Amorphous/Indistinct Calcifications (Group)

2018 ◽  
Author(s):  
Lilian Wang
Keyword(s):  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Morphological Classification ◽  
Imaging Protocols ◽  
Fibrocystic Change ◽  
Ductal Hyperplasia ◽  
Management Recommendations

Amorphous calcifications are calcifications that are sufficiently small and/or hazy that a more specific morphological classification cannot be made. Historically, such calcifications were referred to as “indistinct” calcifications. The likelihood of malignancy and the management of amorphous calcifications largely depend on their distribution. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnosis with radiology–pathology correlation, and management recommendations for amorphous/indistinct calcifications in a group. Topics discussed include spot magnification views for characterization, role of distribution in BI-RADS assessment, and pathological entities, including fibrocystic change, milk of calcium, atypical ductal hyperplasia (ADH), and ductal carcinoma in situ (DCIS).

Minimal (≤0.1 cm) Invasive Carcinoma in Breast Core Needle Biopsies

2004 ◽  
Vol 128 (9) ◽  
pp. 996-999
Author(s):  
Andrew A. Renshaw
Keyword(s):  
Minimally Invasive ◽  
Carcinoma In Situ ◽  
Invasive Carcinoma ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Core Needle ◽  
Ductal Hyperplasia ◽  
Ductal Carcinomas ◽  
Invasive Carcinomas

Abstract Context.—Although minimally invasive (microinvasive) carcinoma (≤0.1 cm) of the breast is a well-known and well-characterized entity in excision specimens, the significance of small foci of invasion in breast core needle biopsies has not been well described. Objective.—To define the significance of minimally invasive carcinoma in breast core needle biopsies. Design.—Review of a large series of core needle biopsies for invasive carcinomas measuring 0.1 cm or less and correlation of the results with those of subsequent excision. Setting.—Large community hospital. Results.—From approximately 8500 biopsies, a total of 18 cases of minimally invasive carcinoma from 16 women aged 42 to 80 years were identified. All were present on only 1 of 8 slides made from the block. Overall, the incidence was approximately 0.1% of all biopsies and 1% of all invasive carcinomas. Six cases were invasive lobular carcinomas, 1 was tubulolobular carcinoma, 3 were tubular carcinomas, and the remaining 8 were ductal carcinomas. Eight cases were associated with high-grade comedo ductal carcinomas, 2 with low-grade ductal carcinoma in situ, 3 with atypical ductal hyperplasia, 3 with atypical ductal hyperplasia and lobular carcinoma in situ, and 2 with no other lesion. From a total of 8 sections done entirely through the block, the lesion was present on the first level in 4 cases and the fifth level in 5 cases. No cases were identified in the last 3 levels. Subsequent pathology was available for 16 of the 18 cases. Invasive carcinomas measuring more than 1 cm were present in 9 cases (64%; along with 2 positive lymph nodes), invasive carcinomas less than 1 cm in 2 cases (14%), ductal carcinoma alone in 4 cases (29%), and no carcinoma in 1 case (7%). No pathologic or radiologic features were associated with the finding of invasive carcinoma at excision. Conclusion.—Invasive carcinoma measuring 0.1 cm or less is a rare finding in breast core needle biopsies, is commonly associated with in situ carcinomas and atypical hyperplasias, and is often associated with larger invasive foci at excision. However, invasive carcinomas smaller than 0.1 cm can occur without any other significant findings and may require relatively extensive sampling to identify.

scholarly journals Diagnostic underestimation of atypical ductal hyperplasia and ductal carcinoma in situ at percutaneous core needle and vacuum-assisted biopsies of the breast in a Brazilian reference institution

2016 ◽  
Vol 49 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Gustavo Machado Badan ◽  
Decio Roveda Júnior ◽  
Sebastião Piato ◽  
Eduardo de Faria Castro Fleury ◽  
Mário Sérgio Dantas Campos ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Surgical Excision ◽  
Target Lesion ◽  
Core Needle ◽  
Ductal Hyperplasia ◽  
Underestimation Rate

Abstract Objective: To determine the rates of diagnostic underestimation at stereotactic percutaneous core needle biopsies (CNB) and vacuum-assisted biopsies (VABB) of nonpalpable breast lesions, with histopathological results of atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) subsequently submitted to surgical excision. As a secondary objective, the frequency of ADH and DCIS was determined for the cases submitted to biopsy. Materials and Methods: Retrospective review of 40 cases with diagnosis of ADH or DCIS on the basis of biopsies performed between February 2011 and July 2013, subsequently submitted to surgery, whose histopathological reports were available in the internal information system. Biopsy results were compared with those observed at surgery and the underestimation rate was calculated by means of specific mathematical equations. Results: The underestimation rate at CNB was 50% for ADH and 28.57% for DCIS, and at VABB it was 25% for ADH and 14.28% for DCIS. ADH represented 10.25% of all cases undergoing biopsy, whereas DCIS accounted for 23.91%. Conclusion: The diagnostic underestimation rate at CNB is two times the rate at VABB. Certainty that the target has been achieved is not the sole determining factor for a reliable diagnosis. Removal of more than 50% of the target lesion should further reduce the risk of underestimation.

Secretory Calcifications

2018 ◽  
Author(s):  
Christopher P. Ho
Keyword(s):  
Carcinoma In Situ ◽  
Plasma Cells ◽  
Ductal Carcinoma ◽  
Close Association ◽  
Epithelial Hyperplasia ◽  
Appropriate Use ◽  
Imaging Protocols ◽  
Management Recommendations

Secretory calcifications are large rod-like calcifications that are often seen in a linear or segmental distribution. They can often be easily differentiated from more malignant-appearing calcifications because they are smooth and much coarser than calcifications seen with ductal carcinoma in situ (DCIS). Secretory calcifications are thought to be associated with duct ectasia and have been historically referred to as “plasma cell mastitis” because of the close association of plasma cells within the ductal infiltrates and epithelial hyperplasia. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for secretory calcifications. Topics discussed include appropriate use of magnification views, how to differentiate the calcifications from more suspicious ones, and appropriate follow-up.

Pleomorphic Calcifications

2018 ◽  
Author(s):  
Stephanie A. Lee-Felker ◽  
Colin J. Wells
Keyword(s):  
Needle Biopsy ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Calcium Deposition ◽  
Imaging Features ◽  
Triangular Shape ◽  
Imaging Protocols ◽  
Multifocal Breast Cancer ◽  
Management Recommendations

Pleomorphic calcifications are categorized among calcifications with suspicious morphology: amorphous, coarse heterogeneous, fine linear or fine-linear branching, and fine pleomorphic calcifications. Unlike amorphous calcifications, pleomorphic calcifications are more conspicuous, with discernible shapes that appear predominantly irregular, and are variable in size and configuration. A segmental distribution, seen as a triangular shape with its apex centered at the nipple, is especially suspicious for ductal carcinoma in situ (DCIS) or multifocal breast cancer, as its pattern of calcium deposition suggests involvement of a duct system within the breast. This chapter, appearing in the section on calcifications, reviews the key clinical and imaging features, imaging protocols, differential diagnoses, and management recommendations for pleomorphic calcifications. Topics discussed include characteristic morphology and distribution of pleomorphic calcifications, BI-RADS assessments, core needle biopsy, and radiological–pathological correlation.

Atypical Ductal Hyperplasia and Ductal Carcinoma In Situ as Revealed by Large-Core Needle Breast Biopsy

2000 ◽  
Vol 175 (5) ◽  
pp. 1341-1346 ◽  
Author(s):  
Marla L. Rosenfield Darling ◽  
Darrell N. Smith ◽  
Susan C. Lester ◽  
Carolyn Kaelin ◽  
Donna-Lee G. Selland ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Large Core ◽  
Core Needle ◽  
Ductal Hyperplasia

Diagnosis of Papillary Breast Lesions on Core Needle Biopsy: Upgrade Rates and Interobserver Variability

2019 ◽  
Vol 27 (7) ◽  
pp. 736-743 ◽  
Author(s):  
Lianqun Qiu ◽  
Daniel D. Mais ◽  
Marlo Nicolas ◽  
Jennifer Nanyes ◽  
Kenneth Kist ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Breast Imaging ◽  
Interobserver Variability ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Breast Lesions ◽  
Ductal Hyperplasia ◽  
Papillary Lesions

The histologic distinction between papillary breast lesions remains challenging, especially with core biopsy (CB) specimens. A retrospective review of the clinical, imaging, and histologic findings was performed for patients with papillary breast lesions on CB from 2013 to 2017. The interpretation accuracy was expressed as upgrade rate relative to the excision diagnosis. Diagnostic reproducibility with and without immunohistochemistry was analyzed as interobserver variability among 3 board-certified pathologists. Among 57 papillary lesions with biopsies and excisions available for review, the upgrade rates were 0% for benign papilloma, 30% for papilloma with atypical ductal hyperplasia, and 25% for papilloma with ductal carcinoma in situ, resulting in an overall upgrade rate of 11.1%. There were no statistical differences between patients in an upgrade group and others, when comparing the patient age, clinical presentation, BI-RADS (Breast Imaging Reporting and Database System) category, location, and histologic grade. The overall interobserver variability of the 60 consecutive core biopsies of papillary breast lesions by morphology alone was in the “substantial” agreement range (κ = 0.79, 86% agreement), with an excellent κ score of 0.88 for papilloma (92% agreement). “Substantial” and “fair” κ values were seen for papilloma with atypical ductal hyperplasia/ductal carcinoma in situ (0.74, 84% agreement) and invasive carcinoma (0.40, 60% agreement). Use of immunohistochemical stains improved the κ values into “excellent” range (0.92, 94% agreement). Our study favors a conservative approach in the management of benign papillomas, at least in cases of good radiologic-pathologic concordance. Papillary breast lesions with atypia/malignancy show lower diagnostic reproducibility on CB, and utility of immunohistochemistry is recommended in challenging cases.

scholarly journals Prospective Analysis Using a Novel CNN Algorithm to Distinguish Atypical Ductal Hyperplasia From Ductal Carcinoma in Situ in Breast

2020 ◽  
Vol 20 (6) ◽  
pp. e757-e760
Author(s):  
Simukayi Mutasa ◽  
Peter Chang ◽  
John Nemer ◽  
Eduardo Pascual Van Sant ◽  
Mary Sun ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Prospective Analysis ◽  
Ductal Hyperplasia

scholarly journals Atypical Ductal Hyperplasia and Those Bordering on Ductal Carcinoma In Situ Should Be Included in the Active Surveillance Clinical Trials

2019 ◽  
Vol 153 (1) ◽  
pp. 131-138 ◽  
Author(s):  
Thaer Khoury ◽  
Nashwan Jabbour ◽  
Xuan Peng ◽  
Li Yan ◽  
Marie Quinn
Keyword(s):  
Clinical Trials ◽  
High Risk ◽  
Active Surveillance ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Screening Mammography ◽  
Ductal Hyperplasia

Abstract Objectives Women with atypical ductal hyperplasia (ADH), unlike those with ductal carcinoma in situ (DCIS), are denied eligibility for active surveillance clinical trials. Methods We applied the inclusion criteria of the Comparison of Operative to Monitoring and Endocrine Therapy (COMET) trial to the cases of women (n = 165) at the Roswell Park Cancer Institute who had a diagnosis of ADH, ADH bordering on DCIS, or low- to intermediate-grade DCIS on core biopsy taken during screening mammography. Upgrade of lesions to high risk was based on invasive carcinoma, high-grade DCIS, or DCIS with comedo necrosis. Results In total, nine (5.5%) lesions were upgraded: two (1.7%) reported ADH, one (5.9%) reported ADH bordering on DCIS, and six (19.4%) reported DCIS (P = .002); and two (1.6%) reclassified ADH vs seven (17.1%) reclassified DCIS (P < .001). In multivariate analysis, only increased number of foci had the potential to predict high risk (odds ratio: 1.39; P = .06). Conclusions We conclude that ADH and ADH bordering on DCIS have lower upgrade rates than DCIS. We recommend opening an active surveillance clinical trial for women with these diagnoses.

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