Breast density is an independent risk factor for the development of breast cancer and also decreases the sensitivity of mammography for screening. Consequently, women with extremely dense breasts ...face an increased risk of late diagnosis of breast cancer. These women are, therefore, underserved with current mammographic screening programs. The results of recent studies reporting on contrast-enhanced breast MRI as a screening method in women with extremely dense breasts provide compelling evidence that this approach can enable an important reduction in breast cancer mortality for these women and is cost-effective. Because there is now a valid option to improve breast cancer screening, the European Society of Breast Imaging (EUSOBI) recommends that women should be informed about their breast density. EUSOBI thus calls on all providers of mammography screening to share density information with the women being screened. In light of the available evidence, in women aged 50 to 70 years with extremely dense breasts, the EUSOBI now recommends offering screening breast MRI every 2 to 4 years. The EUSOBI acknowledges that it may currently not be possible to offer breast MRI immediately and everywhere and underscores that quality assurance procedures need to be established, but urges radiological societies and policymakers to act on this now. Since the wishes and values of individual women differ, in screening the principles of shared decision-making should be embraced. In particular, women should be counselled on the benefits and risks of mammography and MRI-based screening, so that they are capable of making an informed choice about their preferred screening method.
Key Points
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The recommendations in Figure 1 summarize the key points of the manuscript
Axillary lymphadenopathy is a common side effect of COVID-19 vaccination, leading to increased imaging-detected asymptomatic and symptomatic unilateral axillary lymphadenopathy. This has threatened ...to negatively impact the workflow of breast imaging services, leading to the release of ten recommendations by the European Society of Breast Imaging (EUSOBI) in August 2021. Considering the rapidly changing scenario and data scarcity, these initial recommendations kept a highly conservative approach. As of 2023, according to newly acquired evidence, EUSOBI proposes the following updates, in order to reduce unnecessary examinations and avoid delaying necessary examinations. First, recommendation n. 3 has been revised to state that breast examinations should not be delayed or rescheduled because of COVID-19 vaccination, as evidence from the first pandemic waves highlights how delayed or missed screening tests have a negative effect on breast cancer morbidity and mortality, and that there is a near-zero risk of subsequent malignant findings in asymptomatic patients who have unilateral lymphadenopathy and no suspicious breast findings. Second, recommendation n. 7 has been revised to simplify follow-up strategies: in patients without breast cancer history and no imaging findings suspicious for cancer, symptomatic and asymptomatic imaging-detected unilateral lymphadenopathy on the same side of recent COVID-19 vaccination (within 12 weeks) should be classified as a benign finding (BI-RADS 2) and no further work-up should be pursued. All other recommendations issued by EUSOBI in 2021 remain valid.
Graphical abstract
Key points
Worldwide COVID-19 vaccination campaigns have become commonplace.
Post-vaccination COVID-19 lymphadenopathy has been reported in up to 44% of cases in at least one follow-up examination.
Breast examinations should not be delayed because of COVID-19 vaccination.
In average-risk patients without suspicious breast findings, ipsilateral imaging-detected axillary lymphadenopathy within 12 weeks after vaccination should be classified as BI-RADS 2.
Most ductal carcinomas in situ are clinically occult; therefore, proper techniques must be used for adequate diagnosis. Current guidelines recommend minimally invasive tissue sampling before surgical ...excisions of all breast malignancies. Regardless of the technique used, correctly performed biopsies that are geographically, dimensional and numerical representative are essential, and post-interventional markers can be placed at the site. Whenever possible, vacuum-assisted guided by mammography should be the first choice of biopsy for all nonpalpable lesions of the breast, especially for microcalcifications. Surgical excision is expected in most ductal carcinomas in situ; therefore, appropriate imaging-guided localization techniques must be deployed in the hope of aiding the surgeon to perform a free-margin cosmetically adequate procedure.
No significant performance differences have been noticed by comparing wire localization to radio guided occult lesion localization or radioactive seed technique, while the choice of imaging guidance should consider the best visibility of the lesion or marker. In the current paper we review the main interventional procedures used for diagnosis in ductal carcinoma in situ, illustrated with images from the database of the Cluj-Napoca Institute of Oncology and Fundeni Clinical Institute.
DCIS became a topic of interest mainly after the onset of mammography screening programs. Almost 90% of DCIS are detected by mammography, in particular screening, and this remains the main imaging ...method for DCIS. The evaluation of tumor size made by imaging methods helped surgeons to use conservative breast surgery more frequently, instead of mastectomy, with safe oncological results. In many situations mammography could be considered enough to determine the correct extension of the disease.
However, magnetic resonance imaging (MRI) proved to be more accurate in the evaluation of the extension of the disease, especially in young women. The ultrasound is not the method of choice for DCIS but seems to bring its contribution in detecting specific signs of the diagnosis and the tumor extension. The review of the literature is passed through the light of authors own experience.
Unilateral axillary lymphadenopathy is a frequent mild side effect of COVID-19 vaccination. European Society of Breast Imaging (EUSOBI) proposes ten recommendations to standardise its management and ...reduce unnecessary additional imaging and invasive procedures: (1) in patients with previous history of breast cancer, vaccination should be performed in the contralateral arm or in the thigh; (2) collect vaccination data for all patients referred to breast imaging services, including patients undergoing breast cancer staging and follow-up imaging examinations; (3) perform breast imaging examinations preferentially before vaccination or at least 12 weeks after the last vaccine dose; (4) in patients with newly diagnosed breast cancer, apply standard imaging protocols regardless of vaccination status; (5) in any case of symptomatic or imaging-detected axillary lymphadenopathy before vaccination or at least 12 weeks after, examine with appropriate imaging the contralateral axilla and both breasts to exclude malignancy; (6) in case of axillary lymphadenopathy contralateral to the vaccination side, perform standard work-up; (7) in patients without breast cancer history and no suspicious breast imaging findings, lymphadenopathy only ipsilateral to the vaccination side within 12 weeks after vaccination can be considered benign or probably-benign, depending on clinical context; (8) in patients without breast cancer history, post-vaccination lymphadenopathy coupled with suspicious breast finding requires standard work-up, including biopsy when appropriate; (9) in patients with breast cancer history, interpret and manage post-vaccination lymphadenopathy considering the timeframe from vaccination and overall nodal metastatic risk; (10) complex or unclear cases should be managed by the multidisciplinary team.
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