Mammographic,sonographic and MR imaging features of invasive micropapillary breast cancer

Purpose

Describe mammographic, sonographic and MRI findings of invasive micropapillary carcinoma (IMPC) of the breast.

Materials and methods

Review of the pathology database identified 43 patients (mean age, 59.3 years) with the diagnosis of breast IMPC. Three patients had no available imaging studies. Mammograms (40), breast ultrasounds (33) and MRIs (8) were retrospectively evaluated by two radiologists in consensus following the BI-RADS Lexicon. Clinical, histopathologic features, as well as hormone status were recorded.

Results

Twenty patients presented with palpable abnormality (20/40, 50%). Thirty-five patients had an abnormal mammogram (87.5%, 35/40) showing 39 lesions, 29 corresponding to masses (29/39, 74.4%), 11 associated with microcalcifications and two associated with architectural distortion. Sonography identified 41 masses (in 33 patients) displaying an irregular shape (30/41, 73.2%), appearing hypoechoic (39/41, 95%), with spiculated or angular margins (26/41, 63.4%), non-parallel orientation (26/41, 63.4%) and combined acoustic posterior pattern (18/41, 44%). MRI identified 13 lesions (in eight patients), 12 as masses (12/13, 92.3%) with irregular or spiculated margins (12/12, 100%), eight displaying an irregular or lobulated shape (8/12, 66.7%), six with homogeneous internal enhancement (6/12, 50%) and eight with type 3 enhancement curve (8/12, 61.5%). Associated non-mass like enhancement was noted in two patients. Twenty-nine patients had associated lymphovascular invasion (29/40, 72.5%) and axillary lymph node metastases were present in 22 of the 39 patients (22/39, 56%).

Conclusion

Invasive ductal carcinoma with IMPC features display imaging findings highly suspicious of malignant lesions. They are associated with high lymphovascular invasion and lymph node metastases rates.     

乳腺硬化性腺病与浸润性导管癌的超声特征对比研究

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

Computed-tomographic features of invasive lobular carcinoma

We retrospectively analyzed contrast-enhanced computed tomography (CE-CT) findings in 18 patients with pure invasive lobular carcinoma (ILC). The features were divided into five types: an ill-defined and inhomogeneous mass with or without regional heterogeneous enhancement, a spiculated inhomogenous mass, a regional heterogeneous enhancement, and a normal finding. The correlation between tumor size on pathological examination was better with size estimation on CE-CT than that on mammography and sonography. CE-CT may provide additional information on the characteristics and extent of this carcinoma.     

Bilateral invasive papillary carcinoma of the breast

Papillary carcinoma, a rare malignant tumor of the breast, accounts for only 1–2% of breast tumors. It predominantly affects elderly women in the sixth decade to the eighth decade of life. The incidence of bilateral papillary carcinomas is very low, with only one case reported in the literature. However, there has been no report of a case of bilateral invasive papillary carcinoma. A case of bilateral invasive papillary carcinoma of the breasts, along with mammography and ultrasound findings, is reported here.     

Palpable multifocal and multicentric invasive lobular breast carcinoma in a young female

Breast cancer is the most common carcinoma plaguing women in the United States. Invasive lobular carcinoma is the second most prevalent type of breast carcinoma with an incidence rate of 5% and 15% with high propensity for multifocal manifestation of disease. Multifocal disease is defined by two or more malignant foci within a single quadrant. Invasive lobular carcinoma is strongly associated with early menarche, late menopause, late age at first birth, and is typically seen in women ages 50 and older. Invasive lobular carcinoma can be difficult to detect clinically because lesions typically fail to form palpable masses, and it can be challenging to diagnose mammographically due to subtle imaging features of the lesions. Here we present a rare case of a palpable, unilateral, multifocal and multicentric lobular breast carcinoma in a young, previously healthy 41-year-old woman with no family history of breast cancer.     

乳腺浸润性导管癌的X线诊断

目的：分析乳腺浸润性导管癌的高频钼靶X线特征，提高术前X线正确诊断率。方法：回顾性分析经手术病理证实的41例乳腺浸润性导管癌的X线表现。结果：41例乳腺浸润性导管癌中，显示结节或肿块影35例，占85．37％，X线测量肿块大小比临床扪及小有31例，占显示肿块的病例88．57％；显示毛刺状改变23例，占56．1％；有微小钙化17例，占41．46％。结论：乳腺浸润性导管癌在X线上有特征性表现。乳腺高频钼靶X线检查在此病的早期诊断中有重要意义。     

乳腺浸润性导管癌X线表现

目的：分析乳腺浸润性导管癌Ｘ线钼靶检查特征,提高浸润性导管癌的影像学诊断水平。方法：１０５例乳腺浸润性导管癌经手术病理证实,分别摄乳腺Ｘ线钼靶轴、侧位及腋窝斜位片,观察浸润性导管癌影像学特征及腋窝淋巴结表现。结果：①肿块：边缘不规则,分叶、毛刺、星芒状及肿块周围细小结节等（９７．１％）;②钙化：细沙粒样、短小梭形、细条样呈团簇状（５１．４％）;③腋窝淋巴结肿大;形态不规则、分叶、边界不清、密度均匀     

Spindle cell lesions of the breast: Multimodality imaging and clinical differentiation of pathologically similar neoplasms

Spindle cell lesions of the breast comprise a wide-range of entities including reactive, benign and malignant proliferations. They can be pathologically challenging to differentiate as there is often immunohistochemical and morphologic similarities with characteristic spindle shaped cellular patterns. Radiological and pathological correlation is essential. Radiology detects, defines the size and extent, and assists in localizing the lesions. Pathology confirms the diagnosis and provides prognostic parameters. Familiarity with the clinicoradiological features of these diagnostically challenging lesions helps to establish an accurate pathological diagnosis and subsequent clinical decision making.     

Locally advanced invasive lobular carcinoma presenting as skin erythema,with multimodality imaging correlation

Invasive lobular carcinoma comprises 10-15% of invasive carcinomas of the breast. Its inconspicuous pattern of proliferation may lead to tumor manifestations that can be challenging to detect on mammography and clinical exam, which can result in tumor detection at advanced size and stage. This case demonstrates a locally advanced invasive lobular carcinoma and its subtle growth pattern illustrated on several imaging modalities, as well as its unique initial clinical presentation of skin erythema mistaken for rash.     

Ultrasonography of invasive lobular carcinoma of the breast: sonographic patterns and diagnostic value: report of 102 cases

The aim of this study was to define the ultrasonographic (US) features of the invasive lobular carcinoma (ILC). For this purpose, the clinical histories and the mammographic and sonographic findings observed in 102 patients affected by documented ILC were retrospectively reviewed, and the role and value of US in the diagnosis of palpable and nonpalpable breast tumors were evaluated. At US, five proven tumors were not visualized (sensitivity: 95%), while the remaining 97 showed sonographic images that are considered typically malignant: irregular heterogenic, hypoechoic irregular masses in 94 cases, which were associated with posterior shadowing in 87. The presence of only a posterior shadowing was observed in three cases. There were 16 subclinical tumors, and in two of the four in which a mammography showed an indeterminate lesion, US demonstrated a malignant pattern. All the palpable tumors that were not detected mammographically were demonstrated by US. In 13 of the 102 patients (12.7%), the correct diagnosis of malignancy was established by US. On the basis of the data obtained, it is felt that because of its sensitivity and high specificity for malignancy, US plays a very important role in the diagnosis of ILC, whenever in a patient with positive clinical findings, the mammography is negative or the mammographic features are equivocal.     

磁共振扩散加权成像联合动态增强评估乳腺导管内癌与乳腺浸润癌的比较研究

目的：探讨乳腺导管内癌（DCIS）与浸润癌（IC）在动态增强磁共振成像（DCE-MRI）和扩散加权成像（DWI）上的影像特征,提高其影像诊断水平。方法回顾性分析10例DCIS患者（病灶13个）及10例 IC患者（病灶10个）的DCE-M RI及DWI图像,分析病灶强化形态特征、时间信号强度曲线并定量分析 ADC值。结果依据强化形态特征：DCIS强化以非块样强化中的段样强化为主,IC强化以块样强化为主,两者间差异具有统计学意义。依据时间信号强度曲线：DCIS和IC均以流出型为主,无显著性差异。依据ADC值：DCIS的平均ADC值约为（1．036±0．25）×10^-3 mm^2/s , IC的平均ADC值约为（0．79±0．20）×10^-3 mm^2/s ,两者间差异具有统计学意义。结论结合病灶强化形态特征及ADC值,DCE-M RI联合DWI有助于乳腺导管内癌及浸润癌的鉴别诊断,提高影像诊断水平。     

Preoperative breast MRI in patients with invasive lobular breast cancer

To investigate the use of MRI in preoperative characterization of invasive lobular breast cancer (ILC) and in detection of multifocal/multicentric disease. We retrospectively reviewed T1-weighted FLASH 3D precontrast and postcontrast MR images together with subtraction images of 26 women with histopathologically proven invasive lobular cancer. Two experienced radiologists described tumor patterns of ILC independently. MR findings of unifocal, multifocal, single quadrant and multiquadrant disease were correlated with results of other imaging techniques and compared with histopathological findings as gold standard. Most ILC presented on MRI as a single spiculated/irregular, inhomogeneous mass (pattern 1, n=12) or as a dominant lesion surrounded by multiple small enhancing foci (pattern 2, n=8). Multiple small enhancing foci with interconnecting enhancing strands (pattern 3) and an architectural distortion (pattern 4) were both described in three cases. There was one case of a focal area of inhomogeneous enhancement (pattern 5) and one normal MR examination (pattern 6). Unifocal and multifocal lesions were identified on MRI in four patients with normal conventional imaging. In nine women, multiple additional lesions or more extensive multiquadrant disease were correctly identified only on MRI. MRI may play an important role in the evaluation of patients with ILC, which is often difficult to diagnose on clinical examination and conventional imaging and more likely occur in multiple sites and in both breasts. However, false-negative MR findings do occur in a small percentage of ILC.     

MRI测量乳腺浸润性导管癌大小与 微血管密度的相关性

目的利用MRI测量不同组织学分级乳腺浸润性导管癌（IDC）的大小,并探讨其与微血管密度（MVD）间的相关性。方法收集我院2015年1月-2016年12月经术后病理确诊为IDC的42例病人的MRI资料,病人均为女性,年龄30～71岁,平均（51.68±10.24）岁。用MRI测量肿瘤病灶的大小,具体参数包括肿瘤长径、短径、长短径比率和最大截面面积,通过手术标本检测肿瘤MVD,采用t检验比较不同组织学分级的肿瘤大小和MVD的差异,并采用Pearson相关分析肿瘤大小与MVD间的相关性。结果组织学Ⅲ级IDC肿瘤长短径比高于组织学Ⅰ~Ⅱ级（P<0.05）,肿瘤长径、短径、最大截面面积及MVD在不同组织学分级间差异均无统计学意义（均P>0.05）。组织学Ⅰ~Ⅱ级肿瘤长径、短径及最大截面面积分别与MVD呈正相关（分别为r=0.440,P=0.008;r=0.572,P<0.001;r=0.579,P<0.001）,其中肿瘤最大截面面积与MVD间的正相关关系最明显,而肿瘤长短径比与MVD无相关性（r=0.023,P=0.896）。组织学Ⅲ级IDC肿瘤的最大截面面积、肿瘤长径、长短径比、短径与MVD均呈负相关（分别为r=-0.809,P=0.002;r=-0.783,P=0.003;r=-0.694,P=0.012;r=-0.596,P=0.041）,其中最大截面面积与MVD的负相关关系最明显。结论在不同组织学分级时,IDC大小与MVD相关性不一致,一定程度上反映了乳腺IDC在不同组织学分级时血管生成和肿瘤增殖活性状况。     

Correlation between 3 T apparent diffusion coefficient values and grading of invasive breast carcinoma

PurposeThe aim of this study was to evaluate whether the apparent diffusion coefficient (ADC) provided by 3.0 T (3 T) magnetic resonance diffusion-weighted imaging (DWI) varied according to the grading of invasive breast carcinoma.Materials and methodsA total of 92 patients with 96 invasive breast cancer lesions were enrolled; all had undergone 3 T magnetic resonance imaging (MRI) for local staging. All lesions were confirmed by histological analysis, and tumor grade was established according to the Nottingham Grading System (NGS). MRI included both dynamic contrast-enhanced and DWI sequences, and ADC value was calculated for each lesion. ADC values were compared with NGS classification using the Mann–Whitney U and the Kruskal–Wallis H tests. Grading was considered as a comprehensive prognostic factor, and Rho Spearman test was performed to determine correlation between grading and tumor size, hormonal receptor status, HER2 expression and Ki67 index. Pearson's Chi square test was carried out to compare grading with the other prognostic factors.ResultsADC values were significantly higher in G1 than in G3 tumors. No significant difference was observed when G1 and G3 were compared with G2. Tumor size, hormonal receptor status, HER2 expression and Ki67 index correlated significantly with grading but there was a significant difference only between G1 and G3 related to the ER and PR status, HER2 expression and Ki67 index. There was no statistically significant difference in lesion size between the two groups.ConclusionADC values obtained on 3 T DWI correlated with low-grade (G1) and high-grade (G3) invasive breast carcinoma. 3 T ADC may be a helpful tool for identifying high-grade invasive breast carcinoma.     

Comparison of enhancement characteristics between invasive lobular carcinoma and invasive ductal carcinoma

Purpose:

To compare enhancement characteristics between invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) on contrast enhanced MRI of the breast and to observe the magnitude of eventual differences as these may impair the diagnostic value of breast MRI in ILC.

Materials and Methods:

We performed an analysis of enhancement characteristics on biphasic breast MRI in a series of 136 patients (103 IDC, 33 ILC) using an in‐house developed application for pharmacokinetic modeling of contrast enhancement and a commercially available CAD application that evaluated the contrast‐enhancement versus time curve.

Results:

Pharmacokinetic analysis showed that the most enhancing voxels in IDC had significantly higher K^trans‐values than in ILC (P < 0.01). No difference in v_e‐values was noted between groups. Visual assessment of contrast‐enhancement versus time curves revealed wash‐out curves to be less common in ILC (48% versus 84%). However, when using the CAD‐application to assess the most malignant looking curve, the difference was blotted out (76% versus 86%).

Conclusion:

ILC enhances slower than IDC but peak enhancement is not significantly less. The use of a CAD‐application may help to determine the most malignant looking contrast‐enhancement versus time curve, and hence facilitates lesion classification. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

海岛地区乳腺浸润性导管癌超声造影声像图特点分析

目的分析海岛地区乳腺浸润性导管癌（IDC）超声造影前后的声像图特征，提高超声对海岛地区IDC的诊断价值。方法术前对32例乳腺病灶行超声造影观察，分析其二维图像特征、能量多普勒血流形态及造影增强特点，同时应用ACQ分析软件进行时间．强度曲线分析。结果32例超声造影病灶中无造影剂信号进入的7例，其余25例病灶造影剂的明显增强时间及达峰时间比周围组织早，峰值强度及曲线下面积较周围正常组织高。结论超声可成为诊断海岛地区IDC的有效影像学方法之一，结合超声造影可提高超声对IDC的诊断价值。     

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.     

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.     

Invasive papillary carcinoma of the male breast

Intracystic papillary carcinoma of the male breast is a very rare disease with only a few cases reported in the literature. A case is described and the additional value of MRI is discussed. To our knowledge, this is the first report regarding the MRI findings of an intracystic papillary carcinoma of the male breast.     

双能CT定量参数预测乳腺浸润性导管癌病理分级的价值

目的:探讨双能量CT定量参数在预测乳腺浸润性导管癌病理分级中的价值.方法:搜集2019年7月-2020年3月在本院经病理证实的52例浸润性乳腺癌患者的病例资料.其中乳腺癌病理分级为Ⅱ级者31例,Ⅲ级者21例.所有患者行动脉期和静脉期双能胸部CT增强扫描.将双期增强图像传输至MMWP工作站进行后处理,获得碘图和能谱曲线....