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.     

乳腺导管原位癌伴微浸润与导管原位癌的临床病理及X线表现对比分析

目的对比分析乳腺导管原位癌伴微浸润(DCISM)与导管原位癌(DCIS)的X线及临床病理表现及DCISM的预测因子。方法收集2016年1月至2020年7月在青岛大学附属医院经手术病理证实的DCISM及DCIS患者626例,患者术前均接受乳腺X摄影检查。参照乳腺影像报告和数据系统(BI-RADS)标准对DCISM与DCIS患者X线表现进行分类诊断。采用χ²检验或Fisher确切概率法分析DCISM与DCIS患者临床病理及X线表现的差异性,应用单因素和多因素二元logistic回归分析探讨与DCISM相关的危险因素。结果626例患者中,DCISM患者171例,DCIS患者455例。单因素回归分析表明,肿瘤直径≥2.7cm、高核级别、粉刺性坏死、淋巴结阳性、Ki67高表达、雌激素受体及孕激素受体阴性是DCISM的预测因子(P<0.05)。多因素回归分析显示,肿瘤直径≥2.7cm(OR 2.229,95%CI 1.505~3.301,P<0.001)、高核级别(OR 1.711,95%CI 1.018~2.875,P=0.043)、淋巴结阳性(OR 4.140,95%CI 1.342~12.773,P=0.013)是DCISM的独立预测因子(P<0.05)。乳腺X线摄影中,DCIS与DCISM患者的病变类型、有无钙化及钙化分布差异具有统计学意义(χ²分别为17.42、9.65、9.10,P<0.05),17.6%(80/455)的DCIS患者表现为隐匿性病变,49.1%(84/171)的DCISM表现为钙化伴肿块、非对称致密、结构扭曲。团簇状钙化多见于DCIS(41.5%,120/289),而区域性钙化在DCISM中更普遍(35.9%,47/131)。结论乳腺X线摄影表现为钙化性病变及区域性钙化在DCISM中更常见。肿瘤直径≥2.7cm、高核级别、淋巴结阳性是DCISM的独立预测因子。     

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.     

乳腺导管原位癌X线表现与病理学免疫组织化学分型关系的分析

目的:探讨乳腺导管原位癌（DCIS）X线摄影表现与病理学免疫组织化学分型的关系。方法:回顾性分析2016年1月至2019年10月在青岛大学附属医院经手术病理证实的505例DCIS患者共514个病灶的资料。根据免疫组织化学结果将全部DCIS病灶分为雌激素受体（ER）阳性型（215个病灶）、人表皮生长因子受体2（HER2）...     

Breast carcinoma in women previously treated for Hodgkin's disease: clinical and mammographic findings

The aim of this study was to describe the radiological characteristics of breast cancers occurring after treatment of Hodgkin's disease (HD). This study identified 23 women (age range 28–70 years, mean age 40 years) with 29 breast cancers (22 infiltrating carcinomas, 5 in situ, 1 sarcoma, 1 indeterminate) who had previously undergone mantle irradiation (35–40 Gy) for HD. Clinical and mammographic data were reviewed by two radiologists. Dosimetry was available for 16 patients. Time from treatment of HD to the occurrence of breast cancer ranged from 15 months to 35 years (mean 18 years); 79 % were younger than 45 years and 76 % of cancers occurred between 10 and 25 years of follow-up. The physical examination was positive in 76 % and 6 patients had bilateral tumors (synchronous, n = 2; metachronous, n = 4). Eighty-three percent of mammograms (n = 24) were abnormal (microcalcifications, n = 72 %; opacity, n = 54 %; two inflammatory breast cancers). Seven cancers were only detected by mammography, but mammograms were normal in 4 patients. Breast cancer was located beyond or was overlapping radiation fields in 75 % of cases. Starting 10 years after mantle irradiation of women with HD, the follow-up should include annual clinical breast examination and mammography. Received: 27 July 1998; Revision received: 15 January 1999; Accepted: 16 March 1999     

Lobular carcinoma in situ of the breast: clinical, pathologic, and mammographic features

Lobular carcinoma in situ (LCIS) was diagnosed in 165 surgical specimens (119 patients) at our institution between 1974 and 1987. LCIS was seen more often in younger women (mean age, 49 years) than other breast carcinomas were (mean age, 58 years). Sampling of a single breast revealed multifocal disease in 70% (96/138). When both breasts were sampled, bilateral foci were found in 50% (41/82). Of 165 breasts with foci of LCIS, 37% (61/165) had simultaneously occurring invasive cancers in the same breast. Direct mammographic-pathologic correlation of foci of LCIS was possible in 73 breasts (67 patients). Microcalcifications were an indication for biopsy in 49% (20/41) of breasts with a mammographic abnormality, but were a nonspecific finding often found in tissues adjacent to foci of LCIS. The mammogram was normal in 44% (32/73) of breasts with foci of LCIS. The mammograms of patients with LCIS and those from a group of age-matched control subjects were compared by using a modified form of Wolfe's criteria and the percentage of fibroglandular elements. LCIS was seldom found in an N1 breast (1% vs 29%) or in a breast with less than 25% of its parenchymal area occupied by fibroglandular density (3% vs 33%). Compared with the control group, breasts with LCIS had more than 50% fibroglandular density (85% vs 45%) and a much higher frequency of the DY pattern (56% vs 36%). More fibroglandular density was seen in the LCIS group at all ages. Postmenopausally, the frequencies of the DY pattern and fibroglandular density greater than 50% in LCIS patients were nearly double those in the control group. LCIS patients have disease of the entire breast parenchyma, characterized by multifocality and bilaterality of various forms of lobular disease. Their mammograms reveal a higher rate of the DY pattern and higher percentages of fibroglandular or parenchymal density than those of age-matched controls. In LCIS patients, persistence of the DY pattern, or large amounts of fibroglandular density postmenopausally supports the concept that mammographically dense breasts are a marker for increased cancer risk in women 50 years old and older.     

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.     

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.     

Ductal carcinoma in situ: computer-aided detection in screening mammography

PURPOSE: To retrospectively evaluate the sensitivity of computer-aided detection (CAD) in depicting ductal carcinoma in situ (DCIS) on screening mammograms by using biopsy proved lesion location as the reference standard. MATERIALS AND METHODS: Institutional review board approval was obtained, with a waiver of patient informed consent for this HIPAA-compliant study. Findings of all image-guided biopsies with a pathologic diagnosis of DCIS during a 1-year period were reviewed. Fifty-eight lesions in 55 women (average age, 61.41 years +/- 12.89 [standard deviation]) were available for review. The screening mammogram of the affected breast and, if available, the prior screening mammogram were digitized by the CAD system. An assessment was then made as to whether the CAD system marked the area of DCIS on the current and prior mammograms. Patient age, location and mammographic size of the lesion, type of lesion, and breast density were recorded and were analyzed by using chi2, Fisher exact, or Cochran-Mantel-Haenzel tests, where applicable. RESULTS: CAD identified DCIS in 53 (91%) of 58 lesions on craniocaudal (CC) and mediolateral oblique (MLO) views of screening mammograms obtained in the year of the diagnosis. On screening mammograms obtained prior to the year of the diagnosis (34 patients), no radiologically or CAD-detected lesion was present on 11 (32%) of 34 mammograms. CAD identified DCIS in 16 (70%) of 23 lesions on one of the two views. Seven (30%) of 23 lesions had mammographic findings at retrospective review that were not identified with CAD. CONCLUSION: CAD had a high sensitivity in the depiction of DCIS.     

Lobular carcinoma in situ of the breast: mammographic features

Lobular carcinoma in situ (lobular neoplasia; LCIS) of the breast is most commonly an incidental microscopic finding in breast tissue removed for some other reason. The authors reviewed the clinical and mammographic features and surgical findings in 26 cases of LCIS not associated with other breast abnormalities. In 16 instances, needle localization was performed before removal of the tissue, which yielded LCIS on histologic examination. Calcifications were the most common reason for biopsy, although there were no distinctive mammographic features of LCIS.     

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

OBJECTIVE: The purpose of this study was to investigate the mammographic and sonographic findings of metaplastic carcinoma of the breast and to correlate the radiologic features with clinical and histopathologic findings. CONCLUSION: Metaplastic carcinoma of the breast often manifests as a rapidly growing, palpable mass that has high density on mammography and may be microlobulated on sonography. Complex echogenicity with solid and cystic components may be seen sonographically and is related to necrosis and cystic degeneration found histopathologically. Although it is a rare breast malignancy and these features are not unique, metaplastic carcinoma should be included in the differential diagnosis for breast masses with these imaging features.     

Invasive lobular carcinoma: mammographic findings in a 10-year experience

From January 1, 1976 to December 30, 1985, 1,966 cases of breast carcinoma were diagnosed and treated at Malmo General Hospital, Malmo, Sweden. Of these cases, 185 (9.4%) involved invasive lobular carcinoma (ILC). Mammography in 137 cases demonstrated the following findings: spiculated opacity (53%), architectural distortion (16%), poorly defined opacity (7%), normal or benign findings (16%), and parenchymal asymmetry (4%). Radiographic definition of the ILC lesion varied greatly with projection: The craniocaudal view demonstrated significant findings more frequently than either the oblique or lateral views. Secondary radiographic findings were present in 31%, microcalcifications were rare, and physical findings were present in 89%. Because of its diffuse growth pattern and tendency to form lesions with opacity equal to or less than that of the parenchyma, ILC can be extremely difficult to detect mammographically. Therefore, the radiologist must be alert for subtle mammographic signs of malignancy and highly suspicious of any abnormal physical findings regardless of the mammographic appearance.     

Ductal carcinoma in situ: correlation between FDG-PET/CT and histopathology

Purpose  The aim of this study was to determine if any correlation exists between tumor cell density and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET)/CT) for pure or predominant ductal carcinoma in situ (DCIS). Materials and methods  Subjects in this retrospective review comprised 11 patients who underwent FDG-PET/CT for DCIS. Pathological tumor cell density and FDG-PET/CT images were compared. A tumor background count density ratio of >1.5 was defined as the detectable range for DCIS. Results  Pathological density of disease was high in eight patients, intermediate in one, and low in two. In all eight patients with a detectable intraductal component on PET/CT, the density of disease was classified as high. In three patients undetected by PET/CT, the density of disease was classified as intermediate or low. On statistical analysis, the correlation between the density of disease and tumor background count density ratio (TBCDR) on PET/CT was significant (<0.05), whereas the nuclear grade and Van Nuys grade were not significant. In the eight patients detected by PET/CT, the discrepancy between histopathological mapping and FDG-PET/CT mapping was >20 mm in four patients and represented underestimation in four patients who showed low density of disease in the peripheral area. Conclusions  Tumor cell density of intraductal carcinoma appears strongly correlated to detection by FDG-PET/CT.