Primary breast edema on contrast-enhanced digital mammography: a preliminary experience

Abstract Background Primary breast edema can cause marked increase in skin thickness, breast density and echogenicity due to dense breast tissue filled with fluid and so causes subsequent significant attenuation of both the x-ray and ultrasound beams. The study aim is to assess the value of contrast-enhanced digital mammography (CEDM) in assessment and characterization of the obscured underlying breast lesions in cases of primary breast edema. Results Fifty five female participants were evaluated, of median age 51 years old and IQR 21. CEDM shows high sensitivity and specificity in the lesion detection as well as local extension delineation in cases associated with primary breast edema. It was accurate in detection of multifocal/multi-centric disease. CEDM is considered as a good negative test in cases of metastatic axillary lymph nodes to exclude and assess any associated obscured breast lesions, as it is good in delineating breast masses obscured by condensed parenchymal tissue. The calculated sensitivity of DM & CEDM was 87.5%, 95.8%, specificity was 55.5%, 72%, the PPV and NPV were 91, 93.6% and 45%, 77.8%, respectively. Conclusions CEDM has an important additional diagnostic value in the assessment, characterization and better delineation of breast lesions in primary edematous breast cases.

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Prediction of the number of metastatic axillary lymph nodes in breast cancer by radiomic signature based on dynamic contrast-enhanced MRI

Acta Radiologica ◽

10.1177/02841851211025857 ◽

2021 ◽

pp. 028418512110258

Author(s):

Lan Li ◽

Tao Yu ◽

Jianqing Sun ◽

Shixi Jiang ◽

Daihong Liu ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Area Under The Curve ◽

Test Group ◽

Predictive Performance ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Dynamic Contrast Enhanced ◽

Contrast Enhanced ◽

Delayed Phase

Background The number of metastatic axillary lymph nodes (ALNs) play a crucial role in the staging, prognosis and therapy of patients with breast cancer. Purpose To predict the number of metastatic ALNs in breast cancer via radiomics. Material and Methods We enrolled 197 patients with breast cancer who underwent dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). A total of 3386 radiomic features were extracted from the early- and delayed-phase subtraction images. To classify the number of metastatic ALNs, logistic regression was used to develop a radiomic signature and nomogram. Results The radiomic signature were constructed to distinguish the N0 group from the N+ (metastatic ALNs ≥ 1) group, which yielded area under the curve (AUC) values of 0.82 and 0.81 in the training and test group, respectively. Based on the radiomic signature and BI-RADS category, a nomogram was further developed and showed excellent predictive performance with AUC values of 0.85 and 0.89 in the training and test groups, respectively. Another radiomic signature was constructed to distinguish the N1 (1–3 ALNs) group from the N2–3 (≥4 metastatic ALNs) group and showed encouraging performance with AUC values of 0.94 and 0.84 in training and test group, respectively. Conclusions We developed a nomogram and a radiomic signature that can be used to predict ALN metastasis and distinguish the N1 from the N2-3 group. Both nomogram and radiomic signature may be potential tools to assist clinicians in assessing ALN metastasis in patients with breast cancer.

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Atypical axillary lymphadenopathy mimicking an occult breast carcinoma in a patient diagnosed with sarcoidosis: case report

Mastology ◽

10.29289/259453942020v30s1004 ◽

2020 ◽

Vol 30 (Suppl 1) ◽

Author(s):

Paula Clarke ◽

Carolina Nazareth Valadares ◽

Douglas de Miranda Pires ◽

Nayara Carvalho de Sá

Keyword(s):

Breast Cancer ◽

Case Report ◽

Breast Carcinoma ◽

Lymph Nodes ◽

Axillary Lymph Nodes ◽

Breast Lesions ◽

Axillary Lymph ◽

Axillary Lymphadenopathy ◽

Granulomatous Lymphadenitis ◽

Occult Breast Carcinoma

Introduction: Occult breast carcinoma is a rare presentation of breast cancer, with histological evidence of axillary lymph node involvement and clinical and radiological absence of malignant breast lesions. Its survival is similar to that of the usual presentation. The treatment consists of modified radical mastectomy or axillary drainage with breast irradiation, resulting in similar survival, associated with systemic therapy according to the staging. Neoadjuvant therapy should be considered in N2-3 axillary cases. Differential diagnoses of axillary lymphadenopathies include: non-granulomatous causes (reactive, lymphoma, metastatic carcinoma) and granulomatous causes (infectious – toxoplasmosis, tuberculosis, sarcoidosis, atypical mycobacteria). Objectives: To report the case of a patient who needed a differential diagnosis among the various causes of axillary lymphadenopathy. Methods: This is a literature review conducted in the PubMed database, using the keywords "granulomatous lymphadenitis", "breast sarcoidosis", "occult breast cancer". Inclusion and exclusion criteria were applied. Case report: V.F.S., female, 51 years old, was referred to an evaluation of axillary lymphadenopathy in May 2019. She was followed by the department of pulmonology due to mediastinal sarcoidosis since 2017. Physical examination indicated breasts without changes. Axillary lymph nodes had increased volume and were mobile and fibroelastic. Mammography revealed only axillary lymph nodes with bilaterally increased density, and the ultrasound showed the presence of atypical bilateral lymph nodes. Neither presented breast lesions. Axillary lymph node core biopsy was compatible with granulomatous lymphadenitis. This result corroborates the diagnosis of sarcoidosis affecting peripheral lymph nodes. The patient was referred back to the department of pulmonology, with no specific treatment since she is oligosymptomatic. Discussion: Despite the context of benign granulomatous disease, malignancy overlying the condition of sarcoidosis must be ruled out. The biopsy provided a safe and definitive diagnosis, excluding the possibility of occult breast carcinoma. The patient will continue to undergo breast cancer screening as indicated for her age and usual risk. Conclusion: In the presentation of axillary lymphadenopathy, the mastologist must know the various diagnoses to be considered. The most feared include lymphoma and carcinoma metastasis with occult primary site. A proper workup can determine the diagnosis and guide the appropriate treatment.

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The role of contrast-enhanced ultrasound in the diagnosis of malignant non-mass breast lesions and exploration of diagnostic criteria

British Journal of Radiology ◽

10.1259/bjr.20200880 ◽

2021 ◽

Vol 94 (1120) ◽

pp. 20200880

Author(s):

Fan Zhang ◽

Lifang Jin ◽

Gang Li ◽

Chao Jia ◽

Qiusheng Shi ◽

...

Keyword(s):

Diagnostic Criteria ◽

Sensitivity And Specificity ◽

Breast Imaging ◽

Diagnostic Value ◽

Binary Logistic Regression Analysis ◽

Lower Sensitivity ◽

Breast Lesions ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced ◽

Histopathological Results

Objectives: To assess the value of contrast-enhanced ultrasound (CEUS) for diagnosing malignant non-mass breast lesions (NMLs) and to explore the CEUS diagnostic criteria. Methods: A total of 116 patients with 119 NMLs detected by conventional US were enrolled. Histopathological results were used as the reference standard. The enhancement characteristics of NMLs in CEUS were compared between malignant and benign NMLs. The CEUS diagnostic criteria for malignant NMLs were established using independent diagnostic indicators identified by binary logistic regression analysis. The diagnostic performance of Breast Imaging Reporting and Data System-US (BI-RADS-US), CEUS, and BI-RADS-US combined with CEUS was evaluated and compared. Results: Histopathological results showed 63 and 56 benign and malignant NMLs. Enhancement degree (OR = 5.75, p = 0.003), enhancement area (OR = 4.25, p = 0.005), and radial or penetrating vessels (OR = 7.54, p = 0.003) were independent diagnostic indicators included to establish the CEUS diagnostic criteria. The sensitivity and specificity of BI-RADS-US, CEUS, and BI-RADS-US combined with CEUS were 100 and 30.2%, 80.4 and 74.6%, and 94.6 and 77.8%, respectively; the corresponding areas under the receiver operating characteristic curve (AUC) were 0.819, 0.775, and 0.885, respectively. Conclusions: CEUS has a high specificity in malignant NML diagnosis based on the diagnostic criteria including enhancement degree, enhancement area, and radial or penetrating vessels, but with lower sensitivity than BI-RADS-US. The combination of CEUS and BI-RADS-US is an effective diagnostic tool with both high sensitivity and specificity for the diagnosis of malignant NMLs. Advances in knowledge: In this study, we assessed the diagnostic value of CEUS for malignant NMLs and constructed a feasible diagnostic criterion. We further revealed that the combination of CEUS and BI-RADS-US has a high diagnostic value for malignant NMLs.

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Role of Contrast-Enhanced Sonography in the Evaluation of Axillary Lymph Nodes in Breast Carcinoma: A Monocentric Study

Journal of Ultrasound in Medicine ◽

10.7863/ultra.16.04012 ◽

2017 ◽

Vol 36 (3) ◽

pp. 505-511 ◽

Cited By ~ 4

Author(s):

Giacomo Agliata ◽

Gianluca Valeri ◽

Giulio Argalia ◽

Elisa Tarabelli ◽

Gian Marco Giuseppetti

Keyword(s):

Breast Carcinoma ◽

Lymph Nodes ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Contrast Enhanced

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Diagnostic Accuracy of Mammography and Contrast-Enhanced MR Imaging in 238 Histologically Verified Breast Lesions

Acta Radiologica ◽

10.1080/02841859709174374 ◽

1997 ◽

Vol 38 (4) ◽

pp. 489-496 ◽

Cited By ~ 51

Author(s):

B. Boné ◽

Z. Péntek ◽

L. Perbeck ◽

B. Veress

Keyword(s):

Mr Imaging ◽

Breast Surgery ◽

Histopathological Examination ◽

High Sensitivity ◽

Histopathological Diagnosis ◽

Breast Lesions ◽

Benign Lesions ◽

Post Contrast ◽

X Ray ◽

Contrast Enhanced

Purpose: To determine the sensitivity and specificity of X-ray mammography and of MR imaging in 238 consecutively operated breasts, and to correlate the findings to histopathological diagnosis. Material and Methods: Over 15 months, 220 patients scheduled for breast surgery were examined consecutively, before surgery, by means of both mammography and MR imaging. of the 220 patients, 18 underwent bilateral breast surgery. The entire breast was examined by means of T1-weighted transversal images using a 3D fast low-angle shot (FLASH) sequence. One pre— and 2 post-contrast scans were performed. Each breast was examined by means of mammography and 3 views were applied as routine. All palpable and mammographically suspect lesions were examined on additional images as microfocus magnification or spot compression. The two methods were evaluated independently of each other. Results: In total, 145 malignant and 93 benign lesions were found at histopathological examination. The sensitivity of mammography was 89% and MR imaging 92%. The specificity was 72% in both methods. When the results of the 2 methods were combined, a sensitivity of 99% and a specificity of 55% was achieved. Conclusion: Mammography and MR imaging seemed to complement each other to produce a high sensitivity. Unfortunately it is impossible at present to supplement mammography with MR imaging in each patient as a routine owing to the current technical and financial limitations.

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