Purpose To determine rate of malignancy at stereotactic biopsy of amorphous calcifications with different distributions using current imaging, clinical, and histopathologic criteria. Materials and Methods From January 2009 to September 2013, this retrospective study reviewed a large set of stereotactic biopsies to identify amorphous calcifications and their clinical, imaging, and histopathologic characteristics. Calcification distribution was correlated with malignancy rate after adjusting for known risk factors using logistic regression. Results Of 1903 sequential biopsies, 546 (28.7%) were for amorphous calcifications. After excluding atypical lesions not excised and patients with more than one biopsy in the same year, 497 lesions from 494 women (median age, 52 years; age range, 30-81 years) remained. Fifty-two (10.5%; 95% confidence interval [CI]: 7.9, 13.5) lesions proved malignant, with 17 of 52 (42.7%) being invasive cancers (median, 0.3 cm; range, 0.1-1.3 cm) and all 17 of them being estrogen and progesterone receptor positive and node negative. Malignancy rates in a segmental (six of 21 [28.6%]), linear (eight of 32 [25.0%]), or multiple group same quadrant (nine of 36 [25.0%]) distribution were significantly higher than malignancy rate in a solitary group of amorphous calcifications (25 of 356 [7.0%]) (P = .004, P = .003, and P = .002, respectively). Of 356 grouped amorphous calcifications, 102 (28.7%) yielded atypical results prompting excision, with three of 102 (2.9%) upgraded to ductal carcinoma in situ at excision. In women younger than 50 years without a personal history of cancer, grouped amorphous calcifications showed four of 127 (3.1%) (95% CI: 0.9, 7.9) were malignant and 39 of 127 (30.7%) were atypical at final histopathology. Conclusion Biopsy of amorphous calcifications remains necessary, with an overall malignancy rate of 10.5%; only 17 of 497 (3.4%) biopsies showed invasive cancer, and all of these were estrogen and progesterone receptor positive. Grouped amorphous calcifications in women younger than 50 years without history of breast or ovarian cancer showed a low malignancy rate of 3.1% (four of 127).

Purpose To evaluate the influence of bridging local-regional therapy (LRT) on hepatocellular carcinoma (HCC) recurrence and overall survival after orthotopic liver transplantation and to identify factors that predict HCC recurrence after orthotopic liver transplantation. Materials and Methods The United Network for Organ Sharing database was used to identify patients with HCC who underwent liver transplantation between 2002 and 2013. Patients with complete explant data within the Milan criteria for whom a Model for End-Stage Liver Disease exception was approved were retrospectively analyzed. Kaplan-Meier estimation was used for survival analysis with log-rank test and Cox proportional hazard models to assess independent prognostic factors for overall survival. Propensity-matched analysis for treatment groups was performed to minimize selection bias. Results The rate of tumor recurrence after liver transplantation was 11.5% (321 of 2794), which significantly decreased overall survival (P < .001). The bridging LRT group exhibited lower recurrence (59 of 686 [8.6%]; P = .02) and longer median overall survival (75.9 months; P < .001). Recurrence was higher in patients older than 60 years, serum α-fetoprotein greater than 400 mg/L, bilobar distribution, multiple lesions, absent necrosis, microvascular invasion, and tumors beyond the Milan criteria (P < .05). Age, LRT status, serum α-fetoprotein, and microvascular invasion were independent risk factors (P < .05). In the matched cohort, similar factors that predicted recurrence were observed (P < .05), whereas bridging LRT (P = .03) and serum α-fetoprotein (P = .02) were independent risk factors for recurrence. Conclusion LRT significantly decreased tumor recurrence and lengthened overall survival. RSNA, 2016.

Although spontaneous regression of herniated disk material has been reported in the lumbar and cervical spine, reports of complete spontaneous regression of calcified thoracic disk herniations are exceedingly rare. In symptomatic patients, surgery is typically the treatment of choice; however, conservative therapy with surveillance may allow time for spontaneous resolution and potentially avoid high-risk surgery. We report a 40-year-old woman with complete spontaneous resolution of a large calcified thoracic disk extrusion with conservative management over an 8-month period.

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