Papillary lesions of the breast: imaging findings and diagnostic challenges

Advances in breast imaging over the last 15 years have improved early breast cancer detection and management. After treatment for breast cancer, many women choose to have reconstructive surgery. In addition, with the availability of widespread genetic screening for breast cancer, an increasing number of women are choosing prophylactic mastectomies and subsequent breast reconstruction. The purpose of this pictorial essay is to present the spectrum of imaging findings in the reconstructed breast.

Download Full-text

Pseudolymphoma of the breast: imaging findings.

American Journal of Roentgenology ◽

10.2214/ajr.162.3.8109508 ◽

1994 ◽

Vol 162 (3) ◽

pp. 617-619 ◽

Cited By ~ 3

Author(s):

E B Mendelson ◽

N Doshi ◽

B C Grabb ◽

W I Goldfarb

Keyword(s):

Breast Imaging ◽

Imaging Findings

Download Full-text

Rare Extramedullary Relapse of Acute Myeloid Leukemia Manifested as Granulocytic Sarcoma of the Breast: Imaging Findings and Pathology Correlation

Journal of Medical Diagnostic Methods ◽

10.4172/2168-9784.1000103 ◽

2012 ◽

Vol 01 (01) ◽

Author(s):

Limin Yang

Keyword(s):

Acute Myeloid Leukemia ◽

Breast Imaging ◽

Myeloid Leukemia ◽

Granulocytic Sarcoma ◽

Imaging Findings ◽

Extramedullary Relapse ◽

Acute Myeloid

Download Full-text

Breast Papillary Lesions Diagnosed and Treated using Ultrasound-Guided Vacuum-Assisted Excision

10.21203/rs.3.rs-40553/v1 ◽

2020 ◽

Author(s):

Xiaohui Li ◽

Hua Gao ◽

Minling Xu ◽

Yang Wu ◽

Dezong Gao

Keyword(s):

Breast Imaging ◽

Accurate Diagnosis ◽

Atypical Hyperplasia ◽

Breast Lesions ◽

Ultrasound Images ◽

Ultrasound Guided ◽

Linear Probe ◽

Papillary Lesions ◽

Low Rate

Abstract Background: The management of papillary lesions of the breast remains controversial, and thus, we assessed the value of vacuum-assisted excision (VAE)-guided ultrasound in the diagnosis and treatment of breast papillary lesions. Methods: We retrospectively reviewed the data of 108 patients with papillary lesions diagnosed using VAE between August 2014 and January 2019. Cases without postoperative breast imaging in the follow-up were excluded, and 85 cases were eligible for the study. The follow-up period ranged from 6 to 53 months, with 38 months on average. All the papillary lesions were located away from the skin or nipple with a size less than or equal to 30 mm, and the lesions categorized as C2-4b were completely excised using VAE. All VAEs were performed using an 8-gauge vacuum-assisted biopsy needle under the guidance of ultrasound using a 10 MHz linear probe. Results: Most patients with breast papillary lesions were asymptomatic (56.5%), and when the size of the breast papillary lesion was more than 20 mm on ultrasound imaging, atypical hyperplasia may have been concomitant. Breast lesions might have been pathologically diagnosed as papilloma after biopsy when they were categorized as BI-RADS 4a on ultrasound images. The rate of underestimation was 7.7% in papillary lesions diagnosed with VAE, and the recurrence rate of papilloma after VAE was low. Conclusions: Breast papilloma was a common lesion on ultrasonographic screening, and VAE was applicable for completely excising small papillomas, even papillomas with atypical hyperplasia, to obtain an accurate diagnosis with a low rate of underestimation and recurrence. We believe that papilloma diagnosed by VAE might not require immediate excision, and imaging follow-up may be safe for at least 3 years.

Download Full-text

Benign adenomyoepithelioma of the breast: imaging findings mimicking malignancy and histopathological features

Acta Radiologica ◽

10.1080/02841850601080432 ◽

2007 ◽

Vol 48 (1) ◽

pp. 27-29 ◽

Cited By ~ 13

Author(s):

M. L. Ruiz-Delgado ◽

J. A. López-Ruiz ◽

B. Eizaguirre ◽

A. Saiz ◽

E. Astigarraga ◽

...

Keyword(s):

Breast Imaging ◽

Imaging Findings ◽

Histopathological Features

Download Full-text

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

International Journal of Surgical Pathology ◽

10.1177/1066896919854543 ◽

2019 ◽

Vol 27 (7) ◽

pp. 736-743 ◽

Cited By ~ 1

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.

Download Full-text

Injected Breast Materials: Review of Imaging Features and Characteristics

Journal of Breast Imaging ◽

10.1093/jbi/wbab035 ◽

2021 ◽

Author(s):

Yukun Gao ◽

E Jane Karimova ◽

Jordana Phillips ◽

Valerie Fein-Zachary ◽

Vandana Dialani ◽

...

Keyword(s):

Cancer Detection ◽

Breast Augmentation ◽

Breast Imaging ◽

Breast Implants ◽

The United States ◽

Imaging Features ◽

Imaging Findings ◽

Imaging Appearance ◽

Characteristic Imaging ◽

Optimal Patient Management

Abstract In the United States, silicone and saline breast implants with their familiar radiologic appearance are the mainstays of breast augmentation. However, less well-known sequelae of unconventional injected materials introduced for cosmetic and noncosmetic purposes may also be encountered on breast imaging—for example, free silicone, paraffin and/or oil, polyacrylamide gel, autologous fat, and hyaluronic acid, which are encountered in the setting of breast augmentation. Breast injection of go-yak is not cosmetic but also results in characteristic imaging findings. Breast changes due to extravasation of chemotherapy or interstitial brachytherapy can mimic the appearance of injected noncosmetic materials. Because many of these materials can mimic or obscure imaging findings of breast cancer, it is important to recognize their varied appearances and the limitations of imaging alone in delineating breast injection material from cancer. Given the relatively uncommon incidence of injected materials into the breast, this article aims to review the imaging appearance in order to aid radiologists in maximizing cancer detection and ensuring optimal patient management.

Download Full-text