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.     

Tubular carcinoma of the breast: mammographic, sonographic, clinical and pathologic findings

PURPOSE: To determine and quantitate the radiological characteristics of tubular carcinoma of the breast, to report clinical and pathologic findings and to define findings at follow-up. 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 32 histopathologically proven pure tubular 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: Fifty-nine percent of the patients (n=19) presented with a palpable mass. The mammographic findings were a mass in 23 (72%), a mass with microcalcifications in 2 (6%), asymmetric focal density in 1 (3%), architectural distortion in 1 (3%) and negative in 5 (16%) of the 32 patients. Most (96%) masses had spiculated margins. US depicted 30 masses in 29 patients, all of which were hypoechoic, mostly (n=27, 90%) with posterior acoustic shadowing. The cancer was clinically occult in 41% (n=13), mammographically occult in 16% (n=5), and sonographically occult in 6% (n=2) of the patients. Histologically, the tumor was multifocal in 3% (n=1) of the patients. Four (13%) patients developed contralateral breast carcinoma at follow-up. CONCLUSION: Tubular carcinoma has a variety of presentations, but it is mostly seen on mammography as a small spiculated mass, and on sonography as an irregular mass with posterior acoustic shadowing. Although tubular carcinoma is known as a well-differentiated tumor with excellent prognosis, the mammographic follow-up of the contralateral breast is important.     

Mammography and echography in male breast pathology]

From January 1988 through December 1991, 81 men were examined for breast enlargement or mass in our Institute, by means of clinical examination, mammography, and US. The patients' age ranged 15-71 years (mean: 52 years). Of 81 studied patients, 71 had gynecomastia, 8 had adipomastia, 1 had an infiltrating ductal carcinoma, 1 an angiofibrolipoma and 1 a simple cyst. Both the carcinoma and the cyst were associated with gynecomastia. Three mammographic patterns of gynecomastia were observed: a glandular pattern in 42 cases (32 bilateral and 10 monolateral), a dendritic pattern in 12 (8 bilateral and 4 monolateral), and a nodular pattern in 15 (9 bilateral and 6 monolateral). On US, gynecomastia appeared diffuse in 54 patients and focal in 15. The infiltrating ductal carcinoma was clinically evident; no asymptomatic cancers were detected. Surgical biopsy was performed in 40 cases. A good correlation was observed between mammographic and US signs. The combined use of the two modalities can improve diagnostic accuracy. Biopsy must be performed in all questionable cases.     

Fat necrosis of the breast: clinical, mammographic and sonographic features

OBJECTIVE: the purpose of this study was to describe and quantitate the clinical, mammographic and sonographic (US) features and to evaluate the evolution of fat necrosis in the breast. MATERIALS AND METHODS: a retrospective review of the clinical, mammographic and US findings of 126 fat necrosis lesions in 94 patients, diagnosed between 1989 and 1999, was done. All the cases included in the study had at least 3 years follow-up mammograms. In addition, 48 patients with a total of 62 fat necrosis lesions, also had an US follow-up. Fat necrosis was diagnosed on the basis of histologic (n=25) and initial or follow-up imaging (n=69) findings. RESULTS: the predominant mammographic features of the 114 lesions apparent on mammograms were radiolucent oil cyst (n=34, 26.9%), round opacity (n=16, 12.6%), asymmetrical opacity or heterogenicity of the subcutaneous tissues (n=20, 15.8%), dystrophic calcifications (n=34, 26.9%), clustered pleomorphic microcalcifications (n=5, 3.9%), and suspicious speculated mass (n=5, 3.9%). In five patients with 12 (9.5%) palpable masses, mammograms were normal. The predominant US features of the 112 lesions apparent on sonograms were solid (n=18, 14.2%), anechoic with posterior acoustic enhancement (n=21, 16.6%), anechoic with posterior acoustic shadowing (n=20, 15.8%), cystic with internal echoes (n=14, 11.1%), cystic with mural nodule (n=5, 3.9%) and increased echogenicity of the subcutaneous tissues (n=34, 26.9%). In five patients with 14 (11.1%) lesions, sonographic examination was normal. Mammographic follow-up showed that five of the radiolucent oil cysts developed curvilinear calcifications, six of the round opacities decreased in size and density, and another two disappeared. Eleven of the dystrophic calcifications became even more coarse. Six of the asymmetrical opacities became vague and one developed an oil cyst and coarse calcifications. The only nonoperated speculated mass developed a typical small radiolucent oil cyst in the centre. US follow-up showed that 18 of the 29 increased subcutaneous tissue echogenicity turned back to normal, while in the remaining 11 small cysts formed. In 19 solid appearing masses, 15 showed decrease in size, while four remained stable (biopsy disclosed fat necrosis). The four complex masses in two patients showed increase in size and appeared more cystic (FNAB was consistent with fat necrosis). CONCLUSION: a spectrum of imaging findings is associated with fat necrosis. Knowledge of the mammographic and US appearance and evolution of these patterns may enable imaging follow-up of these lesions, reducing the number of unnecessary biopsies.     

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

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.     

Inflammatory breast carcinoma: mammographic,ultrasonographic, clinical,and pathologic findings in 142 cases

PURPOSE: To determine and quantitate radiologic characteristics of inflammatory breast carcinoma and to report clinical and pathologic findings. MATERIALS AND METHODS: A retrospective review of records of 2,733 women who received a diagnosis of breast carcinoma between January 1988 and May 2000 revealed 142 histologically proved inflammatory carcinomas. Analysis included history; findings at physical examination, mammography, and ultrasonography (US); and histologic type of inflammatory carcinoma. RESULTS: At physical examination, skin changes (n = 115, 81%) were the most common findings. A palpable mass was noted in 62% (n = 88), with axillary lymph node involvement in 68% (n = 96) of the carcinomas. Mammography revealed findings in carcinomas: skin thickening, 84% (n = 119); diffusely increased density, 37% (n = 53); trabecular thickening, 81% (n = 115); mass, 16% (n = 23); asymmetric focal density, 61% (n = 87); microcalcifications, 56% (n = 80); nipple retraction, 43% (n = 61); and axillary lymphadenopathy, 24% (n = 34). US showed changes in carcinomas: skin thickening, 96% (n = 136); parenchymal echogenicity changes, 73% (n = 104); dilated lymphatic channels, 68% (n = 96); solid mass, 80% (n = 114); pectoral muscle invasion, 10% (n = 14); focal areas of parenchymal acoustic shadowing, 37% (n = 52); and axillary lymphadenopathy, 73% (n = 104). CONCLUSION: Presence of isolated inflammatory signs is sufficient to suggest inflammatory breast carcinoma clinically. Inflammatory breast carcinoma has a mammographic pattern of inflammatory changes, such as skin thickening and stromal coarsening and/or diffusely increased breast density with or without an associated mass and/or malignant-type microcalcifications. US is helpful not only in depiction of masses masked by the edema pattern but also in demonstration of skin and pectoral muscle invasion and axillary involvement.     

Metastatic intramammary lymph nodes: mammographic and ultrasonographic features.

OBJECTIVE: To evaluate the mammographic and ultrasonographic findings in patients with intramammary lymph node (IMLN) involvement in breast cancer. MATERIALS AND METHODS: The mammograms of 1655 histopathologically proven breast cancer cases diagnosed during the last 10 years were retrospectively reviewed. There were 16 cases in which metastasis to intramammary lymph nodes was suspected mammographically and proven histopathologically. The clinical and radiological features of these 16 cases were evaluated. RESULTS: On mammograms, the involved lymph nodes were all well circumscribed, homogeneous, oval or round opacities in the upper outer quadrant of the breast. They were all larger than 1 cm in size. On US, they were seen as well circumscribed, homogeneously hypoechoic masses with mild acoustic enhancement. In one case, besides enlargement, development of malignant microcalcifications was seen inside the node in the follow up period. In another case with IMLN metastasis, the primary focus of the breast cancer could not be detected either mammographically or histopathologically. So the case was accepted as occult breast carcinoma. All of the primary tumors detected were invasive histopathologically and their sizes varied between 1-6 cm (mean, 3 cm). CONCLUSION: The involvement of the IMLN can be suspected with mammographic and ultrasonographic features. Metastatic disease from breast cancer to IMLN may be the first clinical and/or radiological sign of breast cancer.     

Occult inflammatory breast cancer: review of clinical, mammographic, US and pathologic signs

PURPOSE: To examine the clinical, radiologic and pathologic findings of occult inflammatory breast cancer (OIBC) in order to identify features useful for diagnosis. MATERIALS AND METHODS: We retrospectively reviewed the records of 19 women with OIBC observed at our Department between 1992 and 2001. We analysed the clinical history, mammographic, ultrasonographic, and pathologic findings and investigated overall survival (OS), prognostic variables and radio-pathologic correlations. RESULTS: The most common mammographic findings were: diffusely increased density (52.63%), trabecular thickening (42.1%), mass (36.84%). The most common US findings were axillary lymphadenopathy (68.75%), skin thickening (43.75%) and mass (56.25%). At least one inflammatory sign was found in 14 women (74%) at mammography (subcutaneous thickening, trabecular thickening, diffuse increase in density) or at US (subcutaneous thickening, diffuse increase in echogenicity due to oedema, lymph vessel dilatation). Estrogen receptors (ER) were present in 63.2% and Progesterone receptors (PgR) in 36.8%. Significant prognostic variables were ER and Ki 67. CONCLUSIONS: The typical radiological pattern of clinical inflammatory breast carcinoma is less frequently present in OIBC; nevertheless the radiologist must pay attention because frequently OIBC presents just one radiological sign and this should be enough for a diagnostic suspicion. Moreover, the absence of clinical and radiological inflammatory signs does not exclude inflammatory breast cancer because OIBC can manifest at imaging as a mass or isolated calcifications. ER and PgR are positive in a high percentage of patients and confirm that OIBC has a better prognosis than clinical inflammatory breast cancer.     

Radiography of the male breast in gynecomastia.

In order to investigate the role of imaging methods in the evaluation of the male breast we reviewed the mammograms and ultrasonograms (US) performed in 40 men with breast enlargement or pain. The patients, whose breasts were examined by either mammography (n = 7) or US (n = 1) or both (n = 32), ranged in age from 14 to 83 years. The final diagnoses were gynecomastia in 35 patients, lipomas in one, abscess or sequelae to abscess in 2, and normal in 2. In gynecomastia the subareolar density was of varying shape and size or showed a diffuse pattern of heterogeneous density occupying the whole breast on mammography, and a retromammillar hypoechoic focus, a diffuse heterogenous area, or a combination of these was observed at US. Eleven breasts and one axillary lymph node were examined by US-guided fine-needle aspiration biopsy (FNAB), which was diagnostic in all cases. Mammography is recommended for the evaluation of the male breast if the differential diagnosis between gynecomastia and fatty enlargement is not clinically evident, and in all cases of unilateral breast symptoms. US is a complementary method to mammography and is also useful to provide guidance for FNAB.     

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.     

US of ductal carcinoma in situ.

Little is known about the ultrasonographic (US) features of ductal carcinoma in situ (DCIS) of the breast because this entity usually manifests as pure mammographic calcifications and is rarely evaluated with US. US findings were recorded in 70 patients with DCIS and then analyzed and correlated with mammographic and histologic findings. A microlobulated mass with mild hypoechogenicity, ductal extension, and normal acoustic transmission was the most common US finding in DCIS. Spiculated margins, marked hypoechogenicity, a thick echogenic rim, and posterior acoustic shadowing at US often suggested the presence of invasion. US performed with a 10-13-MHz transducer and optimal technique can be used as a complement to mammography in detecting and evaluating DCIS of the breast, as it demonstrates breast lesions associated with malignant microcalcifications in most cases. The main benefit of identifying a US abnormality in women with mammographically detected DCIS is to allow the use of US to guide interventional procedures (eg, needle biopsy, needle localization). US may also be helpful in detecting DCIS without calcifications and in evaluating disease extent in women with dense breasts. Nevertheless, further research is needed to delineate the role of US in the evaluation of patients with DCIS.     

Augmentation mammoplasty: normal and abnormal findings with mammography and US.

A retrospective review of 133 patients who had undergone augmentation mammoplasty (n = 122), reconstructive mammoplasty (n = 10), and silicone injections (n = 1) was undertaken to establish the normal appearance of various types of implants, to establish a range of normal variations (wrinkles, valves, minor bulges), and to recognize true implant complications (collapse of a saline prosthesis, leakage of silicone gel, capsular contracture, capsular calcification, and deformities). The detection and evaluation of breast parenchymal abnormalities in the presence of a radiopaque implant are more difficult, and frequently ultrasound (US) or special mammographic views in conjunction with physical examination are required. Coned-down compression spot views are suggested for asymmetric opacities or ill-defined mammographic masses, and magnification views are recommended for microcalcifications: Both should be obtained with the Eklund implant displacement technique. Tangential or other special views combined with US are best for the evaluation of palpable abnormalities and suspected silicone implant rupture.     

Epidermal inclusion cyst in male breast: how to differentiate from other male breast lesions

Male breast lesions are relatively less common. The most encountered malignant lesion in the male breast is ductal adenocarcinoma; and benign lesions are gynecomastia, fibrocystic disease, intramammary lymph node, fibroadenoma, lipoma and epidermal inclusion cyst (EIC), respectively [5,6]. To date, there had been published only a few cases of EIC of the male breast in literature [3,5,6]. In this case, we aimed to present a new case of EIC with its clinical, radiological and pathological characteristics in the male breast. It had benign sonographic and magnetic resonance imaging findings but had also malignant imaging findings with diffusion restriction on diffusion-weighted imaging.     

The significance of mammographic calcifications in early breast cancer detection

3,126 medical reports on women sent to mammary biopsy following breast examination at the Florence Center for the Study and Prevention of Cancer in November 1978-July 1982 were reviewed in order to assess the diagnostic significance of mammographic microcalcifications. All mammographies were examined in order to assess the presence and morphological aspects of the microcalcifications on the bioptic site. Microcalcifications were classified on the basis of the following morphological criteria: spatial disposition (isolated, clustered, diffuse); total number; number per cm; morphological aspect (dot-like, stick-like or ramified); shape (regular or irregular); radiological density; association with mammographic opacity; maximum and average diameter. Microcalcifications were encountered in 19.7% of 157 breast cancer diagnosed in a mammographic screening programme conducted on the asymptomatic population in 19.5% of 953 breast cancers diagnosed in self-referring women (most with symptoms). Among cases where subsequent histological examination revealed a benign pathology, microcalcifications were more frequent in the cases deriving from the screening programme (14.5% of 198 cases) than among self-referred cases (4.5% of 1818 cases). The presence of microcalcifications is in itself a predictive sign of the presence of a carcinoma (positive predictive value = 66.2%) but this radiological sign is only present in 20% of breast cancers. Among the various parameters considered in assessing the diagnostic significance of microcalcifications, irregular shape was the most indicative of carcinoma with a predictive value of 80% and presence in 88% of carcinoma with microcalcifications. Other microcalcification parameters with a particular predictive significance are diffuse spatial disposition, total number (over 10) and number per cm (over 50), site contiguous with a mammographic opacity and a mean diameter of 0.6-0.9 mm. Unfortunately these latter parameters are only 24% of tumour cases with microcalcifications. The incidence of microcalcifications in cancer does not vary according to age, but is strongly correlated with the tumour stage. In particular microcalcifications are found in about 1/3 of in situ carcinomas. In invasive cancers, the presence of microcalcifications tends to increase with the diameter of the lesion. No correlation was found in breast cancers between the presence of microcalcifications, lymph node condition and histological type.(ABSTRACT TRUNCATED AT 400 WORDS)     

US of mammographically detected clustered microcalcifications

PURPOSE: To determine whether ultrasonography (US) can depict breast masses associated with mammographically detected clustered microcalcifications and whether the visibility at US is different between benign and malignant lesions. MATERIALS AND METHODS: Ninety-four patients with 100 mammographically detected microcalcification clusters prospectively underwent US with a 10- or 12-MHz transducer before mammographically guided presurgical hook-wire localization. The visibility of breast masses at US was correlated with histologic and mammographic findings. RESULTS: Surgical biopsy revealed 62 benign lesions, 30 intraductal cancers, and eight invasive cancers. At US, breast masses associated with microcalcifications were seen in 45 (45%) of 100 cases. US depicted more breast masses associated with malignant (31 [82%] of 38) than with benign (14 [23%] of 62) microcalcifications (P: <.001). In malignant microcalcification clusters larger than 10 mm, US depicted associated breast masses in all 25 cases. There was no statistically significant difference in shape and distribution of calcific particles, as well as in breast composition, at mammography between US visible and invisible groups. CONCLUSION: Given a known mammographic location, US with a high-frequency transducer can depict breast masses associated with malignant microcalcifications, particularly clusters larger than 10 mm. US can be used to visualize large clusters of microcalcifications that have a very high suspicion of malignancy.     

Breast US in patients who had microcalcifications with low concern of malignancy on screening mammography

PURPOSE: To review ultrasound (US) findings in patients who have suspicious microcalcifications with low concern of malignancy (BI-RADS category 4A) on screening mammography and to evaluate helpful findings in differentiating benign and malignant lesions. MATERIALS AND METHODS: Between August 2005 and July 2006, 192 patients showed microcalcifications only, without mass or associated density, on screening mammography. Among them, we selected 82 patients who had microcalcifications with low concern of malignancy (category 4A) that were pathologically confirmed by surgical excision after wire localization (n=23) or biopsy (n=59). Breast US was performed in 37/82 cases and we analyzed the US findings for the calcification areas in these patients, evaluating the findings with benign or malignant pathological results. We correlated US findings with mammographic calcifications using mammography-guided 2D-localization for the calcifications before US examination. RESULTS: There were 12 malignant lesions (32.4%) including 3 invasive ductal carcinomas (IDC), one microinvasive ductal carcinoma (MIDC), 8 ductal carcinoma in situ (DCIS) and 25 benign lesions (67.6%) including 2 atypical ductal hyperplasias (ADH). IDC showed calcifications within heterogeneous hypoechoic parenchyma or calcifications within complex hypoechoic masses of taller-than-wide shape on US. One MIDC showed calcifications within heterogeneous hypoechoic parenchyma and six DCIS showed negative findings, or calcifications with a small nodule, or only calcifications on US. The most common positive US finding in benign lesions was cysts with calcifications. In 24/37 cases (64.8%) with negative US findings, 18 (75%) were benign lesions and 6 (25%) were DCIS. CONCLUSION: In patients with category 4A microcalcifications without associated findings on screening mammography, negative US findings had a high rate of benign results (18/24, 75%). Visible calcifications within heterogeneous hypoechoic parenchyma or mass on US increased the probability of malignancy.     

乳腺浸润性导管癌的钼靶X线和MRI表现

目的 :分析乳腺浸润性导管癌的钼靶X线特征及MRI表现 ,以提高其诊断正确率。材料和方法 :回顾性分析了3 8例经病理证实的乳腺浸润性导管癌的钼靶X线表现及 5例MRI表现。结果 :钼靶X线阳性表现 3 5例 ( 92 .1% ) ,其中显示肿块影 2 4例 ( 63 .2 % ) ,毛刺影 18例 ( 4 7.4% ) ,针尖状钙化影 3 3例 ( 86.8% ) ;MRI阳性率 10 0 %。结论 :乳腺浸润性导管癌钼靶X线表现较具特征性 ,是首要影像学检查手段 ,MRI检查敏感性高 ,有助于临床制定合理的治疗方案。     

Incremental clinical value of ultrasound in men with mammographically confirmed gynecomastia

Purpose

To determine whether ultrasound is of any value in male patients presenting with focal symptoms who have classic features of gynecomastia but no concerning findings on mammography.

Materials and Methods

Over a 3-year period, all male patients who underwent mammographic evaluation were identified in this retrospective study. Patients with a mammographic diagnosis of gynecomastia and subsequent breast ultrasound at a large tertiary academic medical center comprised the study cohort. Men whose ultrasound diagnosis differed from the initial mammographic evaluation were analyzed for both additional benign findings as well as findings that warranted biopsy.

Results

A total of 353 mammograms were obtained from 327 unique patients (ages 18–95, mean 51 years). Of all mammographic examinations, gynecomastia was the sole finding in 73% (259). In those 259 studies, 85% were further evaluated with ultrasound, in which 6 (2.7%) showed additional benign findings, and 4 (1.8%) showed suspicious findings for which biopsy was recommended. No malignancies were detected in those patients. Furthermore, no malignancies were detected in patients whose mammogram revealed only normal fatty parenchyma or only gynecomastia. In all cases of cancer, mammography revealed visible masses.

Conclusion

Judicious use of breast ultrasound in men improves outcome. Our data suggest that targeted ultrasound is of limited value in symptomatic male patients where mammography is negative or reveals only gynecomastia and leads to unnecessary benign biopsies in these patients. When mammography reveals concerning findings, ultrasound adds positively to clinical management.     

Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach

PURPOSE: To determine if magnetic resonance (MR) imaging can help determine the therapeutic approach in women with breast cancer. MATERIALS AND METHODS: Preoperative contrast-enhanced MR imaging of the breast was performed in 463 patients with probably benign lesions (n = 63), suspicious lesions (n = 230), or lesions highly suggestive of malignancy (n = 170) per established clinical, mammographic, and/or ultrasonographic (US) criteria. T1-weighted fast low-angle shot MR imaging was performed before and after administration of gadopenetetate dimeglumine. MR imaging findings were correlated with other imaging results and histopathologic findings. Special attention was paid to multifocality and multicentricity. RESULTS: Histopathologic analysis revealed 143 benign and 405 malignant lesions. The sensitivity, specificity, and accuracy were 58%, 76%, and 62% for clinical examination; 86%, 32%, and 72% for conventional mammography; 75%, 80%, and 76% for US; and 93%, 65%, and 85% for contrast-enhanced MR imaging. Multifocality in 30 of 42 patients, multicentricity in 24 of 50 patients, and additional contralateral carcinomas in 15 of 19 patients were depicted with MR imaging alone. Due to the MR imaging findings, therapy was changed correctly in 66 patients (14.3%); unnecessary open biopsy was performed in 16 patients (3.5%). CONCLUSION: Contrast-enhanced MR imaging of the breast is highly sensitive for invasive breast cancer. MR imaging may reveal unsuspected multifocal, multicentric, or contralateral breast carcinoma and result in therapy changes.