Sonographic Appearances of Benign and Malignant Male Breast Disease With Mammographic and Pathologic Correlation

Objective. Imaging of the male breast is most often performed for the evaluation of a clinical abnormality such as breast enlargement or tenderness, a palpable mass, nipple skin changes, or nipple discharge. Most breast lesions encountered in men are benign. Malignant breast lesions are less frequent; breast cancer accounts for less than 1% of all male cancers in the United States. The initial imaging evaluation of a finding in the male breast is performed with mammography. Sonography is frequently used as an adjunct to mammography but is less often used as the primary imaging modality. The objective of this article is to provide readers with a thorough review of the sonographic appearances of benign and malignant male breast disease. Methods. We reviewed our institution's case database to identify male patients who underwent mammography, sonography, and subsequent biopsy of a breast lesion. These cases were collected and reviewed to select the best imaging examples. Results. A spectrum of benign and malignant male breast disease is presented with corresponding sonographic, mammographic, and pathologic imaging. For each entity, the salient imaging findings and typical clinical presentation are discussed. Conclusions. Most studies in the literature have reported on the mammographic and sonographic imaging features of primary breast carcinoma in men. However, very little has been reported on the sonographic appearance of benign and malignant male breast conditions. Recognition and correct identification of pathologic male breast entities on sonography is essential to determine appropriate management recommendations and avoid unnecessary biopsies.     

Community‐Based Practice Experience of Unsuspected Breast Magnetic Resonance Imaging Abnormalities Evaluated With Second‐Look Sonography

Objective. The purpose of this study was to assess the utility and efficacy of second‐look breast sonography in the evaluation of abnormalities identified on presurgical breast magnetic resonance imaging (MRI) examinations. Methods. A retrospective review was performed of 152 presurgical breast MRI examinations having 196 unsuspected abnormalities to identify findings that underwent subsequent breast sonography. Eligible examinations had a suspicious abnormality identified on presurgical MRI and documentation of the location and size of the finding on MRI and subsequent second‐look sonography. Fourteen examinations not meeting the criteria were excluded, with 182 abnormalities remaining. Patient medical records were reviewed. Results. Seventy percent (128 of 182) of breast MRI lesions were visible at second‐look sonography; 30% (54 of 182) were sonographically occult. Ninety‐five percent (121 of 128) of sonographically visible abnormalities underwent breast biopsy. Pathologic examinations of sampled sonographically visible lesions revealed 39 cancers, 9 high‐risk lesions, 72 benign lesions, and 1 lesion not specified at surgery; 23% (9 of 128) of cancers were in the contralateral breast. Fifty‐four lesions were sonographically occult. Needle biopsy was performed for 93% (50 of 54) of occult lesions, revealing 8 cancers, 1 high‐risk lesion, and 41 benign lesions; 3 of the benign lesions did not have sufficient pathologic specimens but were benign at follow‐up. Magnetic resonance imaging guidance was used in 86% (43 of 50) of these biopsies. One contralateral cancer was identified in the sonographically occult subset. Of the 182 lesions that underwent second‐look sonography, 20% (36 of 182) had a change in management. Conclusions. Second‐look sonography has value in the evaluation of abnormalities found on breast MRI. We found enhancements in 70% (128 of 182), yielding 39 cancers.     

乳房肿块的超声诊断价值

本文报告２５０例共３１７只乳房肿块的超声检查资料，所有病例均经手术和病理证实。乳腺癌诊断符合率为８１．４１％，腺瘤为８７．２５％。发现的最小良性病灶４×５ｍｍ，最小癌６×６ｍｍ。本文就乳癌的早期发现、良恶性病灶的鉴别及部分病例误诊原因分析等几方面作了讨论。作者认为高分辨率、高频探头的应用为乳腺内小病灶的发现提供了基础。肿块的边界、包膜及形态是鉴别良恶性病灶的首要标准。而彩色多普勒信号仅能在此基础上起辅助作用。对发现的不能明确其性质的病灶可在超声引导下穿刺活检。     

Accuracy of sonographically guided 14-gauge core-needle biopsy: results of 715 consecutive breast biopsies with at least two-year follow-up of benign lesions

PURPOSE: The objective of this study was to examine the diagnostic accuracy of sonographically guided 14-gauge core-needle biopsy (CNB). METHODS: Sonographically guided 14-gauge CNBs of 715 breast lesions were performed in 652 patients. Histopathologic results were correlated with imaging findings, and repeat biopsy was recommended in the cases of discordance between the radiologic and pathologic results. Long-term follow-up was used for patients with CNB findings of a benign lesion. RESULTS: Sonographically guided CNB revealed malignancy in 311 lesions (43%). Thirty-one lesions with CNB findings indicating benign conditions underwent additional image-guided or excisional biopsy because of indeterminate pathologic features, disagreement between radiologic and pathologic results, surgeon preference, or patient request. Within these 31 cases, 9 malignancies were diagnosed. The duration of follow-up for the remaining 373 benign lesions varied from 27 to 60 months. In 3 of these 373 cases, carcinoma was diagnosed at the site of CNB. The false-negative rate of 14-gauge sonographically guided CNB was 3.7%, and the sensitivity of sonographically guided CNB for the diagnosis of breast cancer was 96.3%. CONCLUSIONS: Sonographically guided 14-gauge CNB is a safe and accurate method for evaluating breast lesions that require tissue sampling. Radiologic-pathologic correlation and follow-up of benign lesions are essential for a successful breast biopsy program.     

Characterization of Breast Masses With Sonography

OBJECTIVE: To determine whether sonography can be used to categorize some solid breast masses as probably benign so that biopsy can be deferred. METHODS: We prospectively characterized 844 sonographically visible solid breast masses referred for biopsy. Mammographic and sonographic features of the masses were recorded, and all masses were categorized by American College of Radiology Breast Imaging Reporting and Data System classification before biopsy. Of the 844 masses, 148 were categorized as probably benign (Breast Imaging Reporting and Data System category 3). Sonographically guided biopsy (n = 804) or fine-needle aspiration (n = 40) was performed for pathologic correlation. RESULTS: Of the 148 masses that met the sonographic criteria for probably benign masses, there was 1 malignancy, for a negative predictive value of 99.3%. CONCLUSIONS: Follow-up can be an acceptable alternative to biopsy for sonographically probably benign solid masses.     

Imaging findings of chest wall lesions on breast sonography.

OBJECTIVE: The purpose of this presentation is to illustrate the sonographic findings of chest wall lesions that were depicted on breast sonography. METHODS: Chest wall lesions detected during breast sonography were collected and reviewed retrospectively. RESULTS: The sonographic findings of normal chest walls and various pathologic chest wall lesions, including inflammatory lesions, benign neoplasms, and malignant neoplasms, are discussed. CONCLUSIONS: Familiarity with normal sonographic anatomy and chest wall lesions could be helpful in differentiating a chest wall lesion from a breast lesion and in showing whether the origin of any palpable breast lump is in the breast parenchyma or the chest wall on breast sonography.     

Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses.

OBJECTIVE: Large-core needle biopsy of the breast can be performed with stereotactic or ultrasonographic guidance. However, ultrasonographically guided large-core needle biopsy has notable advantages, including the absence of ionizing radiation, increased patient comfort, and greater cost-effectiveness. The purpose of this study was to evaluate the accuracy of ultrasonographically guided large-core needle biopsy for the diagnosis of breast cancer in palpable and nonpalpable breast masses. METHODS: The study was a retrospective review of consecutive ultrasonographically guided large-core needle biopsies for indeterminate breast masses. A total 424 ultrasonographically guided core biopsies were performed in 367 patients with 1 or more breast masses. Ultrasonographically guided core biopsy was performed with a 14-gauge spring-loaded needle and a freehand technique. Correlation of ultrasonographically guided core biopsy pathologic findings with subsequent surgical pathologic findings or long-term imaging follow-up was performed. RESULTS: Of 424 indeterminate breast lesions for which histopathologic findings were obtained by ultrasonographically guided core biopsy, 234 cancers were diagnosed. Twenty-eight additional lesions had either questionable but not definitively malignant pathologic features (n = 11) or radiologic-pathologic discordance (n = 17) and were surgically excised. Of these, 8 additional cancers were diagnosed. Patients or surgeons chose excision of 41 additional lesions that were benign on ultrasonographically guided core biopsy No cancer was found in these surgical specimens. One additional cancer was diagnosed at a 6-month imaging follow-up because of interval growth. On the basis of surgical and long-term imaging follow-up, the sensitivity of ultrasonographically guided core biopsy for the diagnosis of breast carcinoma was 99.2% (95% confidence interval, 95.6%-99.9%) in 173 palpable breast masses and 93.2% (95% confidence interval, 87.1%-97%) in 251 nonpalpable masses. In cancers diagnosed on the basis of immediate surgical excision as a result of ultrasonographically guided core biopsy that showed either questionable pathologic features or radiologic-pathologic discordance, the sensitivity of ultrasonographically guided core biopsy for the diagnosis of breast cancer was 99.2%. CONCLUSIONS: Ultrasonographically guided large-core needle biopsy is a sensitive percutaneous biopsy method for the diagnosis of breast cancer in palpable and nonpalpable breast masses.     

Prospective evaluation of the value of combined mammographic and sonographic assessment in patients with palpable abnormalities of the breast.

OBJECTIVE: To evaluate the role of combined mammographic and sonographic imaging in patients with palpable abnormalities of the breast. METHODS: Four hundred eleven consecutive cases of palpable abnormalities of the breast underwent combined mammographic and sonographic evaluation. Patients who did not undergo biopsy had imaging and clinical follow-up; the mean follow-up period was 28.9 months (range, 24-33 months). RESULTS: One hundred sixty-five (40.1%) of 411 palpable abnormalities had a benign assessment; 97 (58.7%) of the 165 benign lesions were visible on both mammography and sonography; 66 (40%) of 165 benign lesions were mammographically occult and identified at sonographic evaluation. In 60 (14.6%) of the 411 cases, imaging evaluation resulted in a suspicious assessment; 49 (81.7%) of the 60 lesions categorized as suspicious underwent biopsy; 14 (28.5%) of 49 lesions were histologically proved to be carcinoma. Nineteen (31.6%) of the 60 lesions categorized as suspicious were mammographically occult and identified only on sonography; 14 (73.7%) of these 19 lesions underwent biopsy; 12 (63.1%) of 19 were benign, and 2 (10.5%) were malignant. One hundred eighty-six (45.2%) of the 411 palpable abnormalities had negative imaging assessment findings; 12 patients with negative imaging findings underwent biopsy, and all had benign findings. The sensitivity (14 of 14) and negative predictive value (186 of 186) for a combined mammographic and sonographic assessment were 100%; the specificity was 80.1% (186 of 232). CONCLUSIONS: Cancer was diagnosed in 14 (3.4%) of 411 women who underwent combined imaging for palpable abnormalities of the breast. Combined mammographic and sonographic assessment was shown to be very helpful in identifying benign as well as malignant lesions causing palpable abnormalities of the breast.     

乳腺癌的X线诊断

目的：总结乳腺良、恶性肿瘤的X线表现特征。方法：分析经手术和病理证实的67例乳腺肿瘤X线表现,对其影像特点进行比较.结果:64例乳腺癌中,单纯肿块19例,肿块伴钙化29例,单纯钙化13例,乳腺结构紊乱、扭曲3例。良性误诊为恶性3例。结论：乳腺恶性肿瘤常有不同的X线表现，有时与良性肿块鉴别很难，须结合临床表现、其他检查或针吸活检确诊。     

彩色多普勒血流显像对乳腺肿块的分析

本文通过对48例乳腺肿块的彩色多普勒血流显像(CDFI)检查,经手术和病理证实,良性肿块为21例,恶性肿瘤为27例。其结果显示:恶性肿瘤血流信号检出率为92%,良性肿块是33%,恶性肿瘤血流信号检出率明显高于良性肿块(P＜0.05)。良、恶性肿瘤之间的临界流速值为12cm/s。B型超声辅以彩色多普勒血流显像检查可以提高乳腺恶性肿瘤特别是2cm以下小乳癌的诊断率。     

恶性造影特征对BIRADS-US4类不典型乳腺病变再次分级诊断价值

摘要：目的 探讨恶性造影特征对BIRADS-US4类乳腺不典型病变再次分级诊断价值,方法：对124例（130个病灶）造影前分为BIRADS-US4类乳腺病灶行超声造影检查,依据病变恶性造影特征（不均匀增强,周边环状高增强,增强后范围扩大,内部充盈缺损,周边放射性汇聚）再次对病变进行分级诊断,无任一恶性造影特征者降为3级,有其中任意一项者升一级,有其中任意两项者升两级,有其中三项及以上者升为5级,依据手术病理结果探讨超声造影恶性特征对BIRADS-US4类不典型乳腺病变再次分级诊断价值,结果：130个病灶均经手术病理证实,其中良性67个,恶性63个。造影前BIRADS-US4A类病灶61个,4B类病灶41个,4C类病灶28个,超声造影再次分级后BIRADS-US3类病灶49个,BIRADS-US4A类病灶13个,4B类病灶7个,4C类病灶12个,5级病灶49个,超声造影诊断BIRADS-US4类病灶灵敏度,特异度,准确性,阳性及阴性预测值分别为90.4%,83.6%,86.9%,83.8%,90.3%,依据恶性肿瘤超声造影特征再次分级并与病理对照超声造影恶性特征能够降低良性病灶活检率68.5%（46/67）,同时提高约73.0%（46/63）恶性病灶诊断信心,结论：依据乳腺肿瘤恶性造影特征对BIRADS-US4类不典型病灶再次分级在降低BIRADS4类不典型病灶穿刺活检风险的同时,也能够提高此类病变中恶性病灶诊断信心,能够优化BIRADS-US4类病变分级,更好地为临床提供诊断及治疗的参考依据,值得注意的是对少部分超声造影特征不典型的乳腺癌病灶进行再次分级时需要谨慎,需密切结合二维超声特征同时建议穿刺活检避免漏诊。 关键词：恶性;造影特征,BIRADS-US4类,分级     

Breast hemangiomas: Correlation between imaging and pathologic findings

Hemangiomas are benign vascular tumors that are rare in the breast. A high percentage of hemangiomas are diagnosed incidentally during imaging examinations. They have mammographic, sonographic, and pathologic characteristics that allow radiologists and pathologists to diagnose them. We present four different cases of breast hemangiomas showing their mammographic and sonographic features. Two were diagnosed with an 18‐gauge core needle biopsy and they underwent surgical excision. The other two cases were diagnosed with a 14‐gauge core needle biopsy and their radiologic and pathologic appearances were concordant with breast hemangiomas, so they did not need surgical excision and are being followed. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 40:512–517, 2012     

Evaluation of palpable breast masses with color Doppler sonography and gray scale imaging.

Excisional biopsy is the standard method of distinguishing benign from malignant masses of the breast. However, alternative, less invasive methods of diagnosis are needed to reduce the number of unnecessary biopsies, allay anxiety of the patient, and control costs. In this study, we evaluated breast masses in a series of patients using color Doppler sonography and gray scale ultrasonographic features. In all cases, the pathologic diagnosis of the breast mass was subsequently established by excisional biopsy. The accuracy of gray scale sonography exceeded that of color Doppler sonography at a significance level of P < 0.005.     

乳腺导管内良性乳头状病变的超声表现

目的研究乳腺导管内良性乳头状病变的超声表现,评价超声在其诊断和鉴别诊断中的价值.方法回顾性分析27例导管内良性乳头状病变的超声表现,并与临床病理特征相对照.结果 27例导管内良性乳头状病变中,3例超声提示导管扩张或无异常,其余24例按照声像图特征分为:导管内占位型、囊内占位型、囊实混和性占位-实质为主型、实质占位型.导管内良性乳头状病变典型的超声表现包括扩张导管内的实质回声、厚壁囊性肿块内的低回声实质突起以及境界清楚,存在壁样结构,周边或内部测及液性暗区的低回声占位.结论超声可以发现大多数导管内良性乳头状病变,是一种敏感的诊断方法.当病变表现为实质或实质为主型时,超声的误诊率较高.     

螺旋CT对乳腺疾病的诊断价值

目的:评价螺旋CT在乳腺疾病诊断中的应用价值。材料与方法:对26例乳腺疾病胸部CT平扫的图像进行回顾性分析,男性2例,女性24例,年龄36岁～84岁,平均56岁。恶性病变22例,包括浸润性导管癌20例,转移性腺癌2例,良性病变4例,包括纤维腺瘤2例,乳腺脂肪坏死2例,均经病理证实。分析乳腺病变的形态学表现,并测量CT值进行定量评价。结果:毛刺征、病变周围脂肪组织模糊及乳后脂肪间隙狭窄在良、恶性病变间具有统计学差异(p0.05);良性病变、恶性病变与正常乳腺组织CT值之间具有统计学意义(p0.05),而良性纤维腺瘤与浸润性导管癌CT值之间无统计学意义(p0.05)。淋巴结转移多表现为淋巴结门结构消失、密度增高、肿大,部分有融合趋势。结论:螺旋CT图像的密度分辨力高,清晰显示乳腺的解剖结构及乳腺病变的形态、密度及周边情况,观察胸壁、双肺及淋巴结等转移情况具有无可比拟的优越性。     

Sonographic Findings of Accessory Breast Tissue in Axilla and Related Diseases

Accessory breast tissue results from failed regression of primitive mammary tissue and is most often located in the axilla. Accessory breast tissue itself is normal and should not be misdiagnosed as an abnormality. Both benign and malignant diseases that occur in the normal breast can also develop in accessory breast tissue in the axilla. In this pictorial essay, we show sonographic findings of normal accessory breast tissue in the axilla and various lesions that occur in accessory axillary breast tissue, along with other imaging findings and pathologic features.     

Posterior acoustic shadowing in benign breast lesions: sonographic-pathologic correlation.

OBJECTIVE: To show a variety of benign breast lesions that exhibit posterior acoustic shadowing on sonography. METHODS: The cases illustrate a variety of pathologic breast conditions that were collected at a referral breast center at a tertiary medical center. RESULTS: A variety of pathologic conditions are discussed, with pathologic-imaging correlation. CONCLUSIONS: Although posterior acoustic shadowing is a sonographic feature that is most commonly associated with mammary malignancies, this sonographic finding may also be seen with benign breast lesions.     

Cytomorphology of benign breast disease

Fine needle aspiration biopsy is a widely used technique for the initial diagnosis of mammary lesions. The majority of patients undergoing fine needle aspiration biopsy of a breast lesion will have a benign disease of the breast. This article provides a review of the cytomorphologic features in a variety of benign breast lesions,and discusses the commonly encountered differential diagnoses on aspiration biopsy. Topics discussed include inflammatory and reactive conditions, treatment-induced changes, pregnancy-related changes, benign proliferative lesions, and benign neoplasms of the breast.     

Pathologic breast conditions in childhood and adolescence: evaluation by sonographic diagnosis.

OBJECTIVE: The growing awareness of female breast cancer has led to increased sensitivity toward pathologic breast conditions in children and adolescents. Thus, approximately 15% of patients in child and adolescent gynecology are referred for the first time because of conspicuous features of the breast such as pain, palpable masses, and other findings on visual inspection. The aim of this study was to analyze the underlying diagnoses and diseases and determine the status of breast sonography in the diagnostic process. METHODS: The study population consisted of 62 female patients between 8 weeks and 20 years of age (1997-2002) who were examined clinically, followed by standardized sonography (7.5-13 MHz, conventional B-mode panoramic sonography). Presumed diagnoses were confirmed by biopsy in some patients (n = 16) and by follow-up with clinical examination and sonography in most cases (n = 46). RESULTS: The clinical and sonographic evaluation confirmed 4 main groups of diagnoses: benign tumors (15), developmental disturbances (14), cystic changes (11), and inherent defects (7). In the remaining cases, the findings were no abnormality (9), nipple discharge without evidence of pathologic or morphologic correlates (3), abscesses (2), and epidermoid cyst (1). CONCLUSIONS: Knowledge of regular breast development and its variants is essential for the physician. Given knowledge of the sonographic appearance of physiologic breast development and specific lesions, breast sonography is most helpful in identifying and characterizing abnormalities and guiding further investigation.     

超声引导下导丝定位在不可触及乳腺病灶切除中的应用

目的 探讨超声引导下导丝定位在不可触及的乳腺病灶切除中的应用价值.方法 对2005年1月-2010年9月127例女性患者的137个乳腺病灶(临床扪诊均为阴性),在超声引导下进行导丝定位,后进行外科切除活检,并对相关资料进行回顾性分析.结果 137个病灶的组织学结果中,良性病灶101个(73.7%)、高风险病灶27个(1...