Carcinoma within fibroadenomas: mammographic features

The mammographic features of carcinoma originating within a fibroadenoma in 24 patients were studied by means of retrospective review of pathologic slides. Histologic examination showed that the lesions were lobular carcinoma in situ (LCIS) (seven patients), ductal carcinoma in situ (DCIS) (13 patients), synchronous LCIS and invasive lobular carcinoma (one patient), and synchronous LCIS and DCIS (three patients). In all patients the mammographic manifestation was a mass 1.0 cm or greater in diameter; 14 masses were 1-2 cm in diameter, and the remainder were more than 2 cm in diameter. Features that were considered suspect included large size, indistinct margins, and clustered microcalcifications. In three patients, microcalcifications within the mass raised suspicion of malignancy. At histologic examination these microcalcifications were associated with the intraductal carcinoma harbored in the fibroadenoma in only one of these patients. Fibroadenomas that harbor carcinoma may be indistinguishable from common benign fibroadenomas, but their occurrence is rare. In this study, a single patient had invasive lobular carcinoma; all the other lesions were in situ lesions.

[Parasternal lymphoscintigraphy in planning the radiation therapy of breast cancer]

Altogether 82 breast cancer patients were investigated to determine a possibility of the use of parasternal lymphoscintigraphy with colloid finely divided radiopharmaceuticals 99mTc and 198Au to form individual irradiation fields; 43 patients with fibroadenomatosis were taken as controls. Variants of the localization of parasternal lymph nodes were defined, standard and "optimum" (individual) parasternal irradiation field values were compared. 54.9% of the patients were shown to be in need of correction by increasing a standard irradiation field (5 cm wide).

[Sonography in breast diagnosis]

In a prospective study of 235 tissue masses verified histologically, we examined the diagnostic contribution of ultrasound in comparison to mammography. When the two methods were combined, 96.8% of all malignant neoplasms could be diagnosed correctly. Most (90.5%) were found by mammography alone and 4.8% were detectable by ultrasonography but not by mammography. Despite relatively good results in the evaluation of solid masses, it is not advisable to omit tissue examination. The superiority of ultrasound over mammography in the diagnosis of cystic lesions could lead to a significant reduction in needle aspirations and biopsies.

[Investigation on calcifications in the breast]

This article reported the result of analysis of 96 cases with heaps of calcifications in the breast all verified by operation. The calcifications, according to the appearances on X-ray film were classified into 4 patterns: club-shaped, fine sandy, fragmented stonelike and coalescent. A comprehensive analysis was made in regard to spatial distribution and amount of calcification and the presence of a mass. The results indicated that club-shaped calcification is highly suggestive of malignancy regardless of the amount of calcification and the presence or absence of a mass. Simple fine sandy calcification in the absence of a mass can not differentiate benign from malignancy because of wide range of overlapping, whereas simple fragmented stone and coalescent types, according to the authors opinion denote benign.

Radiologic case. Fibroadenoma of the breast

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The role of fine needle aspiration for breast cancer in the climacteric--a preliminary report

Fine needle biopsy has been used with great accuracy in the diagnosis of breast tumours. There have been few reports on its efficacy as an adjunct to other breast screening techniques like x-ray mammography. Abnormal mammograms in the absence of a palpable breast lump are sometimes detected in the climacteric and these pose a problem of tissue sampling for pathologic diagnosis. We have tried to evaluate the technique of radiologically guided fine needle aspiration in such patients. Our report is of an initial series of 13 cases of non-palpable, mammographically abnormal breast lesions. Eight cases were fibroadenoma, 4 cases mammary dysplasia and 1 a benign breast lesion. Representative cytologic samples were obtained in 11 of our 13 cases. Cytologic diagnosis should be correlated with mammographic findings.

X-ray characterisation of normal and neoplastic breast tissues

Normal and neoplastic breast tissues have been characterised in terms of x-ray attenuation. Samples of normal fat and fibrous tissue were obtained from reduction mammoplasty and autopsy, and infiltrating duct carcinoma specimens from mastectomy and lumpectomy. A high-purity germanium spectroscopy system and a beam of 120 kV constant potential x-rays were used to determine the linear attenuation coefficient from 18 to 110 keV. Densities were determined from buoyancy measurements and were used to obtain mass attenuation coefficients. Infiltrating duct carcinomas and fat are well distinguished by x-ray attenuation. For photon energies used for film-screen mammography, infiltrating duct carcinomas are more attenuating than fibrous tissue. Above 31 keV, the ranges of attenuation of the two tissue types overlap. The attenuation coefficients of tissues have been concisely represented by equivalent thicknesses of lucite and aluminium. Analysis based on the average attenuation properties of tissues indicates that dual-energy mammography, using an ideal imaging system, would require 0.06 cGy to provide images in which 1 cm infiltrating duct carcinomas are displayed with a signal to noise ratio of 5 against a background over which the fat/fibrous contrast has been suppressed. This dose is similar to that currently used in conventional film-screen mammography.

Breast calcifications: mammographic evaluation

Breast calcifications may be categorized as benign, probably benign, and suggestive of malignancy. The interpretation scheme presented here utilizes a systematic structured approach: identify characteristically benign calcifications, for which no further evaluation is needed; define as suggestive of malignancy those remaining calcifications that present as isolated parenchymal clusters of tiny calcific particles; and (optional) attempt to downgrade some of these suspicious calcifications into the "probably benign" category, so that they can be managed by periodic mammographic follow-up rather than biopsy. The clinical acceptability of this approach will vary with local conditions; success in implementing it will encourage increased use of mammography, and ultimately, improved breast health care.

MR imaging of the breast: comparison with mammography and ultrasound

Fifty-seven biopsy proven breast masses have been examined at our institution by magnetic resonance (MR), mammography, and ultrasound. The three techniques have been evaluated concerning their capability to visualize the lesion and the diagnostic information obtained. Magnetic resonance proved comparable to mammography and superior to sonography in the fatty to medium dysplastic breasts but inferior to the combined examination by mammography and sonography in the dense breasts. In some selected cases, however, special advantages of MR have been found.

Evaluation of nonpalpable breast lesions. Experience in a training institution

Biopsy directed by needle localization is a safe and relatively simple method of obtaining abnormal tissue for histologic examination without sacrificing surrounding normal breast tissue. In the setting of a training institution, accurate results can be expected as technical skills are obtained by a variety of housestaff. In this series of 70 biopsies, the lesion targeted on mammography was removed on the initial attempt in all but 1 instance, for an overall accuracy of 99 percent.

[Fibroadenolipoma of the breast]

Three cases of fibroadenolipoma (adenolipoma, hamartoma) of the breast are reported out of sixteen thousand mammographies. Their typical radiological findings are described.

[Direct magnification in mammography with a 0.3 millimeter focus]

The authors emphasize the value of mammography with a 0.3 millimetres microfocus-tube with a magnification system. This technique is limited to those large lesions increasing "twilight effect". For a better study of all breast's lesions the use of fine microfocus-tubes is suggested, as it results also from the latest literature.

Mammographic needle localization of lesions seen in only one view

A new xeromammographic needle localization technique for occult breast lesions seen on only one view is described, which permitted successful localization of an occult lesion visible only on mediolateral projection. To test its accuracy, the method was also applied to 15 other cases (16 lesions) where the lesion was seen in two views, but localization was performed as if it were seen in one view only. The technique takes advantage of the geometry of x-ray beam angulation and triangulation.

Fibroadenolipoma of the breast

Fibroadenolipoma is a well recognised but unusual benign tumour of the breast. It is a circumscribed lesion composed of fat and other breast tissues which may be normal or which may show various benign changes. The presence of smooth muscle has been recorded but was not found in our cases. A series of eight cases is described, occurring over a period of 10 years in a series of 20 000 mammograms. Radiological and pathological correlation is made and histological changes are described. Our findings are compared with other reviews in the literature. The lesions are usually diagnosed radiologically.

[Hamartoma of the breast. Comparative mammographic and histopathological studies]

Hamartomas of the breast are well circumscribed tumour-like lesions composed of fibroadipose and glandular tissue in variable degrees, depending on the patients' age. The nodules have a pseudocapsule and can easily be enucleated surgically. They may be recognised on mammography by their contours and density. Clinically they appear as painless areas of induration most frequently in the fourth and fifth decade of life. Pathogenetically it is assumed that they are an additional sprout of the breast, comparable to an "intra-glandular polymastia".

Fibroadenoma of the breast: sonomammography correlated with pathology in 122 patients

During the performance of 2,000 sonomammograms, there were 122 patients with 140 biopsy-confirmed fibroadenomas. Mass lesions or abnormalities were detected on the sonomammograms in 100 of these patients (82%) (118/140 masses), and a retrospective review of the descriptive sonographic criteria tabulated at the initial interpretation of 118 of these masses was undertaken. The most significant sonographic mass features were a round (48%) or oval (37%) shape, a smooth contour (75%), weak internal echoes (80%) in a uniform distribution (88%), and intermediate acoustic attenuation (71%). A pathologist reviewed all the cases, tabulating the gross and microscopic appearance of each specimen. In addition, the average fibrous and epithelial tissue content of 103 tumors (100 fibroadenomas and three adenofibromas) was recorded from a review of five low-power microscopic fields of representative areas of the tumor and correlated with the sonographic features. The sonomammographic features of seven calcified fibroadenomas, five giant fibroadenomas, and one fibroadenoma containing in situ lobular carcinoma and a subgroup having both sonomammograms and radiomammograms are discussed.