Diagnostic imaging of lobular carcinoma of the breast: mammographic, ultrasonographic and MR findings

PURPOSE: To evaluate the most frequent mammographic, US and MR findings of invasive lobular carcinoma and the role of MRI in defining multifocality and/or multicentricity of this tumor histotype. MATERIAL AND METHODS: We studied 45 lobular carcinomas (39 patients) were selected from 421 breast cancers. Core biopsy with a 14 G needle was performed in 39 cases, under US guidance in 36/39 and under mammographic guidance in 3/39 cases. Surgical biopsy was performed in 2 cases and the diagnosis could be made only after mastectomy in 5 cases. All patients were examined with mammography and US and (10-13 MHz) and 8 also with MRI. RESULTS: 28/46 palpable lesions (60.9%). Core biopsy correctly diagnosed 38/39 lesions (97.4%). The most frequent mammographic findings was that of a nodular opacity without microcalcifications (34.8%), followed by a mass with spiculated borders (30.4%). Microcalcifications were seen in one case only (2.2%). Mammography detected no abnormalities in 15.2% of cases, but US showed a lesion in 2 of these cases. The most frequent US pattern was that of a hypoechoic lesion (43.5%), followed by posterior US beam attenuation. No US signs of abnormality were seen 15.2%. MRI correctly detected 13 lesions. Contrast enhancement was greater than 70% at one minute in 10 cases and greater than 40% in one case; two lesions exhibited atypical slow contrast enhancement, peaking at 5 minutes. MRI detected 5 lesions missed at both mammography and US and showed multifocal (3 and 2) lesions where the other techniques had detected one lesion only. DISCUSSION: At mammography and US invasive lobular carcinoma exhibits no different features than ductal carcinoma but is difficult to identify especially in its early stages. US is a useful tool especially to characterize mammography-detected lesions but in our experience it also demonstrated 2 lesions missed at mammography. MRI is a precious examination to define the multifocal, multicentric or bilateral character of invasive lobular carcinoma. CONCLUSIONS: Invasive lobular carcinoma of the breast is often very difficult to diagnose. Thus, we suggest the use of integrated diagnostic imaging with mammography, US and, in some cases, MRI for earlier diagnosis and to identify further tumor localizations.     

MR imaging of the breast in patients with invasive lobular carcinoma

OBJECTIVE: Our objective was to assess the usefulness of MR imaging in patients diagnosed with invasive lobular carcinoma of the breast. MATERIALS AND METHODS: Between July 1993 and September 1999, 32 women (33 cases) diagnosed with pure invasive lobular carcinoma of the breast underwent contrast-enhanced MR imaging examination. One woman was excluded because of lack of follow-up. Correlation was made between the mammographic and sonographic findings, the MR imaging findings, and the final pathology results for the remaining 32 cases. RESULTS: In 18 women who did not undergo excisional biopsy before the MR imaging, MR imaging showed more extensive tumor burden or the detection of the primary lesion that was occult on conventional imaging in seven (38.9%) of 18 women. In nine (50%) of 18 women, MR imaging performed equally as well as mammography and sonography. In one case (5.6%), MR imaging and mammography underestimated disease extent. In another patient (5.6%), MR imaging overestimated tumor burden, although mammography failed to show the cancer. In 14 patients who had excisional biopsy before the MR imaging, residual tumor was shown in eight women (57.1%) with extensive tumor or additional separate foci in five of the eight patients. In two cases (14.3%) that were interpreted as equivocal, residual tumor was shown in both cases on reexcision. In three cases (21.4%), the MR imaging was interpreted as negative, but microscopic tumor was shown around seroma on reexcision. False-positive enhancement was seen in one case (7.1%). CONCLUSION: MR imaging showed more extensive tumor than conventional imaging and affected the clinical management in 16 (50%) of 32 patients with invasive lobular carcinoma.     

乳腺浸润性小叶癌和导管癌X线表现

本文回顾性总结206例浸润性乳腺癌,其中小叶癌24例,导管癌182例.通过对两组资料的分析对比,提出不对称致密影(37.5%),乳腺结构紊乱(25%)为浸润性小叶癌(ILC)的主要X线表现,而浸润性导管癌(IDC)则分别为5.5%和2.1%.结合文献简要讨论了有关小叶癌的X线的病理特点.     

螺旋CT对胃癌分期的价值

目的评价螺旋CT对胃癌术前分期的应用价值。材料与方法应用水充盈技术对63例胃癌患者行螺旋CT扫描,并与病理对照。结果46例胃癌病灶均明显增强,CT检出率为95.8％,胃癌侵犯深度、淋巴结转移、远处转移分期的准确性分别为70.8％、66.7％、80％。结论应用水充盈技术行螺旋CT扫描对胃癌患者的术前分期有重要价值。     

Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer

PURPOSE: To prospectively assess accuracy of mammography, clinical examination, ultrasonography (US), and magnetic resonance (MR) imaging in preoperative assessment of local extent of breast cancer. MATERIALS AND METHODS: Institutional review board approval and informed patient consent were obtained. Results of bilateral mammography, US, and contrast-enhanced MR imaging were analyzed from 111 consecutive women with known or suspected invasive breast cancer. Results were correlated with histopathologic findings. RESULTS: Analysis included 177 malignant foci in 121 cancerous breasts, of which 89 (50%) foci were palpable. Median size of 139 invasive foci was 18 mm (range, 2-107 mm). Mammographic sensitivity decreased from 100% in fatty breasts to 45% in extremely dense breasts. Mammographic sensitivity was highest for invasive ductal carcinoma (IDC) in 89 of 110 (81%) cases versus 10 of 29 (34%) cases of invasive lobular carcinoma (ILC) (P < .001) and 21 of 38 (55%) cases of ductal carcinoma in situ (DCIS) (P < .01). US showed higher sensitivity than did mammography for IDC, depicting 104 of 110 (94%) cases, and for ILC, depicting 25 of 29 (86%) cases (P < .01 for each). US showed higher sensitivity for invasive cancer than DCIS (18 of 38 [47%], P < .001). MR showed higher sensitivity than did mammography for all tumor types (P < .01) and higher sensitivity than did US for DCIS (P < .001), depicting 105 of 110 (95%) cases of IDC, 28 of 29 (96%) cases of ILC, and 34 of 38 (89%) cases of DCIS. In anticipation of conservation or no surgery after mammography and clinical examination in 96 breasts, additional tumor (which altered surgical approach) was present in 30. Additional tumor was depicted in 17 of 96 (18%) breasts at US and in 29 of 96 (30%) at MR, though extent was now overestimated in 12 of 96 (12%) at US and 20 of 96 (21%) at MR imaging. After combined mammography, clinical examination, and US, MR depicted additional tumor in another 12 of 96 (12%) breasts and led to overestimation of extent in another six (6%); US showed no detection benefit after MR imaging. Bilateral cancer was present in 10 of 111 (9%) patients; contralateral tumor was depicted mammographically in six and with both US and MR in an additional three. One contralateral cancer was demonstrated only clinically. CONCLUSION: In nonfatty breasts, US and MR imaging were more sensitive than mammography for invasive cancer, but both MR imaging and US involved risk of overestimation of tumor extent. Combined mammography, clinical examination, and MR imaging were more sensitive than any other individual test or combination of tests.     

胸腹部局限性Castleman病的CT特征分析

目的 回顾性分析55例胸腹部局限性Castleman病(LCD)的CT特征,并与病理学改变进行对照,研究对LCD有诊断价值的影像特点.方法 搜集20年间胸腹部LCD患者55例,其中胸部25例,腹部30例.55例均经手术切除和组织病理学证实.所有患者均行CT平扫和增强扫描,影像征象由2名放射学医师同时分析.结果 54例透明血管型(50例)和混合型(4例)Castleman病CT表现主要包括孤立性肿物(90.7%,49例)、边缘不规则或分叶或浸润(83.3%,45例)、中央性钙化(38.9%,21例)和显著强化(100%,54例),72.2%(39例)的病灶内可见局灶性非坏死性低密度影,70.4%(38例)和96.3%(52例)的病灶周围可见肿大的淋巴结和扩张的滋养血管.1例浆细胞型Castleman病表现为边缘不规则伴中央缺血坏死的轻度强化的单发肿块影.其CT分型包括边缘光整的单发肿块(4例)、边缘不规则或分叶状单发肿块(30例)、边缘模糊呈浸润性或磨玻璃样肿块(16例)及多发融合肿块(5例).结论 胸腹部LCD的CT表现与发生部位和病理类型密切相关,透明血管型和混合型的CT表现具有特征性,而浆细胞型LCD的CT表现则缺乏特征性.     

Proliferative high-risk lesions of the breast: contribution and limits of US-guided core biopsy

PURPOSE: To retrospectively correlate high-risk proliferative breast lesions (radial scar, atypical lobular hyperplasia, lobular carcinoma in situ and papillary lesions) diagnosed on core biopsy with the definitive histopathological diagnosis obtained after surgical excision or with the follow-up, in order to assess the role of core biopsy in such lesions. To discuss the management of the patient after a core biopsy diagnosis of high-risk proliferative breast lesion. MATERIAL AND METHODS: We evaluated 74 out of 1776 core biopsies consecutively performed on 67 patients. The histopathologic findings were as follows: 11 radial scars (RS), 3 atypical lobular hyperplasias (ALH), 3 lobular carcinomas in situ (LCIS), 57 benign papillary lesions. All patients underwent bilateral mammography, whole-breast ultrasound with a linear-array broadband transducer, and core biopsy with a 14 Gauge needle and a mean number of samples of 5 (range 4-7). Sixty-two of 67 patients, for a total of 69/74 lesions, underwent surgical biopsy despite benign histopathologic findings, mostly because of highly suspicious imaging for malignancy (BIRADS 4-5), whereas 5 patients refused surgery and have been followed up for a least 18 months and are still being followed up (2 with RS, 1 with ADH and 2 with papillary lesions). RESULTS: Among the core biopsied lesions with a diagnosis of RS (n = 11) pathology revealed one ductal carcinoma in situ (DCIS) (this case was characterized by granular microcalcifications on mammography and by a mass with irregular margins on ultrasound). Also in the group of ADH (n = 3) pathology revealed one DCIS (lesion not visible on mammography but depicted as a suspicious mass on US). In the group of LCIS (n = 3) pathologists found an invasive lobular carcinoma (ILC). Among the benign papillary lesions (n = 57) histopathologic analysis of the surgical specimen revealed 7 malignant lesions (4 papillary carcinomas and 3 DCIS), whose mammographic and ultrasound findings were indistinguishable from benign lesions. Altogether there were 10 false negative results (underestimation) out of 74 core biopsies with a diagnosis of high-risk proliferative breast lesions. CONCLUSION: The high rate of histological underestimation after core biopsy (10/74) (13.5%) demands a very careful management of patents with a core biopsy diagnosis of high-risk proliferative breast lesions, especially in the case of RS, lobular neoplasia and papillary lesions. However, the high imaging suspicion for malignancy prompts surgery. It is possible to assume that, when there is a low imaging suspicion for malignancy, when enough tissue has been sampled for pathology and no atypia is found within the lesions, surgery is not mandatory but a very careful follow-up is recommended. We must underline that there is no agreement regarding the quantity of tissue to sample. Vacuum-assisted biopsy may lead to better results, although there is as yet no proof that it can actually replace surgery in this group of lesions, since it seems only to reduce but not abolish the histological underestimation.     

Apparent ipsilateral decrease in breast size at mammography: a sign of infiltrating lobular carcinoma

PURPOSE: To assess if infiltrating lobular carcinoma (ILC) is associated with an ipsilateral mammographic decrease in breast size. MATERIALS AND METHODS: Mammographic change in size was evaluated by measuring the distance from the nipple to the pectoralis major muscle on the mediolateral oblique view of the diagnostic mammogram and on a preceding mammogram in 30 patients with ILC. Clinical, mammographic, and histopathologic findings were retrospectively reviewed. RESULTS: Five patients (17%) had an ipsilateral decrease in mammographic size. No patients noticed a physical decrease in breast size. Patients with an ipsilateral decrease in mammographic size most commonly had breast thickening at examination (four of five patients [80%], P < .001) and either a focal asymmetry density (three of five patients [60%]) or architectural distortion (one of five patients [20%]) at mammography; those patients with no change in size most commonly had a palpable mass (six of 25 patients [24%]) or normal findings (19 of 25 patients [76%]) and a mass (13 of 25 patients [52%]) at mammography. The mean tumor size was 66 mm for those with an ipsilateral size decrease and 16 mm for those with no size decrease (P < .001). At histologic analysis, tumors associated with an ipsilateral decrease in mammographic size had more diffuse involvement of the breast, and discrete masses were not seen. CONCLUSION: An apparent decrease in mammographic size may help identify cases of ILC, especially when associated with thickening at clinical examination and focal asymmetric density at mammography.     

肺腺癌的螺旋CT表现特征及其病理学基础

目的：探讨肺腺癌局部生长的螺旋CT表现特点与组织病理基础的基础关性。方法：34例手术病理证实的肺腺癌采用扫描。结合组织病理发现，观察和评价和评价在螺旋CT上肿瘤内部结构，密度分布、边缘特征及周围肺组织改变。结果：34例肺腺癌中，肿块密度均匀14例（41％），不均匀20例（59％），分叶片22例（65％），空泡征10例（29％），短毛刺16例（47％），支气管气相7例（21％），血管集束征16例（47％），胸膜凹陷征19例（56％），毛玻璃样（ground galass opacity,GGO)征7例（21％），GGO征病理上代表肿瘤细胞沿肺泡壁生长，同时残留含气肺泡组织。结论：肺腺癌的螺旋CT表现可反映肿瘤生长的组织病理学特征。     

Mammographic detection and staging of invasive lobular carcinoma

The aim of the study was to evaluate mammography in detecting and staging of invasive lobular carcinoma (ILC) in order to assess the performance and impact of observer variability. Forty-two cases of ILC were retrospectively evaluated twice by two breast radiologists. Mammographic performance as well as intra- and interobserver variations was evaluated. Thirty-five percent to 37% of the cases were understaged. The largest differences between radiologists were found in the breast imaging reporting and data system (BIRADS) classification and staging performance. These results can have serious influence on patient management.     

Breast multidetector-row CT with histopathologic correlation

PURPOSE: To evaluate the correlation between multidetector-row CT (MDCT) and histopathologic findings using the same MDCT image as the histopathologic cross-section. MATERIALS AND METHODS: MDCT with contrast enhancement was performed in 10 patients with breast cancers (8 invasive ductal carcinomas, one invasive lobular carcinoma, and one non-invasive ductal carcinoma). We tried to reconstruct multiplanar reconstructions (MPR) in the same plane as the histopathologic cross-section, and we evaluated the histopathologic findings of the false-positive lesions. RESULTS: In all cases, we obtained the same MDCT image as the histopathologic cross-section. There were 10 main lesions and 18 other lesions. In the other lesions, we found no false-negative lesions and 11 false-positive lesions. False-positive lesions included periductal fibrosis, cystic change, duct papillomatosis, sclerosing adenosis, fibroadenoma, and others. CONCLUSION: Using MDCT of the breast, it is possible to obtain good correlation between CT images and histopathologic findings. MDCT is thought to be useful in the evaluation CT findings on the basis of histopathologic evidence.     

Stereotactic vacuum-assisted breast biopsy in 268 nonpalpable lesions

PURPOSE: We evaluated the reliability of stereotactic vacuum-assisted breast biopsies (VAB) from our personal experience. MATERIALS AND METHODS: Between January 2003 and December 2005, 268 patients underwent VAB with an 11-gauge probe at our institution. Inclusion criteria were nonpalpable lesions, undetectable by ultrasound and suspected at mammography (microcalcifications, circumscribed mass, architectural distortion), for which cytology and/or core biopsy could not provide a definite diagnosis. Lesion mammographic patterns were microcalcifications in 186 cases (77.5%), mostly localised clusters (130/186: 70%); circumscribed mass with or without microcalcifications in 36 cases (15%) and architectural distortion with or without microcalcifications in 18 cases (7.5%). On the basis of the Breast Imaging Reporting and Data System (BI-RADS) classification, 16 cases (7%) were graded as highly suspicious for malignancy (BI-RADS 5), 81 (34%) as suspicious for malignancy (BI-RADS 4b), 97 (40%) as indeterminate (BI-RADS 4a) and 46 (19%) as probably benign (BI-RADS 3). Lesion size was 20 mm in only 38 cases (16%), 30 of which appeared as microcalcifications. RESULTS: In 28/268 lesions (10.5%) the biopsy could not be performed (nonidentification of the lesion; inaccessibility due to location or breast size). In 12/240 (5%) biopsies, the sample was not representative. Pathology revealed 100/240 (42%) malignant or borderline lesions and 140/240 (58%) benign lesions. Among the malignant lesions, 16/100 (16%) were invasive carcinoma [infiltrating ductal carcinoma (IDC) or infiltrating lobular carcinoma (ILC)], 13/100 (13%) were microinvasive (T1mic), 35/100 (35%) were ductal carcinoma in situ (DCIS), 9/100 (9%) were lobular carcinoma in situ (CLIS). Among the borderline lesions, 27/100 (27%) were atypical epithelial hyperplasia [atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH)]. In 9/100 surgically treated lesions (9%), there was discordance between the microhistological findings of VAB and the pathological results of the surgical procedure: 8/9 were underestimated by VAB (four ADH vs. DCIS, three DCIS vs. IDC, one ADH vs. IDC), and 1/9 was overestimated (T1mic vs. DCIS). Complications following VAB occurred in 9/240 patients (3.7%). CONCLUSIONS: In our experience, VAB showed fair reliability in the diagnosis of nonpalpable breast lesions despite a portion of failed (10.5%), nonsignificant (5%) procedures and underestimated lesions (9%).     

乳腺浸润性微乳头状癌的影像特征分析

目的探讨乳腺浸润性微乳头状癌（IMPC）的临床、影像及组织病理学特点。方法回顾性分析经病理证实的9例IMPC患者的影像学资料并与临床及病理结果进行对照;X线钼靶、超声及磁共振成像结果均参照美国放射学会超声乳腺影像报告和数据系统（BI-RADS）分级标准。结果钼靶摄影最常见的征象表现为边界不清的、不规则形高密度肿块影,其中3例可见肿块内的微钙化灶;超声多表现为不规则低回声肿块,边缘毛刺状,2例可见后方回声衰减;磁共振均表现为不规则形肿块影,增强扫描可见肿块内部不均匀强化,时间-信号强度曲线为廓清型或平台型。术后病理显示7例出现淋巴管侵袭,6例腋窝淋巴结肿大,1例锁骨上淋巴结肿大,免疫组织化学显示雌激素受体（ER）阳性8例。结论乳腺浸润性微乳头状癌常见淋巴管侵袭和区域淋巴结转移,其影像学表现具有典型的恶性肿瘤特征。     

Ductal carcinoma in situ diagnosed with stereotactic core needle biopsy: can invasion be predicted?

PURPOSE: To determine whether mammographic or histologic features can be used to predict which cases diagnosed as ductal carcinoma in situ (DCIS) without invasion by means of stereotactic core needle biopsy (SCNB) will have invasive disease at surgery. MATERIALS AND METHODS: From July 1992 to March 1999, DCIS without invasion was diagnosed by means of SCNB in 59 patients. Seventeen (29%) were found to have invasive disease after surgery. The underestimation rate for SCNB was compared with that obtained by means of open surgical biopsy. Mammographic and histologic features of cases with and those without invasion were compared. RESULTS: All patients had calcifications on mammograms. There was no significant difference (P: =.26) between the underestimation rate for SCNB with the 11-gauge vacuum-assisted device and that for open surgical biopsy. No statistically significant differences between cases with and those without invasion were seen in patient age, mean number of core specimens, level of suspicion, size of lesion, distribution and morphology of the calcifications, presence of an associated mass or density, subtype of DCIS, nuclear grade, or presence of necrosis or desmoplasia. CONCLUSION: Mammographic and histologic features cannot be used reliably to predict cases that are underestimated with SCNB. However, SCNB with the 11-gauge vacuum-assisted device was as reliable as open surgical biopsy for diagnosing DCIS without invasion.     

Collecting duct carcinoma of the kidney: CT and pathologic correlation

PURPOSE: We characterized CT findings of collecting duct carcinoma of the kidney and correlated these with the histopathologic findings. MATERIALS AND METHODS: CT scans of 18 patients with pathologically proven collecting duct carcinoma of the kidney were retrospectively reviewed. We analyzed CT findings of collecting duct carcinoma and also correlated CT findings with the histopathologic findings. RESULTS: The mean size of the tumors was 6.9 cm and all cases were solid. Seventeen (94%) tumors had a medullary location. Nine (69%) and 11 (85%) cases showed weak and heterogeneous enhancement, respectively. A cystic component (50%) was frequently seen within the tumors. Lymphadenopathy and metastasis were noted in 10 (56%) and 6 (33%) cases, respectively. Perinephric stranding and vascular invasion were present in 10 (56%) and 5 (28%) cases, respectively. In 17 (94%) of the 18 cases, involvement of the renal sinus was present. Infiltrative growth (67%) and preservation of the renal contour (61%) were more common than expansile growth (33%) and exophytic configuration (39%), respectively. These CT features were well correlated with the histopathologic findings. CONCLUSION: Medullary location, weak and heterogeneous enhancement, involvement of the renal sinus, infiltrative growth, preserved renal contour, and a cystic component are CT findings frequently seen in patients with collecting duct carcinoma of the kidney. CT findings are nevertheless nonspecific and do not allow collecting duct carcinoma to be easily differentiated from the other subtypes of renal cell carcinoma. However, when CT demonstrates a renal tumor with these findings, collecting duct carcinoma can be considered in the differential diagnosis.     

Influence of breast lesion size and histologic findings on tumor detection rate of a computer-aided detection system

PURPOSE: To evaluate associations between histopathologic findings, tumor size, and detection rate of malignant mammographic findings by using a computer-aided detection (CAD) system. MATERIALS AND METHODS: The study included 208 mammographically detected histologically proven malignant breast lesions in 208 women. Findings were 150 masses and 114 microcalcifications; 56 lesions showed both findings; 94 lesions, mass only; and 58 lesions, microcalcification only. CAD was used to evaluate mammograms in two views retrospectively. Also, corresponding histopathologic findings and lesion size were evaluated. CAD marks were considered positive if, on at least one view, they correctly identified the corresponding mammographic lesion location. RESULTS: Ninety percent (135 of 150) of masses and 93.0% (106 of 114) of microcalcifications were marked correctly by the CAD system. Overall tumor detection rate was 93.8% (195 of 208). Size-related detection rate for masses was 83.3% (25 of 30) for lesions up to 10 mm, 100% (45 of 45) for lesions 11-20 mm, 100% (46 of 46) for lesions 21-30 mm, 83.3% (10 of 12) for lesions 31-40 mm, and 52.9% (nine of 17) for lesions larger than 40 mm. Size-related tumor detection rate for microcalcifications was 92.5% (37 of 40) for microcalcifications up to 10 mm, 93.1% (27 of 29) for lesions 11-20 mm, 100% (20 of 20) for lesions 21-30 mm, 87.5% (seven of eight) for lesions 31-40 mm, and 88.2% (15 of 17) for larger microcalcifications. Detection rates for mammographically visible masses (invasive ductal carcinoma, invasive lobular carcinoma, invasive tubular carcinoma, noninvasive cancers, mucinoid cancers, and others) were 92.3% (84 of 91), 89.3% (25 of 28), 75.0% (six of eight), 100% (15 of 15), 33.3% (one of three), and 80.0% (four of five), respectively. Detectability rates for mammographically visible areas suspicious for microcalcifications (invasive ductal carcinoma, invasive lobular carcinoma, invasive tubular carcinoma, and noninvasive cancers) were 92.3% (60 of 65), 100% (eight of eight), 100% (five of five), and 91.9% (31 of 34), respectively. Highest overall detection rates were observed for invasive ductal carcinomas (96.6% [112 of 116]) and noninvasive cancers (92.9% [39 of 42]). CONCLUSION: Highest detection rates were observed for 10-30-mm tumor masses and for invasive ductal carcinomas and noninvasive cancers.     

Accessory breast tissue in the axilla: mammographic appearance

Mammographic features of normal accessory axillary breast tissue were analyzed in 13 women, 54% of whom had positive findings on physical examination. Radiographically the accessory tissue resembled the remaining normal glandular tissue but was separate from it. The mean radiographic dimension of the accessory tissue, which was best seen on oblique or exaggerated craniocaudal views, was 3.9 cm. In most cases the accessory tissue was either bilateral or confined to the right side. When found on mammography, accessory axillary breast tissue should be recognized as a normal developmental variant rather than considered a pathologic lesion, although carcinoma can develop in the accessory tissue. A specific, radiography-aided diagnosis of accessory axillary breast tissue can eliminate unnecessary biopsy.     

Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core-needle biopsy

PURPOSE: To retrospectively determine the degree of underestimation of breast carcinoma diagnosis in papillary lesions initially diagnosed at core-needle biopsy. MATERIALS AND METHODS: Institutional review board approval and waiver of informed consent were obtained for this HIPAA-compliant study. Mammographic database review (1994-2003) revealed core biopsy diagnoses of benign papilloma (n=38), atypical papilloma (n=15), sclerotic papilloma (n=6), and micropapilloma (n=4) in 57 women (mean age, 57 years). Excisional or mammographic follow-up (>or=2 years) findings were available. Patients with in situ or invasive cancer in the same breast or patients without follow-up were excluded. Findings were collected from mammography, ultrasonography, core technique, core biopsy, excision, and subsequent mammography. Reference standard was excisional findings or follow-up mammogram with no change at 2 years. Associations were examined with regression methods. RESULTS: In 38 of 63 lesions, surgical excision was performed; in 25 additional lesions (considered benign), follow-up mammography (24-month minimum) was performed, with no interval change. In 15 lesions, 14-gauge core needle was used; in 48, vacuum assistance (mean cores per lesion, 8.7). Carcinoma was found at excision in 14 of 38 lesions. Core pathologic findings associated with malignancy were benign papilloma (n=1), sclerotic papilloma (n=1), micropapilloma (n=2), and atypical papilloma (n=10). Frequency of malignancy was one (3%) of 38 benign papillomas, 10 (67%) of 15 atypical papillomas, two (50%) of four micropapillomas, and one (17%) of six sclerotic papillomas. Excisional findings included lobular carcinoma in situ (n=2), ductal carcinoma in situ (n=7), papillary carcinoma (n=2), and invasive ductal carcinoma (n=3). Low-risk group (micropapillomas and sclerotic and benign papillomas) was compared with high-risk atypical papilloma group. Core findings were associated with malignancy at excision for atypical papilloma (P=.006). Lesion location, mammographic finding, core number, or needle type were not associated (P>.05) with underestimation of malignancy at excision. CONCLUSION: Benign papilloma diagnosed at core biopsy is infrequently (3%) associated with malignancy; mammographic follow-up is reasonable. Because of the high association with malignancy (67%), diagnosis of atypical papilloma at core biopsy should prompt excision for definitive diagnosis.     

Sonographic appearance of mucinous carcinoma of the breast

OBJECTIVE: The aim of this study was to evaluate the sonographic and mammographic features of mucinous carcinoma and to correlate the imaging features with two histologic classifications. MATERIALS AND METHODS: Two radiologists analyzed the mammographic and sonographic features of 33 mucinous carcinomas. Mammographic features according to the Breast Imaging Reporting and Data System (BI-RADS) and sonographic features were recorded and analyzed. The imaging features of the mass were correlated with the nuclear grade and mucin content of these 33 mucinous carcinomas. The incidence of axillary lymph nodes metastasis in different histologic grades and their detection by imaging were also assessed. RESULTS: As many as 21.2% (7/33) of mucinous carcinomas could not be detected mammographically. When they were detected mammographically, more than 92% of the tumors presented as a mass, either oval or lobular. Microlobulations were present in 38.5% of these lesions. The margin of the lesion as seen on mammography can be used to predict the histologic grade. A circumscribed margin was associated with a favorable histologic grade (p = 0.01), whereas an indistinct margin was more commonly associated with the mixed type of lesion (p = 0.05). Sonographically, mixed cystic and solid components, distal enhancement, and microlobulated margins were commonly found in mucinous carcinomas, with an incidence of 37.5%, 43.8%, and 56.3%, respectively. Homogeneity on sonography was associated with the pure type of mucinous carcinoma and hence a better prognosis. Sonography showed a sensitivity of 50%, specificity of 89%, positive predictive value of 60%, negative predictive value of 84%, and accuracy of 79.2% in the detection of axillary lymph node metastasis. CONCLUSION: Both sonographic and mammographic assessments are important in the correct diagnosis of mucinous carcinoma, the prediction of histologic grade, and the prognosis of the tumors.     

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.