乳房假体破裂及注射水凝胶扩散的磁共振成像

目的 :探讨乳房假体破裂及注射聚丙烯酰胺水凝胶扩散的MRI表现及临床意义。方法 :对 18例隆乳术后患者行MR扫描 ,并与术中所见比较。对假体置入及注射聚丙烯酰胺水凝胶的MRI表现进行分类分析。结果 :正常单腔硅凝胶假体 9例 ;单腔硅凝胶假体纤维囊内破裂 13例 ,MRI示假体内有多发条丝状短T2 低信号 ,即“条丝征” ;单腔硅凝胶假体纤维囊外破裂 2例 ,MRI示乳房腺体内长T2 结节状内容物颗粒。正常聚丙烯酰胺水凝胶注射 3例 ,注射聚丙烯酰胺水凝胶扩散 9例 ,MRI示乳腺后间隙以外部位出现结节状长T1、长T2 信号。结论 :MRI可诊断乳房假体有无破裂或注射聚丙烯酰胺水凝胶有无扩散 ,可明确其漏出或扩散的范围 ,因此能为手术提供准确定位 ,为随访提供客观资料。     

不同MRI序列检出聚丙烯酰胺水凝胶注射隆乳患者乳腺病变效能的比较研究

目的 探讨不同MRI序列对聚丙烯酰胺水凝胶（PAHG）注射隆乳后乳腺病变的检出效能。 方法 回顾性分析80例临床怀疑合并乳腺病变的注射隆乳患者的MRI影像资料,扫描序列包括T1加权像、T2加权像、短时间反转恢复（STIR）、弥散加权成像（DWI）、MR水成像（MRH）及肝脏容积超快速（LAVA）三维多期动态增强序列,分析各序列图像中病灶的信号特点、位置、形态、大小和数量,以及时间-信号强度曲线,分别计算不同序列对乳腺病变的总检出率和对乳腺癌的诊断准确率。各序列病灶的总检出率差异采用R×C交叉表卡方检验,组内两两比较采用卡方检验分析。 结果 160个乳腺中共检出86个病灶,其中乳腺癌病灶30个。T1加权像、T2加权像、STIR、DWI、MRH及LAVA增强序列对乳腺病灶的总检出率分别为32.56%（28/86）、61.11%（53/86）、63.88%（55/86）、41.66%（36/86）、89.53%（77/86）、100%（86/86）,其中乳腺癌病灶诊断准确率分别为33.33%（10/30）、66.67%（20/30）、66.67%（20/30）、46.67%（14/30）、100%（30/30）、100%（30/30）。对各序列乳腺病变的总检出率行R×C交叉表卡方检验：χ2=129.428,P < 0.05,差异有统计学意义;对各序列乳腺癌病灶诊断准确率行R×C交叉表卡方检验：χ2=51.843,P < 0.05,差异有统计学意义。对各序列乳腺病变总检出率和乳腺癌病灶诊断准确率行组内两两比较分析,除T1加权像与MRH、T2加权像与STIR对乳腺病变总检出率的差异无统计学意义外（χ2=1.593、0.100,P均>0.05）,其他均有统计学意义（χ2=6.729~87.509,P均 < 0.05）;而MRH与T1加权像、MRH与T2加权像、MRH与STIR、T2加权像与STIR,以及DWI与LAVA增强序列对乳腺癌诊断准确率的差异均无统计学意义（χ2=1.111、2.443、2.443、0.000、0.000,P均>0.05）,其他序列的差异有统计学意义（χ2=12.000~30.000,P均 < 0.05）。 结论 DWI和LAVA增强序列对PAHG注射隆乳后乳腺病变的总检出率最高;合理应用MRI序列,有利于提高乳腺癌病灶的诊断准确率。     

Mammographic,sonographic and MR imaging features of invasive micropapillary breast cancer

Purpose

Describe mammographic, sonographic and MRI findings of invasive micropapillary carcinoma (IMPC) of the breast.

Materials and methods

Review of the pathology database identified 43 patients (mean age, 59.3 years) with the diagnosis of breast IMPC. Three patients had no available imaging studies. Mammograms (40), breast ultrasounds (33) and MRIs (8) were retrospectively evaluated by two radiologists in consensus following the BI-RADS Lexicon. Clinical, histopathologic features, as well as hormone status were recorded.

Results

Twenty patients presented with palpable abnormality (20/40, 50%). Thirty-five patients had an abnormal mammogram (87.5%, 35/40) showing 39 lesions, 29 corresponding to masses (29/39, 74.4%), 11 associated with microcalcifications and two associated with architectural distortion. Sonography identified 41 masses (in 33 patients) displaying an irregular shape (30/41, 73.2%), appearing hypoechoic (39/41, 95%), with spiculated or angular margins (26/41, 63.4%), non-parallel orientation (26/41, 63.4%) and combined acoustic posterior pattern (18/41, 44%). MRI identified 13 lesions (in eight patients), 12 as masses (12/13, 92.3%) with irregular or spiculated margins (12/12, 100%), eight displaying an irregular or lobulated shape (8/12, 66.7%), six with homogeneous internal enhancement (6/12, 50%) and eight with type 3 enhancement curve (8/12, 61.5%). Associated non-mass like enhancement was noted in two patients. Twenty-nine patients had associated lymphovascular invasion (29/40, 72.5%) and axillary lymph node metastases were present in 22 of the 39 patients (22/39, 56%).

Conclusion

Invasive ductal carcinoma with IMPC features display imaging findings highly suspicious of malignant lesions. They are associated with high lymphovascular invasion and lymph node metastases rates.     

Calcified pilomatrixoma of the breast: mammographic and sonographic findings

The authors report the ultrasonographic and mammographic features of a case of pilomatrixoma of the breast, a rare benign neoplasm originating from the hair matrix.     

Imaging findings in mucinous breast carcinoma and correlating factors

Objective

To investigate the factors influencing mammographic and sonographic features of mucinous breast carcinoma.

Materials and methods

Forty-six patients diagnosed as mucinous breast carcinoma between March 2005 and April 2009 were studied. Mammographies of all patients and sonographies of 41 patients were analyzed retrospectively. Microscopic slides were re-evaluated by a pathologist in order to estimate the volume of extracellular mucus which was classified as: (+), less than 50% of mucus; (++), 50–80% of mucus; and (+++), more than 80% of mucus.

Results

Thirty-one (61.3%) cases of pure mucinous type and 2 (33.3%) of mixed mucinous carcinoma presented as masses had well-defined margins on mammography. No correlation was found between margin characteristics and histological type as well as extracellular mucus rates. Denser breasts and young age group had significantly higher ratios of tumors presented with ill-defined masses than its counterpart. Sonographically, 100% lesions showed a hypoechoic lesion, 76.5% lesions in pure type and 71.4% lesions in mixed type showed a heterogeneous internal echo. No correlation was found between sonographic findings and histological type as well as extracellular mucus rates. Lesions with >40 positivity PCNA had higher ratio presented as ill-defined margins than those of ≤40% positivity PCNA.

Conclusions

The most common appearance of mucinous breast carcinoma is a mass on mammography and a hypoechoic lesion with heterogeneous internal echo on sonography. Mammographic margins and sonographic findings have no relation with histological type and extracellular mucus rate. Mammographic margin features are correlated with breast density and age and PCNA.     

Detection of breast cancer with conventional mammography and contrast-enhanced MR imaging

The aim of this study was to compare the diagnostic performance of conventional mammography and dynamic contrast-enhanced fast 3D gradient-echo (GRE) MRI regarding the detection and characterization of breast lesions relative to histopathologic analysis and to assess the results of a combined evaluation of both methods. fifty consecutive patients with 63 histopathologically verified breast lesions underwent dynamic contrast-enhanced GRE MRI in addition to routine conventional mammography. All lesions were classified by both methods on a five-point scale as benign or malignant, and the results were correlated to histopathology. Conventional mammography and dynamic MRI yielded a sensitivity and specificity of 82 and 64 %, and 92 and 76 %, respectively. The difference between the results was statistically not significant (p > 0.05) with areas under the receiver-operating-characteristics curves of 0.807 for mammography and 0.906 for MR imaging. Combination of the results of both methods slightly increased the sensitivity for detection of breast cancer to 95 % but decreased specificity to 52 %. In this selected patient subset, including only patients referred for excisional biopsy, contrast-enhanced dynamic MRI proved more sensitive and specific than conventional mammography regarding the detection of malignancy. While a combination of both methods yields a slightly improved sensitivity, specificity is vastly reduced. Received 5 May 1997; Revision received 14 July 1997; Accepted 7 August 1997     

Imaging approaches and findings in the reconstructed breast: a pictorial essay

Advances in breast imaging over the last 15 years have improved early breast cancer detection and management. After treatment for breast cancer, many women choose to have reconstructive surgery. In addition, with the availability of widespread genetic screening for breast cancer, an increasing number of women are choosing prophylactic mastectomies and subsequent breast reconstruction. The purpose of this pictorial essay is to present the spectrum of imaging findings in the reconstructed breast.     

Tubulolobular carcinoma of the breast: clinical, mammographic and sonographic findings

PURPOSE: To determine and quantitate radiologic characteristics of tubulolobular carcinoma of the breast and to report clinical and pathologic findings. MATERIALS AND METHODS: A retrospective review of records of 2872 women who received a diagnosis of breast carcinoma between January 1988 and January 2006 revealed 26 histopathologically proven tubulolobular carcinoma of the breast. Analysis included history; findings at physical examination, mammography, and sonography (US) at the time of diagnosis and in postoperative follow-up, and histopathological results. RESULTS: At physical examination, palpable mass was present in 85% (n=22) of the patients. The mammographic findings were mass in 17 (65%), asymmetric focal density in 2 (8%), architectural distortion in 2 (8%) and negative mammograms in 5 (19%) of the 26 patients. US depicted 25 masses in 24 patients, all of which were hypoechoic, with spiculated (n=13) or microlobulated (n=12) margins. The cancer was clinically occult in 12% (n=3), mammographically occult in 19% (n=5), and radiologically occult in 4% (n=1) of the patients. Histologically, the mean size of the tumor was 1.7cm and 18 (69%) patients were node negative. CONCLUSION: Tubulolobular carcinoma of the breast usually manifests clinically as a firm, immobile mass and mammographically as a spiculated or ill-defined, irregular, isodense mass without microcalcifications. Common findings on sonography include a homogeneously hypoechoic, spiculated or microlobulated mass with posterior acoustic shadowing or normal acoustic transmission. Tubulolobular carcinoma should be included in the differential diagnosis for breast masses with these imaging features.     

Neuroendocrine differentiated breast carcinoma: imaging features correlated with clinical and histopathological findings

The aim of this study was to describe the imaging features of neuroendocrine differentiated breast carcinoma (NEDBC) and to correlate the radiological findings with the clinical and histopathological findings. A retrospective review of the mammograms of 1845 histopathologically proven breast cancer cases revealed five NEDBC. The clinical, imaging, and histopathological findings were analyzed. On mammography, a high-density mass was seen in all patients. The shape of the mass was round in 4 and irregular in 1 patient. The margins were spiculated in 2, indistinct in 1, microlobulated in 1, and partially obscured in 1 patient. On sonography, 4 patients had homogeneously hypoechoic masses with normal sound transmission. In 1 patient the mass was heterogeneously hypoechoic with mild posterior acoustic enhancement. The margins were microlobulated in 2, irregular in 2, and well-circumscribed in 1 patient. Neuroendocrine differentiated breast carcinoma should be included in the differential diagnosis of mammographically dense, round masses with predominantly spiculated or lobulated margins. Sonographically, they mostly present as irregular or microlobulated, homogeneously hypoechoic masses with normal sound transmission. Electronic Publication     

Fibrotic lesions of the breast: radiological findings and core-neddle biopsy results

Objectives

To evaluate the incidence of breast lesions with a histopathological diagnosis of focal fibrosis based on imaging guided core biopsy, to review the radiologic findings and to assess the diagnostic reliability of 14 G core needle biopsy.

Materials and methods

723 patients, who had undergone 14 G core biopsy and/or surgical excisions, were retrospectively analyzed. Overall, 43 lesions were diagnosed as focal fibrosis. Physical examination, mammography, ultrasonography, and follow-up findings were all reviewed.

Results

Radiological evaluation revealed that 35 (81%) lesions were solid masses. Of 35 mass lesions, 24 (69%) were well circumscribed, the remaining 11 (31%) lesions were ill defined on mammograms or sonograms. None of the lesions had pathological microcalcifications. Three lesions were surgically excised because of radio-pathological discordance after core needle biopsy.

Conclusions

Focal fibrosis of the breast is a benign condition and reflects the ductal and lobular atrophy secondary to stromal proliferation. The radiological findings of this entity may vary and sometimes mimic those of malignant lesions. The incidence of focal fibrosis among our study population is 6% and a well-defined mass lesion is the most frequent finding. Core needle biopsy is a safe and reliable diagnostic procedure in the management of these cases.     

Magnetic resonance imaging of metaplastic carcinoma of the breast: sonographic and pathologic correlation

Metaplastic carcinoma of the breast is a rare disease. We describe the MRI findings with the correlative sonographic and pathologic features of two cases. On MRI, T2-weighted images demonstrate a relatively well-defined mass with high signal intensity cystic components. Dynamic enhancement subtraction images showed an early enhancing and delayed washout peripheral rim and non-enhancing internal components. A microlobulated, isoechogenic mass with cystic components was seen sonographically, and was histopathology related to necrosis and cystic degeneration. Although these features are not unique, metaplastic carcinoma should be included in the differential diagnosis for breast masses.     

Applications and literature review of the BI-RADS classification

The Breast Imaging Reporting and Data System (BI-RADS) of the American College of Radiology (ACR) is a tool created to reduce variability in the terminology used in mammographic reports. An illustration of mammographic examples from our institution interpreted according to the BI-RADS lexicon of the American College of Radiology (ACR) is presented. A literature review concerning the usefulness and limitations of the BI-RADS lexicon is given.     

原发性乳腺淋巴瘤X线表现及与病理相关性探讨

目的探讨原发性乳腺淋巴瘤钼靶X线表现特征及其与病理相关性，提高影像医师对该病的认识。方法回顾性复习27例经手术病理证实的原发性乳腺淋巴瘤，其中术前有完整钼靶X线资料的患者为14例。对该14例患者的临床、钼靶X线表现特征及病理进行了回顾性分析。患者均为女性，年龄28～56岁。右乳7例，左乳6例，双乳1例。结果14例原发性乳腺淋巴瘤中，13例为非霍奇金淋巴瘤(Non-Hodgkin lymphoma，NHL)(弥漫型12例，结节型1例)，1例为霍奇金淋巴瘤(Hodgkin lymphoma，HL)。乳腺X线片上9例表现为单乳单发肿块，2例表现为单乳多发肿块，1例为双乳多发肿块，2例表现为单侧乳腺致密浸润伴皮肤增厚。X线片上共发现18个肿块，肿块直径从0．7—5．0cm，平均直径2．6cm，其中13个肿块边缘清楚，5个肿块边缘表现为部分清楚部分不清楚，均未见毛刺、钙化或漏斗征及皮肤凹陷征等乳腺癌典型X线征象。此外，该组资料显示淋巴瘤X线表现与其组织病理学类型无相关性。结论原发性乳腺淋巴瘤的临床及影像学表现缺乏特异性，最后诊断需依靠病理学确诊。如临床乳腺检查考虑恶性且伴有腋下肿大淋巴结，而X线征象表现为良性或不典型乳腺癌者应提示除有不典型髓样癌可能外，还应考虑到淋巴瘤，及时做针吸或切取活检，有利于临床选取恰当的治疗方案。     

Tubular carcinoma of the breast: mammographic, sonographic, clinical and pathologic findings

PURPOSE: To determine and quantitate the radiological characteristics of tubular carcinoma of the breast, to report clinical and pathologic findings and to define findings at follow-up. MATERIALS AND METHODS: A retrospective review of records of 2872 women who received a diagnosis of breast carcinoma between January 1988 and January 2006 revealed 32 histopathologically proven pure tubular carcinoma of the breast. Analysis included history; findings at physical examination, mammography, and sonography (US) at the time of diagnosis and in postoperative follow-up and histopathological results. RESULTS: Fifty-nine percent of the patients (n=19) presented with a palpable mass. The mammographic findings were a mass in 23 (72%), a mass with microcalcifications in 2 (6%), asymmetric focal density in 1 (3%), architectural distortion in 1 (3%) and negative in 5 (16%) of the 32 patients. Most (96%) masses had spiculated margins. US depicted 30 masses in 29 patients, all of which were hypoechoic, mostly (n=27, 90%) with posterior acoustic shadowing. The cancer was clinically occult in 41% (n=13), mammographically occult in 16% (n=5), and sonographically occult in 6% (n=2) of the patients. Histologically, the tumor was multifocal in 3% (n=1) of the patients. Four (13%) patients developed contralateral breast carcinoma at follow-up. CONCLUSION: Tubular carcinoma has a variety of presentations, but it is mostly seen on mammography as a small spiculated mass, and on sonography as an irregular mass with posterior acoustic shadowing. Although tubular carcinoma is known as a well-differentiated tumor with excellent prognosis, the mammographic follow-up of the contralateral breast is important.     

Evaluation of breast nodules with echo colour Doppler sonography: preliminary findings

The authors report the results of using colour Doppler sonography in the evaluation of breast pathology. In particular, 65 solid breast masses were examined by mammography, sonography and colour Doppler. Thirty-eight lesions were proved histologically and 27 cytologically. The lesions had an average diameter of 17 mm (range 6–40 mm). Colour Doppler sonography demostrated the presence of vascularisation in 94.4% of breast cancers while this finding was noted in only 41.4% of benign lesions. Bidirectional blood flow was present in 94.1% of carcinomas compared with 50% of fibroadenomas, and irregular blood flow figured in 61.8% of malignant lesions compared with 8.3% of the benign lesions. In 60% of cancers in which neovascularisation was present, the colour Doppler signals occupied more than 10% of the area of the lesion; in contrast, benign masses were characterised by a low colour dot-nodular area ratio. These preliminary results using colour Doppler did not allow sensitivity and specificity values to be quantified and compared with those for traditional breast imaging techniques; however, we think colour Doppler may be very useful in adding dynamic information to the mammographic and sonographic morphological examinations. Correspondence to: G. M. Giuseppetti     

The negative predictive value of breast Magnetic Resonance Imaging in noncalcified BIRADS 3 lesions

Purpose

The purpose of this study is to determine whether breast MRI can provide a sufficient NPV to safely rule out malignancy in mammographic BIRADS 3 lesions.

Materials and methods

In a 3-year consecutive mammographic examination study 176 out of 4391 patients had a lesion classified as BIRADS 3. 76 out of 176 patients underwent breast MRI as diagnostic work-up. Lesions which MRI classified as BIRADS 1 or 2 were considered negative for malignancy. Sensitivity, specificity, PPV and NPV were calculated.

Results

In 27 out of 76 (35.5%) patients MRI showed no enhancement and was classified as BIRADS 1. In 25 (32.9%) patients MRI showed focal or mass enhancement classified as BIRADS 2. In these 52 (68.4%) patients no malignancy was found during at least 2 years study follow-up. The other 24 (31.6%) patients had a lesion classified as BIRADS ≥3. Thirteen of these 24 lesions were malignant by pathology. MRI had a sensitivity of 100% (95% CI: 75–100%), specificity of 82.5% (95% CI: 71–91%), PPV of 54.2% (95% CI: 33–74%) and NPV of 100% (95% CI: 93–100%).

Conclusion

Breast MRI should be used in a diagnostic strategy for the work-up of noncalcified BIRADS 3 lesions. Malignancy is ruled out with a very high level of confidence in the majority of patients (68%), herewith avoiding invasive diagnostic procedures.     

Imaging Surveillance of Patients with Breast Cancer after Primary Treatment: Current Recommendations

Women who have been treated for breast cancer are at risk for second breast cancers, such as ipsilateral recurrence or contralateral metachronous breast cancer. As the number of breast cancer survivors increases, interest in patient management and surveillance after treatment has also increased. However, post-treatment surveillance programs for patients with breast cancer have not been firmly established. In this review, we focus on the imaging modalities that have been used in post-treatment surveillance for patients with breast cancer, such as mammography, ultrasonography, magnetic resonance imaging, and positron emission tomography, the effectiveness of each modality for detecting recurrence, and how they can be applied to manage patients.     

Imaging findings of a biopsy-proven desmoid tumor of the axilla in a young female

Desmoid tumors (fibromatoses) are rare but locally aggressive tumors that do not metastasize. They are non-encapsulated, well-differentiated lesions made of fibroblasts and collagen, which mainly appear in the mesentery and abdominal wall. Rarely, these tumors can also occur in breasts, making up approximately 0.2% of all breast neoplasms. Treatment typically includes surgical excision and/or medical management.We describe a case of a 31-year-old female presenting with a mass in her left axilla that was biopsy proven to be a desmoid tumor. In this case report, we discuss the various imaging findings present on ultrasound, mammography, computed tomography, and magnetic resonance imaging.     

乳腺叶状瘤的影像诊断

目的 总结分析乳腺叶状瘤X线钼靶照片和超声检查的影像学特征。方法 搜集1991年1月至2003年5月经手术、病理证实的25例乳腺叶状瘤，其中13例行X线钼靶摄片，17例行超声检查，回顾性分析其临床特点及影像学征象。结果 25例乳腺叶状瘤中病理诊断Ⅰ级者17例，Ⅱ级7例，Ⅲ级1例。13例行乳腺X线钼靶检查患者病灶表现为圆形(7例)或浅分叶状(6例)密度高于邻近腺体的肿块，边界清楚(8例)或部分不清(5例)，所有病例均未发现钙化及邻近皮肤增厚、乳头回缩、周围乳腺结构扭曲等恶性征象。行乳腺超声检查的17例患者，病灶表现为低回声者16例，边界规整者16例，出现囊变者10例，11例出现后方回声增强。结论 乳腺叶状瘤的影像学表现有一定的特点，但这些表现为非特征性，与纤维腺瘤等边界清楚的实性病灶的鉴别有一定的困难，对可疑病灶行切除活检非常必要。