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.     

Pure and Mixed Tubular Carcinoma of the Breast: Mammographic and Sonographic Differential Features

Objective

We wanted to evaluate the mammographic and sonographic differential features between pure (PT) and mixed tubular carcinoma (MT) of the breast.

Materials and Methods

Between January 1998 and May 2004, 17 PTs and 14 MTs were pathologically confirmed at our institution. The preoperative mammography (n = 26) and sonography (n = 28) were analyzed by three radiologists according to BI-RADS.

Results

On mammography, a mass was not detected in eight patients with PT and in one patient with MT (57% vs. 8%, respectively, p = 0.021), which was statistically different. The other findings on mammography and sonography showed no statistical differences between the PT and MT, although the numerical values were different. When the lesions were detected mammographically, an irregularly shaped mass with a spiculated margin was more frequently found in the MT than in the PT (100% vs. 83%, respectively, p = 0.353). On sonography, all 28 patients presented with a mass and most lesions showed as not being circumscribed, hypoechoic masses with an echogenic halo. Surrounding tissue changes and posterior shadowing were more frequently found in the MT than in the PT (75% vs. 50%, respectively, p = 0.253, 58% vs. 19%, respectively, p = 1.000). An oval shaped mass was more frequently found in the PT than in the MT (44% vs. 25%, respectively; p = 0.434).

Conclusion

PT and MT cannot be precisely differentiated on mammography and sonography. However, the absence of a mass on mammography or the presence of an oval shaped mass would favor the diagnosis of PT. An irregularly shaped mass with surrounding tissue change and posterior shadowing on sonography would favor the diagnosis of MT and also a less favorable prognosis.     

Tubular carcinoma of the breast: mammographic and sonographic features

OBJECTIVE: The purpose of this study was to define specific mammographic and sonographic features of tubular carcinoma of the breast. MATERIALS AND METHODS: Seventeen pathologically confirmed cases of tubular carcinoma were characterized retrospectively by two radiologists. Mammograms and sonograms were available for all patients. RESULTS: Fifteen of the 17 tubular carcinomas appeared as irregularly shaped masses with spiculated margins on mammography. Sixteen of the 17 masses had central densities. Spicules longer than the diameter of the central lesion were noted in eight (53%) of 15 tubular carcinomas. Eight tubular carcinomas had associated calcifications, with calcifications suspected of being malignant in four cases. On sonography, 15 hypoechoic masses were seen. The margins of the masses on sonography were described as ill-defined in 14 (93%) of the 15 cases. Posterior acoustic shadowing was present in 14 of the 15 cases. CONCLUSION: Tubular carcinomas are usually seen on mammography as irregularly shaped masses with central densities and spiculated margins, and most tubular carcinomas can be identified on sonography as hypoechoic masses with ill-defined margins and posterior acoustic shadowing. Although the mammographic and sonographic features of tubular carcinoma are not sufficiently specific to differentiate tubular carcinomas from radial scars, sonography can be useful for guiding biopsies and evaluating for multifocal and multicentric disease.     

Paget's disease of the breast: clinical, mammographic, sonographic and pathologic findings in 52 cases

PURPOSE: To determine and quantitate radiologic characteristics of Paget's disease 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 52 histologically proved Paget's disease of the breast. Analysis included history, findings at physical examination, mammography and sonography (US) and histologic type of Paget's disease. RESULTS: At physical examination, palpable mass (n=33, 63%), nipple erythema-eczema-ulceration (n=17, 33%) and blood-stained nipple discharge (n=5, 10%) were noted. Among 17 patients who had clinically evident Paget's disease, the mammographic findings were isolated microcalcifications in 3 (18%), mass associated with microcalcifications in 5 (29%), mass in 2 (12%) and negative in 7 (41%) patients. In the 35 patients with clinically inevident Paget's disease, these mammographic findings were 43% (n=15), 34% (n=12), 20% (n=7) and 3% (n=1), respectively. US depicted 43 masses in 35 patients, all of which were lobulated or irregularly contoured, mostly (n=41, 95%) without posterior acoustic shadowing. The cancer was clinically occult in 10% (n=5), mammographically occult in 15% (n=8) and radiologically occult in 13% (n=7) of the 52 patients. Histologically, the tumor was multifocal and/or multicentric in 11 (21%) patients. CONCLUSION: The clinical features of Paget's disease are characteristic and should alert the clinician to the likelihood of an underlying carcinoma, which should be evaluated radiologically. However, as Paget's disease is primarily a clinical diagnosis and mammograms may be negative, screening programs without clinical examination may result with delay in diagnosis. As a result, both clinical and imaging findings are complementary and should be correlated to confirm or exclude a diagnosis of Paget's disease.     

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

PurposeTo determine and quantitate radiologic characteristics of tubulolobular carcinoma of the breast and to report clinical and pathologic findings.Materials and methodsA 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.ResultsAt 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 1.7 cm and 18 (69%) patients were node negative.ConclusionTubulolobular 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.     

Breast MRI for evaluating patients with metastatic axillary lymph node and initially negative mammography and sonography.

OBJECTIVE: We wanted to investigate the ability of breast MR imaging to identify the primary malignancy in patients with axillary lymph node metastases and initially negative mammography and sonography, and we correlated those results with the conventional imaging. MATERIALS AND METHODS: From September 2001 to April 2006, 12 patients with axillary lymph node metastases and initially negative mammography and sonography underwent breast MR imaging to identify occult breast carcinoma. We analyzed the findings of the MR imaging, the MR-correlated mammography and the second-look sonography. We followed up both the MR-positive and MR-negative patients. RESULTS: MR imaging detected occult breast carcinoma in 10 of 12 (83%) patients. Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively). In nine out of 10 patients, the MR-correlated mammography and second-look sonography localized lesions that were not detected on the initial exam. All the non-MR-correlated sonographic abnormalities were benign. CONCLUSION: Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes. Localization of the lesions through MR-correlated mammography and second-look sonography is practically feasible in most cases.     

Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast

AIM: To investigate the relationship between ultrasound characteristics, mammographic findings and histological grade in cases of invasive ductal carcinoma which produce a mass on ultrasound. MATERIAL AND METHODS: A retrospective review was performed of the imaging findings in 120 patients diagnosed with invasive ductal carcinoma of the breast between January 1996 and December 1997. Imaging findings were correlated with the histological grade of tumour. RESULTS: High-grade tumours were significantly larger both on ultrasound and mammography (P < 0.016). A spiculated margin on mammogram was documented in 72% of low-grade tumours compared with only 24% of high-grade tumours (P = 0.001). Twenty-two per cent of low-grade tumours had a poorly defined margin on mammography compared with 66% of high-grade tumours (P = 0.001). At ultrasound, 16% of high-grade tumours (95% confidence limits 7-29%) had a well-defined margin. Acoustic enhancement was seen in 36% of high-grade tumours compared with only 9% of low and intermediate-grade tumours (P = 0.003): 22% of all tumours showed acoustic enhancement. Acoustic shadowing was seen in 71% of low-grade tumours compared with only 28% of high-grade tumours (P = 0.003). Malignant-type microcalcification was seen on mammogram in 6% of low-grade tumours compared with 31% of high-grade tumours (P = 0.045). CONCLUSION: The classical appearance of a malignant breast mass as a spiculated mass on mammogram associated with acoustic shadowing on ultrasound is more typical of a low-grade tumour. In comparison, high-grade tumours are more likely to demonstrate posterior acoustic enhancement, and a proportion has a well-defined margin on ultrasound. Therefore, high-grade invasive ductal carcinoma may paradoxically display similar imaging features to a benign breast mass.     

Unusual presentation of tubular breast carcinoma as non-mass enhancement

A tubular carcinoma is a rare and well-differentiated histological subtype of invasive ductal carcinoma. Its lesion is generally presented as a spiculated, solid mass on mammography, ultrasonography (US), and magnetic resonance imaging (MRI) with posterior acoustic shadowing on US. Here, we describe unusual MRI findings of focal-type clumped non-mass enhancement and type 2 kinetic curve. This tumour should be included as a differential diagnosis with focal-type clumped non-mass enhancement on MRI, because this finding can refer benign lesions like as fibrocystic changes of breast.     

乳腺脂肪坏死的X线和超声诊断

目的探讨乳腺脂肪坏死的X线及B超表现，提高对本病影像诊断的认识。资料与方法回顾性分析25例经手术、病理证实的乳腺脂肪坏死X线平片及超声声像图表现。结果X线片表现：(1)双侧乳腺结构、密度不对称10例；(2)淡薄片影3例；(3)有毛刺的结节5例；(4)X线片无阳性发现5例。超声声像图表现：(1)16例(16／17，94．1％)非医源性脂肪坏死病灶位于皮下脂肪层；(2)结节回声高低不一(高、低、无)；(3)彩色Doppler超声病灶无血流信号8例。结论乳腺脂肪坏死根据其病因和时期，其影像表现多种多样。X线与B超检查结合，本组有65％可排除乳腺癌的诊断。位于乳腺脂肪层内的网状片影或有毛刺的结节首先考虑脂肪坏死的可能，紧密结合临床病史，可提高本病诊断准确性。     

Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ

OBJECTIVE: The purpose of this study was to describe the features of symptomatic ductal carcinoma in situ (DCIS) of the breast shown on high-resolution sonography and to correlate them with findings from mammography and histopathology to evaluate the prognostic ability of sonographic findings. MATERIALS AND METHODS: We retrospectively reviewed mammographic and sonographic images of 60 DCIS lesions from 55 symptomatic women. Images were reviewed by a radiologist who knew that the patients had DCIS but had no other information regarding pathology. Lesions were evaluated pathologically and classified using the Van Nuys classification system. Statistical comparisons were made using Fisher's exact test. RESULTS: Of the 60 lesions, 33 were classified as Van Nuys group 1, 19 as Van Nuys group 2, and eight as Van Nuys group 3. Six (10%) of the 60 lesions were not visible on sonography, and 12 lesions (20%) were not visible on mammography. Sonography revealed a mass in 43 cases (72%), ductal changes in 14 cases (23%), and architectural distortion in four cases (7%). Eight lesions had more than one of these features. A sonographically visualized, irregularly shaped mass with indistinct or angular margins and no posterior acoustic shadowing or enhancement was associated with a high Van Nuys classification (p < 0.05). Microcalcifications were visible on sonography in 13 (22%) of the 60 lesions or on mammography in 25 lesions (42%). Both findings were associated with a high Van Nuys classification (p < 0.05). CONCLUSION: Although sonography can reveal microcalcifications within masses, it is unreliable in depicting and characterizing the morphology and extent of microcalcifications, particularly when they are in isolation. Therefore, sonography should not be used to replace mammography but instead as an adjunctive tool to increase the sensitivity of mammography in breast diagnosis.     

Invasive micropapillary carcinoma of the breast: clinical,mammographic, and sonographic findings with histopathologic correlation

OBJECTIVE: The purpose of our study was to investigate the imaging features of invasive micropapillary carcinoma of the breast, which is a recently described, rare variant of infiltrating ductal carcinoma. CONCLUSION: Invasive micropapillary carcinoma of the breast usually manifests as a firm, immobile mass. Findings on mammography are of a spiculated, irregular or round, high density mass with or without associated microcalcifications. On sonography, the common findings are of a homogeneously hypoechoic, irregular or microlobulated mass with posterior acoustic shadowing or normal sound transmission. Axillary lymph nodes are frequently involved. Although these findings are not specific and may be seen with other breast malignancies, invasive micropapillary carcinoma should be included in the differential diagnosis for breast masses with these imaging features. Also, radiologic findings may help in the histopathologic differentiation of cases that are difficult to diagnose, such as metastatic tumors.     

Comparison of mammographic and sonographic findings in typical and atypical medullary carcinomas of the breast

AIM: The aim of this study was to describe the contribution of mammographic and sonographic findings to the discrimination of typical and atypical histopathologic groups of medullary carcinomas of the breast. MATERIALS AND METHODS: Imaging findings were retrospectively assessed in 33 women with medullary carcinomas (15 typical medullary carcinomas and 18 atypical medullary carcinomas) identified during pre-operative mammography. Twenty-nine of these women also had ultrasound and these findings were reviewed. RESULTS: Mammography showed a well circumscribed mass in 10 of the 15 (67%) typical medullary carcinomas and in four of the 17 (24%) atypical medullary carcinomas (P < 0.02). One small tumour in a woman with atypical medullary carcinoma was missed on mammography and was shown only on sonography. Sonographically, an irregular margin surrounding the whole mass or part of it was seen in three out of 14 (21%) patients with typical medullary carcinoma and in nine out of 15 (60%) patients with atypical medullary carcinomas (P < 0.05). Posterior acoustic shadowing was more often observed in the typical medullary carcinoma group than in atypical medullary carcinoma and the difference was found to be statistically significant (P < 0.05). None of the other mammographic and sonographic findings were sufficiently characteristic to allow for a differentiation between two groups. CONCLUSION: When typical medullary carcinomas were compared with atypical medullary carcinomas according to imaging features, they tended to be well circumscribed masses on both mammography and sonography, and a posterior acoustic shadow was not found on sonography. However, the imaging findings in these two subgroups often resembled each other and histopathology will always be required to confirm the diagnosis.     

Sclerosing adenosis: mammographic and ultrasonographic findings with clinical and histopathological correlation

OBJECTIVE: To evaluate the mammographic and ultrasonographic findings of sclerosing adenosis, a relatively uncommon entity which may sometimes mimic carcinoma. MATERIALS AND METHODS: A retrospective review of the records of 33,700 women, who have undergone mammographic examination at our institution between January 1985 and July 2001 revealed 43 histopathologically proven sclerosing adenosis. The history, physical examination, mammographic and ultrasonographic findings were analyzed in all patients. In 30 patients, the nonpalpable lesions were preoperatively localized by the needle-hookwire system under the guidance of mammography (n=22) or ultrasonography (US) (n=8). Radiological features were correlated with histopathological findings. RESULTS: The age of the patients varied between 32 and 55 years (mean, 43.7 years). Only two patients had a family history of breast cancer. In six patients, the presenting complaint was mastalgia. A palpable mass was present in 13 cases. The mammographic findings were; microcalcifications in 24 (55.8%) (clustered in 22, diffuse in two), mass in five (11.6%), asymmetric focal density in three (6.9%), and focal architectural distortion in three (6.9%) patients. Four of the masses were irregularly contoured, while one was well-circumscribed. On US, focal acoustic shadowing without a mass configuration was noted in the three patients who showed asymmetrical focal density on mammography. In eight patients, who showed normal mammograms, a solid mass was detected on US. Two masses had discrete well-circumscribed oval or lobulated contours, while six showed microlobulation and irregularity. In one case, the irregularly contoured mass had marked posterior acoustic shadowing. Two of the three patients, who had focal architectural distortion on mammograms, had an irregularly contoured solid mass, while the third presented as focal acoustic shadowing without a mass configuration. CONCLUSION: Sclerosing adenosis mostly presents as a nonpalpable lesion with different mammographic and sonographic appearances. The most common finding is microcalcifications on mammograms. Awareness of the possible imaging features will enable us to consider sclerosing adenosis in the differential diagnosis. The radiological features may sometimes mimic malignancy, so histopathologic examination is mandatory for definite diagnosis.     

Mammography in women with axillary lymphadenopathy and normal breasts on physical examination: value in detecting occult breast carcinoma.

OBJECTIVE. The purpose of this study was to determine the value of mammography in detecting occult carcinoma in patients with axillary adenopathy and normal breasts on physical examination. MATERIALS AND METHODS. We analyzed the results of mammography performed in 17 patients; all women had palpable axillary lymphadenopathy of unknown origin and all had normal breasts on physical examination. RESULTS. In 10 of the 17 patients, mammographic findings were abnormal. The mammographic finding of axillary adenopathy in seven patients was inconsequential because the nodes were evident on physical examination. Three patients had abnormal mammographic findings that were potentially significant, including one with a poorly defined mass suggestive of breast carcinoma, one with a subcutaneous nodule, and one with parenchymal breast edema. Two of 17 patients had an occult breast cancer. In only one of the patients was the cancer detected on mammography. The other patient had undergone prior left mastectomy and was thought to have metastases to the right axilla from the contralateral breast. Mammographic findings in this latter patient were normal. CONCLUSION. While occult breast carcinoma was relatively common in our series (two of 17 patients), the ability to detect the tumor with mammography was disappointing (one of two patients). This may be explained by the fact that one postmastectomy patient with occult carcinoma had metastatic disease to the contralateral axilla and a normal remaining breast, which was pathologically confirmed at mastectomy. Our experience suggests that mammography is valuable in patients with normal breasts on physical examination who have primary carcinoma involving ipsilateral axillary lymph nodes. The procedure should be included in the diagnostic evaluation of patients with axillary adenopathy in order to detect the unusual case of occult breast carcinoma.     

Inconclusive findings at mammography: the value of MR imaging

Summary Purpose: To evaluate the usefulness of magnetic resonance (MR) imaging in the assessment of inconclusive findings at mammography, such as indeterminate focal or diffuse breast abnormalities, post-treatment breasts with extensive scarring, dense breasts, and findings suggesting multifocal or multicentric breast cancer. Material and Methods: 254 patients underwent mammography, sonography, and MRI of the breast. Dynamic MR imaging was done using a thin-section three-dimensional gradient-echo sequence (FLASH, TR = 11.8 ms; TE = 5 ms; flip angle = 25 °) which was applied in a dynamic fashion before and every 90 seconds after injection of gadopentetate dimeglumine. Diagnoses were confirmed at biopsy (n = 165) or by follow-up (n = 89). Results: Among various breast anomalies, the highest proportion of breast cancers was associated with dense breast tissue (27.8 %), architectural distortion (26.9 %), and irregular scars (15.8 %). Sensitivity of dynamic MR imaging was 93.7 %, and specificity was 83.3 %. As compared to mammography and sonography, MR detected 6 occult carcinomas, and showed additional malignant lesions in 19/63 women (30.2 %) with biopsy-proven breast cancer. Conclusion: MR imaging of the breast may provide valuable additional information in indeterminate breast anomalies. However, because of its inherent limitations, it should not replace core needle biopsy in all lesions which are amenable to biopsy. Because of its high sensitivity in the detection of invasive carcinomas in any type of breast tissue, MR imaging is considered the modality of choice in the evaluation of dense breasts in high-risk patients or in patients with clinical suspicion of occult breast cancer, and for preoperative tumor staging.      

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     

Foreign Body Granulomas of the Breast Presenting as Bilateral Spiculated Masses

In Asia, mammography following the injection of foreign materials into the breasts for cosmetic augmentation is frequently seen and diagnosis based on the typical radiologic findings is straightforward.We report the unusual radiologic findings in two patients with foreign body granulomas caused by injected foreign materials and discovered incidentally during screening work up. The mammographic findings were bilateral, hyperdense, spiculated masses, with occasional microcalcification, and at sonography, markedly hypoechoic, spiculated solid masses, located near the pectoralis muscle and partly extending into it, were observed. These radiologic findings mimicked malignancy.     

乳腺脂肪坏死的X线表现及病理对照研究

目的 探讨乳腺脂肪坏死的X线表现及病理基础，提高对脂肪坏死的认识。方法 回顾性分析经手术、病理证实的91例（其中2例为双侧乳腺脂肪坏死，共93个病变。）脂肪坏死X线表现，并与病理结果对照。结果 主要X线表现：（1）无任何异常X线发现14例（15．4％）；（2）脂性囊肿6例（6．6％）；（3）表现为肿物20例（22．0％），其中1例为双侧乳腺脂肪坏死；（4）表现为小结节13例（14．3％）；（5）脂肪层内星芒影、斑片影、索条影混杂出现28例（30．8％），其中1例为双侧乳腺脂肪坏死；（6）脂肪层内索条影交织呈网状5例（5．5％）；（7）结构不良者5例（5．5％）。分布部位：（1）位于脂肪层内55例；（2）向脂肪层突出或位于脂肪层与腺体交界处13例，常规位摄片位于脂肪层与腺体交界处的脂肪坏死，切线位投照有利于将病变显示于脂肪层内；（3）位于腺体之间9例；（4）乳腺平片未见异常发现14例。病理表现：（1）脂性囊肿是病变早期的特征性X线表现。（2）脂肪层内不均匀密度肿物影或小结节影为病变中期的特征性表现，反应了纤维组织逐渐替代了液化坏死的脂肪组织。（3）脂肪层内或浅层腺体内局限星芒状致密影以及不规则的网状影最常见，是病变后期的特征性表现。反应了坏死脂肪组织被吸收，周围残留部分纤维组织。通常不同病理时期的X线表现常同时出现。结论 乳腺X线摄影对于脂肪坏死具有重要诊断价值。     

Mammographic control after quadrantectomy and radiation therapy]

The efficacy of combined surgery and radiation therapy in the treatment of breast cancer has increased the use of mammography in the follow-up to detect early recurrences. The authors report their experience in the follow-up of 43 breast cancers after treatment with local excision, axillary dissection, and irradiation. Mammography was performed at 6.12, and 24 months. The radiological findings were: 38/43 (88.3%) breasts with abnormal mammographic patterns, skin thickening in 36/43 (83.7%) cases, breast retraction in 16/43 (37.2%), architectural distortion in 17/43 (39.5%), increased parenchymal density in 33/43 (76.7%), calcifications in 6/43 (13.9%), and a mass in 10/43 (23.2%) cases. The authors describe histologic changes, corresponding to mammographic findings, and evolution of the treated breasts. Suspicious findings were microcalcifications in one case and a mass in 6 cases (4 of them at 6 months and 2 at 12). Excisional biopsy, performed in the above 7 patients, confirmed recurrence in 4 cases. In 3 cases with negative pathology, where the malignant nature of the lesion could not be demonstrated, we observed: a cluster of microcalcifications undistinguishable from neoplasm in 1 case and spiculated nodules with architectural distortion in the extant 2 cases. Further limitations of mammography were due to radiological density of the breast in one case, and to its minimal size in another--these elements delayed both correct interpretation of mammographic findings and final diagnosis. The low agreement between mammography and histology proved the difficulty of both analysis and evaluation of abnormal post-irradiation breast tissue. The authors, in agreement with literature reports, suggest the schedule for clinical and mammographic follow-up.