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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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Parashar S, Arora J, Mittal A. Bright Is Not Always Better: A Pictorial Review of Hyperechoic Malignant Breast Masses. Indian J Radiol Imaging 2023; 33:532-540. [PMID: 37811173 PMCID: PMC10556334 DOI: 10.1055/s-0043-1768641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Hyperechogenic breast lesions are a relatively rare finding at breast ultrasonography and are traditionally thought to be benign. However, hyperechogenicity on the ultrasound alone does not provide enough evidence to rule out malignancy completely. We herein reported a short series of nine cases of echogenic malignant breast lesions, which include invasive ductal carcinoma, ductal carcinoma in situ, invasive lobular carcinoma, angiosarcoma, lymphoma, and metastasis to the breast. Echogenic breast lesions should be carefully evaluated and properly categorized based on any other suspicious sonographic characteristics and must be correlated with mammographic findings and clinical history to lower the threshold for biopsy and avoid delay in diagnosis. Hyperechogenicity should not be considered as a characteristically benign feature and should not supersede the less specifically benign features of the same lesion on the other examination.
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Affiliation(s)
- Shivya Parashar
- Department of Radiodiagnosis, Medanta the Medicity, Gurugram, Haryana, India
| | - Jyoti Arora
- Department of Radiodiagnosis, Medanta the Medicity, Gurugram, Haryana, India
| | - Ayushi Mittal
- Department of Radiodiagnosis, Medanta the Medicity, Gurugram, Haryana, India
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Koufopoulos N, Pateras IS, Gouloumis AR, Ieronimaki AI, Zacharatou A, Spathis A, Leventakou D, Economopoulou P, Psyrri A, Arkadopoulos N, Panayiotides IG. Diagnostically Challenging Subtypes of Invasive Lobular Carcinomas: How to Avoid Potential Diagnostic Pitfalls. Diagnostics (Basel) 2022; 12:diagnostics12112658. [PMID: 36359501 PMCID: PMC9689338 DOI: 10.3390/diagnostics12112658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/11/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Invasive lobular carcinoma is the most common special breast carcinoma subtype, with unique morphological (discohesive cells, single-cell files, targetoid pattern) and immunohistochemical (loss of E-cadherin and β-catenin staining) features. Moreover, ILC displays a poor response to neoadjuvant therapy, a different metastatic pattern compared to invasive breast carcinoma of no special type, as well as unique molecular characteristics. In addition to the classic variant of invasive lobular carcinoma, several other well-recognized variants exist, including classic, alveolar, tubulolobular, solid, pleomorphic, signet-ring, and mixed. Furthermore, three novel variants of invasive lobular carcinoma, i.e., with extracellular mucin production, papillary features, and tubular elements, have been described during the last decade. We herewith focus on the unique morphological and immunohistochemical characteristics of these novel varieties of invasive lobular carcinoma, as well as differential diagnostic considerations and potential diagnostic pitfalls, especially when dealing with biopsy specimens.
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Affiliation(s)
- Nektarios Koufopoulos
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
- Correspondence: ; Tel.: +30-697-203-0941
| | - Ioannis S. Pateras
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Alina Roxana Gouloumis
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Argyro Ioanna Ieronimaki
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Andriani Zacharatou
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Aris Spathis
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Danai Leventakou
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Panagiota Economopoulou
- Medical Oncology Unit, 2nd Department of Internal Medicine-Propaedeutic, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Amanda Psyrri
- Medical Oncology Unit, 2nd Department of Internal Medicine-Propaedeutic, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Ioannis G. Panayiotides
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
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Dołęga-Kozierowski B, Lis M, Marszalska-Jacak H, Koziej M, Celer M, Bandyk M, Kasprzak P, Szynglarewicz B, Matkowski R. Multimodality imaging in lobular breast cancer: Differences in mammography, ultrasound, and MRI in the assessment of local tumor extent and correlation with molecular characteristics. Front Oncol 2022; 12:855519. [PMID: 36072800 PMCID: PMC9441946 DOI: 10.3389/fonc.2022.855519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Invasive lobular breast cancer (ILC) is a diagnostic challenge due to the diversity of morphological features. The objective of the study was to investigate the presentation and local extent of ILC using various imaging techniques and to assess the correlation between imaging and molecular profile. Materials and methods We reviewed 162 consecutive patients with ILC found on vacuum-assisted biopsy, who underwent evaluation of the lesion morphology and extent using ultrasound (US), mammography (MMG), and magnetic resonance imaging (MRI). Radiographic features were compared with ILC intrinsic subtype based on the expression of Ki-67 and estrogen, progesterone, and HER2 receptors. Results A total of 113 mass lesions and 49 non-mass enhancements (NMEs) were found in MRI. Masses were typically irregular and spiculated, showing heterogeneous contrast enhancement, diffusion restriction, and type III enhancement curve. NMEs presented mainly as the area of focal or multiregional distribution with heterogeneous or clumped contrast enhancement, diffusion restriction, and type III enhancement curve. Lesion extent significantly varied between MRI and MMG/ultrasonography (USG) (P < 0.001) but did not differ between MGF and ultrasonography (USG). The larger the ILC, the higher the disproportion when lesion extent in MRI was compared with MMG (P < 0.001) and ultrasonography (USG) (P < 0.001). In the study group, there were 97 cases of luminal A subtype (59.9%), 54 cases of luminal B HER2− (33.3%), nine cases of luminal B HER2+ (5.5%), and two cases of triple negative (1.2%). The HER2 type was not found in the study group. We did not observe any significant correlation between molecular profile and imaging. Conclusion MRI is the most effective technique for the assessment of ILC local extent, which is important for optimal treatment planning. Further studies are needed to investigate if the intrinsic subtype of ILC can be predicted by imaging features on MRI.
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Affiliation(s)
- Bartosz Dołęga-Kozierowski
- Breast Unit, Department of Breast Imaging, Lower Silesian Oncology, Pulmonology and Hematology Center, Wroclaw, Poland
| | - Michał Lis
- Burn and Plastic Surgery Department, Ludwik Rydygier Memorial Specialized Hospital in Krakow, Krakow, Poland
- *Correspondence: Michał Lis,
| | - Hanna Marszalska-Jacak
- Breast Unit, Department of Breast Imaging, Lower Silesian Oncology, Pulmonology and Hematology Center, Wroclaw, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Celer
- Breast Unit, Department of Breast Imaging, Lower Silesian Oncology, Pulmonology and Hematology Center, Wroclaw, Poland
| | - Małgorzata Bandyk
- Breast Unit, Department of Breast Imaging, Lower Silesian Oncology, Pulmonology and Hematology Center, Wroclaw, Poland
| | - Piotr Kasprzak
- Breast Unit, Department of Breast Imaging, Lower Silesian Oncology, Pulmonology and Hematology Center, Wroclaw, Poland
| | - Bartłomiej Szynglarewicz
- Breast Unit, Department of Breast Surgery, Lower Silesian Oncology, Pulmonology and Hematology Center, Wroclaw, Poland
- Department of Oncology, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Rafał Matkowski
- Breast Unit, Department of Breast Surgery, Lower Silesian Oncology, Pulmonology and Hematology Center, Wroclaw, Poland
- Department of Oncology, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
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5
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Park SY, Park JY, Park JW, Kim WH, Park JY, Kim HJ. Unexpected hyperechoic lesions of the breast and their correlations with pathology: a pictorial essay. Ultrasonography 2022; 41:597-609. [PMID: 35462528 PMCID: PMC9262659 DOI: 10.14366/usg.21243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/12/2022] [Indexed: 12/04/2022] Open
Abstract
Hyperechoic lesions of the breast encompass a wide range of conditions that are occasionally encountered during breast ultrasonography. Although typical hyperechoic lesions with a distinct fat component on imaging are well known, some hyperechoic lesions are diagnosed as unexpected pathology, making the radiology-pathology correlation difficult. Therefore, understanding the pathology of these lesions and how it correlates with imaging findings can help radiologists accurately diagnose and properly manage a range of related conditions. This article presents a pictorial review of unexpected hyperechoic benign and malignant breast lesions, with a focus on the pathological conditions that give rise to the hyperechoic pattern.
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Affiliation(s)
- Seo Young Park
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Radiology, Fatima Hospital, Daegu, Korea
| | - Jee Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ji Won Park
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Radiology, Chamteunteun Hospital, Daegu, Korea
| | - Won Hwa Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ji Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Hye Jung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
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Wanis ML, Wong JA, Rodriguez S, Wong JM, Jabo B, Ashok A, Lum SSJ, Solomon NL, Reeves ME, Garberoglio CA, Senthil M. Rate of Re-excision after Breast-conserving Surgery for Invasive Lobular Carcinoma. Am Surg 2020. [DOI: 10.1177/000313481307901034] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Invasive lobular carcinoma (ILC) accounts for approximately 5 to 20 per cent of all breast cancers and is often multicentric. Despite pre- and intraoperative assessments to achieve negative margins, ILC is reported to be associated with higher rates of positive margin. This cross-sectional study examined patients with breast cancer treated at our institution from 2000 to 2010. The objective was to investigate the rate of re-excision resulting from positive or close margin (1 mm or less) in patients who underwent breast-conserving surgery (BCS) for ILC compared with invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). Of the 836 patients treated, 416 patients underwent BCS. The rate of re-excision after BCS for ILC was 35.1 versus 17.7 per cent for IDC and 20.0 per cent for DCIS ( P = 0.04). Re-excisions were more often performed for positive margin in patients with ILC (11 of 37 [29.7%]) versus IDC (36 of 334 [10.8%]) and DCIS (five of 45 [11.1%];( P = 0.004). In this single-institution review, BCS for ILC had significantly higher rates of re-excision as a result of positive margins when compared with IDC and DCIS. Tumor size greater than 2 cm and lymph node involvement were identified as factors associated with positive surgical margin in ILC. The higher possibility of positive margins and the need for additional procedures should be discussed with patients undergoing BCS for ILC.
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Affiliation(s)
- Morcos L. Wanis
- From Loma Linda University Medical Center, Loma Linda, California
| | - Jennifer A. Wong
- From Loma Linda University Medical Center, Loma Linda, California
| | - Samuel Rodriguez
- From Loma Linda University Medical Center, Loma Linda, California
| | - Jasmine M. Wong
- From Loma Linda University Medical Center, Loma Linda, California
| | - Brice Jabo
- From Loma Linda University Medical Center, Loma Linda, California
| | - Arjun Ashok
- From Loma Linda University Medical Center, Loma Linda, California
| | - Sharon S. J. Lum
- From Loma Linda University Medical Center, Loma Linda, California
| | | | - Mark E. Reeves
- From Loma Linda University Medical Center, Loma Linda, California
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Kuhl CK, Lehman C, Bedrosian I. Imaging in Locoregional Management of Breast Cancer. J Clin Oncol 2020; 38:2351-2361. [PMID: 32442068 PMCID: PMC7343437 DOI: 10.1200/jco.19.03257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, RWTH, Aachen, Germany
| | - Constance Lehman
- Breast Imaging Section, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, Division of Surgery, University of Texas MD Anderson Cancer, Center, Houston, TX
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8
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Kuba MG, Giess CS, Wieczorek TJ, Lester SC. Hyperechoic malignancies of the breast: Underlying pathologic features correlating with this unusual appearance on ultrasound. Breast J 2019; 26:643-652. [PMID: 31512794 DOI: 10.1111/tbj.13501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 11/28/2022]
Abstract
Hyperechogenicity in the breast on ultrasound (US) is usually regarded as a benign feature with only rare hyperechoic malignancies reported to date. In this study, we evaluated the pathologic findings on core needle biopsy of hyperechoic lesions and investigated the histologic features in malignancies that give rise to an echogenic pattern. A total of 163 core needle biopsies (CNB) were performed for "hyperechoic" or "echogenic" lesions between 1/1/05 and 7/31/17. Lesions were classified based on the proportion of hyperechoic areas identified. We found that all lesions with a homogenous hyperechoic pattern (>90% hyperechoic) were benign (n = 17), regardless of the type of margins. Malignancies were found in 21% (7/34, six invasive carcinomas and one lymphoma) of heterogenous lesions with ≥50% hyperechoic areas (all with noncircumscribed margins) and in 31% of lesions with <50% hyperechoic areas (19/61, 14 invasive carcinomas, two lymphomas, and three metastases), including five with circumscribed margins (one invasive carcinoma, one lymphoma, and three metastases). Two major US patterns were identified in malignant lesions, those with a hypoechoic center and hyperechoic rim, corresponding to a central tumor area with dense stroma and tumor cells infiltrating adipose tissue at the periphery ("rim pattern"), and a second "dispersed pattern" with hyperechoic areas distributed throughout the lesion. Hyperechoic malignancies were found to be comprised of a complex intermixture of elements of differing echogenicity including tumor cells, adipose tissue, and fluid (in tubules, stromal clefts, or blood vessels). Our findings support the importance of radiologists specifying the echogenic pattern of hyperechoic lesions, as heterogenous lesions are associated with a higher risk of malignancy and pathologists should be alert to the associated pathologic findings.
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Affiliation(s)
- Maria G Kuba
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Catherine S Giess
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tad J Wieczorek
- Department of Pathology, Brigham and Women's Faulkner Hospital, Boston, Massachusetts
| | - Susan C Lester
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Malherbe K, Bresser P. Association between ultrasound morphologic features and histopathological findings of lobular carcinoma. J Med Radiat Sci 2019; 66:177-183. [PMID: 31472006 PMCID: PMC6745349 DOI: 10.1002/jmrs.336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/17/2019] [Accepted: 05/08/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Despite the incidence and recurrence rates of breast cancer, there are currently no biomarkers to predict which cases will develop into lobular carcinoma (LC). The purpose of this study was to determine the association between ultrasound morphologic characteristics of LC and histopathological classifications. METHODS A retrospective, cross-sectional study was conducted on the ultrasound images and histopathological reports of 100 patients with a confirmed LC diagnosis between January 2013 and December 2016. RESULTS Morphologic ultrasound characteristics most frequently reported in the dataset of positively diagnosed LC patients were; irregular ultrasound shape (86%), hypoechoic echogenicity (88%), poorly circumscribed margin (95%), posterior acoustic enhancement (93%) and absent calcifications (81%). Using Fisher's extract test, it was found that stromal fibrosis, single file type pattern, atypical lobular hyperplasia and LC Grade II were significantly correlated with irregular shape and hypoechoic echogenicity. CONCLUSION A prognostic predictor tool can be designed from this study's findings which can then be used in practice to raise awareness of the unique morphometric markers related to LC of the breast.
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Affiliation(s)
- Kathryn Malherbe
- Department of Health Sciences, Department Radiographic SciencesUniversity of PretoriaPretoriaSouth Africa
| | - Philippa Bresser
- Department of Health Sciences, Department Radiographic SciencesUniversity of PretoriaPretoriaSouth Africa
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Vijayaraghavan GR, Vedantham S, Santos-Nunez G, Hultman R. Unifocal Invasive Lobular Carcinoma: Tumor Size Concordance Between Preoperative Ultrasound Imaging and Postoperative Pathology. Clin Breast Cancer 2018; 18:e1367-e1372. [PMID: 30131246 DOI: 10.1016/j.clbc.2018.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/17/2018] [Accepted: 07/20/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND We systematically analyzed the extent of disease in unifocal invasive lobular carcinoma (ILC) using ultrasonography, with the histopathologic findings as the reference standard. PATIENTS AND METHODS In the present single-institution retrospective study, 128 cases of ILC were identified during a 5-year period. After exclusions, the analyzed cohort included 66 cases. Ultrasound measurements of the tumor extent along 3 axes were obtained. The tumor size was determined as the largest extent among the 3 axes and the tumor volume by ellipsoidal approximation. Pathology review provided the tumor size and volume. Correlation and regression analyses of tumor size and volume from the ultrasound and pathologic examinations were performed. The tumor stage from the ultrasound and pathologic examinations were used for the concordance analyses. RESULTS The median and quartiles (Q1, Q3) of tumor size from ultrasonography and pathology were 12.5 mm (Q1, 9 mm; Q3, 19 mm) and 17 mm (Q1, 12 mm; Q3, 25 mm), respectively. The corresponding data for tumor volume were 0.52 cm3 (Q1, 0.18 cm3; Q3, 1.92 cm3) and 1.04 cm3 (Q1, 0.45 cm3; Q3, 2.49 cm3). The ultrasound measurements correlated with the pathology-reported tumor size (Spearman ρ = 0.678; P < .0001) and volume (Spearman ρ = 0.699; P < .0001). The ultrasound-measured size and volume differed from the pathology-reported size and volume (P < .0001; Wilcoxon signed ranks test). Concordance between the clinical tumor size stage from ultrasound (cT) and pathology tumor size stage (pT) varied with the pT stage (P = .0003, Fisher's exact test), with the greatest concordance rate of 95.7% (95% confidence limit, 85.2%-99.5%) observed for pT1 tumors. CONCLUSION Ultrasonography underestimates the tumor size and volume, with the underestimation increasing for larger tumors. Hence, the concordance rate in tumor size stage between ultrasonography and pathology is tumor size dependent, with the greatest concordance rate observed for pT1 tumors.
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11
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van Zelst JCM, Mann RM. Automated Three-dimensional Breast US for Screening: Technique, Artifacts, and Lesion Characterization. Radiographics 2018; 38:663-683. [DOI: 10.1148/rg.2018170162] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jan C. M. van Zelst
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Internal Address 766, Geert Grooteplein Zuid 10, PO Box 9101, 6500HB Nijmegen, the Netherlands
| | - Ritse M. Mann
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Internal Address 766, Geert Grooteplein Zuid 10, PO Box 9101, 6500HB Nijmegen, the Netherlands
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12
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B-mode ultrasound examination of canine mammary gland neoplastic lesions of small size (diameter < 2 cm). Vet Res Commun 2018. [PMID: 29541992 DOI: 10.1007/s11259-018-9716-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Ultrasonography is a valuable tool for the evaluation of neoplastic lesions in the dog and there is a growing interest in the use of this technique for the stadiation of canine mammary tumours. An accurate assessment of small sized nodules facilitates the stadiation of the mammary lesions and helps the clinician in the choice of the most indicated surgical therapy. The aim of this study was to identify those ultrasound criteria that may be useful in discriminating between benign and malignant lesions of small size (diameter smaller than 2 cm). Sixty-two nodules, < 2 cm in larger diameter, belonging to thirty-five bitches presented between January 2012 and February 2014 were evaluated. Tumours were observed by conventional ultrasound and assessed for: shape (regular-irregular), limit (defined-ill-defined), margins (regular-irregular), echogenicity (hypoechoic-isoechoic-hyperecoic), echotexture (homogeneus-heterogeneus), presence of hyperecoic halo, distal acoustic enhancement or shadowing and surrounding tissue alterations. Among the alterations in surrounding tissues, the disruption of the glandular tissue and the increase in echogenicity of the peritumoral tissues were assessed. Thereafter, bitches were subjected to mastectomy and nodules were evaluated histologically. None of the ultasound criteria considered in the current study showed a statistically significant relation with malignancy, except for the presence of alterations in the tissue surrounding the nodules. According to our results, this characteristic may indicate malignancy, however its subjectivity may affect the applicability in clinical practice. In conclusions, conventional ultrasound in bitches had a limited ability in discriminating benign and malignant mammary gland neoplastic lesions of small size (diameter < 2 cm).
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13
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Kousi E, Smith J, Ledger AE, Scurr E, Allen S, Wilson RM, O'Flynn E, Pope RJ, Leach MO, Schmidt MA. Quantitative evaluation of contrast agent uptake in standard fat-suppressed dynamic contrast-enhanced MRI examinations of the breast. Med Phys 2018; 45:287-296. [PMID: 29095484 PMCID: PMC5814859 DOI: 10.1002/mp.12652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To propose a method to quantify T1 and contrast agent uptake in breast dynamic contrast-enhanced (DCE) examinations undertaken with standard clinical fat-suppressed MRI sequences and to demonstrate the proposed approach by comparing the enhancement characteristics of lobular and ductal carcinomas. METHODS A standard fat-suppressed DCE of the breast was performed at 1.5 T (Siemens Aera), followed by the acquisition of a proton density (PD)-weighted sequence, also fat suppressed. Both sequences were characterized with test objects (T1 ranging from 30 ms to 2,400 ms) and calibration curves were obtained to enable T1 calculation. The reproducibility and accuracy of the calibration curves were also investigated. Healthy volunteers and patients were scanned with Ethics Committee approval. The effect of B0 field inhomogeneity was assessed in test objects and healthy volunteers. The T1 of breast tumors was calculated at different time points (pre-, peak-, and post-contrast agent administration) for 20 patients, pre-treatment (10 lobular and 10 ductal carcinomas) and the two cancer types were compared (Wilcoxon rank-sum test). RESULTS The calibration curves proved to be highly reproducible (coefficient of variation under 10%). T1 measurements were affected by B0 field inhomogeneity, but frequency shifts below 50 Hz introduced only 3% change to fat-suppressed T1 measurements of breast parenchyma in volunteers. The values of T1 measured pre-, peak-, and post-contrast agent administration demonstrated that the dynamic range of the DCE sequence was correct, that is, image intensity is approximately directly proportional to 1/T1 for that range. Significant differences were identified in the width of the distributions of the post-contrast T1 values between lobular and ductal carcinomas (P < 0.05); lobular carcinomas demonstrated a wider range of post-contrast T1 values, potentially related to their infiltrative growth pattern. CONCLUSIONS This work has demonstrated the feasibility of fat-suppressed T1 measurements as a tool for clinical studies. The proposed quantitative approach is practical, enabled the detection of differences between lobular and invasive ductal carcinomas, and further enables the optimization of DCE protocols by tailoring the dynamic range of the sequence to the values of T1 measured.
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Affiliation(s)
- Evanthia Kousi
- CR‐UK and EPSRC Cancer Imaging CentreRoyal Marsden NHS Foundation TrustInstitute of Cancer ResearchSuttonSurreySM2 5PTUK
| | - Joely Smith
- Brighton and Sussex University Hospitals NHS TrustBrightonBN2 5BEUK
| | - Araminta E. Ledger
- CR‐UK and EPSRC Cancer Imaging CentreRoyal Marsden NHS Foundation TrustInstitute of Cancer ResearchSuttonSurreySM2 5PTUK
| | - Erica Scurr
- CR‐UK and EPSRC Cancer Imaging CentreRoyal Marsden NHS Foundation TrustInstitute of Cancer ResearchSuttonSurreySM2 5PTUK
| | - Steven Allen
- Department of RadiologyRoyal Marsden NHS Foundation TrustChelsea, LondonSW3 6JJUK
| | - Robin M. Wilson
- Department of RadiologyRoyal Marsden NHS Foundation TrustChelsea, LondonSW3 6JJUK
| | - Elizabeth O'Flynn
- CR‐UK and EPSRC Cancer Imaging CentreRoyal Marsden NHS Foundation TrustInstitute of Cancer ResearchSuttonSurreySM2 5PTUK
| | - Romney J.E. Pope
- Department of RadiologyRoyal Marsden NHS Foundation TrustChelsea, LondonSW3 6JJUK
| | - Martin O. Leach
- CR‐UK and EPSRC Cancer Imaging CentreRoyal Marsden NHS Foundation TrustInstitute of Cancer ResearchSuttonSurreySM2 5PTUK
| | - Maria A. Schmidt
- CR‐UK and EPSRC Cancer Imaging CentreRoyal Marsden NHS Foundation TrustInstitute of Cancer ResearchSuttonSurreySM2 5PTUK
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Chamming's F, Bouaboula M, Depetiteville MP, Catena V, Rousseau C, Boisserie-Lacroix M. Cancers lobulaires infiltrants : imagerie conventionnelle et gestes interventionnels. IMAGERIE DE LA FEMME 2017. [DOI: 10.1016/j.femme.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Corso G, Intra M, Trentin C, Veronesi P, Galimberti V. CDH1 germline mutations and hereditary lobular breast cancer. Fam Cancer 2016; 15:215-9. [PMID: 26759166 DOI: 10.1007/s10689-016-9869-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hereditary diffuse gastric cancer is an autosomal dominant inherited disease associated of CDH1 germline mutations (that encodes for the E-cadherin protein), and lobular breast cancer is the second most frequent type of neoplasia. Recently, novel E-cadherin constitutional alterations have been identified in pedigree clustering only for lobular breast carcinoma without evidence of diffuse gastric tumors and in absence of BRCA1/2 mutations. This first evidence opens novel questions about the inherited correlation between diffuse gastric and lobular breast cancers. In this brief review we revise the literature data about the CDH1 mutation frequency affecting exclusively lobular breast cancer, providing clinical recommendation for asymptomatic mutation carriers.
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Affiliation(s)
- Giovanni Corso
- Division of Senology, European Institute of Oncology, via G, Ripamonti 435, 20141, Milan, Italy.
| | - Mattia Intra
- Division of Senology, European Institute of Oncology, via G, Ripamonti 435, 20141, Milan, Italy
| | - Chiara Trentin
- Division of Breast Imaging, European Institute of Oncology, via G, Ripamonti 435, 20141, Milan, Italy
| | - Paolo Veronesi
- Division of Senology, European Institute of Oncology, via G, Ripamonti 435, 20141, Milan, Italy
| | - Viviana Galimberti
- Division of Senology, European Institute of Oncology, via G, Ripamonti 435, 20141, Milan, Italy
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Tiang S, Metcalf C, Dissanayake D, Wylie E. Malignant hyperechoic breast lesions at ultrasound: A pictorial essay. J Med Imaging Radiat Oncol 2016; 60:506-13. [PMID: 27216965 DOI: 10.1111/1754-9485.12468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/06/2016] [Indexed: 11/28/2022]
Abstract
Malignant breast lesions are typically hypoechoic at sonography. However, a small subgroup of hyperechoic malignant breast lesions is encountered in clinical practice. We present a pictorial essay of a number of different hyperechoic breast malignancies with mammographic, sonographic and histopathologic correlation. Suspicious sonographic features in a hyperechoic lesion include inhomogeneity in echogenic pattern, an irregular margin, posterior acoustic shadowing and internal vascularity. A hyperechoic lesion at ultrasound does not discount the need to undertake histological assessment of a mammographically suspicious lesion.
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Affiliation(s)
- Stephen Tiang
- Radiology Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Cecily Metcalf
- PathWest, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Deepthi Dissanayake
- Radiology Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Elizabeth Wylie
- Radiology Department, Royal Perth Hospital, Perth, Western Australia, Australia.,University of Western Australia, Crawley, Western Australia, Australia
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Savaridas SL, Bristow GD, Cox J. Invasive Lobular Cancer of the Breast: A Pictorial Essay of Imaging Findings on Mammography, Sonography, and Magnetic Resonance Imaging. Can Assoc Radiol J 2016; 67:263-76. [PMID: 27038644 DOI: 10.1016/j.carj.2015.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 09/04/2015] [Accepted: 09/07/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sarah L Savaridas
- North Tyneside General Hospital, North Shields, Tyne and Wear, United Kingdom
| | - Garry D Bristow
- North Tyneside General Hospital, North Shields, Tyne and Wear, United Kingdom
| | - Julie Cox
- Sunderland Royal Hospital, Sunderland, Tyne and Wear, United Kingdom.
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18
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Jung NY, Kim SH, Kim SH, Seo YY, Oh JK, Choi HS, You WJ. Effectiveness of Breast MRI and (18)F-FDG PET/CT for the Preoperative Staging of Invasive Lobular Carcinoma versus Ductal Carcinoma. J Breast Cancer 2015; 18:63-72. [PMID: 25834613 PMCID: PMC4381125 DOI: 10.4048/jbc.2015.18.1.63] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 11/27/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose We evaluated the utility of magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for the preoperative staging of invasive lobular carcinoma (ILC) of the breast and compared the results with those of invasive ductal carcinoma (IDC). Methods The study included pathologically proven 32 ILCs and 73 IDCs. We compared clinical and histopathological characteristics and the diagnostic performances of MRI and 18F-FDG PET/CT for the primary mass, additional ipsilateral and/or contralateral lesion(s), and axillary lymph node metastasis between the ILC and IDC groups. Results Primary ILCs were greater in size, but demonstrated lower maximum standardized uptake values than IDCs. All primary masses were detected on MRI. The detection rate for ILCs (75.0%) was lower than that for IDCs (83.6%) on 18F-FDG PET/CT, but the difference was not significant. For additional ipsilateral lesion(s), the sensitivities and specificities of MRI were 87.5% and 58.3% for ILC and 100.0% and 66.7% for IDC, respectively; whereas the sensitivities and specificities of 18F-FDG PET/CT were 0% and 91.7% for ILC and 37.5% and 94.7% for IDC, respectively. The sensitivity of 18F-FDG PET/CT for ipsilateral lesion(s) was significantly lower in the ILC group than the IDC group. The sensitivity for ipsilateral lesion(s) was significantly higher with MRI; however, specificity was higher with 18F-FDG PET/CT in both tumor groups. There was no significant difference in the diagnostic performance for additional contralateral lesion(s) or axillary lymph node metastasis on MRI or 18F-FDG PET/CT for ILC versus IDC. Conclusion The MRI and 18F-FDG PET/CT detection rates for the primary cancer do not differ between the ILC and IDC groups. Although 18F-FDG PET/CT demonstrates lower sensitivity for primary and additional ipsilateral lesions, it shows higher specificity for additional ipsilateral lesions, and could play a complementary role in the staging of ILC as well as IDC.
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Affiliation(s)
- Na Young Jung
- Department of Radiology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Sung Hoon Kim
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ye Young Seo
- Department of Radiology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin Kyoung Oh
- Department of Radiology, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Hyun Su Choi
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Won Jong You
- Department of Radiology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
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Nam SY, Ko ES, Han BK, Shin S, Ko EY, Shin JH, Hahn SY. Ultrasonographic hyperechoic lesions of the breast: are they always benign? Acta Radiol 2015; 56:18-24. [PMID: 24252817 DOI: 10.1177/0284185113512482] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most of the breast lesions show hypoechogenicity relative to fat on ultrasonography. The frequency and malignancy rate of hyperechoic lesions are not investigated in a large series. PURPOSE To evaluate the frequency and malignancy rate of hyperechoic lesions on breast sonography and to investigate sonographic characteristics that may predict malignancy in hyperechoic breast lesions. MATERIAL AND METHODS Radiologic reports of 16,416 patients who underwent breast sonography between 2007 and 2008 were searched using "hyperechoic", "echogenic" or "heterogeneous echoic" to describe lesions. Sonographic findings were evaluated according to the Breast Imaging Reporting and Data System lexicon. Clinical records including follow-up and pathologic findings were also reviewed. We calculated the frequency of hyperechoic lesions and their malignancy rate. Differences in sonographic appearances between benign and malignant lesions were also investigated. RESULTS Among the 16,416 patients, 103 (0.6%) hyperechoic lesions were identified (mean size, 1.79 cm). Of these 103 lesions, 27 (26.2%) were pathologically evaluated and five (4.9%, 4 invasive ductal carcinoma and 1 mucinous carcinoma) were confirmed as malignant. Among the 819 malignant lesions diagnosed using sonography-guided core needle biopsy, five (0.6%) were hyperechoic. In benign lesions, fat necrosis and fibroadenoma were common pathologic diagnoses. Malignant lesions were more likely to have irregular shape (P = 0.003), non-parallel orientation (P = 0.002), non-circumscribed margin (P = 0.007), and a hypoechoic area (P = 0.027) than benign lesions. All hyperechoic carcinomas were seen as suspicious masses on mammograms. CONCLUSION Hyperechoic masses are very rare and mostly benign. As an adjunct to mammography, the imaging findings reported here could help to avoid misdiagnosis for malignant hyperechoic lesion.
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Affiliation(s)
- Sang Yu Nam
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Radiology, Gil Hospital, Gachon University of Medicine and Science, Incheon, Republic of Korea
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Boo-Kyung Han
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Suyoung Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Young Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Hee Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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20
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Corso G, Figueiredo J, Biffi R, Trentin C, Bonanni B, Feroce I, Serrano D, Cassano E, Annibale B, Melo S, Seruca R, De Lorenzi F, Ferrara F, Piagnerelli R, Roviello F, Galimberti V. E-cadherin germline mutation carriers: clinical management and genetic implications. Cancer Metastasis Rev 2014; 33:1081-94. [PMID: 25332147 DOI: 10.1007/s10555-014-9528-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hereditary diffuse gastric cancer is an autosomic dominant syndrome associated with E-cadherin protein (CDH1) gene germline mutations. Clinical criteria for genetic screening were revised in 2010 by the International Gastric Cancer Linkage Consortium at the Cambridge meeting. About 40 % of families fulfilling clinical criteria for this inherited disease present deleterious CDH1 germline mutations. Lobular breast cancer is a neoplastic condition associated with hereditary diffuse gastric cancer syndrome. E-cadherin constitutional mutations have been described in both settings, in gastric and breast cancers. The management of CDH1 asymptomatic mutation carriers requires a multidisciplinary approach; the only life-saving procedure is the prophylactic total gastrectomy after thorough genetic counselling. Several prophylactic gastrectomies have been performed to date; conversely, no prophylactic mastectomies have been described in CDH1 mutant carriers. However, the recent discovery of novel germline alterations in pedigree clustering only for lobular breast cancer opens up a new debate in the management of these individuals. In this critical review, we describe the clinical management of CDH1 germline mutant carriers providing specific recommendations for genetic counselling, clinical criteria, surveillance and/ or prophylactic surgery.
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Affiliation(s)
- Giovanni Corso
- Molecular Senology Unit, via G. Ripamonti 435, European Institute of Oncology, 20141, Milan, Italy,
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21
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Bouzoubaa W, Laadioui M, Alaoui FZF, Jayi S, Bouguern H, Chaara H, Melhouf MA. [The place of magnetic resonance imaging in lobular carcinoma of the breast]. Pan Afr Med J 2014; 18:21. [PMID: 25368710 PMCID: PMC4214568 DOI: 10.11604/pamj.2014.18.21.4055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/14/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Wail Bouzoubaa
- Service de Gynécologie Obstétrique II, CHU Hassan II, Fès, Maroc
| | - Meryem Laadioui
- Service de Gynécologie Obstétrique II, CHU Hassan II, Fès, Maroc
| | | | - Sofia Jayi
- Service de Gynécologie Obstétrique II, CHU Hassan II, Fès, Maroc
| | - Hakima Bouguern
- Service de Gynécologie Obstétrique II, CHU Hassan II, Fès, Maroc
| | - Hikmat Chaara
- Service de Gynécologie Obstétrique II, CHU Hassan II, Fès, Maroc
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22
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Arps DP, Jorns JM, Zhao L, Bensenhaver J, Kleer CG, Pang JC. Re-excision rates of invasive ductal carcinoma with lobular features compared with invasive ductal carcinomas and invasive lobular carcinomas of the breast. Ann Surg Oncol 2014; 21:4152-8. [PMID: 24980090 DOI: 10.1245/s10434-014-3871-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Invasive ductal carcinoma (IDC) with lobular features (IDC-L) is not recognized as a subtype of breast cancer. We previously showed that IDC-L may be a variant of IDC with clinicopathological characteristics more similar to invasive lobular carcinoma (ILC). We sought to determine the re-excision rates of IDC-L compared with ILC and IDC, and the feasibility of diagnosing IDC-L on core biopsies. METHODS Surgical procedure, multiple tumor foci, tumor size, and residual invasive carcinoma on re-excision were recorded for IDC-L (n = 178), IDC (n = 636), and ILC (n = 251). Re-excision rates were calculated by excluding mastectomy as first procedure cases and including only re-excisions for invasive carcinoma. Slides of correlating core biopsies for IDC-L cases initially diagnosed as IDC were re-reviewed. RESULTS For T2 tumors (2.1-5.0 cm), re-excision rates for IDC-L (76 %) and ILC (88 %) were higher than that for IDC (42 %) (p = 0.003). Multiple tumor foci were more common in IDC-L (31 %) and ILC (26 %) than IDC (7 %) (p < 0.0001), which was a significant factor in higher re-excision rates when compared with a single tumor focus (p < 0.001). Ninety-two of 149 patients (62 %) with IDC-L were diagnosed on core biopsies. Of the 44 patients initially diagnosed as IDC, 30 were re-reviewed, of which 24 (80 %) were re-classified as IDC-L. CONCLUSIONS Similar to ILC, re-excision rates for IDC-L are higher than IDC for larger tumors. Patients may need to be counseled about the higher likelihood of additional procedures to achieve negative margins. This underscores the importance of distinguishing IDC-L from IDC on core biopsies.
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Affiliation(s)
- David P Arps
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA
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Wojcinski S, Stefanidou N, Hillemanns P, Degenhardt F. The biology of malignant breast tumors has an impact on the presentation in ultrasound: an analysis of 315 cases. BMC WOMENS HEALTH 2013; 13:47. [PMID: 24252758 PMCID: PMC3840587 DOI: 10.1186/1472-6874-13-47] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 11/15/2013] [Indexed: 02/13/2023]
Abstract
Background The aim of this study was to evaluate the relation of some ultrasound morphological parameters to biological characteristics in breast carcinoma. Methods Ultrasound data from 315 breast masses were collected. We analyzed the ultrasound features of the tumors according to the ACR BI-RADS®-US classification system stratified by hormone receptor status, HER2 status, histology grade, tumor type (ductal versus lobular), triple-negativity, breast density, tumor size, lymph node involvement and patient’s age. Results We found a variety of ultrasound features that varied between the groups. Invasive lobular tumors were more likely to have an angulated margin (39% versus 22%, p = 0.040) and less likely to show posterior acoustic enhancement (3% versus 16%, p = 0.023) compared to invasive ductal carcinoma. G3 tumors were linked to a higher chance of posterior acoustic enhancement and less shadowing and the margin of G3 tumors was more often described as lobulated or microlobulated compared to G1/G2 tumors (67% versus 46%, p = 0.001). Tumors with an over-expression of HER2 exhibited a higher rate of architectural distortions in the surrounding tissue, but there were no differences regarding the other features. Hormone receptor negative tumors were more likely to exhibit a lobulated or microlobulated margin (67% versus 50%, p = 0.037) and less likely to have an echogenic halo (39% versus 64%, p = 0.001). Furthermore, the posterior acoustic feature was more often described as enhancement (33% versus 13%, p = 0.001) and less often as shadowing (20% versus 47%, p < 0.001) compared to hormone receptor positive tumors. Conclusion Depending on their biological and clinical profile, breast cancers are more or less likely to exhibit the typical criteria for malignancy in ultrasound. Moreover, certain types of breast cancer tend to possess criteria that are usually associated with benign masses. False-negative diagnosis may result in serious consequences for the patient. For the sonographer it is essential to be well aware of potential variations in the ultrasound morphology of breast tumors, as described in this paper.
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Affiliation(s)
- S Wojcinski
- Department for Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany.
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24
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Pure Lobular Carcinoma of the Breast Presenting as a Hyperechoic Mass: Incidence and Imaging Characteristics. AJR Am J Roentgenol 2013; 201:W765-9. [DOI: 10.2214/ajr.12.9742] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Porter AJ, Evans EB, Foxcroft LM, Simpson PT, Lakhani SR. Mammographic and ultrasound features of invasive lobular carcinoma of the breast. J Med Imaging Radiat Oncol 2013; 58:1-10. [DOI: 10.1111/1754-9485.12080] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 04/08/2013] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Peter T Simpson
- UQ Centre for Clinical Research; The University of Queensland; Australia
| | - Sunil R Lakhani
- UQ Centre for Clinical Research; The University of Queensland; Australia
- The University of Queensland; School of Medicine; Australia
- Pathology Queensland: The Royal Brisbane & Women's Hospital; Brisbane Queensland Australia
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26
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Mann RM, Veltman J, Huisman H, Boetes C. Comparison of enhancement characteristics between invasive lobular carcinoma and invasive ductal carcinoma. J Magn Reson Imaging 2012; 34:293-300. [PMID: 21780225 DOI: 10.1002/jmri.22632] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To compare enhancement characteristics between invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) on contrast enhanced MRI of the breast and to observe the magnitude of eventual differences as these may impair the diagnostic value of breast MRI in ILC. MATERIALS AND METHODS We performed an analysis of enhancement characteristics on biphasic breast MRI in a series of 136 patients (103 IDC, 33 ILC) using an in-house developed application for pharmacokinetic modeling of contrast enhancement and a commercially available CAD application that evaluated the contrast-enhancement versus time curve. RESULTS Pharmacokinetic analysis showed that the most enhancing voxels in IDC had significantly higher K(trans) -values than in ILC (P < 0.01). No difference in v(e) -values was noted between groups. Visual assessment of contrast-enhancement versus time curves revealed wash-out curves to be less common in ILC (48% versus 84%). However, when using the CAD-application to assess the most malignant looking curve, the difference was blotted out (76% versus 86%). CONCLUSION ILC enhances slower than IDC but peak enhancement is not significantly less. The use of a CAD-application may help to determine the most malignant looking contrast-enhancement versus time curve, and hence facilitates lesion classification.
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Affiliation(s)
- Ritse M Mann
- Radboud University Nijmegen Medical Centre, Department of Radiology, Nijmegen, The Netherlands.
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Kombar OR, Fahmy DM, Brown MV, Farouk O, El-Damshety O. Sonomammographic characteristics of invasive lobular carcinoma. BREAST CANCER-TARGETS AND THERAPY 2012; 4:115-24. [PMID: 24367199 DOI: 10.2147/bctt.s34655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of our study was to identify characteristic features of invasive lobular carcinoma on mammography and ultrasound examinations. MATERIALS AND METHODS This is a retrospective multicenter study of women with biopsy-proven invasive lobular carcinoma. All patients had undergone diagnostic sonomammography. The imaging findings were identified by experienced breast imagers. Final surgical pathology results were used as the reference standard. RESULTS Thirty-two women ranging in age from 42 to 63 years old (mean age, 53 years), All had biopsy-proven invasive lobular carcinomas. Common features on mammogram included dense mass followed by architectural distortion; three cases showed breast asymmetry and one case was reported as normal. On ultrasound, common features included solid mass with spiculated margins, posterior shadowing, and perpendicular to the skin. CONCLUSION Although no specific features could be linked to invasive lobular carcinoma, care should be directed to subtle signs such as architectural distortion and breast asymmetry in order not to miss any lesions. The combination of mammographic and sonographic helps to decrease the relatively high false negative diagnosis of this type of breast cancer.
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Affiliation(s)
- Osama R Kombar
- Diagnostic Radiology Department, Oncology Center, Mansoura University, Mansoura, Egypt ; Diagnostic Radiology Department, Al-Amiri Hospital, Safat, Kuwait
| | - Dalia M Fahmy
- Diagnostic Radiology Department, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Mary V Brown
- Diagnostic Radiology Department, Al-Amiri Hospital, Safat, Kuwait
| | - Omar Farouk
- Surgical Oncology Department, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Osama El-Damshety
- Surgical Oncology Department, Oncology Center, Mansoura University, Mansoura, Egypt
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How reassuring is a normal breast ultrasound in assessment of a screen-detected mammographic abnormality? A review of interval cancers after assessment that included ultrasound evaluation. Clin Radiol 2011; 66:928-39. [DOI: 10.1016/j.crad.2011.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 03/07/2011] [Accepted: 03/23/2011] [Indexed: 11/21/2022]
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Le-Petross H, Lane D. Challenges and Potential Pitfalls in Magnetic Resonance Imaging of More Elusive Breast Carcinomas. Semin Ultrasound CT MR 2011; 32:342-50. [DOI: 10.1053/j.sult.2011.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wang X, Xu P, Wang Y, Grant EG. Contrast-enhanced ultrasonographic findings of different histopathologic types of breast cancer. Acta Radiol 2011; 52:248-55. [PMID: 21498359 DOI: 10.1258/ar.2010.100279] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The new application of contrast-enhanced ultrasonography (CEUS) in the diagnosis of breast masses has evolved quickly only in recent years. Nevertheless, mixed results owing to the overlap in characteristics of benign and malignant lesions are simultaneously discovered by most studies, partially attributed to different histopathologic characteristics of breast cancer. PURPOSE To explore the characteristics of different histopathologic types of breast cancer at real-time gray-scale CEUS and evaluate its diagnostic value. MATERIAL AND METHODS One hundred and one histopathologically confirmed malignant lesions were included. We retrospectively reviewed the contrast-enhanced ultrasonographic findings including morphologic features, quantitative parameters, and correlated them with histopathology. True-positive rate was calculated to assess the diagnostic performance of CEUS. RESULTS The 101 malignancies displayed irregular shape (72 [71%]), poorly-defined margin (73 [72%]), penetrating or tortuous surrounding vessels (79 [78%]), heterogeneous enhancement (84 [83%]), including focal perfusion defects (24 [24%]). For each histopathologic type, 87% (58/67) of invasive ductal carcinoma (IDC) showed heterogeneous enhancement. Of all the 24 perfusion defects, IDC account for 88% (21/24). Low average peak intensity (PI) of 4.9 was detected in this type. Ductal carcinoma in situ (DCIS) excellently showed the features of irregular shape (82% [14/17]), poorly-defined margin (82% [14/17]), heterogeneous enhancement (94% [16/17]). While 83% (5/6) of medullary carcinoma exhibited regular shape, well-defined margin, homogenous enhancement, and high average PI value of 9.6. Invasive lobular carcinoma showed similar enhancement pattern to that of IDC. Intraductal papillary carcinoma displayed high average PI value of 8.1. The overall true-positive rate for conventional US and CEUS was 88%, 86%, respectively. DCIS, medullary carcinoma, and intraductal papillary carcinoma achieved an improved true-positive rate (94%, 100% and 100%, respectively). CONCLUSION The imaging characteristics of CEUS are variable in different histopathologic types of breast cancer. CEUS does not appear to be superior to conventional ultrasound as a diagnostic tool overall, however, it is a useful adjunct to conventional ultrasound in diagnosing some special types of breast cancer.
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Affiliation(s)
- Xiaohong Wang
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Ping Xu
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Wang
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Edward G Grant
- Department of Radiology, University of Southern California, Keck School of Medicine, USC University Hospital, Los Angeles, CA, USA
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Linda A, Zuiani C, Lorenzon M, Furlan A, Londero V, Machin P, Bazzocchi M. The wide spectrum of hyperechoic lesions of the breast. Clin Radiol 2011; 66:559-65. [PMID: 21371696 DOI: 10.1016/j.crad.2010.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 12/06/2010] [Accepted: 12/14/2010] [Indexed: 11/30/2022]
Abstract
Although breast lesions are commonly detected because of their hypoechogenicity, some lesions may present with hyperechogenicity due to their histological components. Hyperechogenicity has been shown to be highly predictive of benignity; however, hyperechoic lesions can occasionally be malignant. This article reviews hyperechoic lesions of the breast, describes the underlying histological causes associated with hyperechogenicity, and the sonographic features useful for the differential diagnosis between benign and malignant hyperechoic lesions.
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Affiliation(s)
- A Linda
- Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy.
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van Leeuwen FWB, Buckle T, Batteau L, Pool B, Sinaasappel M, Jonkers J, Gilhuijs KGA. Potential value of color-coded dynamic breast-specific gamma-imaging; comparing (99m)Tc-(V)-DMSA, (99m)Tc-MIBI, and (99m)Tc-HDP in a mouse mammary tumor model. Appl Radiat Isot 2010; 68:2117-24. [PMID: 20627742 DOI: 10.1016/j.apradiso.2010.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 05/11/2010] [Accepted: 05/12/2010] [Indexed: 11/19/2022]
Abstract
Using a mouse mammary tumor model based on orthotopic transplantation of luciferase-expressing mouse ILC cells (KEP1-Luc cells), we evaluated the diagnostic value of three clinically applied tracers: (99m)Tc-(V)-DMSA, (99m)Tc-MIBI, and (99m)Tc-HDP. Uptake of the tracers is compared using static and dynamic imaging procedures. We found that dynamic imaging in combination with pixel-by-pixel color coding has an added value over (high resolution) static imaging procedures. Such dynamic imaging procedures could enhance the potential of breast-specific gamma-imaging.
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Affiliation(s)
- Fijs W B van Leeuwen
- Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands.
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The Effectiveness of MR Imaging in the Assessment of Invasive Lobular Carcinoma of the Breast. Magn Reson Imaging Clin N Am 2010; 18:259-76, ix. [DOI: 10.1016/j.mric.2010.02.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Anwar IF, Down SK, Rizvi S, Farooq N, Burger A, Morgan A, Hussien MI. Invasive lobular carcinoma of the breast: should this be regarded as a chronic disease? Int J Surg 2010; 8:346-52. [PMID: 20420942 DOI: 10.1016/j.ijsu.2010.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 03/08/2010] [Accepted: 04/20/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND The surgical treatment of patients with invasive lobular carcinoma is still controversial due to its different clinical and pathological features. Most studies report local recurrence after relatively short follow-up periods, which is usually 5 years. However there is some evidence to suggest that local recurrence may occur late in the course of follow-up. AIM OF THE STUDY To study the implications and outcome of extending the follow-up period of patients treated for invasive lobular carcinoma. PATIENTS AND METHODS Patients (268) treated between 1989 and 1996 were reviewed. Thirty-three patients were excluded as they had primary hormonal therapy. The outcomes for 235 patients were analyzed. RESULTS Seventy-nine patients (33.6%) had breast conservation surgery (group I), which was followed by re-excision due to positive margins in 23 patients (29%), and 156 patients (66.3%) had mastectomy (group II). Compared to group II, tumours in group I were smaller (mean size 17 vs. 37 mm, P=0.001), multifocal [20 (25%) vs. 14 (9%), P=0.003] and with more positive margins [23 (29%) vs. 24 (15%), P=0.0009]. Only 33 patients (21%) in group II, and all patients in group I had post-operative radiotherapy (P=0.0001). Forty-eight patients (17.9%) developed local recurrence [27 (34%) in group I and 21 (13.4%) in group II, P=0.0005] after a median follow-up period of 167.8 months. The mean time to local recurrence was 127 (range 24-196) months. Univariate analysis showed that the type of surgery, margin status, adjuvant radiotherapy and chemotherapy significantly affected local recurrence (P=0.0005, 0.02, 0.04 and 0.05 respectively). Cox regression analysis showed that the only factor affected local recurrence was the type of surgery (relative risk 2.43, 95% confidence interval 1.22-4.83, P=0.01) The overall survival was 99.3 months (78.2%). Univariate and Cox regression analyses showed that only the patients age at diagnosis significantly affected survival (P=0.003). CONCLUSION Local recurrence may be a late event in patients treated for invasive lobular carcinoma of the breast and extended follow-up may be considered. In this study mastectomy offers better local control.
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Affiliation(s)
- I F Anwar
- Breast Surgery Unit, Norfolk & Norwich University Hospital, Norwich, UK
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Mann RM, Loo CE, Wobbes T, Bult P, Barentsz JO, Gilhuijs KGA, Boetes C. The impact of preoperative breast MRI on the re-excision rate in invasive lobular carcinoma of the breast. Breast Cancer Res Treat 2010; 119:415-22. [PMID: 19885731 DOI: 10.1007/s10549-009-0616-6] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Accepted: 10/21/2009] [Indexed: 02/07/2023]
Abstract
Re-excision rates after breast conserving surgery(BCS) of invasive lobular carcinoma (ILC) are high.Preoperative breast MRI has the potential to reduce re-excision rates, but may lead to an increased rate of mastectomies. Hence, we assessed the influence of preoperative breast MRI on the re-excision rate and the rate of mastectomies. We performed a retrospective cohort study of a consecutive series of patients with ILC who presented in one of two dedicated tertiary cancer centers between 1993 and 2005. We assessed the initial type of surgery(BCS or mastectomy), the re-excision rate and the final type of surgery. Patients were stratified into two groups:those who received preoperative MRI (MR? group) and those who did not (MR- group). In the MR- group, 27%of the patients underwent a re-excision after initial BCS. In the MR? group, this rate was significantly lower at 9%.The odds ratio was 3.64 (95% CI: 1.30-10.20, P = 0.010).There was a trend towards a lower final mastectomy rate in the MR? group compared to the MR- group (48 vs. 59%,P = 0.098). In conclusion, preoperative MRI in patients with ILC can reduce re-excision rates without increasing the rate of mastectomies.
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Affiliation(s)
- R M Mann
- Department of Radiology, Radboud University Nijmegen, Medical Centre, huispost 667, Geert Grooteplein 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Hwang KT, Kim H, Chung JK, Jung IM, Heo SC, Ahn YJ, Ahn HS, Cha JH, Chung SY, Chang MS, Noh DY. A Comparative Study between the Preoperative Diagnostic Tumor Size and the Postoperative Pathologic Tumor Size in Patients with Breast Tumors. J Breast Cancer 2010. [DOI: 10.4048/jbc.2010.13.2.187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ki-Tae Hwang
- Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea
| | - Hyeyoung Kim
- Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea
| | - Jung Kee Chung
- Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea
| | - In Mok Jung
- Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea
| | - Seung Chul Heo
- Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea
| | - Young Joon Ahn
- Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea
| | - Hye Seong Ahn
- Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea
| | - Joo Hee Cha
- Department of Radiology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Se-Yeong Chung
- Department of Radiology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Mee Soo Chang
- Department of Pathology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Dong-Young Noh
- Cancer Research Institute and Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Mann RM, Veltman J, Barentsz JO, Wobbes T, Blickman JG, Boetes C. The value of MRI compared to mammography in the assessment of tumour extent in invasive lobular carcinoma of the breast. Eur J Surg Oncol 2007; 34:135-42. [PMID: 17574805 DOI: 10.1016/j.ejso.2007.04.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 04/28/2007] [Indexed: 12/12/2022] Open
Abstract
AIMS Invasive lobular carcinoma of the breast (ILC) is known to be substantially underestimated by mammography, which makes correct planning of treatment difficult. MRI has been proposed as a valuable adjunct to mammography. The purpose of the current study is to evaluate its value, compare it to mammography and assess the possible causes of over- and underestimation of lesion size on MRI. METHOD The mammograms and MRI scans of 67 consecutive patients with ILC were retrieved and re-evaluated. Size measurements were correlated to the sizes extracted from the pathology report. RESULTS MRI measurements correlated better to pathologic size (r=0.85) than mammographic measurements (r=0.27). Underestimation of tumour size was more common on mammography (p<0.001); overestimation occurred with equal frequency (p=0.69). Overestimation on MRI, caused by non-malignant findings, was attributed to enhancing lobular carcinoma in situ. CONCLUSION MRI is a more accurate modality for determining tumour size in patients with ILC than mammography. The typical underestimation of lesion size by mammography can be prevented with the aid of MRI, without increasing the risk of lesion overestimation.
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Affiliation(s)
- R M Mann
- Department of Radiology, University Medical Center Nijmegen, The Netherlands.
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MRI compared to conventional diagnostic work-up in the detection and evaluation of invasive lobular carcinoma of the breast: a review of existing literature. Breast Cancer Res Treat 2007; 107:1-14. [PMID: 18043894 PMCID: PMC2096637 DOI: 10.1007/s10549-007-9528-5] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Accepted: 01/19/2007] [Indexed: 02/07/2023]
Abstract
Purpose The clinical diagnosis and management of invasive lobular carcinoma (ILC) of the breast presents difficulties. Magnetic resonance imaging (MRI) has been proposed as the imaging modality of choice for the evaluation of ILC. Small studies addressing different aspects of MRI in ILC have been presented but no large series to date. To address the usefulness of MRI in the work-up of ILC, we performed a review of the currently published literature. Materials and methods We performed a literature search using the query “lobular AND (MRI OR MR OR MRT OR magnetic)” in the Cochrane library, PubMed and scholar.google.com, to retrieve all articles that dealt with the use of MRI in patients with ILC. We addressed sensitivity, morphologic appearance, correlation with pathology, detection of additional lesions, and impact of MRI on surgery as different endpoints. Whenever possible we performed meta-analysis of the pooled data. Results Sensitivity is 93.3% and equal to overall sensitivity of MRI for malignancy in the breast. Morphologic appearance is highly heterogeneous and probably heavily influenced by interreader variability. Correlation with pathology ranges from 0.81 to 0.97; overestimation of lesion size occurs but is rare. In 32% of patients, additional ipsilateral lesions are detected and in 7% contralateral lesions are only detected by MRI. Consequently, MRI induces change in surgical management in 28.3% of cases. Conclusion This analysis indicates MRI to be valuable in the work-up of ILC. It provides additional knowledge that cannot be obtained by conventional imaging modalities which can be helpful in patient treatment.
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Whitman GJ, Huynh PT, Patel P, Wilson J, Cantu A, Krishnamurthy S. Sonography of Invasive Lobular Carcinoma. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.cult.2007.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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