定量动态增强磁共振在乳腺肿块样腺病中的应用价值

目的：探讨定量动态增强磁共振(DCE-MRI)在诊断乳腺肿块样腺病中的应用价值。方法收集54例依据乳腺磁共振半定量增强检查方法 BI-RADS 诊断为4、5类的肿块样病灶,测量其定量灌注参数包括容量转移常数(Ktrans )、单位体积组织中血管体积(Vp )值。依据病理结果分为腺病组、乳腺癌组,将腺病组对侧腺体作为正常对照组。将腺病组和正常腺体组及腺病组和乳腺癌组 Ktrans 、Vp 值分别进行组间的两两秩和检验,绘制腺病组和乳腺癌组 Ktrans 值的受试者工作特征曲线(ROC),寻找最佳诊断界值并计算其敏感度、特异度。结果腺病组(n=21)的 Ktrans 、Vp 值分别为(0.289±0.163)min-1、(0.0428±0.045);乳腺癌组(n=33)的 Ktrans 、Vp 值分别为(0.959±0.451)min-1、0.057±0.079;正常腺体(n=21)的 Ktrans 、Vp 值分别为(0.048±0.022)min-1、0.016±0.019。腺病组与正常腺体组的 Ktrans 、Vp 值差异均有统计学意义(Z 值分别为-5.733、-2.844,P 值为0.000、0.004,P <0.05),乳腺癌与腺病组Ktrans 值差异有统计学意义(Z 值为-5.421,P 值为0.000,P<0.05),乳腺癌与腺病组 Vp 值差异无统计学意义(Z=-0.009,P =0.993,P >0.05)。Ktrans 值的 ROC 曲线下面积(AUC)为0.941,界值为0.304 min-1时,敏感度、特异度分别为93.9%、85.7%。结论定量DCE-MRI Ktrans 值作为辅助诊断的定量参数对鉴别乳腺肿块样腺病有较高的参考价值。     

乳腺癌组织中p27kip1和ER的表达及意义

目的：检测p27^kipl和ER在乳腺良性与恶性病变组织中的表达与分布情况，探讨p27^kipl和ER的表达水平在乳腺癌发病、预后评估方面的价值。方法：采用DAKO EnVision^TM Systems结合组织病理学观察，检测了32例良性乳腺腺病、35例乳腺纤维腺瘤、24例乳腺癌组织中的p27^kipl和ER的表达与分布情况。结果：在良性乳腺疾病、乳腺纤维腺瘤组织中，p27^kipl有强阳性表达，阳性检出率分别为65．6％、60．0％；而在乳腺癌组织中，p27^kipl阳性检出率为29．2％；说明在良性乳腺疾病与乳腺癌组织中，p27^kipl有不同水平的表达。ER在乳腺癌组织中阳性检出率为66．7％；明显高于良性乳腺腺病(34．4％)、乳腺纤维腺瘤(37．1％)的阳性检出率。结论：在乳腺癌发病过程中，p27^kipl和ER的表达水平有可能起着重要的作用；同时检测p27^kipl和ER的表达与分布情况,在乳腺癌病人预后判断中具有辅助诊断价值。     

Imaging Features of Triple Negative Breast Cancer and the Effect of BRCA Mutations

Objective: The purpose of this study is to review the mammographic and the ultrasound features of triple negative breast cancer (TNBC) patients and to investigate the potential effect of BRCA mutations on the imaging features of these patients. Methods: One hundred and seven patients with TNBC were enrolled in a retrospective study following IRB approval and approval of waiver of informed consent. BRCA mutations were assessed using genetic testing. Imaging features on mammography and ultrasound (US) as well as pathology and clinical information were retrospectively reviewed and characterized according to the BI-RADS lexicon (fifth edition). The relationships between BRCA mutations and the imaging findings were examined. Results: TNBC commonly presented as an irregular mass with obscured margins on mammography and as an irregular hypoechoic mass with microlobulated or angular margins on US. Approximately two thirds of TNBC cases had a parallel orientation and approximately one third had posterior enhancement, features often associated with benign masses. There was no statistically significant difference in the mammographic and the US features of BRCA positive and BRCA negative triple negative tumors. Conclusion: TNBC may have a parallel orientation and posterior enhancement, which are features often seen with benign masses. BRCA mutations do not affect the imaging features of triple negative breast tumors.     

Breast imaging findings in women with BRCA1- and BRCA2-associated breast carcinoma

AIM: To document the breast imaging findings of women with BRCA1 and BRCA2-associated breast carcinoma. MATERIALS AND METHODS: Family history clinic records identified 18 BRCA1 and 10 BRCA2 cases who collectively were diagnosed with 27 invasive breast carcinomas and four ductal carcinoma in situ (DCIS) lesions. All underwent pre-operative imaging (29 mammogram and 22 ultrasound examinations). All invasive BRCA-associated breast carcinoma cases were compared with age-matched cases of sporadic breast carcinoma. RESULTS: Within the BRCA cases the age range was 26-62 years, mean 36 years. Two mammograms were normal and 27 (93%) abnormal. The most common mammographic features were defined mass (63%) and microcalcifications (37%). Thirty-four percent of women had a dense mammographic pattern, 59% mixed and 7% fatty. Ultrasound was performed in 22 patients and in 21 (95%) indicated a mass. This was classified as benign in 24%, indeterminate in 29% and malignant in 48%. Mammograms of BRCA1-associated carcinomas more frequently showed a defined mass compared with BRCA2-associated carcinomas, 72 versus 36% (73% control group) whilst mammograms of BRCA2-associated carcinomas more frequently showed microcalcification, 73 versus 12% (8% control group; p < 0.001). Thirty-six percent of the BRCA2-associated carcinomas were pure DCIS while none of the BRCA1 associated carcinomas were pure DCIS (p = 0.004). Of those patients undergoing regular mammographic screening, 100% of BRCA2-associated carcinomas were detected compared with 75% of BRCA1-associated carcinomas. CONCLUSION: These data suggest that the imaging findings of BRCA1 and BRCA2-associated carcinomas differ from each other and from age-matched cases of sporadic breast carcinoma.     

Mammographic features of sclerosing adenosis presenting as a tumour

A re-examination study was made of 18 cases of histologically verified adenosis tumour from 12 different hospitals in Denmark. Four mammographic appearances could be identified. No pathognomonic sign or appearance could be identified. The median age of the patients was 42 years. The mean diameter of the 'tumour' was 2.1 cm. The diagnostic problem of malignant and benign breast disease is discussed.     

Relationship between thallium-201 kinetics and proliferative activity assessed by monoclonal antibody MIB-1 in brain tumours.

To clarify the relationship between thallium-201 chloride kinetics and proliferative activity in brain tumours. a single-photon emission tomographic (SPET) study was performed and the results correlated with monoclonal antibody MIB-1 staining of the tumour tissue. 201T1 SPET was performed 10 min (early scan) and 2 h (delayed scan) after intravenous administration of 201TI (111 MBq) in 34 intra-axial tumours including 24 malignant tumours, and in 27 extra-axial tumours including one malignant tumour. Tumour 201T1 kinetic parameters [early and delayed uptake ratios (ER and DR, respectively), retention index (RI), and the ratio of tumour delayed activity to early activity (Td/Te)] were compared with tumour tissue MIB-1 labelling indices (MIB-1 LI) representative of tumour cell proliferative activity. In the intra-axial tumours, ER and DR and MIB-1 LI were significantly higher in the malignant tumours than in the benign tumours. ER and DR were significantly correlated with MIB-1 LI (P<0.01 and P<0.05, respectively), but RI and Td/Te were not. In the extra-axial benign tumours, ER was as high as that in the intra-axial malignant tumours, while MIB-1 LI was equal to that in the intra-axial benign tumours. There were no significant correlations between any 201T1 kinetic parameters and MIB-1 LI. This study indicates that 201T1 ER may be the most reliable parameter for predicting the proliferative activity of intra-axial tumours.     

74例早发性乳腺癌患者BRCA1和BRCA2基因致病突变研究

目的 研究乳腺癌易感基因BRCA1和BRCA2在早发性乳腺癌(确诊年龄≤35岁)患者中突变情况,分析致病突变与临床特征之间关系.方法 选择2014年9月至2016年6月期间就诊于军事医学科学院附属医院的早发性乳腺癌患者74例,采用高通量二代测序技术以及生物信息分析,对纳入患者BRCA1和BRCA2基因的49个外显子序列及拼接区序列进行检测分析,并将患者按临床特征分组,χ2检验比较BRCA1和BRCA2致病突变在各组的分布.结果 在74例早发性乳腺癌患者中,检测到15例(20.27%)BRCA1/2致病突变,包括5例(6.76%)BRCA1致病突变,10例(13.51%)BRCA2致病突变.其中11例为新发现致病突变,检测到1例患者携带相对高频致病基因突变BRCA1:c.5470_5477delTGCCCAAT.有乳腺癌或卵巢癌家族史组携带致病突变率明显高于无家族史组(40.91% vs 11.54%,χ2=6.534,P=0.011).结论 BRCA1/2致病突变对早发性乳腺癌意义重大,尤其是伴有乳腺癌或卵巢癌家族史的早发性乳腺癌.新发现的致病突变可能为中国人群特有突变.BRCA1:c.5470_5477delTGCCCAAT可能成为中国人群的始祖突变.     

Ki-67 immunostaining in pancreatic cancer and chronic active pancreatitis: does in vivo FDG uptake correlate with proliferative activity?

PET with 18F-FDG has been shown to be useful in the detection and staging of pancreatic cancer. However, whether FDG uptake is dependent on proliferative activity is still unclear. The aim of this prospective study was to evaluate a probable correlation between FDG uptake and proliferative activity in benign and malignant pancreatic tumors. METHODS: Our series consisted of 23 patients with pancreatic cancer and 9 patients with chronic active pancreatitis (CAP). FDG PET was performed within 2 wk before surgery, and standardized uptake values (SUVs) were calculated for benign and malignant pancreatic tumors. Patients were selected when focally increased FDG uptake in previously known pancreatic tumors was present. Proliferation fraction was measured in tissue specimens using the anti-Ki-67 antibody MIB-1. A computer-assisted imaging system was used for quantification of nuclear Ki-67 immunostaining. Immunohistochemical findings were correlated to SUVS: RESULTS: Pancreatic cancer showed both intense nuclear staining of Ki-67 (39% +/- 16%) and high FDG uptake (SUV = 3.6 +/- 1.6). However, no significant correlation was found between in vivo FDG uptake and Ki-67 immunoreactivity (P = 0.65). By contrast, Ki-67 nuclear staining was significantly lower (3.8% +/- 2.7%, P < 0.05) in CAP, whereas FDG uptake was in the same range as for pancreatic cancer (SUV = 3.5 +/- 1.8). CONCLUSION: FDG uptake did not correlate with proliferative activity in pancreatic cancer. Proliferative activity was tenfold higher in malignant pancreatic tumors than in benign tumors associated with CAP, whereas FDG uptake in vivo did not differ significantly. Thus, a PET tracer indicating cellular proliferation should better differentiate between cancer and inflammatory lesions than do metabolic markers such as FDG.     

Characterization of lesions of the breast with proton MR spectroscopy: comparison of carcinomas, benign lesions, and phyllodes tumors

OBJECTIVE: Proton MR spectroscopy is a recently described technique with high sensitivity and specificity for differentiating breast carcinoma from benign lesions. We evaluated the possible relationship between spectroscopy results and the tumor proliferative index, angiogenesis, and HER2/neu oncogene overexpression. SUBJECTS AND METHODS. We prospectively evaluated 19 breast carcinomas, 21 benign breast lesions (including 18 fibroadenomas, one fibrocystic change, one hamartoma, and one papilloma), and six phyllodes tumors (four benign, two of borderline malignancy) using proton MR spectroscopy. All lesions were larger than 1.5 cm. Tumor Ki-67 proliferative index, tumor angiogenesis, and HER2/neu oncogene overexpression were evaluated by immunohistochemistry of the histologic material. RESULTS: Spectroscopy findings were positive in 17 (89%) of 19 carcinomas but negative for all benign lesions and phyllodes tumors (sensitivity, 89%; specificity, 100%). Significantly higher levels were obtained for all biologic parameters in carcinomas compared with benign lesions and phyllodes tumors. HER2/neu oncogene overexpression was present in 37% of carcinomas but not in other lesions. The two false-negative findings of breast carcinoma showed similar Ki-67 proliferative index and microvessel density compared with the remaining carcinomas, but both cases were negative for HER2/neu overexpression. CONCLUSION: Proton MR spectroscopy is useful in the in vivo characterization of breast masses when the lesion exceeds 1.5 cm in maximal dimension. Spectroscopy is unable to reveal benign breast lesions and phyllodes tumors of benign and borderline malignancy. We suggest that a false-negative spectroscopic result may be related to an absence of HER2/neu overexpression in carcinoma of the breast.     

Relationship between thallium-201 kinetics and proliferative activity assessed by monoclonal antibody MIB-1 in brain tumours

To clarify the relationship between thallium-201 chloride kinetics and proliferative activity in brain tumours, a single-photon emission tomographic (SPET) study was performed and the results correlated with monoclonal antibody MIB-1 staining of the tumour tissue. ²⁰¹Tl SPET was performed 10 min (early scan) and 2 h (delayed scan) after intravenous administration of ²⁰¹Tl (111 MBq) in 34 intra-axial tumours including 24 malignant tumours, and in 27 extra-axial tumours including one malignant tumour. Tumour ²⁰¹Tl kinetic parameters [early and delayed uptake ratios (ER and DR, respectively), retention index (RI), and the ratio of tumour delayed activity to early activity (Td/Te)] were compared with tumour tissue MIB-1 labelling indices (MIB-1 LI) representative of tumour cell proliferative activity. In the intra-axial tumours, ER and DR and MIB-1 LI were significantly higher in the malignant tumours than in the benign tumours. ER and DR were significantly correlated with MIB-1 LI (P<0.01 and P<0.05, respectively), but RI and Td/Te were not. In the extra-axial benign tumours, ER was as high as that in the intra-axial malignant tumours, while MIB-1 LI was equal to that in the intra-axial benign tumours. There were no significant correlations between any ²⁰¹Tl kinetic parameters and MIB-1 LI. This study indicates that ²⁰¹Tl ER may be the most reliable parameter for predicting the proliferative activity of intra-axial tumours.     

乳腺硬化性腺病与浸润性导管癌的超声特征对比研究

目的 对照乳腺早期浸润性导管癌,比较研究乳腺硬化性腺病的超声表现特点.方法 研究组为我院病理确诊为乳腺硬化性腺病患者41例,对照参考组为病理确诊浸润性导管癌患者21例,对比分析两组患者的超声表现.结果 通过对两组患者的常规及超声影像特征比较,我们发现乳腺硬化性腺病与乳腺浸润性导管癌在Alder分级、腋窝淋巴结肿大及钙化灶表现方面有显著的统计学差异（P＜0.05）.结论 乳腺肿块建议二维超声与CDFI结合诊断,其中Alder分级及部分超声影像学指标在乳腺硬化性腺病与浸润性导管癌鉴别诊断中有一定价值.     

Sclerosing adenosis and infiltrating epitheliosis of the breast. Radiohistopathologic correlations and differential diagnosis of carcinoma

Sclerosing adenosis and infiltrating epitheliosis are both benign diseases which are clinically, radiologically and macroscopically impossible to distinguish from cancer. Over a four years' period, 27 lesions of this kind, which are usually considered as rare, were found in 27 patients. The average age of the patients was 36 years, which confirmed the lesions as diseases typical of fertile women. In all cases, both clinical and instrumental findings (mammography and echotomography) indicated a kind of malignant cancer. The final diagnosis was always made on surgical/bioptic (fine-needle biopsy) specimens. This paper is aimed at stressing the lack of mammographic findings useful for the differential diagnosis of sclerosing adenosis-infiltrating epitheliosis and breast cancer. The utility of fine-needle aspiration biopsy is also stressed.     

Bilaterales Mammakarzinom und Lokalrezidiv: Prävalenz von BRCA-1- und BRCA-2-Genmutationen an einem unselektionierten Kollektiv

BACKGROUND: Mutations of the BRCA 1/BRCA 2 genes strongly predispose towards the development of contralateral breast cancer. We therefore investigated a hospital-based series of patients with bilateral breast cancer and a comparison group of patients with unilateral breast cancer, pairwise matched by age and family history, for mutations of the BRCA 1/BRCA 2 genes. PATIENTS AND METHODS: Between 1995 and 2000 genomic DNA from blood samples of 75 patients with bilateral breast cancer, who received postoperative radiotherapy, was analyzed for mutations of all coding regions and flanking intron sequences of the BRCA 1/BRCA 2 genes by single strand conformation polymorphism analysis (SSCP) and sequencing of aberrant findings. The results were compared to 75 unilateral breast cancer patients who were screened for common mutations in the BRCA 1 and BRCA 2 genes. Treatment results of patients with bilateral disease were analyzed with regard to a possible carriership of a BRCA 1/BRCA 2 gene mutation. RESULTS: Five distinct frameshift deletions (one in BRCA 1, four in BRCA 2) were identified in six patients with bilateral breast cancer. Three of six carriers developed local relapse, whereas this was the case in only nine of 69 non-carriers. After radiotherapy local relapse occurred in five patients (five of 126 irradiated breasts or chest walls). Three of these patients (60%) were carriers of a pathogenic BRCA 1/BRCA 2 mutation. In the comparison group of patients with unilateral breast cancer three pathogenic BRCA 1 mutations were identified. CONCLUSIONS: We failed to confirm an increased prevalence of BRCA 1/BRCA 2 mutations in our hospital-based series of patients with bilateral breast cancer. However, local relapse, especially when occurring after radiotherapy, may be predictive for an underlying pathogenic BRCA 1 and BRCA 2 gene mutation in patients with bilateral breast cancer.     

Computerized analysis of digitized mammograms of BRCA1 and BRCA2 gene mutation carriers

PURPOSE: To evaluate, by using computer image analysis, the mammographic density patterns of women with germ-line mutations in BRCA1 and BRCA2 genes in comparison with those of women at low risk of developing breast cancer. MATERIALS AND METHODS: Mammograms from 30 carriers of BRCA1 and BRCA2 mutations and from 142 low-risk women were collected retrospectively and digitized. In addition, 60 of the 142 low-risk women were randomly selected and age matched at 5-year intervals with the 30 mutation carriers. Mammographic features were extracted from the central regions of the breast images to characterize the mammographic density and heterogeneity of dense portions of the breast. These features were then merged into a single value related to the risk of breast cancer by using linear discriminant analysis. The applicability of these computer-extracted features and the output from linear discriminant analysis to differentiate between the carriers of BRCA1 and BRCA2 mutations and the low-risk women in the entire database and in an age-matched group were evaluated by using receiver operating characteristic analysis. RESULTS: Quantitative analysis of mammograms demonstrated that carriers of BRCA1 and BRCA2 mutations tended to have dense breast tissue, and their mammographic patterns tended to be low in contrast, with a coarse texture. Linear discriminant analysis resulted in values of the areas under the receiver operating characteristic curve of 0.91 and 0.92 in distinguishing between the BRCA1 and BRCA2 mutation carriers and the low-risk women in the entire database and the age-matched group, respectively. CONCLUSION: The computerized analysis of mammograms suggests that mammographic patterns in carriers of BRCA1 and BRCA2 mutations differ from those of women at low risk for breast cancer. Our computer-extracted features may be useful as radiographic markers for identifying women at high risk for breast cancer.     

Breast conservation in BRCA1 or BRCA2 mutation carriers with early stage breast cancer

The role of breast conservation therapy (limited surgery and irradiation of the breast with/without axilla) in the approximately 5% of breast cancer patients who harbour a germline mutation in BRCA1 or BRCA2, is a largely unexplored area and is seen by some as controversial. The relatively high cumulative risk of second primary cancers in such patients and concern about a possible decreased ability of mutation carriers to repair DNA damage caused by radiation has fuelled this controversy. Published studies of breast conservation therapy in carriers of a mutation in BRCA1 or BRCA2 are reviewed, with particular attention to their methodology. These studies have not demonstrated any increase in radiation sensitivity of normal tissues in mutation carriers, either in terms of increased early or late toxicity or tumourigenesis. Likewise, tumour sensitivity to radiotherapy, which might be expected based on the known functions of the BRCA1 and BRCA2 genes, has not been documented to date in mutation carriers. Further, methodologically rigorous studies of large numbers of breast cancer patients who carry a mutation in BRCA1 or BRCA2 are required to fully elucidate these issues.     

ERCCI与BRCA1在非小细胞肺癌及癌旁组织中的表达及临床意义

目的探讨DNA修复基因ERCCI与BRCA1在非小细胞肺癌（NSCLC）中的表达及临床意义。方法应用免疫组织化学方法检测32例肺癌,24例癌旁组织ERCCI与BRCA1的表达。结果NSCLC中ERCCI与BRCA1在癌旁组织内表达高于癌组织,且差异具有统计学意义（P〈0.05）;BRCA1在淋巴结有无转移之间表达差异具有统计学意义（P〈0.05）。结论NSCLC中,ERCCI与BRCA1在癌旁组织的表达高于癌组织,BRCA1可作为判断预后的一项指标。     

Benign breast lesions that simulate malignancy: magnetic resonance imaging with radiologic-pathologic correlation

The typical appearance of benign breast conditions on magnetic resonance imaging (MRI) is well established and diagnosis is usually easy. However, cases of benign breast lesions that are extremely difficult to differentiate from malignant breast tumors are occasionally encountered in MRI of the breast because overlap between benign and malignant lesions characteristics is found. This article describes the MRI features of a variety of suspicious breast conditions that were confirmed to be benign in the histopathologic study. We evaluated both enhancement kinetics and lesion morphological information to differentiate malignant from benign lesions. We also correlated the MRI findings with clinical data, and mammographic, ultrasound, and pathologic findings. Lesions evaluated included benign proliferative breast disease, fibroadenoma, intraductal papilloma, granular cell tumor, pseudoangiomatous stromal hyperplasia, fat necrosis, mastitis, inflammatory granuloma, epidermal inclusion cyst, and benign intramammary lymph node.     

Differing effects of breast cancer 1, early onset (BRCA1) and ataxia-telangiectasia mutated (ATM) mutations on cellular responses to ionizing radiation

PURPOSE: The ataxia-telangiectasia mutated (ATM) gene encodes a protein kinase, the activation of which is an early event in the cellular response to ionizing radiation. One of the many substrates of ATM is BRCA1 (breast cancer 1, early onset gene), which has been associated with susceptibility to breast and ovarian cancer, and has been implicated in DNA repair processes. Various cellular responses to radiation were analysed in cells with mutations in ATM or BRCA1 in an attempt to clarify which effects of ATM can be mediated through BRCA1. MATERIALS AND METHODS: The response to radiation of cells with mutations in ATM or BRCA1 was examined, as were BRCA1-mutant tumour cells transfected with an exogenous wild-type BRCA1 allele. Assays included cell-survival curves, studies of potentially lethal damage repair, measurement of chromosomal aberrations and of G1 arrest, and Western blot analysis of lysates of irradiated cells to determine the phosphorylation of the product of the human Mdm2 gene (HDM2). RESULTS: Both ATM and BRCA1 mutations were associated with sensitivity to ionizing radiation, deficient repair of potentially lethal damage and markedly increased chromosomal aberrations. A BRCA1-mutated tumour cell line HCC1937, like ATM mutant cells, did not exhibit a normal G1 arrest but, unlike ATM mutant cells, did exhibit phosphorylation of HDM2. Expression of wild-type BRCA1 in HCC1937 cells partially restored radioresistance, restored repair of potentially lethal damage and markedly reduced radiation-induced chromosomal aberrations. G1 arrest, however, was not restored by expression of BRCA1. CONCLUSIONS: The results are consistent with a model in which ATM phosphorylation of BRCA1 regulates DNA repair functions, particularly those involved in potentially lethal damage repair and chromosomal integrity, but not other aspects of the cellular response to radiation such as G1 cell cycle arrest. To the authors' knowledge, this is the first demonstration of the ability of exogenously expressed BRCA1 to restore the ability to perform potentially lethal damage repair and maintain chromosomal integrity in irradiated cells.     

Real-time sonography of palpable breast masses

In order to evaluate the clinical usefulness of an electronic real-time linear array scanner in breast diseases, ultrasonography was performed in 148 cases of histologically confirmed palpable breast masses. The real-time images were observed on a television monitor while moving the hand-held transducer probes over the masses. It took only a few minutes to examine and diagnose a palpable mass. Among 45 carcinomas, 39 lesions were correctly diagnosed, four lesions were not detected by ultrasound and two were misdiagnosed as fibroadenomas. On the other hand, ten benign lesions were falsely diagnosed as breast cancers: seven mastopathies (including four sclerosing adenosis), two fibroadenomas and one abscess. The sensitivity and specificity for diagnosing breast cancer were 0.87 and 0.90 respectively. Real-time sonography is a simple, time-saving and useful tool for examining palpable breast masses. However, it should be realised that some breast cancers are difficult to image and differentiate from benign lesions.