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Zhang P, Kong P, Liu D, He S, Zhang X. Non-mass-type ductal carcinoma in situ of the breast on ultrasound: Features and pathological analysis. J Cancer Res Ther 2024; 20:665-668. [PMID: 38687938 DOI: 10.4103/jcrt.jcrt_2251_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/15/2023] [Indexed: 05/02/2024]
Abstract
AIMS The aims of this study were to investigate the ultrasound features of non-mass-type ductal carcinoma in situ (DCIS) of the breast and conduct a pathological analysis. MATERIAL AND METHODS Ultrasound images of 32 cases of non-mass-type DCIS of the breast, collected between September 2014 and June 2016, were analyzed. The characteristics of the lesions, including border, internal echogenicity, local glandular hyperplasia, micro-calcification, and intra-tumoral blood flow resistance index (RI), were analyzed, and a concurrent pathological analysis was conducted. RESULTS Obvious local glandular hyperplasia was commonly observed in the 32 cases of non-mass-type DCIS of the breast. The internal echogenicity varied in intensity, exhibiting a "leopard pattern" or "zebra pattern." Color Doppler imaging revealed abundant blood flow signals within the lesion with an RI of >0.7. Isolated duct dilatation and micro-calcifications were occasionally observed within the lesions. High-grade DCIS was the predominant pathological type of non-mass-type DCIS. CONCLUSIONS Non-mass-type DCIS of the breast often presents with obvious local glandular hyperplasia and varying internal echogenicity. High-grade DCIS is the frequent pathological type. Color Doppler imaging and RI measurement can assist in diagnosing non-mass-type DCIS of the breast.
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Affiliation(s)
- Peipei Zhang
- Department of Ultrasound Diagnosis and Treatment, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
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Watanabe T. Features of ductal carcinoma in situ ultrasound images. J Med Ultrason (2001) 2023; 50:347-350. [PMID: 37369884 PMCID: PMC10354177 DOI: 10.1007/s10396-023-01334-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
Ultrasound images of ductal carcinoma in situ (DCIS) show a wide range of variations from mass to non-mass lesions. This article describes the characteristics of ultrasound images of DCIS based on the BC-02 study conducted by The Japanese Association of Breast and Thyroid Sonology (JABTS). In the BC-02 study, ultrasound images of 705 DCIS cases were classified by imaging findings. The results showed that non-mass abnormalities accounted for 60% of all lesions and masses for 40%. Looking at each subclassification, hypoechoic areas in the mammary gland were the most common (50% of the total), followed by solid masses (31%), mixed masses (9%), and abnormalities of the ducts (8%). These four classifications accounted for 98% of the total. Echogenic foci without a hypoechoic area, architectural distortion, and clustered microcysts were very rare, accounting for about 1% of the total. The ultrasound images of DCIS were characterized by a wide range of variations from masses to non-masses abnormalities, with hypoechoic areas in the mammary gland being the most common, followed by solid masses.
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Affiliation(s)
- Takanori Watanabe
- National Hospital Organization Sendai Medical Center, 2-11-12 Miyaginohara, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
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Kong J, Liu X, Zhang X, Zou Y. The predictive value of calcification for the grading of ductal carcinoma in situ in Chinese patients. Medicine (Baltimore) 2020; 99:e20847. [PMID: 32664078 PMCID: PMC7360308 DOI: 10.1097/md.0000000000020847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
High-grade ductal carcinoma in situ (DCIS) requires resection due to the high risk of developing invasive breast cancer. The predictive powers of noninvasive predictors for high-grade DCIS remain contradictory. This study aimed to explore the predictive value of calcification for high-grade DCIS in Chinese patients.This was a retrospective study of Chinese DCIS patients recruited from the Women's Hospital, School of Medicine, Zhejiang University between January and December 2018. The patients were divided into calcification and non-calcification groups based on the mammography results. The correlation of calcification with the pathologic stage of DCIS was evaluated using the multivariable analysis. The predictive value of calcification for DCIS grading was examined using the receiver operating characteristics (ROC) curve.The pathologic grade of DCIS was not associated with calcification morphology (P = .902), calcification distribution (P = .252), or breast density (P = .188). The multivariable analysis showed that the presence of calcification was independently associated with high pathologic grade of DCIS (OR = 3.206, 95% CI = 1.315-7.817, P = .010), whereas the age, hypertension, menopause, and mammography BI-RADS were not (all P > .05) associated with the grade of DCIS. The ROC analysis of the predictive value of calcification for DCIS grading showed that the area under the curve was 0.626 (P = .019), with a sensitivity of 73.1%, specificity of 52.2%, positive predictive value of 72.2%, and negative predictive value of 53.3%.The presence of calcification is independently associated with high pathologic grade of DCIS and could predict high-grade DCIS in Chinese patients.
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4
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Ban K, Tsunoda H, Watanabe T, Kaoku S, Yamaguchi T, Ueno E, Hirokaga K, Tanaka K. Characteristics of ultrasonographic images of ductal carcinoma in situ with abnormalities of the ducts. J Med Ultrason (2001) 2019; 47:107-115. [PMID: 31655940 PMCID: PMC6971153 DOI: 10.1007/s10396-019-00981-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 09/19/2019] [Indexed: 11/15/2022]
Abstract
Purpose Although the number of ductal carcinoma in situ (DCIS) cases has increased with the spread of breast cancer screening in Japan, there are very few reports that summarize ultrasound image features of DCIS. The Japan Association of Breast and Thyroid Sonology (JABTS) investigated the incidence of DCIS with masses and non-mass abnormalities and the characteristics of US images in a retrospective, multicenter, observational study (JABTS BC-02 study). The purpose of this report is to clarify the proportion of DCIS with abnormalities of the ducts with each ultrasound finding and the characteristics of US images. Methods The JABTS BC-02 study population was comprised of patients who were examined by ultrasonography, underwent surgery, and were histopathologically diagnosed with DCIS at each study site between January 2008 and December 2012. The US images of DCIS and pathology and clinical information were retrospectively collected from 16 institutions in Japan. The US images were evaluated by 22 experts on the Central Image Interpretation Committee of JABTS. Results Abnormalities of the ducts were noted in 78 (10.5%) of 705 US images of DCIS. Of the 78 cases, the distribution of abnormalities of the ducts was focal or segmental. The second characteristic was the presence of internal echoes in dilated ducts. All cases were accompanied by intraductal solid echoes, and 40 cases (51.3%) were accompanied by echogenic foci. In addition, intraductal solid echoes were continuous or multiple in 72 cases (92.4%), and the shape of the solid echoes was broad-based and/or irregular in 62 cases (79.5%). Conclusion DCIS cases with duct abnormalities on ultrasound were investigated in this study. The important characteristics were as follows: (1) the distribution of ductal dilatation was focal or segmental, (2) solid parts were present in the dilated ducts, (3) the distribution of internal echoes was continuous or multiple, (4) the shape of solid echoes was broad-based and/or irregular, and (5) internal echoes were sometimes accompanied by echogenic foci. Accurate evaluation of these findings may be useful for diagnosing DCIS. Although the duct abnormalities are included in “ASSOCIATED FEATURES” in ACR BI-RADS ATLAS (USA), we emphasize that this concept is very important for understanding US characteristics of DCIS.
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Affiliation(s)
- Kanako Ban
- Department of Cancer Detection and Diagnosis, Tokyo Health Service Association, 1-2 Ichigaya-Sadohara-cho, Shinjuku-ku, Tokyo, 162-8402, Japan.
| | - Hiroko Tsunoda
- Department of Radiology Diagnostic Breast Imaging, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Takanori Watanabe
- Department of Breast Surgery, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan
| | - Setsuko Kaoku
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takuhiro Yamaguchi
- Clinical Research Data Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Ei Ueno
- Tsukuba International Breast Clinic, Tsukuba, Ibaraki, Japan
| | - Koichi Hirokaga
- Department of Breast Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Kumiko Tanaka
- Department of Breast Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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5
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Wang H, Lin J, Lai J, Tan C, Yang Y, Gu R, Jiang X, Liu F, Hu Y, Su F. Imaging features that distinguish pure ductal carcinoma in situ (DCIS) from DCIS with microinvasion. Mol Clin Oncol 2019; 11:313-319. [PMID: 31396390 DOI: 10.3892/mco.2019.1891] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 06/10/2019] [Indexed: 11/05/2022] Open
Abstract
Patients with ductal carcinoma in situ with microinvasion (DCISM) have worse cancer-specific survival, disease-free survival and overall survival, and a higher mortality rate compared with patients with ductal carcinoma in situ (DCIS). Distinguishing DCISM from DCIS via preoperative imaging could help to predict the prognosis of patients. The present study compared the sonographic and mammographic features of patients with DCIS and DCISM. A total of 147 women (94 patients with DCIS and 53 patients with DCISM) were retrospectively included. The sonographic lesions were classified as either masses or non-mass abnormalities. The lesions observed on mammography were classified as calcifications only, mass, asymmetry or architectural distortion. Statistical comparisons were performed using the Mann-Whitney U test, χ2 test, Fisher's exact test and multiple logistic regression analysis. Univariate and multivariate analyses showed that the presence of calcifications (P=0.038) and vascularity (P=0.025) on sonography were associated with DCISM. Furthermore, a lager distribution of calcifications was associated with a higher likelihood of DCISM (P=0.002). In conclusion, the presence of calcifications and vascularity on sonography or a lager distribution of calcifications on mammography may suggest DCISM.
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Affiliation(s)
- Hongli Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510288, P.R. China
| | - Jinjiang Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Jianguo Lai
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510288, P.R. China
| | - Cui Tan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510288, P.R. China
| | - Yaping Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510288, P.R. China
| | - Ran Gu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510288, P.R. China
| | - Xiaofang Jiang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510288, P.R. China
| | - Fengtao Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510288, P.R. China
| | - Yue Hu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510288, P.R. China
| | - Fengxi Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510288, P.R. China
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6
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Qu XX, Song Y, Zhang YH, Qing HM. Value of Ultrasonic Elastography and Conventional Ultrasonography in the Differential Diagnosis of Non-Mass-like Breast Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1358-1366. [PMID: 30975535 DOI: 10.1016/j.ultrasmedbio.2019.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to evaluate the diagnostic value of ultrasonic elastography (UE) and conventional ultrasonography (CUS) in the differential diagnosis of non-mass-like (NML) breast lesions. Static sonograms of 39 pathologically diagnosed NML breast lesions were reviewed. Lesions were evaluated by CUS and UE using CUS subjective ratings (benign, malignant or indeterminate), a 5-point subjective elasticity scoring system and the quantitative strain ratio (SR). Receiver operating characteristic curves and diagnostic tests were used to assess the diagnostic value of CUS and UE. Areas under the receiver operating characteristic curves (Az) of the CUS, 5-point elasticity and SR methods were 0.848 (p < 0.001), 0.895 (p < 0.001) and 0.943 (p < 0.001), respectively. In diagnosing NML breast lesions, there was no significant difference between the 5-point elasticity and CUS methods. The combination of UE and CUS helps to improve the accuracy of the ultrasonic diagnosis of NML breast lesions.
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Affiliation(s)
- Xiao-Xia Qu
- Department of Diagnostic Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yu Song
- Department of Diagnostic Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Yu-Hong Zhang
- Department of Diagnostic Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hua-Min Qing
- Department of Pathology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
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7
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Crnogorac M, Ivanac G, Tomasović-Lončarić Č, Žic R, Kelava T, Brkljačić B. SONOELASTOGRAPHIC FEATURES OF HIGH-RISK BREAST LESIONS AND DUCTAL CARCINOMA IN SITU - A PILOT STUDY. Acta Clin Croat 2019; 58:13-22. [PMID: 31363320 PMCID: PMC6629205 DOI: 10.20471/acc.2019.58.01.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to evaluate the quantitative sonoelastographic values recorded on shear-wave sonoelastography (SWE) of high-risk breast lesions and ductal carcinoma in situ (DCIS). We retrospectively analyzed histopathologic and SWE data (quantitative maximum, minimum and mean stiffness, lesion-to-fat ratio (E-ratio), lesion size) of 228 women referred to our Department for core needle breast biopsy during a four-year period. Among 230 lesions, histopathologic findings showed 34 high-risk breast lesions and 29 DCIS, which were compared with 167 ductal invasive carcinomas. High-risk lesions had lower values of all sonoelastographic features than ductal in situ and invasive carcinoma, however, only E-ratio showed a statistically significant difference in comparison to DCIS (3.7 vs. 6, p<0.001). All sonoelastographic features showed significant difference between in situ and invasive carcinoma. There was a significant correlation between lesion size and stiffness (r=0.36; p<0.001). Stiffness measured by SWE is an effective predictor of the histopathologic severity of sonographically detectable breast lesions. Elasticity values of high-risk lesions are significantly lower than those of malignant lesions. Furthermore, we showed that along with the sonographic appearance, which in most cases shows typical microcalcifications, DCIS had significantly different elasticity parameters than invasive carcinoma.
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Affiliation(s)
| | - Gordana Ivanac
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Čedna Tomasović-Lončarić
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Rado Žic
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Tomislav Kelava
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Boris Brkljačić
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
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8
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Amornsiripanitch N, Lam DL, Rahbar H. Advances in Breast MRI in the Setting of Ductal Carcinoma In Situ. Semin Roentgenol 2018; 53:261-269. [PMID: 30449344 DOI: 10.1053/j.ro.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Diana L Lam
- University of Washington, Seattle Cancer Care Alliance, Seattle, WA.
| | - Habib Rahbar
- University of Washington, Seattle Cancer Care Alliance, Seattle, WA.
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9
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Kim HR, Jung HK. Histopathology findings of non-mass cancers on breast ultrasound. Acta Radiol Open 2018; 7:2058460118774957. [PMID: 29872548 PMCID: PMC5977436 DOI: 10.1177/2058460118774957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/08/2018] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Hye Rin Kim
- Department of Radiology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | - Hae Kyoung Jung
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seoul, Republic of Korea
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10
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Current Approaches to Diagnosis and Treatment of Ductal Carcinoma In Situ and Future Directions. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2017; 151:33-80. [PMID: 29096897 DOI: 10.1016/bs.pmbts.2017.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The presentation and treatment of ductal carcinoma in situ (DCIS) has changed substantially over the years. While previously an incidental pathologic finding in more advanced, palpable tumors, the institution of screening mammography has repositioned this disease entity as one largely diagnosed as a non-palpable lesion, often prior to any invasive disease. As DCIS is a precursor to invasive carcinoma, evolution in the approach to treatment has followed in the footsteps of that for invasive disease, including breast conservation therapy, adjuvant radiation, and use of antihormonal therapy. Survival outcomes for DCIS are very high and more recent literature has investigated tailoring therapeutic approaches to avoid overtreatment. Two important areas of ongoing clinical debate concerning overtreatment include use of preoperative MRI and the role of adjuvant radiation. The heterogeneity of the disease makes it difficult to differentiate lesions that would benefit from more aggressive treatment from those in which overtreatment could be avoided. Clinical characteristics, such as histologic appearance, age at diagnosis, and margin status at tumor excision have been established as moderate predictors of disease recurrence, but none has provided strong enough evidence as to guide consensus decisions on adjuvant therapy. Continuing research seeks to define the genetic and molecular characteristics that can predict disease course and serve as the potential targets for novel therapeutic agents. While several markers have shown promise in differentiating tumor aggressiveness, there is still much to be discovered about the precise mechanisms of disease progression and how this can be applied clinically to optimize treatment.
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11
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Watanabe T, Yamaguchi T, Tsunoda H, Kaoku S, Tohno E, Yasuda H, Ban K, Hirokaga K, Tanaka K, Umemoto T, Okuno T, Fujimoto Y, Nakatani S, Ito J, Ueno E. Ultrasound Image Classification of Ductal Carcinoma In Situ (DCIS) of the Breast: Analysis of 705 DCIS Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:918-925. [PMID: 28242086 DOI: 10.1016/j.ultrasmedbio.2017.01.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 06/06/2023]
Abstract
The Japan Association of Breast and Thyroid Sonology (JABTS) proposed, in 2003, a conceptual classification system for non-mass abnormalities to be applied in addition to the conventional concept of masses, to facilitate detecting ductal carcinoma in situ (DCIS) lesions. The aim of this study was to confirm the utility of this system and to clarify the distribution of these findings in DCIS lesions. Data on 705 surgically treated DCIS lesions from 16 institutions in Japan were retrospectively reviewed. All 705 DCIS lesions could be classified according to the JABTS classification system. The most frequent findings were hypo-echoic areas in the mammary gland (48.6%), followed by solid masses (28.0%) and duct abnormalities (10.2%) or mixed masses (8.1%). Distortion (1.3%), clustered microcysts (1.4%) and echogenic foci without a hypo-echoic area (2.5%) were uncommon. These results suggest that the concept of non-mass abnormalities is useful in detecting DCIS lesions.
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Affiliation(s)
- Takanori Watanabe
- Department of Breast Surgery, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan.
| | - Takuhiro Yamaguchi
- Clinical Research Data Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hiroko Tsunoda
- Department of Radiology Diagnostic Breast Imaging, St Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Setsuko Kaoku
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eriko Tohno
- Tsukuba International Breast Clinic, Tsukuba, Ibaraki, Japan
| | - Hidemitsu Yasuda
- Department of Breast Surgery, National Center for Global Health and Medicine, Shinjuku-Ku, Tokyo, Japan
| | - Kanako Ban
- Department of Cancer Detection and Diagnosis, Tokyo Health Service Association, Shinjuku-ku, Tokyo, Japan
| | - Koichi Hirokaga
- Department of Breast Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Kumiko Tanaka
- Breast Surgery, Shonan Kamakura General Hospital, Kamakura-shi, Kanagawa, Japan
| | - Takeshi Umemoto
- Tsukuba International Breast Clinic, Tsukuba, Ibaraki, Japan
| | - Toshitaka Okuno
- Breast Surgery, Nishi-kobe Medical Center, Nishi-ku, Kobe City, Japan
| | | | - Shuichi Nakatani
- Department of Breast Surgery, Minami Osaka General Hospital, Higashi-Kagaya Suminoe-ku, Osaka City, Japan
| | - Jun Ito
- Department of Surgery I, Dokkyo Medical University, Mibu-Machi, Tochigi, Japan
| | - Ei Ueno
- Tsukuba International Breast Clinic, Tsukuba, Ibaraki, Japan
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12
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Yao JJ, Zhan WW, Chen M, Zhang XX, Zhu Y, Fei XC, Chen XS. Sonographic Features of Ductal Carcinoma In Situ of the Breast With Microinvasion: Correlation With Clinicopathologic Findings and Biomarkers. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1761-1768. [PMID: 26324758 DOI: 10.7863/ultra.15.14.07059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/29/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To compare the sonographic results, clinicopathologic characteristics, and biomarkers in pure ductal carcinoma in situ (DCIS) of the breast and DCIS with microinvasion. METHODS A total of 218 patients with pathologically proven DCIS based on sonography in our hospital (2009-2013) were retrospectively enrolled. Clinicopathologic characteristics and biomarkers were examined. Grayscale sonographic results were investigated according to the American College of Radiology Breast Imaging Reporting and Data System lexicon, and color Doppler sonography was used to assess the vascularization distribution and degree. All variables were compared by univariate and multivariate logistic regression analyses. RESULTS All patients were female, with a mean age of 55.3 years (range, 32-78 years). One hundred sixty patients with 160 lesions had pure DCIS, and 58 patients with 58 lesions had DCIS with microinvasion. Ductal carcinoma in situ with microinvasion was more likely to have sentinel lymph node metastases, larger tumors, a higher tumor grade, human epidermal growth factor receptor 2 positivity, and a high Ki-67 index (all P < .05). Univariate analysis showed that DCIS with microinvasion was more likely to be hypoechoic with microcalcifications, have a mixed vascularization distribution (equal peripheral and internal blood flow signals), and have a high degree of vascularization (at least 2 penetrating vessels; all P < .05). Multivariate analysis indicated that the presence of microcalcifications and a high degree of vascularization were significantly and independently associated with microinvasion (both P < .001). CONCLUSIONS Our findings suggest that DCIS with microinvasion is more likely to have microcalcifications and a high degree of vascularization than pure DCIS. Patients with these sonographic features are more likely to have a high tumor grade, sentinel lymph node metastases, larger tumors, a high Ki-67 index, and human epidermal growth factor receptor 2 positivity.
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Affiliation(s)
- Jie-Jie Yao
- Departments of Ultrasound (J.-J.Y., W.-W.Z., M.C., X.-X.Z., Y.Z.,) and Pathology (X.-C.F.) and Comprehensive Breast Health Center (X.-S.C.), Rui-Jin Hospital, School of Medicine, Shanghai Jiao-Tong University, Shanghai, China
| | - Wei-Wei Zhan
- Departments of Ultrasound (J.-J.Y., W.-W.Z., M.C., X.-X.Z., Y.Z.,) and Pathology (X.-C.F.) and Comprehensive Breast Health Center (X.-S.C.), Rui-Jin Hospital, School of Medicine, Shanghai Jiao-Tong University, Shanghai, China.
| | - Man Chen
- Departments of Ultrasound (J.-J.Y., W.-W.Z., M.C., X.-X.Z., Y.Z.,) and Pathology (X.-C.F.) and Comprehensive Breast Health Center (X.-S.C.), Rui-Jin Hospital, School of Medicine, Shanghai Jiao-Tong University, Shanghai, China
| | - Xiao-Xiao Zhang
- Departments of Ultrasound (J.-J.Y., W.-W.Z., M.C., X.-X.Z., Y.Z.,) and Pathology (X.-C.F.) and Comprehensive Breast Health Center (X.-S.C.), Rui-Jin Hospital, School of Medicine, Shanghai Jiao-Tong University, Shanghai, China
| | - Ying Zhu
- Departments of Ultrasound (J.-J.Y., W.-W.Z., M.C., X.-X.Z., Y.Z.,) and Pathology (X.-C.F.) and Comprehensive Breast Health Center (X.-S.C.), Rui-Jin Hospital, School of Medicine, Shanghai Jiao-Tong University, Shanghai, China
| | - Xiao-Chun Fei
- Departments of Ultrasound (J.-J.Y., W.-W.Z., M.C., X.-X.Z., Y.Z.,) and Pathology (X.-C.F.) and Comprehensive Breast Health Center (X.-S.C.), Rui-Jin Hospital, School of Medicine, Shanghai Jiao-Tong University, Shanghai, China
| | - Xiao-Song Chen
- Departments of Ultrasound (J.-J.Y., W.-W.Z., M.C., X.-X.Z., Y.Z.,) and Pathology (X.-C.F.) and Comprehensive Breast Health Center (X.-S.C.), Rui-Jin Hospital, School of Medicine, Shanghai Jiao-Tong University, Shanghai, China
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