Enhancing area surrounding breast carcinoma on MR mammography: comparison with pathological examination

The enhancing area surrounding breast carcinoma on MR mammography is correlated with findings from pathological examination. We studied 194 patients with breast cancer who underwent preoperative MR mammography. Of all malignant lesions presenting with an enhancing surrounding area on MR mammography, morphologic features including long spicules, a ductal pattern, diffuse enhancement or nodules were evaluated and compared with histopathological examination. A double breast coil was used; we performed a 3D FLASH sequence with contiguous coronal slices of 2 mm, before and after injection of 0.2 mmol/kg GD-DTPA, and subtraction images were obtained. In total, 297 malignant lesions were detected at MR mammography and 101 of them had one or more types of enhancing surrounding area. In 49 of the 53 cancers with long spicules and in 49 of the 55 cancers with surrounding ductal pattern of enhancement, pathological examination showed in situ and/or invasive carcinoma. Multiple nodules adjacent to the carcinoma were seen in 20 patients and corresponded with six cases of invasive and ten cases of ductal in situ carcinoma. A diffuse enhancing area next to a mass was seen in ten patients and consisted of carcinoma in all cases: seven in situ and three invasive carcinomas. Enhancing areas including long spicules, a ductal pattern, noduli, or diffuse enhancement surrounding a carcinoma corresponded with in situ or invasive extension of the carcinoma in 92.5, 89, 80 and 100% of cases, respectively.     

乳腺钼靶X线摄影和超声诊断乳腺导管内癌的对照研究

目的 :评价乳腺钼靶X线摄影和超声诊断乳腺导管内癌的价值。材料和方法 :回顾性分析 3 8例病理证实乳腺导管内癌的乳腺钼靶X线摄影和超声的表现。结果 :3 8例中 ,乳腺钼靶X线摄影表现为丛样微小钙化点 16例( 4 2 .1% ) ,边界不规则高密度影 13例 ( 3 4.2 % )。乳腺导管造影显示导管充盈缺损或中断 6例 ( 15 .8% )。超声显示为界限不清和形态不规则实性肿块 11例 ( 2 8.9% ) ,界限清楚和形态规则实性肿块 6例 ( 15 .8% ) ,囊实性肿块 3例 ( 7.9% )。乳腺钼靶X线摄影和超声准确诊断率分别为 78.9%和 5 2 .6%。结论 :乳腺钼靶X线摄影和超声对乳腺导管内癌有诊断价值 ,但前者优于后者 ,二者结合能提高诊断率     

Cystic hypersecretory ductal carcinoma of the breast: a rare cause of cystic breast mass

We present the case of a surgically confirmed, invasive, cystic hypersecretory ductal carcinoma (CHDC) of the breast in a 43-year-old woman. The initial sonography showed a complex cyst, which required a core biopsy; however, the diagnosis was delayed as the patient refused to undergo the biopsy and the cyst decreased in size, as seen on follow-up sonography. Excision biopsy was performed, and invasive CHDC was diagnosed after regrowth of the cystic lesion. Meticulous sonographic evaluation of a cystic breast mass is always important, and pathology confirmation must be considered if the lesion shows features suspicious for malignancy, as a CHDC could be the cause of a cystic breast mass.     

Imaging-guided core needle biopsy of papillary lesions of the breast

OBJECTIVE: Our objective was to assess the incidence of papillary lesions of the breast diagnosed at imaging-guided core needle biopsy and the need for surgical excision after a benign diagnosis. MATERIALS AND METHODS: This retrospective study included 1374 patients with consecutive suspicious breast lesions that underwent either mammography or sonographically guided large-core needle breast biopsy. Fifty-seven lesions (4%) were classified as papillary lesions. Eleven of the 57 cases were lost to follow-up (n = 6) or had not yet shown 2 years of stability (n = 5) and were excluded from this study. The remaining 46 papillary lesions constitute our study population. RESULTS: Surgical excision was performed in 17 (37%) of 46 papillary lesions. In the group of patients whose lesions were recommended for excision because carcinoma was identified at core biopsy, surgical excision revealed one false-positive and two true-positive diagnoses. In four cases, histologic diagnoses of the excisional biopsy and the core needle biopsy were discordant. One false-positive finding at core needle biopsy initially was interpreted as invasive ductal carcinoma on the basis of core needle biopsy specimens. In three false-negative findings, the initial diagnosis at core needle biopsy was upgraded after surgical excision. Two cases of papilloma with adjacent atypical ductal hyperplasia and one of atypical papilloma were upgraded to ductal carcinoma in situ after surgical excision. Imaging follow-up was performed in the remaining 29 patients. All lesions were stable or had decreased in size during the 2-year follow-up period. The negative predictive value of core needle biopsy for excluding malignancy among the papillary lesions diagnosed in our study was 93%. CONCLUSION: When the histologic diagnosis is benign, our data suggest that papillary lesions may be safely managed with imaging follow-up rather than with surgical excision. However, atypical papillary lesions or those associated with atypia require surgical excision because histologic underestimation occurs at a frequency similar to that in other atypical lesions undergoing core needle biopsy.     

伴乳头溢液乳腺癌的乳腺导管造影表现与病理对照研究

目的:分析伴有乳头溢液乳腺癌的乳腺导管造影表现,并分析其病理基础,以提高诊断水平。方法:临床表现有乳头溢液并经手术、病理证实的乳腺癌23例,回顾性分析其乳腺导管造影的影像表现,并与手术病理结果进行对比分析。结果:23例中原位癌8例,浸润性导管癌10例(包括单纯癌6例、乳头状癌4例),导管癌早期浸润3例,乳头状瘤病恶变2例。病理上诊断早期癌13例(56.5%),其中8例临床未触及乳腺肿块。乳腺导管造影主要表现:导管内充盈缺损并伴有不同程度的导管扩张12例;乳腺肿瘤侵蚀导管形成潭湖征5例;溢液导管受乳腺肿块推挤,导管变形3例;导管持续显影、管壁不规则伴广泛微钙化灶1例。本组中乳腺导管造影诊断乳腺癌的符合率为82.6%。结论:乳腺导管造影对伴有乳头溢液乳腺癌的检出是一项安全、有效的检查方法,能准确观察到肿块与溢液导管的位置关系、溢液导管受侵蚀程度,而且还能检测出临床触诊阴性的早期乳腺癌。     

乳腺立体定位核芯针活检的病理组织学低估原因分析

目的 分析乳腺立体定位核芯针活检的病理组织学低估的原因,以期引起临床多学科的重视及客观对待.方法 2000年9月至2005年9月,对146例乳腺病变患者(179个病变)进行立体定位核芯针病变部位穿刺活检,发生病理组织学低估21个.病变均不可触及(NPBL),根据乳腺影像报告和数据系统(BI.RADS),活检前诊断BI-RADS m类6个,Ⅳ类12个,V类3个,影像表现为钙化16个,肿块2个,不对称性致密1个,星芒征2个.结果 活检为纤维囊性乳腺病并导管上皮不典型增生11个,手术诊断为导管原位癌7个,伴早期浸润4个;活检为重度乳腺导管不典型增生3个,手术诊断为原位癌1个,原位癌伴早期浸润2个;活检为乳腺导管原位癌3个,手术证实均为浸润性癌;活检为乳头状病变4个,手术证实为原位癌及伴早期浸润各1个、浸润性导管癌及乳腺导管内乳头状腺癌各1个.结论 乳腺核芯针活检的病理组织学低估与立体定位技术、病变本身及医师的认识有关,放射科医师应熟练掌握活检技术并力求全面取材,当穿刺活检结果与影像表现不符时,应重新评价病变的实际病理诊断.     

Stereotactic biopsy of ductal carcinoma in situ of the breast using an 11-gauge vacuum-assisted device: persistent underestimation of disease.

OBJECTIVE: The purpose of this study was to compare the diagnostic accuracy of 14-gauge automated gun and 11-gauge directional vacuum-assisted biopsy techniques in the diagnosis of ductal carcinoma in situ of the breast. MATERIALS AND METHODS: We retrospectively reviewed 41 consecutive lesions that had been diagnosed as ductal carcinoma in situ using stereotactic needle biopsy. The first 21 lesions had been biopsied using a 14-gauge automated gun; the remaining 20 lesions, using an 11-gauge vacuum-assisted device. Surgical histopathologic results at lumpectomy were compared with the findings at needle biopsy and defined as either concordant, when only ductal carcinoma in situ (i.e., no evidence of invasive carcinoma) was evident at surgery, or discordant, when invasive carcinoma was found. One patient from the automated gun group was lost to follow-up and was not included in the analysis. RESULTS: Invasive carcinoma was found at surgery in seven (35%) of the 20 cases diagnosed using the automated gun compared with three (15%) of the 20 cases diagnosed using the vacuum-assisted device (p = .13). In all three of these discordant vacuum-assisted cases, only microinvasive disease was found at surgery. However, in only two of the seven discordant automated gun cases was only microinvasive disease found at surgery. CONCLUSION: The 11-gauge directional vacuum-assisted biopsy technique may improve the accuracy of ductal carcinoma in situ diagnosis. Underestimation of disease still occurs, however.     

MRI动态增强扫描在乳腺良恶性病变中的诊断价值

目的:评价MRI动态增强扫描在乳腺良恶性病变中的诊断价值。方法:回顾性分析58例经病理证实的乳腺病变的MRI动态增强扫描强化形态及时间-信号强度曲线图表现。结果:良性病变共22例(纤维腺瘤8例,导管内乳头状瘤5例,乳腺囊肿5例,导管囊状扩张伴慢性炎症1例,囊性乳腺病3例);恶性病变共36例(浸润性导管癌28例,浸润性小叶癌3例,导管原位癌2例,浸润性乳头状癌2例,髓样癌1例)。恶性病变多表现为边缘毛刺、分叶征或边缘模糊,环状强化或不规则强化。良性病变多表现为边缘光滑整齐的均匀强化,其中5例囊肿无强化。其中形态学阳性预测值为89.47%,阴性预测值为90.00%,准确率为89.66%。强化表现阳性预测值为89.74%,阴性预测值为94.74%,准确率为91.38%。时间-信号强度曲线图:22例良性病变,13例(59.09%)表现为Ⅰ型,8例(36.36%)表现为Ⅱ型,1例(4.55%)表现为Ⅲ型;36例恶性病变,1例(2.78%)表现为Ⅰ型,9例(25.00%)表现为Ⅱ型,26例(72.22%)表现为Ⅲ型,阳性预测值为79.55%,阴性预测值为92.86%,准确率为82.76%。结论:乳腺MRI动态增强的形态学表现与时间-信号强度曲线图相结合,在良恶性病变的诊断与鉴别诊断中具有较高的价值。     

乳腺癌MRI研究

目的：探讨MRI对乳腺癌的综合诊断价值。材料和方法：随机选择临床和（或）乳腺钼靶片疑有肿瘤的患者进行前瞻性系列MRI检查，将其中58例乳腺癌作为研究对象。女性57例，男性1例。所有病例均经手术病理或活检证实。分别从病灶的信号特点、形态学、强化模式及时间－信号强度曲线等方面进行分析和诊断，并评估MRI的综合价值。结果：58例乳腺癌中浸润性导管癌48例，导管原位癌3例，浸润性小叶癌3例，小叶原位癌1例，髓样癌2例及纤维腺瘤恶变1例。根据乳腺癌病灶的信号及形态学、强化模式、时间－信号强度曲线及各因素的综合诊断正确率分别为89．7％、77．6％，79．3％－91．4％和94．8％，病灶的检出率达100％。结论：MRI检查对乳腺癌检出和定性诊断具有重要价值。     

Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy.

PURPOSE: To evaluate the use of stereotactic directional vacuum-assisted biopsy (SDVAB) in diagnosing and managing papillary lesions of the breast. MATERIALS AND METHODS: The authors retrospectively reviewed the mammographic and histopathologic findings of 26 cases in which papillary lesions were diagnosed at SDVAB. In all cases, subsequent surgical excision (n = 20) or long-term imaging follow-up (n = 6) was performed and correlated with findings at SDVAB. RESULTS: SDVAB of 26 lesions yielded tissue that was classified as benign in 12, atypical in six, and malignant in eight. Of the 12 lesions that were diagnosed as histologically benign at SDVAB, six were surgically excised. Of these six lesions, five yielded benign correlative results. The sixth lesion was thought to be discordant with the imaging findings, and was surgically excised and determined to be malignant. Of the six benign lesions that were not surgically sampled for biopsy, five decreased in size and one was not seen at radiographic follow-up. Of the six lesions diagnosed as atypical at SDVAB that were surgically excised, one was benign and five were atypical. None proved to be malignant. Of the eight lesions diagnosed as malignant at SDVAB, surgical excision demonstrated ductal carcinoma in situ in all eight; two also had foci of invasive carcinoma. CONCLUSION: Benign and malignant papillary lesions of the breast can be reliably diagnosed at SDVAB when the SDVAB results correlate with the imaging findings. However, the extent of malignant papillary disease may be underestimated at SDVAB; in our study, invasive carcinoma was later discovered in 25% of patients with this diagnosis.     

Stereotactic vacuum-assisted breast biopsy (Mammotome biopsy) for non-palpable microcalcification on mammography

PURPOSE: The purpose of this study was to assess the benefits of stereotactic vacuum-assisted breast biopsy in patients with non-palpable microcalcification detected on mammography. METHODS: Between October 2001 and November 2003, stereotactic Mammotome biopsies were performed for 150 microcalcified lesions on mammography using the prone-type stereotactic vacuum-assisted breast biopsy system (Mammotest and Mammovision, Fischer, Denver, USA) . The mammography findings were classified according to the guidelines of The Japan Radiological Society/The Japan Association of Radiological Technologists. Ninety-eight cases were category 3, 38 were category 4, and 14 were category 5. RESULTS: All cases were determined to be cases of microcalcification by specimen radiography or histology. Complications were negligible. One hundred twenty of the cases were mastopathy, and 30 of them were breast cancer (14 were ductal carcinoma in situ, 7 were ductal carcinoma in situ with microinvasion, and 9 were invasive ductal carcinoma). Twenty-seven breast cancers were diagnosed as category 4 or 5 (51.9%) on mammography. The operative stages of 27 cases were as follows: 7 were stage 0, 17 were stage 1, and 3 were stage 2A. Twenty-four of 27 (88.9%) were early breast cancers. CONCLUSION: Mammotome biopsy is a safe and useful modality for the histological diagnosis of non-palpable microcalcifications.     

Radiological appearances of papillary breast lesions

This review illustrates the varied appearances of benign and malignant papillary breast tumours, as identified by a breast cancer-screening programme. The commonest mammographic appearance of a papillary tumour is as a soft-tissue mass, with calcification present in less than half of cases. When calcification is present the pattern is variable, but clusters of pleomorphic calcification can occur, sometimes resembling the mammographic appearance of invasive ductal carcinoma. Ultrasonography of papillary lesions typically shows a solid, oval, intraductal mass, often associated with duct dilatation. A cystic component is also commonly seen, and lesions may appear hypervascular on colour Doppler ultrasound. Magnetic resonance imaging (MRI) has a high sensitivity, but low specificity for detecting papillary tumours, and is useful in establishing the extent and distribution of lesions in patients with multiple papillomatosis. Despite a benign histology on core biopsy, an argument exists for complete surgical excision of all papillary tumours, as a significant proportion of papillomas will contain foci of atypia or overt malignant change.     

Ductal carcinoma in situ of the breast: correlation between mammographic calcification and tumor subtype.

OBJECTIVE. Histologic subtypes of ductal carcinoma in situ of the breast have been correlated with disease progression after local excision only. This study was undertaken to determine how the predominant type of calcification seen on mammography correlates with the predominant histologic tumor subtype, knowledge that could aid in the development of clinical criteria for selecting patients for appropriate local treatment. MATERIALS AND METHODS. A prospective double-blind study was performed to correlate the mammographic and histologic findings in 66 consecutive cases of ductal carcinoma in situ, or ductal carcinoma in situ associated with small invasive foci (n = 11), in which microcalcifications seen on mammograms were found in the ductal carcinoma during histologic evaluation of excisional biopsy specimens. Microcalcifications were categorized as predominantly linear or granular and were correlated with the predominant histologic subtype of ductal carcinoma in situ in the tissue containing the calcifications seen on mammograms. RESULTS. Predominantly linear calcifications were present in 47% (18/38) of ductal comedocarcinomas in situ compared with 18% (5/28) of cribriform, solid, or papillary subtypes (p = .01). Predominantly granular calcifications were present in 53% (20/38) of comedocarcinomas compared with 82% (23/28) of the noncomedo types (p = .01). In 94% (16/17) of cribriform ductal carcinomas in situ, granular microcalcifications were seen on mammograms. Seventy-eight percent (18/23) of linear calcifications in ductal carcinoma in situ were associated with the comedo subtype, whereas 53% (23/43) of the granular calcifications were associated with noncomedo subtypes. CONCLUSION. We conclude that the comedo subtype of ductal carcinoma in situ is more likely to be accompanied by linear calcifications than are the noncomedo subtypes, and noncomedo ductal carcinoma in situ is more likely to be associated with granular calcifications than is the comedo subtype when microcalcifications are seen on mammograms. However, there is considerable overlap, and the predominant histologic subtype cannot be predicted on the basis of the microcalcification type with a high degree of accuracy.     

乳腺恶性病变的钼靶X线及磁共振表现对照研究

目的:探讨乳腺恶性病变的钼靶X线和MRI表现及与病理结果的关系.方法:回顾性分析38例经穿刺或手术病理证实的乳腺恶性病变的钼靶X线、MRI表现,并与病理结果对比分析.38例中乳腺浸润性导管癌21例,导管原位癌11例,黏液癌3例,腺样囊性癌2例,髓样癌1例.结果:乳腺恶性病变主要表现为乳腺结构及局部血管异常,肿瘤多呈星芒状、蟹足样,边缘多毛刺状、不光滑.钼靶X线示病灶内部密度不均匀,钙化点数量较多,多呈沙粒样,可成簇生长,也可弥散在腺体的一个区内.主要MRI表现为病灶T1WI多呈低、等信号,T2WI多为混杂信号,增强扫描呈明显不均匀强化.结论:钼靶乳腺摄影操作简单,准确性较高,是乳腺恶性病变的首选检查方法.MRI能清楚的显示乳腺内病变的细微结构,提高诊断准确性.     

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.     

Sonographically guided biopsy of suspicious microcalcifications of the breast: a pilot study

OBJECTIVE: The purpose of this study is to evaluate the use of sonographic guidance for biopsy of mammographically detected suspicious microcalcifications. SUBJECTS AND METHODS: Twenty-three patients with suspicious microcalcifications detected on mammography (15 associated with masses or distortion; eight with microcalcifications alone) underwent sonographically guided core biopsy (n = 18) or sonographically guided needle localization before excision (n = 5). Microcalcifications were targeted, and specimen radiographs were obtained for each lesion, with the success of the procedure based on identifying microcalcifications on the specimen radiograph. For core biopsies, the number of cores obtained was compared with that in 49 control patients who underwent sonographically guided core biopsy of noncalcified masses. RESULTS: All 23 lesions (100%) were successfully biopsied under sonographic guidance, with microcalcifications seen on specimen radiographs in each case. Of 18 core biopsies, a mean of 8.7 cores was obtained compared with a mean of 5.5 cores in the control group (p<0.0001). Of 13 lesions sampled with core biopsy that subsequently underwent surgical excision, three (23%) were upgraded from atypical ductal hyperplasia to ductal carcinoma in situ (n = 1) and from ductal carcinoma in situ to invasive carcinoma (n = 2). Mammographically, most lesions contained more than 15 pleomorphic microcalcifications. On sonography, echogenic foci corresponded to microcalcifications in all but two cases in which broader echogenic regions were seen. When no mass or distortion was visible on mammography, sonography showed a mass or dilated ducts with internal echogenic foci. CONCLUSION: Microcalcifications identifiable on sonography can be successfully biopsied under sonographic guidance. Further study is necessary to determine whether targeting microcalcifications seen sonographically in the mass or duct can improve the rate of underestimation of disease compared with stereotactic core biopsy.     

Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision

OBJECTIVE: This investigation compares the frequency of histologic underestimation of breast carcinoma that occurs when a large-core needle biopsy reveals atypical ductal hyperplasia or ductal carcinoma in situ with the automated 14-gauge needle, the 14-gauge directional vacuum-assisted biopsy device, and the 11-gauge directional vacuum-assisted biopsy device. SUBJECTS AND METHODS: Evaluation of 428 large-core needle biopsies yielding atypical ductal hyperplasia (139 lesions) or ductal carcinoma in situ (289 lesions) was performed. The results of subsequent surgical excision were retrospectively compared with the needle biopsy results. RESULTS: For lesions initially diagnosed as ductal carcinoma in situ, underestimation of invasive ductal carcinoma was significantly less frequent using the 11-gauge directional vacuum-assisted biopsy device when compared with the automated 14-gauge needle (10% versus 21%, p < 0.05) but was not significantly less frequent when compared with the 14-gauge directional vacuum-assisted device (10% versus 17%, p > 0.1). For lesions diagnosed initially as atypical ductal hyperplasia, underestimation of ductal carcinoma in situ and invasive ductal carcinoma was significantly less frequent using the 11-gauge directional vacuum-assisted biopsy device compared with the 14-gauge directional vacuum-assisted device (19% versus 39%, p = 0. 025) and with the automated 14-gauge needle (19% versus 44%, p = 0. 01). CONCLUSION: The frequency of histologic underestimation of breast carcinoma in lesions initially diagnosed as atypical ductal hyperplasia or ductal carcinoma in situ using large-core needle biopsy is substantially lower with the 11-gauge directional vacuum-assisted device than with the automated 14-gauge needle and with the 14-gauge directional vacuum-assisted device.     

乳腺导管造影在溢液性乳腺癌诊断中的应用

目的：探讨不同病理类型的溢液性乳腺癌在乳腺导管造影中的X线征象,提高对本病的诊断水平。方法：搜集经手术病理证实并行乳腺X线片及腺导管造影检查的乳腺癌108例,溢液性质为血性62例,浆液46例,临床因溢液而疑及乳腺癌。分析不同病理类型乳腺癌（浸润性导管癌64例,浸润性小叶癌23例,其他21例包括髓样癌7例,化生性癌1例,富于脂质癌2例,导管原位癌7例,粘液癌1例,浸润性乳头状癌3例）在乳腺导管造影中的X线征象。结果：乳腺癌导管造影主要征象：鼠尾征13例,导管走行僵直16例,充盈缺损（杯口征）7例,导管扩张99例,截断征（刀切征）24例,导管结构紊乱60例,断续征37例,虫蚀样改变30例,潭湖征32例。108例乳腺癌中有106例合并两种以上征象。浸润性导管癌最多见,64例,占50%;其次为浸润性小叶癌,23例,占21.3%。结论：充分认识溢液性乳腺癌的乳腺导管造影征象,对进一步明确乳腺癌的诊断具有重要价值,合并征象越多,对乳腺癌的诊断价值越高。     

Nonpalpable breast cancer: mammographic appearance as predictor of histologic type.

PURPOSE: To investigate the association between mammographic appearance and histologic diagnosis of nonpalpable breast cancers. MATERIALS AND METHODS: Mammographic characteristics of 317 consecutive clinically nonpalpable breast cancers in patients treated with breast-conserving surgery were reviewed. Malignant lesions were categorized as spiculated masses, other lesions, calcifications, and combined findings. Calcifications were characterized as amorphous, pleomorphic, or fine linear and branching. Logistic regression was used for the evaluation. Odds ratios (ORs) represent the magnitude of the association between a histologic diagnosis and a mammographic finding. RESULTS: Spiculated mass without calcifications (n = 150) and calcifications alone (n = 79) accounted for three of four cancers. A spiculated mass without calcifications was strongly associated with invasive cancers (OR = 12). Calcifications alone were strongly associated with ductal carcinoma in situ (DCIS) (OR = 19). In a decreasing order, the following invasive cancers were each associated with spiculated lesions without calcifications: ductal carcinoma grade 1 (OR = 28), ductal carcinoma grade 2 (OR = 17), lobular carcinoma (OR = 11), and ductal carcinoma grade 3 (OR = 4.6). Fine linear and branching calcifications alone were associated with not only DCIS nuclear grades 3 (OR = 17) and 2 (OR = 9.7) but also with invasive ductal carcinoma grade 3 (OR = 13). CONCLUSION: Mammographic appearance can be a predictor of histologic diagnosis in three of four nonpalpable breast cancers.     

Imaging of Intracystic Papillary Carcinoma

OBJECTIVETo describe the clinical, imaging, and histopathologic findings of intracystic papillary carcinoma (IPC) of the breast.MATERIALS AND METHODSFollowing institutional review board approval, a database at a single institution was searched to identify cases of patients who received a diagnosis of IPC from 1999-2013 and who had undergone preoperative imaging with mammography, sonography, or MRI. The clinical, mammographic, sonographic, and MRI features of IPC were compared and analyzed using the BI-RADS mammography, ultrasound, and MRI lexicons.RESULTSThe study sample included 40 patients, 36 females and 4 males. The most common clinical presentation was a palpable mass. Mammographic data was assessed in 31 patients. A tumor was mammographically occult in one patient. The predominant features were oval shape of 17 tumors (57%), obscured margins of 12 (40%), and high density of 20 (67%). Ultrasound data of 37 patients revealed 20 oval masses, 13 irregular masses, and 4 round masses. Fourteen complex solid and cystic masses were identified. One patient underwent MRI that showed a complex, enhancing mass with washout kinetics. Ultrasound guided biopsy was performed on 33 of the 37 masses. Core needle biopsy and fine needle aspiration (FNA) biopsy were most commonly performed on the solid components of the complex solid and cystic masses. IPC was diagnosed by stereotactic biopsy in 1 patient with a suspicious mass on mammography with no correlate on sonography and 6 patients had surgical excision without imaging-guided biopsy.Pathology showed in situ IPC in 31/40 tumors and 11 were solid and cystic complex masses on ultrasound. Pathology revealed invasive IPC in 9 tumors and five had an irregular mass on ultrasound.CONCLUSIONOur study reveals no specific imaging features to differentiate in situ vs invasive IPC. The most common ultrasound feature in biopsy proven IPC was an oval mass, however, we identified that a complex solid and cystic mass is more often associated with the diagnosis of in situ IPC and an irregular mass is more often associated with the diagnosis of invasive IPC. Future studies with larger cohorts are needed to further define the clinical and imaging features of this rare malignancy.