A Case of Ductal Carcinoma In Situ (DCIS:noncomedo type)Detected by Ultrasonography: Demonstration of Occult Multiple Foci

Role of ultrasonography in treatment selection

In spite of difficulties impacting objectivity and reproducibility due to its dependence on the technical and diagnostic ability of each examiner, ultrasonography (US) in general can evaluate very well soft tissue lesions, especially small lesions of 1 cm or less in size. US can reliably delineate the nature of several lesions, and can detect dilated mammary ducts and lymph nodes. On the other hand, US may miss ductal spread or lymph node metastasis of breast cancer, especially if the lesions are too minute to be detected by the instrument. US should be used together with X-ray or MR mammography to prevent false negative cases. US is useful for evaluating the local nature and characteristics of cancerous lesions such as size, invasiveness, histological type, intraductal spread etc, and can evaluate regional lymph node and liver metastasis for pre-treatment staging. In addition, US-guided techniques are essential for preoperative pathological diagnosis by FNAC or CNB and for marking the marginal line for partial mastectomy. US should be more actively used to monitor intra-mammary recurrence after breast conserving surgery.

Clinical management of nonpalpable or small breast masses by fine-needle aspiration biopsy (FNAB) under ultrasound guidance

BACKGROUND AND OBJECTIVES

Open breast biopsy of palpable breast masses is widely accepted. Now, the use of high-resolution, real-time ultrasound (US) makes it easy to detect nonpalpable or small breast nodules, as well as palpable breast masses.

METHODS

We performed fine-needle aspiration biopsy (FNAB) under US guidance to manage the nonpalpable or small breast masses detected by US examination and to distinguish between benign and malignant tumors. To investigate the usefulness and sensitivity of FNAB under US guidance, we reviewed a total of 137 FNAB records for cases diagnosed between January 1993 and December 1994.

RESULTS

Fifty-five cases were classified as benign, 70 as atypical/indeterminate, 1 as suspicious/probably malignant, 6 as malignant, and 5 as unsatisfactory. Of these, five cases were confirmed as malignant, but one case showed no malignancy at surgery. Four cases were nonpalpable breast cancer, two were in stage 0, and two were in stage I. One case in the suspicious/probably malignant group on the initial FNAB was shown to be malignant by re-aspiration on follow-up study. The sensitivity of FNAB under US guidance was 83.3% (5/6) and the specificity was 99.2% (125/126). The diagnostic accuracy was 83.3% (5/6) and the negative predictive value was 99.2% (125/126).

CONCLUSIONS

FNAB under US guidance is useful for the management of nonpalpable or small breast masses; it is sensitive for distinguishing between benign and malignant tumors and may reduce unnecessary surgical procedures and replace conventional manual aspiration biopsy.