary and secondary end point results?

  • How will this study impact your practice?

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2. Abbreviated and Ultrafast Breast MRI in Clinical Practice. Radiographics. 2020 (Educational) 

  • What are the differences between structural versus functional imaging?

  • What are the two types of abridged imaging reviewed in this article? How do they different?

  • What are the new terms used for ultrafast imaging and how do they relate to lesion type?

  • Review the challenges, advantages, and disadvantages of these imaging techniques?​

  • Would you consider using these in your practice, if not already?

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3. Abbreviated Breast MRI Utilization: A Survey of the Society of Breast Imaging, Journal of Breast Imaging, September/October 2022 (Practical) 

  • Review the methodology. How do you interpret the response rate?

  • Review the responses.

  • How does understanding SBI member usage impact your practice?

OCtober 2022

1. Bleeding Complications After Breast Core Needle Biopsy—An Approach to Managing Patients on Antithrombotic Therapy (JBI 2022)​

  • How risky are Breast Imaging procedures?

  • What are the most common complications from Breast Imaging procedures?

  • Review how antithrombotic agents work.

  • Besides antithrombotic medication, what are other factors that may impact bleeding risk?

  • What is proposed algorithm for managing patients undergoing biopsy?

  • Will this article impact your clinical practice?

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2. Antithrombotic Therapy and Hematoma Risk during Image-guided Core-Needle Breast Biopsy (Radiology 2022)

  • Review study methodology and results.

  • How do the results of this study impact your thoughts on the previous review?

SEPTEMBER 2022

Breast Cancer Screening in High-Risk Patients during Pregnancy and Breastfeeding: A Systematic Review of the Literature (JBI 2019)​

  • What is the purpose of this article?

  • What are the eligibility criteria?

  • How was the data extracted and synthesized?

  • How many final studies and what types of studies were included in the analysis?

  • What were the indications for high-risk in these studies?

  • What were the recommendations for CBE, mammography, ultrasound, and MRI?

  • What are the limitations of this study?

  • How will you apply this scientific review to your practice?

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2. Pregnancy Associated Breast Cancer Among Israeli BRCA1/BRCA2 Carriers in a High-Risk Clinic (Academic Radiology 2022)

  • What is the purpose of this article?

  • How was this study designed?

  • What are the inclusion criteria?

  • What is the breast imaging protocol?

  • Review the results, including the PPV2/3, CDR, and false positives.

  • Review the subtypes of cancers found and patient outcomes.

  • Discuss the limitations.

  • How will you apply these results to your practice?

AUGUST 2022

Artificial Intelligence (AI) for Screening Mammography, From the AJR Special Series on AI Applications (AJR 2022)​

  • What is purpose of this article?

  • What are different ways AI can be used for breast imaging?

  • Is there sufficient evidence to use AI in clinical practice? Why or why not? And for which indications?

  • How can AI tools be evaluated?

  • What are steps to consider when integrating AI into your workflow? How can you use these considerations for your practice?

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2. The Economic Impact of AI on Breast Imaging (JBI 2022)

JULY 2022

1. Invited Commentary: Breast Cancer Risk Assessment and Screening Strategies—What’s New? (Radiographics 2020)​

  • What are the NCCN guidelines for genetic counseling referral?

  • What are the drawbacks of Gail risk assessment model? 

  • Which are the high- and moderate-risk genes associated with breast cancer?

  • What are the additional cancers associated with BRCA mutations?

  • Describe the screening recommendations for the most common genetic mutations.

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Supplement: Genetic Testing and Screening Recommendations for Patients with Hereditary Breast Cancer (Radiographics 2020)

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2. Molecular classification of Infiltrating breast cancer (Radiographics 2014)

  • What are the four intrinsic molecular subtypes of breast cancer?

  • Which subtype has the most favorable prognosis and what is the molecular explanation for that? 

  • Which subtypes have the worst prognosis and poorer clinical outcomes?

  • How is the genetic expression of luminal B tumors distinct from the A subtypes?

  • What is the classic benign appearance of basal like triple negative breast cancers on multimodality breast imaging?

  • What are the specific characteristics of the newer subtypes like Claudin-low and luminal HER2 breast cancers?

 

Supplement: Molecular Subtypes of Breast Cancer: A Review for Breast Radiologists (JBI 2020)​

jUNE 2022

The Fundamental Flaws of the CNBSS Trials: A Scientific Review (JBI 2022)

  • Review the HIP trial from 1963. What were the key results?

  • What were the key goals of the CNBSS trials?

  • Review the 8 key features of RCT and how they were applied to the CNBSS trials.

  • Does review of the CNBSS trials impact your view of breast cancer screening?

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2. Overdetection of Breast Cancer (Current Oncology 2022)

  • What are the two components to overdetection?

  • What are the harms associated with overdetection?

  • How is overdetection estimated and what are the challenges with these approaches?

  • Review the modeling approach.

  • Review the results.

 

Supplement: How did CNBSS Influence Guidelines for So Long and What Can That Teach Us (Current Oncology 2022)

mAY 2022

Screening Breast MRI and Gadolinium Deposition: Cause for Concern? (JBI 2022)

  • What is the classification of gadolinium based agents?

  • Which body tissues has gadolinium demonstrated tissue deposition in?

  • What is the cause of gadolinium deposition in central nervous system tissues?

  • What is gadolinium deposition disease?

  • What are FDA regulations for patients exposed to Gad based agents?

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Supplement: Gadolinium retention and breast MRI screening: more harm than good? (AJR 2020)

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2.  Contralateral Breast Screening with Preoperative MRI: Long-Term Outcomes for Newly Diagnosed Breast Cancer (Radiology 2022)

  • Review background data regarding use of breast MRI for breast cancer staging

  • Discuss the goal of this study

  • Outline the study design. How were the two groups being compared similar and different?

  • Summarize study results. What is different about this study compared to others on similar topic?  

  • Describe how this impact your clinical practice?  Will you recommend breast MRI more frequently now or not?

APRIL 2022

A Randomized Trial Comparing Breast Cancer Incidence and Interval Cancers after Tomosynthesis Plus Mammography versus Mammography Alone, Radiology 2022

  • What was the purpose of this prospective study?

  • What was the study methodology? Any benefits/limitations that you notice? Comment on:  number of participants, number of compared rounds of DBT/DM vs DM, invited-to-screen vs screened methodology

  • What are the key results in the total population? How do results vary by age? by tissue density?

  • How will these results impact your clinical practice?

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Supplements:

Breast Cancer Screening: Understanding the Randomized Controlled Trials: A nice simple to follow explanation of RCT and how to evaluate randomized screening trials.

 

Breast Cancer Screening Recommendations Inclusive of All Women at Average Risk: Update from the ACR and Society of Breast Imaging, JACR 2021: A current overview of screening guidelines for women at average risk.

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2.  Breast Cancer Screening Strategies for Women With ATM, CHEK2, and PALB2 Pathogenic Variants A Comparative Modeling Analysis, JAMA Oncol 2022

  • What is the purpose of this study?

  • What is the study methodology? Comment on: What models were used and what populations were compared?

  • What are the key results? 

  • How will these results impact your clinical practice?

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3.  Developing Asymmetries without Sonographic Correlate at Digital Breast Tomosynthesis, Radiology 2022

  • What is the purpose of this retrospective study?

  • What is the study methodology? Comment on: the population that was analyzed, how were images and path slides were reviewed?

  • What are the key results? 

  • How will these results impact your clinical practice?

MARCH 2022

1.  A new approach to breast cancer terminology based on the anatomic site of tumour origin: The importance of radiologic imaging biomarkers, Eur Journal of Radiol 2022

  • What is the purpose of the article?

  • How is breast cancer currently classified?

  • Review the new classification system and terminology proposed in this paper.

  • What information do you need to better understand this proposed system?

  • How might this change impact your clinical practice?

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Supplement: Ductal Carcinoma in Situ: State-of-the-Art Review, Radiology 2021

  • What are pathologic features that help differentiate forms of DCIS?

  • What are the proposed models for progression of DCIS to invasive cancer?  What questions remain?

  • Summarize the imaging appearance of DCIS and how they correspond to types of DCIS and outcomes.

  • Review current treatment paradigms for DCIS in your institution.

  • What is active surveillance? Review current trials.

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2.  Breast Cancer Screening in High-Risk Men: A 12-year Longitudinal Observational Study of Male Breast Imaging Utilization and Outcomes, Radiology 2019

  • What was the purpose of this retrospective study?

  • What was the study approach? Any limitations that you notice?

  • What are the key results in the screening and diagnostic populations?

  • How do these results support (or not) the NCCN and ASCO guidelines for screening of high risk male patients?

  • How will these results impact your clinical practice?

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3.  Leveling the Workload for Radiologists in Diagnostic Mammography: Application of Lean Principles and Heijunka, Journal of Breast Imaging 2021

  • What is the purpose of this review?

  • Define Lean principles and Heijunka. How are they being used to assess breast imaging workflow?

  • Identify some challenges in the technologist and radiologist workflows.

  • Can you brainstorm opportunities for improvement in your workflow using these principles?

FEBRUARY 2022

1.  Digital Breast Tomosynthesis and Digital Mammography Recall and False-Positive Rates by Time of Day and Reader Experience, Radiology 2022

  • What was the key question(s) of the article?

  • What type of study was it?

  • Review the study design including the study population (screening exams and radiologist readers), the main data elements collected (type of exam, interpretation time, exam BI-RADS, exam outcome, interpreting radiologist experience), and analysis

  • Do you have any questions regarding the study design?

  • Which result most interests you? 

  • How can we apply these results to our practice of screening mammography?

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2.  Imaging Updates to Breast Cancer Lymph Node Management, Radiographics 2021

  • Which imaging features of nodes are more predictive of malignant involvement?

  • The AJCC staging guidelines have changed.  Why do you think they kept the standard TNM staging and added prognostic information rather than creating an entirely new classification system?

  • Radiology practices vary in their approach to the axilla. What imaging tool, if any, does your practice use to image the axilla?

  • Do you routinely image axilla in all BI-RADS 4&5 breast masses? 

  • How does your practice handle abnormal nodes seen by imaging? Discuss your practice approach as it relates to referenced clinical trials (for the surgery 1st and NST 1st settings)

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