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Conti M, Morciano F, Amodeo S, Gori E, Romanucci G, Belli P, Tommasini O, Fornasa F, Rella R. Special Types of Breast Cancer: Clinical Behavior and Radiological Appearance. J Imaging 2024; 10:182. [PMID: 39194971 DOI: 10.3390/jimaging10080182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/21/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
Breast cancer is a complex disease that includes entities with different characteristics, behaviors, and responses to treatment. Breast cancers are categorized into subgroups based on histological type and grade, and these subgroups affect clinical presentation and oncological outcomes. The subgroup of "special types" encompasses all those breast cancers with insufficient features to belong to the subgroup "invasive ductal carcinoma not otherwise specified". These cancers account for around 25% of all cases, some of them having a relatively good prognosis despite high histological grade. The purpose of this paper is to review and illustrate the radiological appearance of each special type, highlighting insights and pitfalls to guide breast radiologists in their routine work.
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Affiliation(s)
- Marco Conti
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Francesca Morciano
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Silvia Amodeo
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Elisabetta Gori
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Giovanna Romanucci
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi 1, 37142 Verona, Italy
| | - Paolo Belli
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Oscar Tommasini
- UOC Diagnostica per Immagini, Dipartimento Emergenza e Accettazione, Ospedale G.B. Grassi, Via Gian Carlo Passeroni, 28, 00122 Rome, Italy
| | - Francesca Fornasa
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi 1, 37142 Verona, Italy
| | - Rossella Rella
- UOC Diagnostica per Immagini, Dipartimento Emergenza e Accettazione, Ospedale G.B. Grassi, Via Gian Carlo Passeroni, 28, 00122 Rome, Italy
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Gulati M, Singla V, Singh T, Bal A, Irrinki RNNS. Nipple Discharge: When is it Worrisome? Curr Probl Diagn Radiol 2023; 52:560-569. [PMID: 37460358 DOI: 10.1067/j.cpradiol.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/25/2023] [Accepted: 06/28/2023] [Indexed: 10/16/2023]
Abstract
Nipple discharge is the third most common breast related complaint seen in the breast clinics. Although the majority of cases are due to a benign etiology, 5%-12% cases of pathological nipple discharge may be harboring an underlying malignancy. A thorough radiological workup in cases of pathological nipple discharge is thus of utmost importance, with the initial imaging modality depending on the age of the patient. The imaging modalities include mammogram (MG) and ultrasound (US) with addition of breast MRI if the nipple discharge is clinically suspicious and no MG or US correlate is identified. Magnetic Resonance Imaging (MRI) also holds promise in demonstrating the exact extent of a pathology detected on US and thus aids in the planning of further management.
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Affiliation(s)
- Malvika Gulati
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
| | - Veenu Singla
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India.
| | - Tulika Singh
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
| | - R N Naga Santhosh Irrinki
- Department of General Surgery, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
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Tagliati C, Ercolani P, Marconi E, Simonetti BF, Giuseppetti GM, Giovagnoni A. Apparent diffusion coefficient value in breast papillary lesions without atypia at core needle biopsy. Clin Imaging 2019; 59:148-153. [PMID: 31821971 DOI: 10.1016/j.clinimag.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The main aim of the study was to assess if the mean apparent diffusion coefficient (ADC) value was significantly different between papillary lesions (PL) without atypia and PLs with atypical or malignant foci. A secondary objective was to evaluate if patients mean age, MRI BI-RADS® descriptors and assessment category were significantly different between these two PL groups. METHODS In this eight year retrospective study were included 122 patients (mean age, 51 years; range, 24-78) with 122 PLs without atypia at micro-histological examination after core needle biopsy (CNB) performed under sonographic guidance. All patients underwent surgical excision biopsy within 3 months after CNB. All patients underwent MRI examination before surgical excision, including STIR, DWI and Dynamic Contrast-Enhanced sequences. RESULTS Mean ADC value difference between PLs without and with atypia or malignant foci was statistically significant (p < 0.0001). Mean ADC value optimal threshold in order to distinguish the two groups was 1.418 × 10-3 mm2/s. A mean ADC value ≤ 1.418 × 10-3 mm2/s could predict atypical or malignant foci within a PL with 83.9% sensitivity and 75.8% specificity. No statistically significant difference was found with regard to patients mean age, MRI BI-RADS® descriptors and assessment category between these two PL groups. CONCLUSIONS Mean ADC value of PLs without atypia at CNB is an efficient tool in order to help distinguish between PLs without and with atypical or malignant foci at final pathology on surgical excision, and it could be used to help decide how to manage these lesions.
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Affiliation(s)
- Corrado Tagliati
- School of Radiology, Università Politecnica delle Marche, Ancona, Italy.
| | - Paola Ercolani
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Elisabetta Marconi
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Barbara Franca Simonetti
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Gian Marco Giuseppetti
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy.
| | - Andrea Giovagnoni
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy.
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Fuentes JAP, Martínez CEM, Casadiego AKR, Freites VFA, Marín VAA, Castellano ACR. Papillary breast lesions diagnosed by percutaneous needle biopsy: management approach. Ecancermedicalscience 2019; 13:902. [PMID: 30915160 PMCID: PMC6390833 DOI: 10.3332/ecancer.2019.902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Indexed: 11/29/2022] Open
Abstract
Papillary breast lesions are a heterogeneous group of neoplasms of diverse imagenological, clinical and morphological presentation that display different behaviour, prognosis and, therefore, controversial diagnosis and management. The aim of this study is to propose an algorithm for the management of mammary lesions.
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Jiang T, Tang W, Gu Y, Xu M, Yang W, Peng W. Magnetic Resonance Imaging Features of Breast Encapsulated Papillary Carcinoma. J Comput Assist Tomogr 2018; 42:536-541. [PMID: 29787497 DOI: 10.1097/rct.0000000000000737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to describe the magnetic resonance imaging (MRI) features of pure breast encapsulated papillary carcinoma (EPC). MATERIALS AND METHODS Ten patients with histopathologically confirmed breast pure EPC were reviewed. Two radiologists evaluated lesion MRI characteristics. RESULTS The EPC presented oval or round mass with circumscribed margin on MRI. In addition, 4 cases exhibited a cystic-solid mixed mass with mural nodules, and 4 cases exhibited a liquid level that indicated the possibility of hemorrhage. CONCLUSIONS A well-defined cystic-solid mixed mass with mural nodules, or a circumscribed mass exhibiting the possibility of hemorrhage, may suggest the diagnosis of EPC.
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A practical guide to managing CT findings in the breast. Clin Imaging 2018; 60:274-282. [PMID: 30064719 DOI: 10.1016/j.clinimag.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/21/2018] [Accepted: 07/09/2018] [Indexed: 11/23/2022]
Abstract
While it is well accepted that CT is not an optimal imaging study to evaluate the breasts, findings on chest CT may be the first indication of an occult malignancy. The nonspecific appearance of breast findings and the lack of consensus guidelines for managing incidental breast findings may dissuade radiologists from thoroughly evaluating the breasts on CT. We review commonly encountered breast findings on CT and present an algorithm for managing incidentally detected breast findings.
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Foley NM, Racz JM, Al-Hilli Z, Livingstone V, Cil T, Holloway CMB, Romics L, Matrai Z, Bennett MW, Duddy L, Nofech-Mozes S, Slodkowska E, Mallon EA, Dawson N, Roche T, Relihan N, Hill ADK, Redmond HP, Corrigan MA. An International Multicenter Review of the Malignancy Rate of Excised Papillomatous Breast Lesions. Ann Surg Oncol 2015; 22 Suppl 3:S385-90. [PMID: 26240010 DOI: 10.1245/s10434-015-4773-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Papillary lesions of the breast are a relatively rare, but heterogeneous group ranging from benign to atypical and malignant. Debate exists regarding the optimal management of these lesions. In the absence of more accurate risk-stratification models, traditional management guidelines recommend surgical excision, despite the majority of lesions proving benign. This study sought to determine the rate of malignancy in excised breast papillomas and to elucidate whether there exists a population in which surgical excision may be unnecessary. METHODS A multicenter international retrospective review of core biopsy diagnosed breast papillomas and papillary lesions was performed between 2009 and 2013, following institutional ethical approval. Patient demographics, histopathological, and radiological findings were recorded. All data was tabulated, and statistical analysis performed using Stata. RESULTS A total of 238 patients were included in the final analysis. The age profile of those with benign pathology was significantly younger than those with malignant pathology (p < 0.001). Atypia on core needle biopsy was significantly associated with a final pathological diagnosis of malignancy (OR = 2.73). The upgrade rate from benign core needle biopsy to malignancy on the final pathological sample was 14.4 %; however, only 3.7 % had invasive cancer. CONCLUSIONS This international dataset is one of the largest in the published literature relating to breast papillomas. The overall risk of malignancy is significantly associated with older age and the presence of atypia on core needle biopsy. It may be possible to stratify higher-risk patients according to age and core needle biopsy findings, thereby avoiding surgery on low-risk patients.
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Affiliation(s)
- N M Foley
- Breast Research Centre, Cork University Hospital, Cork, Ireland.
| | - J M Racz
- Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada
| | - Z Al-Hilli
- Department of Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - V Livingstone
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - T Cil
- Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada
| | - C M B Holloway
- Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada
| | - L Romics
- Departments of Breast Surgery, Radiology & Pathology, Victoria Infirmary, Glasgow, UK
| | - Z Matrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - M W Bennett
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - L Duddy
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - S Nofech-Mozes
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - E Slodkowska
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - E A Mallon
- Departments of Breast Surgery, Radiology & Pathology, Victoria Infirmary, Glasgow, UK
| | - N Dawson
- Departments of Breast Surgery, Radiology & Pathology, Victoria Infirmary, Glasgow, UK
| | - T Roche
- Department of Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - N Relihan
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - A D K Hill
- Department of Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - H P Redmond
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - M A Corrigan
- Breast Research Centre, Cork University Hospital, Cork, Ireland
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Boin DP, Baez JJ, Guajardo MP, Benavides DO, Ortega MEN, Valdés DR, Apphun MC. Breast papillary lesions: an analysis of 70 cases. Ecancermedicalscience 2014; 8:461. [PMID: 25228917 PMCID: PMC4162680 DOI: 10.3332/ecancer.2014.461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction Papillary breast lesions are rare and constitute less than 10% of benign breast lesions and less than 1% of breast carcinomas. Objective To analyse the clinical presentation, preoperative evaluation, and surgical and anatomopathological characteristics of the patients operated on for papillary breast lesions. Material and Methods Retrospective descriptive and analytical study. We analysed the database of patients with definitive histopathological diagnosis of papillary breast lesions operated on at our institution from January 2004 to May 2013. Results During the period described, 70 patients with histopathological diagnosis of papillary breast lesions were operated upon. The median age was 50 years (19–86 years). Thirty-seven patients (52.8%) were symptomatic at diagnosis. Preoperative ultrasound was reported to be altered in all patients. A mammography showed pathologic findings in only 50% of cases. All patients underwent partial mastectomy, after needle localisation under ultrasound, if the lesion was not palpable on physical examination. The final pathological diagnosis was: benign papillary lesion in 55 patients (78.6%) and malignant in 15 patients (21.4%). Adjuvant treatment was performed in all malignant cases. Median follow-up was 46 months (3–115 months). Conclusions Patients with papillary breast lesions presented with symptoms in half of all cases. There was a high frequency of malignancy (21.4%), therefore surgical resection was recommended for papillary breast lesions.
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Affiliation(s)
- Dahiana Pulgar Boin
- Department of Oncology and Maxillofacial Surgery, College of Medicine, Pontifical Catholic University of Chile, Marcoleta 352, Santiago 8330033, Chile
| | - Jaime Jans Baez
- Department of Oncology and Maxillofacial Surgery, College of Medicine, Pontifical Catholic University of Chile, Marcoleta 352, Santiago 8330033, Chile
| | - Militza Petric Guajardo
- Department of Oncology and Maxillofacial Surgery, College of Medicine, Pontifical Catholic University of Chile, Marcoleta 352, Santiago 8330033, Chile
| | - David Oddo Benavides
- Department of Pathologic Anatomy, College of Medicine, Pontifical Catholic University of Chile, Marcoleta 352, Santiago 8330033, Chile
| | - Maria Elena Navarro Ortega
- Department of Radiology, College of Medicine, Pontifical Catholic University of Chile, Marcoleta 352, Santiago 8330033, Chile
| | - Dravna Razmilic Valdés
- Department of Radiology, College of Medicine, Pontifical Catholic University of Chile, Marcoleta 352, Santiago 8330033, Chile
| | - Mauricio Camus Apphun
- Department of Oncology and Maxillofacial Surgery, College of Medicine, Pontifical Catholic University of Chile, Marcoleta 352, Santiago 8330033, Chile
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