scholarly journals Non-mass breast lesions on ultrasound: final outcomes and predictors of malignancy

2017 ◽  
Vol 58 (9) ◽  
pp. 1054-1060 ◽  
Author(s):  
Jong Won Park ◽  
Kyung Hee Ko ◽  
Eun-Kyung Kim ◽  
Cherie M Kuzmiak ◽  
Hae Kyoung Jung
Keyword(s):  
Ductal Carcinoma ◽  
Architectural Distortion ◽  
Breast Lesions ◽  
Invasive Ductal Cancer ◽  
Ultrasound Findings ◽  
Risk Of Malignancy ◽  
Malignant Lesions ◽  
Mass Lesions

Background Breast cancer can present as non-mass lesions (NMLs) on ultrasound. However, knowledge of and understanding about NMLs are scarce. Purpose To retrospectively investigate the final outcomes of sonographic breast NMLs and determine the clinical and radiologic variables associated with malignancy Material and Methods In our radiologic database of breast ultrasound examinations between 2011 and 2014, we found 119 women with 121 NMLs with available histopathologic or sonographic follow-up (over 2 years) data. We collected the clinical variables (patient’s age, symptoms, and mammographic density) and histopathologic data as well as radiologic variables (mammographic and ultrasound findings) after retrospective review by two radiologists, the authors of the current paper, in consensus. We classified the ultrasound findings according to distribution (focal, linear or segmental, and regional) and associated features (calcification, architectural distortion, and ductal changes) and analyzed the associations between variables and malignancy using the t test and χ2 test. Results Of the 121 NMLs, 88 (72.7%) were benign and 33 (27.3%) were malignant. Ductal carcinoma in situ (DCIS) (17/33, 51.5%) and invasive ductal cancer with or without DCIS (13/33, 39.4%) comprised the main malignancies, and malignancy was significantly associated with palpability ( P = 0.000). Mammographic findings and sonographic distribution and associated features were significantly different between benign and malignant lesions ( P = 0.000, P = 0.004, and P = 0.001, respectively). Malignant lesions showed more frequent calcifications combined with asymmetry ( P = 0.000) on mammography and linear-segmental distributions ( P = 0.001) and associated calcifications ( P = 0.019) or architectural distortions ( P = 0.015) on ultrasound. Conclusion Breast NMLs on ultrasound showed high risk of malignancy. Symptoms and mammographic and ultrasound findings can be possible predictors of malignancy in NMLs.

A Case Series of Malign Hyperechoic Breast Lesions

2020 ◽  
Vol 16 (6) ◽  
pp. 766-773
Author(s):  
Temel Fatih Yilmaz ◽  
Lütfullah Sari ◽  
Hafize Otçu Temur ◽  
Hüseyin Toprak ◽  
Şeyma Yildiz
Keyword(s):  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Case Series ◽  
Clinical History ◽  
Routine Practice ◽  
Breast Lesions ◽  
Breast Masses ◽  
Malignant Lesions ◽  
Rare Group

Background:: Hyperechoic breast lesions are a rare group of breast masses in routine practice. Most of these lesions are benign. However, they rarely may be malignant. Hyperechoic lesions can be evaluated using the same criteria for malignant lesions. Clinical history, mammographic appearance, and certain sonographic features (non-circumscribed margins, irregular shape, presence of hypoechoic areas, nonparallel orientation, and association with microcalcifications can be suggestive of malignancy). In this article, hyperechoic breast lesions with malignant pathology have been presented. Methods: : Seven cases during breast ultrasound examination were detected. Results:: Four patients had invasive ductal carcinoma, 1 patient had invasive lobular carcinoma, 1 patient had high-grade ductal carcinoma in situ (DCIS), and 1 patient had lymphoma. Ultrasonography of the breast showed a heterogeneous appearance in all the patients, microcalcification in two patients, and an ambiguous contour in one patient. Conclusion:: Hyperechoic breast lesions should be evaluated using specific sonographic criteria to prevent misdiagnosis and identify patients who require biopsy and further examination.

Marking of Wire-Localized Breast Biopsies for Mammographically Detected Microcalcifications

2002 ◽  
Vol 32 (3) ◽  
pp. 171-173
Author(s):  
Suzanne E Shirley ◽  
Deanne P Soares
Keyword(s):  
Simple Technique ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Screening Mammography ◽  
Hypodermic Needle ◽  
Breast Lesions ◽  
Main Method ◽  
Biopsy Specimens ◽  
Malignant Lesions

Impalpable breast lesions that are detected during screening mammography for breast cancer must be accurately identified and adequately sampled in biopsy specimens. Open wire-localized breast biopsy using hookwires remains the main method of sampling these lesions in centres without expensive stereotactic facilities. However, the hookwires can shift or become dislodged in the biopsy specimen. We have successfully modified a simple technique for the localization of impalpable lesions in these biopsies. The insertion of a small hypodermic needle into the fixed specimen with the assistance of the compression paddle and crosshairs on the mammography machine resulted in the precise localization of clusters of microcalcifications in 15 of 16 (94%) cases. In contrast, calcifications were identified in sections taken in the plane of the hookwire in only three cases (19%). The rate of detection of malignancy was 50% and the majority of malignant lesions were represented by ductal carcinoma in situ.

Classification of Male Breast Lesions According to the IAC Yokohama System for Reporting Breast Cytopathology

2020 ◽  
pp. 1-8
Author(s):  
Melissa Oosthuizen ◽  
Rubina Razack ◽  
Jenny Edge ◽  
Pawel Tomasz Schubert
Keyword(s):  
Predictive Value ◽  
Best Practice ◽  
Internal Audit ◽  
Needle Aspiration ◽  
Male Breast ◽  
Histopathological Diagnosis ◽  
Breast Lesions ◽  
Risk Of Malignancy ◽  
Sensitivity Specificity

<b><i>Objective:</i></b> This study aims to determine the diagnostic utility of the International Academy of Cytology (IAC) Yokohama System for reporting breast cytopathology in lesions of the male breast. <b><i>Study Design:</i></b> Fine-needle aspiration biopsy (FNAB) reports between 2015 and 2019 were retrospectively recategorized according to the 5-tiered IAC Yokohama Reporting System. Our database yielded a total of 1,532 FNAB reports from breast lesions, obtained from 1,350 male patients. The risk of malignancy (ROM) and diagnostic performance of FNAB were determined using follow-up histopathological diagnosis and/or clinical follow-up, where available, for each category. <b><i>Results:</i></b> The category distribution were as follows: inadequate, 40%; benign, 57%; atypical, 0.6%; suspicious for malignancy, 0.7%; and malignant, 1.6%. The ROM in each category was nondiagnostic, 11%; benign, 3%; atypical, 28%; suspicious for malignancy, 56%; and malignant, 100%. The sensitivity, specificity, positive predictive value, and negative predictive value were recorded as 63, 100, 100, and 84.6% respectively, when only malignant cases were considered as positive tests. <b><i>Conclusion:</i></b> This study validates the IAC Yokohama System for reporting male breast cytopathology. In accordance with the aim of the Yokohama System to establish best practice guidelines for reporting breast cytopathology, this comprehensive scheme facilitates comparisons between local and international institutions. The ROM acts as an internal audit for quality assurance within one’s own laboratory and provides guidance for clinical management. It highlights inefficiencies such as high inadequacy rates for category 1 and also features strengths with impressive specificity for categories 4 and 5.

Breast-Conserving Treatment With or Without Radiotherapy in Ductal Carcinoma-In-Situ: Ten-Year Results of European Organisation for Research and Treatment of Cancer Randomized Phase III Trial 10853—A Study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group

2006 ◽  
Vol 24 (21) ◽  
pp. 3381-3387 ◽  
Author(s):  
Nina Bijker ◽  
Philip Meijnen ◽  
Johannes L. Peterse ◽  
Jan Bogaerts ◽  
Irène Van Hoorebeeck ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Phase Iii ◽  
Breast Conserving Treatment ◽  
European Organisation ◽  
Radiotherapy Group ◽  
Long Term Follow Up

Purpose The European Organisation for Research and Treatment of Cancer conducted a randomized trial investigating the role of radiotherapy (RT) after local excision (LE) of ductal carcinoma-in-situ (DCIS) of the breast. We analyzed the efficacy of RT with 10 years follow-up on both the overall risk of local recurrence (LR) and related to clinical, histologic, and treatment factors. Patients and Methods After complete LE, women with DCIS were randomly assigned to no further treatment or RT (50 Gy). One thousand ten women with mostly (71%) mammographically detected DCIS were included. The median follow-up was 10.5 years. Results The 10-year LR-free rate was 74% in the group treated with LE alone compared with 85% in the women treated by LE plus RT (log-rank P < .0001; hazard ratio [HR] = 0.53). The risk of DCIS and invasive LR was reduced by 48% (P = .0011) and 42% (P = .0065) respectively. Both groups had similar low risks of metastases and death. At multivariate analysis, factors significantly associated with an increased LR risk were young age (≤ 40 years; HR = 1.89), symptomatic detection (HR = 1.55), intermediately or poorly differentiated DCIS (as opposed to well-differentiated DCIS; HR = 1.85 and HR = 1.61 respectively), cribriform or solid growth pattern (as opposed to clinging/micropapillary subtypes; HR = 2.39 and HR = 2.25 respectively), doubtful margins (HR = 1.84), and treatment by LE alone (HR = 1.82). The effect of RT was homogeneous across all assessed risk factors. Conclusion With long-term follow-up, RT after LE for DCIS continued to reduce the risk of LR, with a 47% reduction at 10 years. All patient subgroups benefited from RT.

scholarly journals Ductal carcinoma in situ presenting as a cystic retroareolar lesion in an African American man

2021 ◽  
Author(s):  
Amara Ndumele ◽  
Amy Kerger ◽  
Gary Tozbikian ◽  
Samilia Obeng-Gyasi ◽  
Bridget Oppong
Keyword(s):  
African American ◽  
Health Outcomes ◽  
Chest Wall ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Cystic Lesion ◽  
Ductal Carcinoma ◽  
Unusual Finding

We report an unusual finding of DCIS within a cystic lesion in a black man highlighting the need for adequate workup, and timely follow-up for men with breast/chest wall masses given the lack of screening in this population. Furthermore, we will explore how race contributes to prognosis and health outcomes.

scholarly journals Complex fibroadenoma with focal ossification- an enigmatic finding in a less common tumor

2021 ◽  
Vol 8 (5) ◽  
pp. 1650
Author(s):  
Subhransu Kumar Hota ◽  
Ranjana Giri ◽  
Hardik Kabra ◽  
Devika Chauhan ◽  
Prita Pradhan ◽  
...  
Keyword(s):  
Excision Biopsy ◽  
Radiological Findings ◽  
Breast Lump ◽  
In Situ Carcinoma ◽  
Unusual Occurrence ◽  
Malignant Lesions ◽  
Breast Lumps ◽  
Sclerosing Adenosis

Breast lumps have diverse causes including benign as well as malignant lesions. Fibroadenoma (FA) is a common cause of breast lump. Complex fibroadenomas, a particular subtype, pose diagnostic dilemmas due to confusing the radiological findings and hold higher incidence of transformation to malignancy. A 49 year old female presented with a painless lump in right breast for 2 years which appeared calcified on radiology. Excision biopsy was performed which grossly revealed an encapsulated grey-white firm to hard with cystic areas. Microscopically the sections showed a well encapsulated fibroepithelial tumor showing areas of sclerosing adenosis, hyalinization, cysts lined by cuboidal cells with eosinophilic secretions, areas of calcification and ossification. No evidence of lobular hyperplasia or in-situ carcinoma was seen. Patient was advised follow up. This case represents the unusual occurrence of complex fibroadenoma in a middle-aged female showing with ossification.

scholarly journals Histopathology findings of non-mass cancers on breast ultrasound

2018 ◽  
Vol 7 (6) ◽  
pp. 205846011877495 ◽  
Author(s):  
Hye Rin Kim ◽  
Hae Kyoung Jung
Keyword(s):  
Ductal Carcinoma ◽  
Immunohistochemical Analysis ◽  
Breast Ultrasound ◽  
Her2 Overexpression ◽  
Tumor Type ◽  
Breast Cancers ◽  
Mammographic Finding ◽  
Minimal Invasion ◽  
Mass Lesions

Background There is little research done on non-mass cancers (NMCs) on breast ultrasound (US). Purpose To evaluate large-sectional histopathology findings of NMCs on breast US. Material and Methods The mammographic and histopathology features of biopsy proven 36 breast cancers which showed pure non-mass lesions on US were retrospectively reviewed. Results The most common mammographic finding was microcalcification (23/35, 65.7%); fine pleomorphic microcalcification was predominant (18/23, 78.3%). The main tumor type was pure ductal carcinoma in situ (DCIS) (14/36, 38.9%) and DCIS with micro- or minimal invasion (11/36, 30.6%). Among the 25 DCIS, histologic grade was high in 15 (60.0%) and intermediate in nine (36%); comedo necrosis was seen in 17 (68%). Immunohistochemical analysis was available in 27 lesions and showed HER2-overexpression in 12 (44.4%) and triple-negative in two (7.4%). Conclusion According to our limited patient sample, NMCs on breast US were mainly associated with high-grade DCIS.

Architectural Distortion on Digital Breast Tomosynthesis: Management Algorithm and Pathological Outcome

2020 ◽  
Vol 2 (5) ◽  
pp. 424-435
Author(s):  
Naziya Samreen ◽  
Linda Moy ◽  
Cindy S Lee
Keyword(s):  
Digital Mammography ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Digital Breast Tomosynthesis ◽  
Percutaneous Biopsy ◽  
Architectural Distortion ◽  
Imaging Findings ◽  
Breast Tomosynthesis ◽  
Management Algorithm

Abstract Architectural distortion on digital breast tomosynthesis (DBT) can occur due to benign and malignant causes. With DBT, there is an increase in the detection of architectural distortion compared with 2D digital mammography, and the positive predictive value is high enough to justify tissue sampling when imaging findings are confirmed. Workup involves supplemental DBT views and ultrasound, with subsequent image-guided percutaneous biopsy using the modality on which it is best visualized. If architectural distortion is subtle and/or questionable on diagnostic imaging, MRI may be performed for problem solving, with subsequent biopsy of suspicious findings using MRI or DBT guidance, respectively. If no suspicious findings are noted on MRI, a six-month follow-up DBT may be performed. On pathology, malignant cases are noted in 6.8%–50.7% of the cases, most commonly due to invasive ductal carcinoma, followed by invasive lobular carcinoma. Radial scars are the most common benign cause, with stromal fibrosis and sclerosing adenosis being much less common. As there is an increase in the number of benign pathological outcomes for architectural distortion on DBT compared with 2D digital mammography, concordance should be based on the level of suspicion of imaging findings. As discordant cases have upgrade rates of up to 25%, surgical consultation is recommended for discordant radiologic-pathologic findings.

Histological Assessment of Breast Lesions Identified Exclusively by Magnetic Resonance

2014 ◽  
Vol 80 (10) ◽  
pp. 944-947
Author(s):  
Victoria O'connor ◽  
Elizabeth Arena ◽  
Joslyn Albright ◽  
Nefertiti Brown ◽  
Ryan O'connor ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Low Grade ◽  
Breast Lesions ◽  
Significant Family History ◽  
Ductal Hyperplasia ◽  
Significant Pathology

Radiologic–pathologic correlation of lesions diagnosed by magnetic resonance (MR) is precluded by insufficient data on histological characteristics of lesions suspicious on MR but not visible on concurrent mammogram or ultrasound. The objective of this study was to describe histological features of breast lesions diagnosed exclusively by MR. The participants underwent MR-guided breast biopsy between 2007 and 2012 for a suspicious lesion not identified by mammography or ultrasound. Histology slides were interpreted retrospectively by a breast pathologist. Of 126 patients (126 lesions), 34 (27%) had new breast cancer, 51 (40.5%) previous breast cancer, and 41 (32.5%) dense breasts or a significant family history of breast cancer. MR identified 23 (18.3%) invasive cancers: 20 were Grade 1 and 17 were ductal. Of the 126 lesions, 16 (13%) were ductal carcinoma in situ (DCIS), four were atypical ductal hyperplasia and atypical lobular hyperplasia (3%), and 68 (54%) were benign. Fifteen biopsies (12%) had no significant pathology. Five DCIS lesions were upgraded to T1 invasive cancers. Approximately 30 per cent of suspicious lesions detected exclusively by MR are invasive or in situ cancers that are predominantly low grade. Further studies are needed to determine if malignant lesions can be prospectively distinguished by MR characteristics.

Solitary, Well-Circumscribed, T2 Hyperintense Masses on MRI Have Very Low Malignancy Rates

2019 ◽  
Vol 1 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Lars J Grimm ◽  
Michael Enslow ◽  
Sujata V Ghate
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Mri ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Malignancy Rate ◽  
The Masses

Abstract Objective The purpose of this study was to determine the malignancy rate of solitary MRI masses with benign BI-RADS descriptors. Methods A retrospective review was conducted of all breast MRI reports that described a mass with a final BI-RADS assessment of 3, 4, or 5, from February 1, 2005, through February 28, 2014 (n = 1510). Studies were excluded if the mass was not solitary, did not meet formal criteria for a mass, or had classically suspicious BI-RADS features (e.g., washout kinetics, and spiculated margin). The masses were reviewed by 2 fellowship-trained breast radiologists who reported consensus BI-RADS mass margin, shape, internal-enhancement, and kinetics descriptors. The T2 signal was reported as hyperintense if equal to or greater than the signal intensity of the axillary lymph nodes. Pathology results or 2 years of imaging follow-up were recorded. Comparisons were made between mass descriptors and clinical outcomes. Results There were 127 women with 127 masses available for analysis. There were 76 (60%) masses that underwent biopsy for an overall malignancy rate of 4% (5/127): 2 ductal carcinoma in situ (DCIS) and 3 invasive ductal carcinoma. The malignancy rate was 2% (1/59) for T2 hyperintense solitary masses. The malignancy rate was greater than 2% for all of the following BI-RADS descriptors: oval (3%, 3/88), round (5%, 2/39), circumscribed (4%, 5/127), homogeneous (4%, 3/74), and dark internal septations (4%, 2/44). Conclusion T2 hyperintense solitary masses without associated suspicious features have a low malignancy rate, and they could be considered for a BI-RADS 3 final assessment.

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