Purpose To investigate primary physician awareness of the California Breast Density Notification Law and its impact on primary care practice. Materials and Methods An online survey was distributed to 174 physicians within a single primary care network system 10 months after California’s breast density notification law took effect. The survey assessed physicians’ awareness of the law, perceived changes in patient levels of concern about breast density, and physician comfort levels in breast density management issues. Results The survey was completed by 77 physicians (45%). Roughly half of those surveyed (49%) reported no knowledge of the breast density notification legislation. Only 32% of respondents noted an increase in patient levels of concern about breast density compared to prior years. The majority were only “somewhat comfortable” (52%) or “not comfortable” (10%) with breast density questions, and almost one-third (32%) had referred patients to a breast health clinic for these discussions. 75% of those surveyed would be interested in more specific education on the subject. Conclusion Awareness of California’s Breast Density Notification Law among primary care clinicians is low, and many do not feel comfortable answering breast density related patient questions. Breast imagers and institutions may need to devote additional time and resources to primary physician education in order for density notification laws to have significant impact on patient care.

Objectives To evaluate imaging characteristics of ovarian fibromas and fibrothe‐comas and to identify select clinical markers and imaging features to help in their diagnosis. Methods Over a 5‐year period, 18 of 29 women with histologically proven fibromas or fibrothecomas underwent sonography, computed tomography (CT), or magnetic resonance imaging (MRI). On review of the images, tumor size, solid component characteristics, and cystic components were evaluated. Age, cancer antigen 125 (CA‐125), and Meig syndrome were assessed. Results Eleven fibrothecomas and 7 fibromas were evaluated. Sonography was performed for 15 tumors, CT for 9, and MRI for 6. Mean age was 52.6 (range, 13–82) years. Mean tumor size was 8.8 (range, 2–18) cm. Seventy‐two percent of the tumors were solid, and 28% had cystic components. On sonography, the solid components were isoechoic or hypoechoic compared to the uterus. On CT with contrast, 2 of 8 lesions (25%) showed enhancement. On T1‐weighted MRI, 5 lesions (83%) showed an isointense signal, and 1 (17%) showed a hyperintense signal compared to the myometrium. On T2‐weighted MRI, 4 of 6 lesions (67%) were hypointense; 1 (16.5%) was isointense; and 1 (16.5%) was hyperintense. Elevated CA‐125 was present in 5 of 29 patients (28%). One had Meig syndrome. Conclusions For a cystic adnexal mass where the primary consideration is commonly an epithelial tumor, the possibility of a cystic stromal tumor should also be considered. Unlike previous studies reporting both T1 and T2 hypointensity, fibrothecomas and fibromas can also show T1 and T2 isointensity and, exceptionally, hyperintensity. Vascularity, shown by Doppler flow and MRI and CT enhancement, is a characteristic of some fibromas and fibrothecomas. Although CA‐125 is elevated in some patients, a true correlation is difficult to assess. Meig syndrome is infrequent.

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Metaplastic carcinoma of the breast is an uncommon type of malignancy that is aggressive but can mimic other benign breast neoplastic processes on imaging. We present a case of a young female patient who presented with a rapidly progressing metaplastic carcinoma with osteoclastic giant cells subtype. There have been only very rare published reports of this pathologic subtype of metaplastic carcinoma containing osteoclastic giant cells.

Purpose: To evaluate the utility of artificial ascites induction for radiofrequency ablation (RFA) of peridiaphragmatic hepatocellular carcinoma (HCC) through retrospective cohort analysis comparing characteristics and complications of peridiaphragmatic HCC without the use of artificial ascites to non-peridiaphragmatic HCC. Materials and Methods: IRB approval was obtained. From September 2003 to December 2008, 150 consecutive patients with hepatic tumors received percutaneous RFA. 110 patients had presumed HCC, and of those 21 had lesions abutting the diaphragm. Of the remaining 89 patients with non-peridiaphragmatic HCC lesions, 21 were randomly selected for the comparison group. RFA volume, major and minor complication rates, pain, technical success, and recurrence rates were compared between the two groups. Results: There was no statistical difference in RFA volume (P = 0.962), overall major complication rate (P = 0.343) and minor complication rate (P = 0.118) between the two groups. However, the peridiaphragmatic group that underwent RFA with a clustered-needle demonstrated a statistically significant higher proportion of major complications compared to the non-peridiaphragmatic clustered-needle group (P = 0.033). There was no statistical difference in pain severity (P = 0.8802) or pain location (P = 0.15). There was no statistical difference in technical success rates (P = 1), local tumor progression rates (P = 1), or time to local tumor recurrence (P = 0.67). Conclusion: Artificial ascites induction for RFA of HCC lesions adjacent to the diaphragm may not be necessary, although clustered electrode technique should be avoided in this location as they present with a higher complication rate.

Purpose: To investigate the efficacy of a new algorithm to increase the volume of tissue ablation via gradual ramp-up of power using an internally cooled electrode for ablating hepatomas 3 cm or less. Materials and Methods: 44 patients with 62 hepatomas were treated from March 4, 2004 to May 24, 2009. Ablation with a gradual ramp-up of power was performed using a single needle with an internally cooled electrode. Evaluation for tumor response was performed with 4-phase CT at 24 hours and 3 months. All immediate and follow-up complications were recorded. Results: Complete tumor ablation was achieved in 86%. The ablation volumes were 16 cm 3 +/− 12 cm 3 for tumors <2 cm and 28 cm 3 +/− 12 cm 3 for tumors 2-3 cm. Out of 68 total ablation sessions, there were 2 major complications (pleural effusions) requiring intervention (thoracentesis). Conclusion: Compared with existing techniques using a constant full-power setting, ablation of small hepatomas using an algorithm of gradual ramp-up of power provides comparable rate of complete tumor ablation, adequate ablation volumes, and a low rate of complications that require treatment.