The correlation of mammographic-and histologic patterns of breast cancers in BRCA1 gene mutation carriers, compared to age-matched sporadic controls

Breast cancers in BRCA1 gene mutation carriers often have specific histologic features: grade III tumors with pushing margins. Our purpose was to compare the mammographic and histologic features of breast cancers in carriers with those in age-matched sporadic controls. The features of breast cancers in 27 BRCA1 carriers found during annual surveillance were compared to those in 107 age-matched sporadic controls. The carriers had no (classic) spiculated mammographic lesions, a high percentage of well-defined masses and hardly any masses with microcalcifications, whereas the controls had significantly fewer well-defined ones and only in 27% spiculated lesions on the mammogram. The well-defined mammographic tumors correlated in 83% of the carriers and in 70% of the controls with histologic circumscribed tumor margins. Spiculated mammographic lesions in the controls were in 90% grade I or II tumors. DCIS with or without infiltration was seen in 22% of the carriers and in 45% of the controls. In conclusion, breast cancers diagnosed in BRCA1 carriers do not have classic malignant mammographic features. A minority of the young sporadic controls show the classic malignant lesion on the mammogram. Both carriers and controls generally show a good correlation between their mammographic- and histologic tumor pattern.     

Experience with breast biopsies using the Advanced Breast Biopsy Instrumentation system

OBJECTIVE: A retrospective review of our experience with advanced breast biopsy instrumentation (ABBI) was undertaken to evaluate its efficacy for excisional breast biopsy of lesions detected on mammography. To our knowledge, experience with ABBI has not been previously reported in the radiology literature. MATERIALS AND METHODS: Biopsies using the ABBI system and an adapted dedicated table were performed in 53 patients who had 54 mammographically evident lesions. Samples were obtained with cannulas ranging in size between 5 and 20 mm. Indications for biopsy were calcifications (n = 22) and masses (n = 31). RESULTS: Forty-five specimens (44 patients) had benign results at pathology: 15 specimens were diagnosed as fibroadenoma, 15 as cystic breast disease, and four as reactive lymph nodes; the remaining 11 specimens had benign diagnoses of adenosis, fibrosis, and hyperplasia. The average specimen size was 4.8 cm in greatest longitudinal dimension. One patient had a nondiagnostic biopsy for calcifications later found to be dermal. Seven patients were diagnosed as having breast cancer; in six of these, the tumor involved the margins of the specimen. One patient had marked atypia that required reexcision for the diagnosis of intraductal carcinoma to be made. CONCLUSION: The ABBI procedure is a more invasive and less readily available procedure than core needle biopsy for sampling of benign breast lesions. In seven cases of malignancy diagnosed at breast biopsy, the ABBI technique completely excised only a single lesion. In our experience, the ABBI procedure offered no advantages over core needle biopsy for either benign or malignant lesions.     

3.0T磁共振动态增强在乳腺浸润性导管癌诊断中的应用价值

目的 探讨MR动态增强在乳腺浸润性导管癌诊断与鉴别诊断中的应用价值.方法 17例乳腺浸润性导管癌,均采用3.0T MR扫描仪及乳腺专用线圈行常规MR平扫和动态增强检查.所有病例均经手术病理证实,分析比较病灶的MRI信号强度、形态学以及血流动力学特点.结果 17例17个乳腺浸润性导管癌均表现为肿块型,T_1WI呈低信号影(8/17)或等信号影(9/17),T_2WI呈高信号影(14/17)或等信号影(3/17).形态学表现:病灶不规则形及分叶状占82.4%(14/17);病灶边界不清楚(12/17)、边缘不光滑(15/17),其中毛刺征或星芒征7例.病灶增强后多表现为不均匀性显著强化(10/17)或环形强化(5/17);在最大信号强度投影(MIP)图上有82.4%(14/17)的病灶周围可见血管纠集征.血流动力学表现为所有病例早期强化率均＞90%;88.2%(15/17)的病灶强化峰值＜3 min;时间-信号强度曲线以Ⅱ、Ⅲ型为主,Ⅱ型35.3%(6/17),Ⅲ型58.8%(10/17).结论乳腺浸润性导管癌MR动态增强影像学表现具有一定的特征性,有助于本疾病的诊断与鉴别诊断.     

The differential diagnostic criteria of breast microcalcifications]

The authors evaluated 127 cases (31 infiltrating carcinomas, 22 intraductal carcinomas, 74 benign lesions) of breast microcalcifications with no palpable lesions. The patients had undergone mammography, stereotaxic cytology and direct magnification (87 cases). Blind interpretation of standard films and of direct magnification was performed by two independent readers (A, B), who classified the cases according to radiologic pattern (annular, punctate, granular, linear, branching), degree of suspicion and need for surgical biopsy. The study confirmed the association of different types of microcalcifications with breast cancer (predictivity: annular, punctate, granular, linear, branching; A = 25%, 15%, 40%, 92%, 86%; B = 14%, 26%, 39%, 90%, 100%). However, diagnosis was not very accurate (sensitivity: A = 83%, B = 71.1%; specificity: A = 83%, B = 78.4%); it was also observed that most cancers can be diagnosed only at a relatively high cost in terms of unnecessary biopsies. Interobservers' agreement was high relative to diagnosis (negative/dubious vs. suspicious/positive = -88.9%; K = 58.5) and low for pattern attribution (52%). Direct magnification allowed better detail definition but if sensitivity improved (A = 87% vs. 80.6%; B = 64.5% vs. 51.6%), specificity was negatively affected (A = 73.2% vs. 80.4%; B = 69.6% vs. 80.3%), due to an excess of false positives. Stereotaxic cytology [inadequacy rate = 26%, sensitivity and specificity (ex inadequates) = 80% and 100%, respectively] was more accurate than mammography as far as the decision for surgical biopsy was concerned, and was correct in identifying most (A = 6/7, B = 7/11) of the cancers which had been misdiagnosed as benign at conventional and magnification mammography. Stereotaxic cytology should be routinely performed in cases of microcalcifications with no associated palpable lesions.     

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     

乳腺钼靶X线低密度病变的诊断与鉴别诊断

目的 :探讨钼靶X线诊断乳腺低密度病变的价值。材料和方法 :回顾性分析 16例经手术病理证实的乳腺低密度病变的钼靶X线征象及B超、CT表现。结果 :脂肪瘤 8例 ,脂肪为主型纤维腺脂肪瘤 1例 ,低密度型乳汁潴留囊肿 3例 ,创伤后油脂囊肿 4例。最大病变 4cm× 4.5cm ,最小 0 .8cm× 1.5cm。均为低密度或以低密度为主体病变 ,13例密度均匀 ,1例内有分支状钙化 ,1例见弧线形或环线形边缘钙化 ,1例病变内散在斑点状中等密度影。圆形或类圆形 15例 ,分叶状 1例。边缘清楚 14例。结论 :钼靶X线结合B超、CT、临床对乳腺低密度病变可做出正确诊断。     

乳腺脂肪瘤钼靶X线及CT诊断

目的　探讨钼靶X线与CT在诊断乳腺脂肪瘤中的价值。方法　回顾分析8例经手术病理证实乳腺脂肪瘤的钼靶X线、CT表现。结果　乳腺浅层脂肪瘤3例,腺体间脂肪瘤2例,乳腺后脂肪瘤3例。右乳6例,左乳2例。病变最大4cm×4. 5cm,最小2cm×3cm。均为低密度或以低密度为主体病变, 1例内有分支状钙化。圆形或类圆形7例,分叶状1例。边缘均清楚。结论　钼靶X线征象结合临床与病史,对乳腺脂肪瘤可做出正确诊断。CT显示病变密度与部位层次优于钼靶X线。     

Imaging features of focal breast fibrosis: mammographic-pathologic correlation of noncalcified breast lesions.

OBJECTIVE: Our objective was to describe the spectrum of imaging and histologic findings of focal breast fibrosis with an emphasis on noncalcified lesions, thereby offering a means of confirming mammographic-pathologic concordance on core biopsy of this increasingly encountered diagnosis. MATERIALS AND METHODS: Retrospective review of 610 core needle biopsies revealed the histologic diagnosis of focal fibrosis in 89 (15%). Thirty-nine cases were excluded: 17 in which focal fibrosis was not the primary diagnosis and 22 in which calcifications were the main imaging findings. The 50 remaining patients with noncalcified lesions that proved on histology to be focal fibrosis constituted the basis of the study. RESULTS: Mammographically, focal fibrosis presented as a mass in 68% of patients (n = 34), architectural distortion in 12% (n = 6), and asymmetric density in 10% (n = 5); focal fibrosis was mammographically occult in 10% (n = 5). Sonographically, 72% (n = 36) of cases of focal fibrosis presented as masses with three echo texture patterns: hypoechoic, isoechoic, and centrally echogenic with a peripheral hypoechoic rim. The sonographic margins were well circumscribed (n = 21), lobulated (n = 10), or ill defined (n = 5). Histologic review revealed three morphologic patterns of collagen deposition: perilobular, septal, and haphazard fibrosis. Correlation with the imaging findings showed that septal and perilobular fibrosis most often presented as hypoechoic or centrally echogenic masses, whereas the haphazard form was more often seen with architectural distortion. CONCLUSION: Focal fibrosis often presents as a noncalcified mass on mammography or sonography. The diagnosis of focal fibrosis on core needle biopsy can be considered concordant for a mass exhibiting well-circumscribed or partially obscured margins. Imaging findings discordant with focal fibrosis, such as marginal spiculation, require excisional biopsy.     

Analysis of cancers missed at screening mammography.

Analysis of 320 cancers found in a screened population between August 1985 and May 1990 revealed 77 cancers that were "missed" at screening mammography. The missed lesions consisted of cancers incorrectly diagnosed after mammography (false-negative results) but visible in retrospect (n = 19); cancers correctly diagnosed after mammography but visible in retrospect on an earlier mammogram (n = 47); and cancers that went undetected by the first of two readers (n = 11). Missed lesions were categorized according to type of miss, reason for the miss, breast density, lesion features, and lesion location. The missed lesion were compared with 121 cancers that were correctly diagnosed at screening mammography. The missed cancers occurred in women with denser breasts (P = .046), were less likely to demonstrate malignant microcalcifications, and were more likely to demonstrate a developing opacity as an indication of cancer (P = .005). An understanding of the characteristics of missed lesions may be a valuable aid in increasing the sensitivity of screening mammography.     

Mucinous (colloid) breast cancer: mammographic and US features with histologic correlation

OBJECTIVE: Mucinous carcinoma of the breast presents with different survival rates in pure and mixed types. The purpose of this study was to correlate the mammographic and ultrasonographic findings of mucinous carcinoma with histologic features in different types and mucin rates. MATERIAL AND METHODS: Thirty-four patients (2.3%) had mucinous cancer after retrospective review of the 1439 breast cancers diagnosed between 1990 and 1996. Twenty-seven patients, 19 pure and eight mixed type of mucinous carcinomas of the breast, were included in this study to evaluate the imaging findings. In 22 of these, the microscopic slides were available and re-evaluated to estimate the volume of extracellular mucin. The volume of the extracellular mucin was classified histologically as: (+), less than 50% of mucin; (++), 50-80% of mucin; and ( ), more than 80% of mucin. Mammographic features with emphasis on margin characteristics and sonographic echo pattern of tumors were correlated with histologic findings. RESULTS: Ten cases (53%) of pure mucinous type carcinomas had a circumscribed mass lesion on the mammograms. The well-defined, lobulated margins of the masses were well correlated with pure histologic type (P<0.01; chi(2) analysis) Two-thirds of these tumors had high volume extracellular mucin. All mixed type mucinous carcinomas demonstrated poorly defined or spiculated margins with no relation to the mucin rates (P<0.01). The sonographic appearances of the tumors showed correlation with histologic types. Most of the pure type carcinomas (53%) were seen with isoechogenic echo texture relative to that of subcutaneous fat, while all of the mixed type carcinomas were hypoechogenic (P<0.01). CONCLUSION: The mammographic and sonographic features of mucinous breast carcinoma show differences in pure and mixed types of the tumor. The most common mammographic appearance of pure mucinous carcinomas with high percentages of mucin is a mass lesion having well-defined margins, which is isoechogenic relative to fat on the sonographic examination. Pure type of carcinomas with small percentages of mucin and mixed type carcinomas have more aggressive imaging characteristics.     

Mammographic features predicting an extensive intraductal component in early-stage infiltrating ductal carcinoma.

Several studies have shown that the presence of an extensive intraductal component in patients with infiltrating ductal carcinoma is a major factor for predicting local recurrence after breast-conserving surgery and radiotherapy. A prospective study of 101 consecutive mammograms in patients with stage I or II infiltrating ductal carcinoma was performed to determine the predictive values of mammographic features in determining the presence or absence of an extensive intraductal component. Thirty-five (35%) of the lesions contained a pathologically verified extensive intraductal component. Sixty-five percent (22/34) of lesions showing mammographic evidence of calcifications with or without a mass were associated with an extensive intraductal component (p less than .001). Lesions with calcifications greater than 3 cm in extent were significantly (p less than .05) more likely to have an extensive intraductal component (9/10; 90%) than those with calcifications less than 3 cm in extent (13/24; 54%). Only 17% (8/46) of patients in whom mammograms showed only a mass or architectural distortion and 24% (5/21) of patients who had a mass palpable clinically or who had normal findings on mammograms had lesions with an extensive intraductal component. We conclude that infiltrating ductal carcinomas associated with calcifications on mammography, especially if the calcifications are extensive, are likely to be associated with an extensive intraductal component. Carcinomas without calcifications that show masses or architectural distortion on mammography, or carcinomas with palpable masses and normal findings on mammography, are unlikely to have an extensive intraductal component.     

Differentiation of phyllodes tumors versus fibroadenomas

Purpose: To determine if mammographic and sonographic findings allow discrimination between phyllodes tumor and large sized fibroadenoma, which mimic each other in the clinical, radiologic and histopathologic appearances.Material and Methods: Thirty-one histopathologically proven masses including 12 phyllodes tumors and 19 fibroadenomas 3 cm or greater in diameter were compared. In total 28 women were retrospectively evaluated by mammography and pre-operative sonography.Results: Mammography revealed a high-density mass compared with surrounding fibroglandular breast tissue to be present in 9 of the 12 (75%) phyllodes tumors and 7 of the 19 (37%) fibroadenomas. At sonography a mass, which had a round or lobulated shape, marked posterior acoustic enhancement and intramural cystic areas, were statistically significantly more likely to be phyllodes tumors than fibroadenomas. None of the other mammographic or sonographic characteristics proved to be useful in differentiating phyllodes tumors and fibroadenomas.Conclusion: Although masses of high density at mammography, circumscribed border associated with posterior acoustic enhancement and internal cystic areas at sonography should suggest the diagnosis of phyllodes tumors rather than large sized fibroadenomas, there was a substantial overlap in the mammographic and sonographic characteristics of these two tumors. Therefore, an excisional biopsy would be necessary for equivocal masses.     

钼靶X线征象与不同类型乳腺癌关系的病理基础研究

目的:探讨不同类型乳腺癌的X线表现与其病理基础之间的关系。方法:经乳腺X线检查,手术、病理证实的乳腺癌36例,共36个病灶,包括浸润性导管癌26个,导管内癌及导管内癌伴微浸润7个,浸润性小叶癌2个,黏液腺癌伴浸润性导管癌1个。观察乳腺癌的X线表现,与病理分型对照。结果:①癌灶的X线表现有肿块者23个(63.9%),有钙化者18个(50%),有结构扭曲者3个(8.3%);②呈肿块表现的以浸润性导管癌为主,占87.9%;有钙化者易出现在导管内癌和浸润性导管癌中,分别占87.5%、42.3%,尤其单纯钙化多出现在导管内癌中(71.4%,5/7);结构扭曲可见于浸润性导管癌和导管内癌中,其它类型未见。结论:肿块、钙化和结构扭曲为乳腺癌的主要X线表现。浸润性导管癌占乳腺癌的大部分,除单纯钙化首先考虑导管内癌,其余征象均首先考虑浸润性导管癌;肿块改变尚要想到髓样癌和黏液腺癌的可能;结构扭曲也可出现在导管内癌中。     

Primary malignant lymphoma of the breast

Primary malignant lymphoma of the breast is a rare tumor. Recently, we encountered a case of primary malignant lymphoma of the breast and present here the mammographic and ultrasonographic (US) findings with the pathology of this rare breast tumor. The patient was a 47-year-old woman with a left breast mass. Mammography showed a 3.0 × 1.5 cm, lobulated high-density mass with well-defined margins. US revealed a lobulated mass with fairly well-defined borders, hypoechoic and heterogenous internal echoes, and posterior acoustic enhancement. It was difficult to differentiate malignant lymphoma from breast carcinoma by imaging studies. This type of breast cancer should be added to a differential diagnosis when a solitary tumor is found in the breast on mammography.     

肾上腺转移瘤的CT诊断

目的探讨CT对肾上腺转移瘤的诊断价值。方法回顾性分析23例经手术病理证实的肾上腺转移瘤CT征象。结果23例肾E腺转移瘤中10例为双侧,右侧5例,左侧8例。瘤体大小在1．5cm×1．2cm～12．5cm×9．7cm。23例的33个肿块均为实质性肿块,26个肿块小于4cm,为类圆形或椭圆形,密度均匀,边界清楚,其中5例增强扫描肿块呈均匀强化;7个肿块大于4cm,呈不规则形或分叶状,密度不均匀,其内可见坏死、囊变,边缘模糊,其中2例增强扫描呈不均匀强化。结论结合临床病史,CT平扫与增强扫描能对大多数肾上腺转移瘤作出正确诊断。     

Imaging features of breast malignancy: breast ultrasound and MR imaging correlation

Recent advances in breast imaging, including volumetric breast ultrasound and breast magnetic resonance (MR) imaging, now provide multiplanar capability for detailed morphologic assessment of breast malignancies. This article describes the imaging findings of common breast cancers, utilizing volumetric breast ultrasound with MR imaging correlation. Knowledge of the characteristic appearances of breast malignancy can facilitate the diagnosis and management of breast masses, particularly when obscured by excessive breast density on mammography examinations.     

卵巢颗粒细胞瘤的CT表现

目的：分析卵巢颗粒细胞瘤（OGCT）的CT征象,提高对本病的诊断水平。方法：回顾性分析19例经手术病理证实的卵巢颗粒细胞瘤的CT资料,其中11例为初发病例,8例为复发病例。结果：19例OGCT患者共有23个肿瘤,其中14个呈类圆形或圆形,9个呈不规则或分叶状,共有2个囊性肿块,15个囊实性肿块和6个实性肿块。囊性肿块在CT图像上以均匀低密度、无强化的囊性成分为主,囊壁、分隔或壁结节有强化;实性肿块CT表现为肿块大部分为实性,内有单发或多发灶性低密度坏死区;囊实性肿块CT表现为囊性与实性成分大致相等。所有病例增强扫描病灶实性部分呈轻度-中度强化。13例伴腹水,9例伴子宫内膜增厚,19例均无淋巴结肿大。结论：卵巢颗粒细胞瘤的CT表现有一定特征,结合临床和CT有助于对本病的诊断和鉴别诊断。     

Multicentric and multifocal cancer: whole-breast US in preoperative evaluation

PURPOSE: To evaluate preoperative whole-breast ultrasonography (US) in the management of breast cancer. MATERIALS AND METHODS: The ipsilateral breast in 40 patients with known breast cancer or in whom there was high suspicion of breast cancer was evaluated with whole-breast US. Biopsy was performed on all discrete solid lesions. RESULTS: US depicted 45 (94%) of 48 invasive tumor foci and seven (44%) of 16 foci of ductal carcinoma in situ (DCIS). Mammography depicted 39 (81%) of 48 invasive tumor foci and 14 (88%) of 16 foci of DCIS. The nine (14%) of 64 malignant foci seen only at US included three infiltrating ductal carcinomas, two mixed infiltrating and intraductal carcinomas, two infiltrating lobular carcinomas, and two foci of DCIS. Two (18%) of 11 foci of infiltrating lobular carcinoma were missed at both US and mammography. Of 20 patients mammographically suspected of having unifocal disease, three (15%) required wider excision on the basis of US findings. Two additional foci were depicted only at US in one of 16 patients mammographically suspected of having multicentric or multifocal disease. Of four patients with mammographically occult disease, US correctly depicted the diffuse (n = 2) or unifocal (n = 2) extent of the cancer. CONCLUSION: Whole-breast US complements mammography in the preoperative evaluation of patients with breast cancer, particularly when breast conservation is contemplated.     

Small (< 2.0-cm) breast cancers: mammographic and US findings at US-guided cryoablation--initial experience

PURPOSE: To determine the mammographic and ultrasonographic (US) findings at cryoablation of small solitary invasive breast cancers and compare them with presence of residual malignancy after treatment. MATERIALS AND METHODS: Institutional review board approval and informed patient consent were obtained. Nine patients with small solitary invasive breast cancers diagnosed at core biopsy were treated with US-guided cryoablation and a 2.7-mm cryoprobe. Mean cancer size was 12 mm (range, 8-18 mm); four were palpable. Tabletop argon gas-based cryoablation system with a double-freeze-thaw protocol was used to treat cancers in outpatient setting. Tumor sites were excised at lumpectomy 2-3 weeks after cryoablation. Findings at mammography and US before, during, and after cryoablation were assessed to categorize densities and masses on mammograms and masses on US images with Breast Imaging Reporting and Data System (BI-RADS); maximum cancer size was measured. Imaging findings and clinical breast examination data were compared with histologic findings from lumpectomy specimens to determine presence of intraductal or invasive cancer. RESULTS: With US guidance, ice balls (maximal mean size, 4.4 cm) were formed around cancers. Before excision, eight patients underwent mammography; all had new focal densities (maximum size, 2.5-5.0 cm) at cancer sites. Six patients underwent preexcisional US; 100% of them had new hyperechogenicity in tissue surrounding cancer site. Seven (78%) of nine patients had no residual cancer; specimens contained fat necrosis. One patient had a small focus of invasive cancer; one had extensive multifocal ductal carcinoma in situ. Patients with BI-RADS category 1 or 2 densities on mammograms or nonpalpable tumors had no residual malignancy. No residual invasive cancer occurred in tumors 17 mm or smaller or in cancers without spiculated margins at US. CONCLUSION: After cryoablation, there was increased echogenicity at US and increased density at mammography; these findings were observed in areas that approximated location and size of the ice ball. Tumor size, mammographic density, and US characteristics may be indicators of likelihood of complete cryoablation.