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Sun J, Shao S, Wan H, Wu X, Feng J, Gao Q, Qu W, Xie L. Prediction models for postoperative recurrence of non-lactating mastitis based on machine learning. BMC Med Inform Decis Mak 2024; 24:106. [PMID: 38649879 PMCID: PMC11036744 DOI: 10.1186/s12911-024-02499-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVES This study aims to build a machine learning (ML) model to predict the recurrence probability for postoperative non-lactating mastitis (NLM) by Random Forest (RF) and XGBoost algorithms. It can provide the ability to identify the risk of NLM recurrence and guidance in clinical treatment plan. METHODS This study was conducted on inpatients who were admitted to the Mammary Department of Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine between July 2019 to December 2021. Inpatient data follow-up has been completed until December 2022. Ten features were selected in this study to build the ML model: age, body mass index (BMI), number of abortions, presence of inverted nipples, extent of breast mass, white blood cell count (WBC), neutrophil to lymphocyte ratio (NLR), albumin-globulin ratio (AGR) and triglyceride (TG) and presence of intraoperative discharge. We used two ML approaches (RF and XGBoost) to build models and predict the NLM recurrence risk of female patients. Totally 258 patients were randomly divided into a training set and a test set according to a 75%-25% proportion. The model performance was evaluated based on Accuracy, Precision, Recall, F1-score and AUC. The Shapley Additive Explanations (SHAP) method was used to interpret the model. RESULTS There were 48 (18.6%) NLM patients who experienced recurrence during the follow-up period. Ten features were selected in this study to build the ML model. For the RF model, BMI is the most important influence factor and for the XGBoost model is intraoperative discharge. The results of tenfold cross-validation suggest that both the RF model and the XGBoost model have good predictive performance, but the XGBoost model has a better performance than the RF model in our study. The trends of SHAP values of all features in our models are consistent with the trends of these features' clinical presentation. The inclusion of these ten features in the model is necessary to build practical prediction models for recurrence. CONCLUSIONS The results of tenfold cross-validation and SHAP values suggest that the models have predictive ability. The trend of SHAP value provides auxiliary validation in our models and makes it have more clinical significance.
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Affiliation(s)
- Jiaye Sun
- Department of Mammary, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 200021, Shanghai, China
| | - Shijun Shao
- Department of Mammary, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 200021, Shanghai, China
| | - Hua Wan
- Department of Mammary, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 200021, Shanghai, China.
| | - Xueqing Wu
- Department of Mammary, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 200021, Shanghai, China.
| | - Jiamei Feng
- Department of Mammary, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 200021, Shanghai, China
| | - Qingqian Gao
- Department of Mammary, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 200021, Shanghai, China
| | - Wenchao Qu
- Department of Mammary, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 200021, Shanghai, China
| | - Lu Xie
- Department of Mammary, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 200021, Shanghai, China
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Guirguis MS, Arribas EM, Kapoor MM, Patel MM, Perez F, Nia ES, Ding Q, Moseley TW, Adrada BE. Multimodality Imaging of Benign and Malignant Diseases of the Nipple-Areolar Complex. Radiographics 2024; 44:e230113. [PMID: 38483829 DOI: 10.1148/rg.230113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The nipple-areolar complex (NAC), a unique anatomic structure of the breast, encompasses the terminal intramammary ducts and skin appendages. Several benign and malignant diseases can arise within the NAC. As several conditions have overlapping symptoms and imaging findings, understanding the distinctive nipple anatomy, as well as the clinical and imaging features of each NAC disease process, is essential. A multimodality imaging approach is optimal in the presence or absence of clinical symptoms. The authors review the ductal anatomy and anomalies, including congenital abnormalities and nipple retraction. They then discuss the causes of nipple discharge and highlight best practices for the imaging workup of pathologic nipple discharge, a common condition that can pose a diagnostic challenge and may be the presenting symptom of breast cancer. The imaging modalities used to evaluate and differentiate benign conditions (eg, dermatologic conditions, epidermal inclusion cyst, mammary ductal ectasia, periductal mastitis, and nonpuerperal abscess), benign tumors (eg, papilloma, nipple adenoma, and syringomatous tumor of the nipple), and malignant conditions (eg, breast cancer and Paget disease of the breast) are reviewed. Breast MRI is the current preferred imaging modality used to evaluate for NAC involvement by breast cancer and select suitable candidates for nipple-sparing mastectomy. Different biopsy techniques (US -guided biopsy and stereotactic biopsy) for sampling NAC masses and calcifications are described. This multimodality imaging approach ensures an accurate diagnosis, enabling optimal clinical management and patient outcomes. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Mary S Guirguis
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Elsa M Arribas
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Megha M Kapoor
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Miral M Patel
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Frances Perez
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Emily S Nia
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Qingqing Ding
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Tanya W Moseley
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Beatriz E Adrada
- From the Departments of Breast Imaging (M.S.G., E.M.A., M.M.K., M.M.P., F.P., E.S.N., T.W.M., B.E.A.), Pathology-Anatomical (Q.D.), and Breast Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
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Zhou F, Li H, Wang F, Liu L, Yu L, Xiang Y, Zheng C, Huang S, Yu Z. Efficacy and safety of rifampicin-based triple therapy for non-puerperal mastitis: A single-arm, open-label, prospective clinical trial. Int J Infect Dis 2024; 140:25-30. [PMID: 38142735 DOI: 10.1016/j.ijid.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023] Open
Abstract
OBJECTIVES To assess the efficacy and safety of rifampicin-based triple therapy (rifampicin, isoniazid, and ethambutol) for treating NPM. METHODS This single-center, single-arm, prospective clinical trial was conducted at the Second Hospital of Shandong University (Jinan, China). Patients with pathologically diagnosed granulomatous lobular mastitis and periductal mastitis received triple drugs, i.e., rifampicin (450 mg/day), isoniazid (300 mg/day), and ethambutol (15 mg/kg/day), until complete response or the investigator decided to discontinue treatment. The primary endpoint was the complete response rate (CRR) assessed by the investigator. The secondary endpoints included the overall remission rate (ORR), recurrence rate (RR), and safety. RESULTS A total of 218 patients were enrolled in the study between January 1, 2013 and October 31, 2020. With a median follow-up time of 48 months, the CRR and the ORR were 78.44% and 94.04%, respectively. While 13 patients (5.96%) demonstrated no response and 19 relapsed (8.72%). Adverse events (AEs) were not common. The most common AEs during treatment were liver dysfunction (1.83%), gastrointestinal reactions (1.83%), fatigue (1.83%), erythema (1.38%), and menstrual disorders (0.92%). CONCLUSION Rifampicin, isoniazid, and ethambutol demonstrated promising response rates with acceptable safety profiles in patients with NPM. Further confirmatory trial is warranted in the future. TRIAL REGISTRATION The study was approved by the Ethics Committee of the Second Hospital of Shandong University and retrospectively registered at the China Clinical Trial Registration Center (registration number: ChiCTR2100049591).
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Affiliation(s)
- Fei Zhou
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China; Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, China
| | - Huanjie Li
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China; Institute of Medical Sciences, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China
| | - Fei Wang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China; Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, China
| | - Liyuan Liu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China; Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, China
| | - Lixiang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China; Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, China
| | - Yujuan Xiang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China; Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, China
| | - Chao Zheng
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China; Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, China
| | - Shuya Huang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China; Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, China
| | - Zhigang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China; Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, China.
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Wang Z, Hua L, Liu X, Chen X, Xue G. A hematological parameter-based model for distinguishing non-puerperal mastitis from invasive ductal carcinoma. Front Oncol 2023; 13:1295656. [PMID: 38152369 PMCID: PMC10751305 DOI: 10.3389/fonc.2023.1295656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023] Open
Abstract
Purpose Non-puerperal mastitis (NPM) accounts for approximately 4-5% of all benign breast lesions. Ultrasound is the preferred method for screening breast diseases; however, similarities in imaging results can make it challenging to distinguish NPM from invasive ductal carcinoma (IDC). Our objective was to identify convenient and objective hematological markers to distinguish NPM from IDC. Methods We recruited 89 patients with NPM, 88 with IDC, and 86 with fibroadenoma (FA), and compared their laboratory data at the time of admission. LASSO regression, univariate logistic regression, and multivariate logistic regression were used to screen the parameters for construction of diagnostic models. Receiver operating characteristic curves, calibration curves, and decision curves were constructed to evaluate the accuracy of this model. Results We found significant differences in routine laboratory data between patients with NPM and IDC, and these indicators were candidate biomarkers for distinguishing between the two diseases. Additionally, we evaluated the ability of some classic hematological markers reported in previous studies to differentiate between NPM and IDC, and the results showed that these indicators are not ideal biomarkers. Furthermore, through rigorous LASSO and logistic regression, we selected age, white blood cell count, and thrombin time to construct a differential diagnostic model that exhibited a high level of discrimination, with an area under the curve of 0.912 in the training set and with 0.851 in the validation set. Furthermore, using the same selection method, we constructed a differential diagnostic model for NPM and FA, which also demonstrated good performance with an area under the curve of 0.862 in the training set and with 0.854 in the validation set. Both of these two models achieved AUCs higher than the AUCs of models built using machine learning methods such as random forest, decision tree, and SVM in both the training and validation sets. Conclusion Certain laboratory parameters on admission differed significantly between the NPM and IDC groups, and the constructed model was designated as a differential diagnostic marker. Our analysis showed that it has acceptable efficiency in distinguishing NPM from IDC and may be employed as an auxiliary diagnostic tool.
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Affiliation(s)
- Zhichun Wang
- Department of Breast Surgery, Jiujiang NO.1 People’s Hospital, Jiujiang, Jiangxi, China
| | - Lin Hua
- Department of Clinical Laboratory, Jiujiang NO.1 People’s Hospital, Jiujiang, Jiangxi, China
| | - Xiaofeng Liu
- Department of Clinical Laboratory, Jiujiang NO.1 People’s Hospital, Jiujiang, Jiangxi, China
| | - Xueli Chen
- Department of Clinical Laboratory, Jiujiang NO.1 People’s Hospital, Jiujiang, Jiangxi, China
| | - Guohui Xue
- Department of Clinical Laboratory, Jiujiang NO.1 People’s Hospital, Jiujiang, Jiangxi, China
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Li Q, Wan J, Feng Z, Shi J, Wei W. Predictive Significance of the Preoperative Neutrophil-lymphocyte Ratio for Recurrence in Idiopathic Granulomatous Mastitis Patients. Am Surg 2023; 89:5577-5583. [PMID: 36880848 DOI: 10.1177/00031348231161793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND To investigate and assess the correlation between inflammatory markers, such as the preoperative neutrophil-lymphocyte ratio (NLR), and the recurrence of idiopathic granulomatous mastitis (IGM). METHODS All patients with IGM who were free of malignancy or inflammatory diseases were included in this retrospective analysis between January 2013 and December 2019. On the basis of the presence or absence of recurrence, the patients were split into two groups. After collecting retrospective data, the relationship between patient characteristics, hematological markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), NLR, platelet-lymphocyte ratio (PLR), and white blood cell count (WBC), and their connection with postoperative recurrence were assessed utilizing univariate and multivariate analyses, receiver operating characteristic curves (ROC curves), and logistic regression. RESULTS Recurrences occurred in 40.0% (32/80) of the 80 patients over a median follow-up duration of 35.5 months (22.0-47.8 months). The recurrent group showed higher NLR and CRP than the non-recurrent group (PNLR = .003, PCRP = .02). Neutrophil-lymphocyte ratio and postoperative recurrence were associated (correlation coefficient r = .436, P = .01). The ROC curve's ideal threshold, which had predictive value for IGM recurrence, was 2.18 (sensitivity: 46.9%; specificity: 14.6%). CONCLUSION The preoperative NLR is a simple and affordable way to predict IGM relapse, which is important for directing clinical work.
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Affiliation(s)
- Qiang Li
- Department of Breast and Thyroid Surgery, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
| | - Jiangyang Wan
- Department of Breast and Thyroid Surgery, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
| | - Ziyu Feng
- Department of Breast and Thyroid Surgery, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
| | - Jianhua Shi
- Department of Breast and Thyroid Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, Nanjing, China
| | - Wan Wei
- Department of Breast and Thyroid Surgery, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
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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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Turashvili G, Li X. Inflammatory Lesions of the Breast. Arch Pathol Lab Med 2023; 147:1133-1147. [PMID: 37196345 DOI: 10.5858/arpa.2022-0477-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/19/2023]
Abstract
CONTEXT.— Inflammatory lesions of the breast are rare but not infrequently pose problems both clinically and morphologically, particularly on needle core biopsies. These lesions range from acute inflammatory conditions to chronic lymphoplasmacytic and lymphohistiocytic to granulomatous inflammatory diseases. OBJECTIVE.— To provide a comprehensive overview of inflammatory lesions of the breast, with etiopathogenesis and clinical, radiologic, and pathologic features as well as differential diagnostic considerations, clinical management, and prognosis. DATA SOURCES.— The existing literature in the English language, including original research articles and review articles describing inflammatory lesions of the breast. CONCLUSIONS.— Inflammatory lesions of the breast are characterized by a wide variety of clinical, radiologic, and morphologic features. The histopathologic differential diagnosis often includes a neoplastic process requiring ancillary studies and correlation with clinical and radiologic findings. Although most specimens display nonspecific findings precluding a definitive pathologic diagnosis, pathologists have a unique opportunity to play a crucial role in identifying key histologic features suggestive of certain entities, such as cystic neutrophilic granulomatous mastitis, immunoglobulin (Ig) G4 mastitis, or squamous metaplasia of lactiferous ducts, in the right clinical and radiologic context, and thereby guiding optimal and timely clinical management. The information presented herein will be helpful to practicing anatomic pathologists and pathology trainees in becoming more familiar with specific morphologic features and overcoming differential diagnostic challenges related to pathology reporting of inflammatory lesions of the breast.
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Affiliation(s)
- Gulisa Turashvili
- From the Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
| | - Xiaoxian Li
- From the Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
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Jiao Y, Chang K, Jiang Y, Zhang J. Identification of periductal mastitis and granulomatous lobular mastitis: a literature review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:158. [PMID: 36846004 PMCID: PMC9951018 DOI: 10.21037/atm-22-6473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/13/2023] [Indexed: 02/07/2023]
Abstract
Background and Objective Non-puerperal mastitis (NPM) is a breast disease with poor clinical manifestations, which seriously affects women's health and quality of life. Due to the low incidence rate of the disease and the paucity of related research, there is much misdiagnosis and mis-management of periductal mastitis (PDM) and granulomatous lobular mastitis (GLM). Therefore, understanding the differences between PDM and GLM, in terms of etiology and clinical manifestations, is crucial for patient treatment and prognosis. At the same time, choosing different treatment methods may not achieve the best treatment effect, so the appropriate treatment method can often reduce the patient's pain and reduce the recurrence of the patient's disease. Methods The PubMed database was searched for articles published from 1 January 1990 to 16 June 2022 using the following search terms: "non-puerperal mastitis", "periductal mastitis", "granulomatous lobular mastitis", "mammary duct ectasia", "idiopathic granulomatous mastitis", "plasma cell mastitis", and "identification". The key findings of the related literatures were analyzed and summarized. Key Content and Findings We systematically described the key points in the differential diagnosis, treatment, and prognosis of PDM and GLM. The use of different animal models for research and novel drugs to treat the disease were also described in this paper. Conclusions The key points in the differentiation of the two diseases are clearly explained, and the respective treatment options and prognosis are summarized.
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Affiliation(s)
- Yangchi Jiao
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Kexin Chang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yue Jiang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Juliang Zhang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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Zhou S, Sheng C, Hu P, Ni X, Xu X, Song Q, Jiang X, Zhao H, Chen X. A Preliminary Study of Ultrasound-Guided Microwave Ablation for Nonpuerperal Mastitis Treatment. Breast Care (Basel) 2023; 18:1-11. [PMID: 36876169 PMCID: PMC9982351 DOI: 10.1159/000527128] [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: 04/18/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction This study investigated the feasibility of ultrasound (US)-guided microwave ablation (MWA) as a treatment for nonpuerperal mastitis (NPM). Methods Fifty-three patients with NPM diagnosed by biopsy and treated with US-guided MWA at the Affiliated Hospital of Nantong University between September 2020 and February 2022 were classified according to whether they underwent MWA alone (n = 29) or MWA with incision and drainage (n = 24). Patients were followed up by interviews, physical and US examinations, and evaluation of breast skin at 1 week and 1, 2, and 3 months after treatment. Data from these patients were prospectively collected and retrospectively analyzed. Results The overall mean patient age was 34.42 ± 9.20 years. The groups differed significantly by age, involved quadrants, and the initial maximum diameter of lesions. In the MWA group, the cure rate was 34.48%, and the apparent efficiency rate was 65.52%. In the MWA with incision and drainage, the apparent efficiency rate was 91.66%, and the effective rate was 4.17%. The excellent rate for breast aesthetics in the MWA group was 79.31%, and the good rate was 20.69%. The excellent rate in the MWA with incision and drainage group was 45.83%, the good rate was 41.67%, and the qualified rate was 12.5%. The mean maximum diameter of lesions in the two groups decreased significantly. Conclusion For NPM with small lesions in a single quadrant, MWA therapy is a direct and effective method. For larger lesions involving two or more quadrants, the combined treatment of MWA with incision and drainage showed significant improvement in a short period. MWA treatment of NPM has importance for further research and clinical applications.
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Affiliation(s)
- Shengluan Zhou
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Chenyi Sheng
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Ping Hu
- Department of Traditional Chinese Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Xuejun Ni
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaoping Xu
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, China
| | - Qian Song
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Xiaoxiao Jiang
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Hui Zhao
- Department of Interventional Radiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaoyang Chen
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, China
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Biomedical Indicators of Patients with Non-Puerperal Mastitis: A Retrospective Study. Nutrients 2022; 14:nu14224816. [PMID: 36432503 PMCID: PMC9695051 DOI: 10.3390/nu14224816] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Non-puerperal mastitis (NPM), a recurrent chronic inflammation of non-lactating breast, often proves tremendous difficulty in treatment, and it may give rise to its complicated symptoms and unclear etiology. Furthermore, the clinical morbidity rate of NPM has been increasing in recent years. METHODS Overall, 284 patients diagnosed with NPM were consecutively recruited as cases in this study, and patients with benign breast disease (n = 1128) were enrolled as control. The clinical, biomedical, and pathological indicators were analyzed. Univariate and multivariate logistic analysis were used to distinguish risks between NPM and benign breast mass patients. Furthermore, according to the pathological characteristics, the patients of NPM were classified into two subgroups: mammary duct ectasia (MDE) and granulomatous lobular mastitis (GLM). The differences of biomedical indicators between MDE and GLM groups were also analyzed. RESULTS Compared with benign breast mass group, the level of high-density lipoprotein (HDL-C) significantly decreased, while lipoprotein(a) (Lp(a)) and blood glucose (GLU) both increased in NPM group. According to univariate and multivariate logistic analysis, the onset age and HDL-C were generally decreased, while Lp(a) and GLU were increased in NPM group. The onset age, HDL-C, Lp(a), and GLU were modeled to distinguish NPM and benign breast mass. Significant differences were also observed between MDE and GLM patients in biomedical indicators, such as lipoprotein(a) (Lp(a)), lactate dehydrogenase (LDH), creatine kinase (CK), total cholesterol (TC), and so on. CONCLUSIONS Our results indicated for the first time that biomarkers were associated with NPM. The biomedical indicators involved in lipid metabolism might be important factors in the development and treatment of NPM. In addition, MDE and GLM are two diseases with different inflammatory states of NPM. These findings would be helpful for a better understanding of NPM and give us some insights to develop new diagnostic and therapeutic strategies.
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Wu PS, Xiong D, Feng YB, Xiang L, Zhu J. Case report: A case of acute mastitis associated with reactive cutaneous capillary endothelial proliferation after camrelizumab treatment: A new immune-related adverse event. Front Immunol 2022; 13:939873. [PMID: 36090986 PMCID: PMC9452652 DOI: 10.3389/fimmu.2022.939873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/09/2022] [Indexed: 12/13/2022] Open
Abstract
Lung cancer is a malignant tumor with the highest morbidity and mortality rate worldwide, and it seriously endangers human health. In recent years, immunotherapy has been widely used in lung cancer and has achieved great benefits, especially the application of promoting antitumor immune defense. However, immune-related adverse events (irAEs) caused by immune checkpoint inhibitors have received increasing attention, which largely limits their use. We report the first case of new acute mastitis caused by anti-PD1 inhibitors due to lung adenocarcinoma. A 65-year-old female patient came to our hospital for treatment with cough and shortness of breath for one month. Chest CT showed that the malignant tumor in the lower lobe of the right lung with pleural effusion had metastasized to many places, and then pleural effusion was taken for pathological examination. Pathological examination indicated that the pleural fluid originated from lung adenocarcinoma. Subsequently, the patient received platinum-containing dual-agent chemotherapy (carboplatin and pemetrexed disodium) combined with immunotherapy (camrelizumab). During treatment, the patient developed known adverse events and unreported acute mastitis. After stopping camrelizumab, the patient’s mastitis gradually improved. Our case shows that acute mastitis might be a new adverse event after the use of camrelizumab. Since this new adverse event has not been reported, we hope that oncology medical workers can obtain insight from our case and use it as a reference for the identification and management of irAEs.
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Affiliation(s)
- Ping-Shang Wu
- Department of Thoracic Cardiovascular Surgery, The Third Hospital of Wuhan, Wuhan, China
| | - Dan Xiong
- Department of Cadre Ward First, General Hospital of Central Theater Command of the People’s Liberation Army, Wuhan, China
| | - Yang-Bo Feng
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Luan Xiang
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People’s Liberation Army, Wuhan, China
- *Correspondence: Jian Zhu, ; Luan Xiang,
| | - Jian Zhu
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People’s Liberation Army, Wuhan, China
- *Correspondence: Jian Zhu, ; Luan Xiang,
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Li C, Yao M, Li X, Shao S, Chen J, Li G, Jia C, Wu R. Ultrasonic multimodality imaging features and the classification value of nonpuerperal mastitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:675-684. [PMID: 35475482 DOI: 10.1002/jcu.23205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/12/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the value of ultrasonic multimodality imaging for characterizing nonpuerperal mastitis (NPM) lesions and feasibility of distinguishing different subtypes. METHODS Thirty-eight NPM lesions were assessed using conventional ultrasonography (US), strain elastography (SE), and contrast-enhanced ultrasound (CEUS). The lesions were confirmed pathologically and classified as granulomatous lobular mastitis (GLM), plasma cell mastitis (PCM), or nonspecific mastitis (NSM). Furthermore, diagnostic indicators were evaluated. The diagnostic performances of the modalities were compared using the area under the receiver operating characteristic curve (AUC). RESULTS The overall morphological features on US differed significantly between the GLM and PCM groups (p = 0.002). Lesion size (≤10 mm) (p = 0.003) and mean SE score (p = 0.001) differed significantly between the PCM and NSM groups. The frequent NPM characteristic on CEUS was hyperenhancement with (or without) increased lesion size; intergroup differences were not significant. Breast Imaging Reporting and Data System > 3 was considered to indicate malignancy; accordingly, the accuracy of US alone, US with CEUS, and US with SE was 10.5%, 21.1%, and 65.8%, respectively. Moreover, the AUC for US with SE for classifying GLM and PCM was 0.616. CONCLUSION CEUS cannot accurately classify NPM subtypes, while US and SE are valuable for classification.
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Affiliation(s)
- Chunxiao Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minghua Yao
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sihui Shao
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Chen
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Xing M, Zhang S, Zha X, Zhang J. Current Understanding and Management of Plasma Cell Mastitis: Can We Benefit from What We Know? Breast Care (Basel) 2022; 17:321-329. [PMID: 35949416 PMCID: PMC9247483 DOI: 10.1159/000517572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/20/2021] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Plasma cell mastitis (PCM), also known as mammary duct ectasia, is a chronic nonbacterial breast inflammation characterized by duct expansion and plasma cell infiltration. The severe and intense clinical manifestations profoundly affect the quality of life of female patients. Although the pathological process of PCM is known to include four stages (duct dilatation, inflammation, abscess and fistula), there is still lack of imaging techniques and serum markers with high specificity in clinical practice. Due to recurrent acute attacks and the prolonged healing process of the disease, most patients choose to accept mastectomy. SUMMARY We searched for studies, reports and reviews referring to PCM in the past 20 years; more than half of the results were related to animal studies, and little attention has been paid to human beings, which may explain the frequent misdiagnosis of PCM as breast cancer and the limited treatment options. This review focuses on the current diagnostic methods and markers for PCM and hierarchically discusses the typical clinical features, etiological causes and relevant molecular mechanisms of PCM. KEY MESSAGES We herein highlight the urgent need to develop more specific and sensitive biomarkers in the clinical laboratory. It will help to establish a standardized flowchart for the diagnosis and treatment of PCM in order to improve recovery for female patients.
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Affiliation(s)
- Mengying Xing
- Department of Laboratory Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shichang Zhang
- Department of Laboratory Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoming Zha
- Department of Breast Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiexin Zhang
- Department of Laboratory Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Radiology–Pathology Correlation: Inflammatory Conditions of the Breast. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Long Q, Fan Y, Zhang J, Li H, Lv Q. Pruritic breast mass with palpable lymph nodes in a male patient: a case report. Gland Surg 2021; 10:826-831. [PMID: 33708564 DOI: 10.21037/gs-21-40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This paper presents a case study of a 78-year-old male patient who presented with exacerbated skin redness and edema on the left chest wall, especially on the left breast, and who had been suffering from associated pruritus for 6 months. The patient also presented with enlarged ipsilateral axillary lymph nodes that were suspected to be carcinomas after a preliminary ultrasound and enhanced computerized tomography (CT) examination were performed. To examine these symptoms, an ultrasound-guided core biopsy and a chronic inflammatory test were also performed. The results of the excision biopsy and the immunohistochemistry test of the left breast and ipsilateral lymph node revealed no signs of cancer in this patient. Finally, combined with his medical history, the laboratory tests and pathology results, the patient was diagnosed with plasma cell mastitis (PCM) after another suspicious lesion (e.g., inflammatory breast cancer, etc.) was excluded. PCM is a kind of benign lesion of the breast with an unclear etiology. It usually affects non-pregnant and non-lactational females, who display clinical symptoms that are often similar to those of inflammatory breast cancer (IBC), the main manifestations were erythema and edema on the chest wall. To date, there is no standardized clinical treatment strategy or management approach for PCM.
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Affiliation(s)
- Quanyi Long
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Fan
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jia Zhang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hongjiang Li
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Lv
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
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Woodard GA, Bhatt AA, Knavel EM, Hunt KN. Mastitis and More: A Pictorial Review of the Red, Swollen, and Painful Breast. JOURNAL OF BREAST IMAGING 2021; 3:113-123. [PMID: 38424840 DOI: 10.1093/jbi/wbaa098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 03/02/2024]
Abstract
Clinically, acute mastitis presents as a red, swollen, and painful breast. Targeted ultrasound can be performed to evaluate the extent of infection and for an underlying abscess. Noncomplicated mastitis or a small fluid collection may respond to oral antibiotics without further intervention, but a larger or more complex abscess may require single or serial percutaneous aspiration. Breast infections, particularly those complicated by an abscess, can have a prolonged clinical course, and close follow-up is required. Since the clinical presentation and imaging features of acute infectious mastitis can overlap with other etiologies, such as inflammatory breast cancer and idiopathic granulomatous mastitis, a percutaneous biopsy may be indicated to accurately diagnose patients.
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Affiliation(s)
| | - Asha A Bhatt
- Mayo Clinic, Department of Radiology, Rochester, MN
| | | | - Katie N Hunt
- Mayo Clinic, Department of Radiology, Rochester, MN
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Chen ST, Covelli J, Okamoto S, Daniel BL, DeMartini WB, Ikeda DM. Clumped vs non-clumped internal enhancement patterns in linear non-mass enhancement on breast MRI. Br J Radiol 2020; 94:20201166. [PMID: 33332980 DOI: 10.1259/bjr.20201166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To compare positive predictive values (PPVs) of clumped vs non-clumped (homogenous and heterogeneous) internal enhancement on MRI detected linear non-mass enhancement (NME) on MRI-guided vacuum-assisted breast biopsy (MRI-VABB). METHODS With IRB (Institutional Review Board) approval, we retrospectively reviewed 598 lesions undergoing MRI-VABB from January 2015 to April 2018 that showed linear NME. We reviewed the electronic medical records for MRI-VABB pathology, any subsequent surgery and clinical follow-up. The X2 test was performed for univariate analysis. RESULTS There were 120/598 (20%) linear NME MRI-VABB lesions with clumped (52/120, 43%) vs non-clumped (68/120, 57%) internal enhancement, average size 1.8 cm (range 0.6-7.6 cm). On MRI-VABB, cancer was identified in 22/120 (18%) lesions, ductal carcinoma in situ (DCIS) was found in 18/22 (82%) and invasive cancer in 4 (18%). 3/31 (10%) high-risk lesions upgraded to DCIS at surgery, for a total of 25/120 (21%) malignancies. Malignancy was found in 12/52 (23%) clumped lesions and in 13/68 (19%) of non-clumped lesions that showed heterogeneous (5/13, 38%) or homogenous (8/13, 62%) internal enhancement. The PPV of linear NME with clumped internal enhancement (23.1%) was not significantly different from the PPV of non-clumped linear NME (19.1%) (p = 0.597). The PPV of linear NME lesions <1 cm (33.3%) was not significantly different from the PPV of lesions ≥1 cm (18.6%) (p = 0.157). CONCLUSIONS Linear NME showed malignancy in 21% of our series. Linear NME with clumped or non-clumped internal enhancement patterns, regardless of lesion size, might need to undergo MRI-VABB in appropriate populations. ADVANCES IN KNOWLEDGE Evaluation of linear NME lesions on breast MRI focuses especially on internal enhancement pattern.
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Affiliation(s)
- Shu Tian Chen
- Department of Diagnostic Radiology, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - James Covelli
- Department of Radiology, Stanford University School of Medicine, California, United States
| | - Satoko Okamoto
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Bruce L Daniel
- Department of Radiology, Stanford University School of Medicine, California, United States
| | - Wendy B DeMartini
- Department of Radiology, Stanford University School of Medicine, California, United States
| | - Debra M Ikeda
- Department of Radiology, Stanford University School of Medicine, California, United States
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Chen R, Hu B, Zhang Y, Liu C, Zhao L, Jiang Y, Xu Y. Differential diagnosis of plasma cell mastitis and invasive ductal carcinoma using multiparametric MRI. Gland Surg 2020; 9:278-290. [PMID: 32420252 DOI: 10.21037/gs.2020.03.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Evaluate the potential of multiparametric magnetic resonance imaging (MRI) for the differential diagnosis of plasma cell mastitis (PCM) and invasive ductal carcinoma (IDC). Methods A total of 465 female patients, including 197 PCM (42.4%) and 268 IDC (57.6%), were examined using breast MRI scanning using routine sequences, dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted imaging (DWI) and MR spectroscopy (MRS). The MRI features of PCM and IDC lesions were analyzed and compared to the histological results. Results Compared to IDC, the PCM lesions were more frequent in the subareolar regions, hyperintense on T2WI (P<0.01) and showed an initial signal increase ≤90%, a persistent and plateau pattern of time-intensity curves, non-mass enhancement, multiple rim enhancements, central hyperintensity on DWI, a higher ADC value, and total choline (tCho) peak negative and tCho peak integral <29.95 AU (P<0.01). The following breast-associated findings were also observed frequently in PCM: Ipsilateral breast enlargement, nipple retraction, skin thickening, peripheral edema and axillary lymphadenopathy. However, no significant difference was observed between the two groups for the shape, border and adjacent vessel signs of the lesion. Conclusions Some of the MRI features of PCM and IDC lesions were different. An integrated analysis of these multiparametric MRI features can thus assist in the differential diagnosis of PCM and IDC lesions.
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Affiliation(s)
- Rong Chen
- Department of Radiology, Huatai Kuige Hospital, Guang'an 638000, China.,Department of Radiology, Daping Hospital, Army Military Medical University, Chongqing 400042, China
| | - Baoquan Hu
- Department of Breast and Thyroid Surgery, Daping Hospital, Army Military Medical University, Chongqing 400042, China
| | - Yulong Zhang
- Department of Radiology, Daping Hospital, Army Military Medical University, Chongqing 400042, China
| | - Caibao Liu
- Department of Radiology, Daping Hospital, Army Military Medical University, Chongqing 400042, China
| | - Lianhua Zhao
- Department of Pathology, Daping Hospital, Army Military Medical University, Chongqing 400042, China
| | - Yan Jiang
- Department of Breast and Thyroid Surgery, Daping Hospital, Army Military Medical University, Chongqing 400042, China
| | - Yan Xu
- Department of Breast and Thyroid Surgery, Daping Hospital, Army Military Medical University, Chongqing 400042, China
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Hu J, Huang X. Combining ultrasonography and mammography to improve diagnostic accuracy of plasma cell mastitis. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:555-561. [PMID: 32333573 DOI: 10.3233/xst-190607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate the diagnostic value of ultrasonography and mammography for plasma cell mastitis. METHODS The ultrasonographic and mammographic images of 111 women with histopathologically confirmed plasma cell mastitis were retrospectively analyzed. The diagnostic accuracy of the two imaging methods was compared. RESULTS Ultrasonography identified 91 out of 111 (82.0%) patients with plasma cell mastitis, while the other twenty (18.0%) patients were misdiagnosed. Mammography identified 83 (74.8%) out of 111 patients with plasma cell mastitis. Nineteen (17.1%) patients were misdiagnosed. There was no significant difference between the diagnostic accuracy of using two imaging tests (P = 0.127). Mammography clouds identified 11 out of 20 patients who were not diagnosed by ultrasonography. Meanwhile, 19 of the 28 cases misdiagnosed with mammography were correctly identified by ultrasonography. Overall, 91.9% (102/111) of the patients were identified by the combination of ultrasonography and mammography, which yielded statistically significant higher accuracy than using each single test only (P < 0.05). CONCLUSIONS In diagnosis of plasma cell mastitis, high-frequency ultrasonography and mammography should be combined to improve the diagnostic accuracy.
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Affiliation(s)
- Jun Hu
- Department of Ultrasound, Chonggang General Hospital, Chongqing, China
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoling Huang
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Qu N, Luo Y, Yu T. Differentiation between Clinically Noninflammatory Granulomatous Lobular Mastitis and Noncalcified Ductal Carcinoma in situ Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Breast Care (Basel) 2020; 15:619-627. [DOI: 10.1159/000506068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/21/2020] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> Challenges in differentiation between clinically noninflammatory granulomatous lobular mastitis (GLM) and noncalcified ductal carcinoma in situ (DCIS) remain. <b><i>Objective:</i></b> To identify the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) characteristics contributing to their differential diagnosis. <b><i>Methods:</i></b> A total of 33 clinically noninflammatory GLM and 36 noncalcified DCIS were retrospectively analyzed in the study. Internal enhancement of a nonmass enhancement (NME) lesion was divided into clustered enhanced ring (absence/presence), and clustered enhanced ring (presence) was further classified as small and large ring based on the optimal cutoff value. The 5th Breast Imaging and Data System MRI descriptors were used for assessing the other DCE-MRI characteristics. Multivariate analysis including variables with significant differences in univariate analyses was conducted to identify the independent predictors. The discriminative abilities of different predictors and their combination were compared by area under the receiver-operating characteristic curves (AUCs). <b><i>Results:</i></b> An NME lesion was seen more commonly in clinically noninflammatory GLM than in noncalcified DCIS (<i>p</i> = 0.003). DCE-MRI characteristics with significant differences in univariate analyses included NME size, clustered enhanced ring (absence/presence), ring size, initial increase and kinetic characteristics for the differentiation between these two entities presenting as NME lesion. Clustered enhanced ring (presence) was further classified as small (≤7 mm) or large ring (>7 mm). Multivariate analysis revealed that internal enhancement and initial increase were identified as significant independent predictors, and the AUC of their combination achieved the highest value of 0.867 (95% CI, 0.748–0.943). <b><i>Conclusions:</i></b> An NME lesion with a large ring is more highly suggestive of clinically noninflammatory GLM.
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Febery A, Bennett I. Sonographic features of inflammatory conditions of the breast. Australas J Ultrasound Med 2019; 22:165-173. [PMID: 34760553 DOI: 10.1002/ajum.12170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Inflammatory conditions of the breast can be a diagnostic challenge, and ultrasound is a proven valuable tool in this setting. In acute infective conditions, ultrasound is often a superior tool to mammography due to the impracticality of applying compression to the breast and the increased parenchymal density of these often younger patients. Although infective processes comprise the majority of inflammatory conditions in the breast, not infrequently other various disease processes can masquerade as infections. In particular, inflammatory breast cancer can be easily misdiagnosed as an infective process and sonography can play an important role in expediting the correct diagnosis. Furthermore, aspiration, drainage and biopsy are frequently required in managing breast inflammation and breast disease generally, and ultrasound is the most practical imaging modality facilitating such interventions. This article provides a review of the ultrasound characteristics of some of the more frequently encountered inflammatory disorders of the breast which span a spectrum of acute to chronic conditions. The various conditions in this report are described in terms of their specific sonographic imaging features as well as pathogenesis, common clinical presentations, and aspects of management are outlined where appropriate.
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Affiliation(s)
- Alice Febery
- Department of Surgery, University of Queensland Princess Alexandra Hospital 199 Ipswich Road Woolloongabba, Brisbane Queensland Australia
| | - Ian Bennett
- Department of Surgery, University of Queensland Princess Alexandra Hospital 199 Ipswich Road Woolloongabba, Brisbane Queensland Australia
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Matusiak D, Wichtowski M, Pieszko K, Kobylarek D, Murawa D. Is negative-pressure wound therapy beneficial in modern-day breast surgery? Contemp Oncol (Pozn) 2019; 23:69-73. [PMID: 31316287 PMCID: PMC6630394 DOI: 10.5114/wo.2019.85199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/02/2019] [Indexed: 12/20/2022] Open
Abstract
Negative-pressure wound therapy (NPWT) is used to treat many different types of wounds, but there is still a lack of large studies describing its effectiveness in breast surgery. Enhanced recovery, reduction of complications, and good scar quality might be improved by the application of NPWT. Existing data show that vacuumassisted closure (VAC) application after expander-based breast reconstruction may be beneficial because of decreasing overall complications in comparison with standard wound treatment. There are few cases in which the use of negative pressure resulted in healing of complicated breast wounds after implant insertion - most breasts achieved healing, wherein duration of NPWT ranged from seven to 21 days. The use of NPWT leads to a decrease of seroma formation (from 70% to 15%), the mean percutaneous aspirated volume (from 193 ml to 26 ml) and the numbers of percutaneous aspirations (from three to one) in latissimus dorsi flap reconstruction. Furthermore, a prospective, within-patient, randomised study with 200 participants showed that treating closed incisional wounds after reduction mammoplasty with a VAC system resulted in a decrease of overall complications and protected against wound dehiscence. In the literature, there are cases showing that NPWT may be useful for the successful treatment of chronic and non-healing wounds, included non-puerperal mastitis and surgical sites affected by radiation therapy due to breast cancer. There is still a need for evidence confirming the effectiveness of NPWT in breast surgery because of the deficiency of large prospective studies that compare NPWT with standard treatment.
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Affiliation(s)
- Damian Matusiak
- Chair of Surgery and Oncology, Clinic of General Surgery and Surgical Oncology, Faculty of Medicine and Health Sciences, University of Zielona Gora, Poland
| | - Mateusz Wichtowski
- Chair of Surgery and Oncology, Clinic of General Surgery and Surgical Oncology, Faculty of Medicine and Health Sciences, University of Zielona Gora, Poland
| | - Karolina Pieszko
- Chair of Surgery and Oncology, Clinic of General Surgery and Surgical Oncology, Faculty of Medicine and Health Sciences, University of Zielona Gora, Poland
| | - Dominik Kobylarek
- Chair of Surgery and Oncology, Clinic of General Surgery and Surgical Oncology, Faculty of Medicine and Health Sciences, University of Zielona Gora, Poland
| | - Dawid Murawa
- Chair of Surgery and Oncology, Clinic of General Surgery and Surgical Oncology, Faculty of Medicine and Health Sciences, University of Zielona Gora, Poland
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Liu SQ, Liu YP, Zhou BG, Deng XH, Li XL, Xiang LH, Ren WW, Xu HX. Two-dimensional shear wave elastography for differential diagnosis between mastitis and breast malignancy. Clin Hemorheol Microcirc 2018; 70:347-354. [PMID: 29710692 DOI: 10.3233/ch-180400] [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: 12/31/2022]
Abstract
OBJECTIVE To determine the diagnostic performance of conventional ultrasound (US) and two-dimensional shear wave elastography (2D SWE) in the differential diagnosis between mastitis and breast malignancy. METHODS Between January 2016 and March 2017, 105 patients with 105 pathologically proven breast lesions were enrolled. All the lesions were subject to conventional US and 2D SWE examinations. In 2D SWE, the qualitative parameter of stiff rim sign and quantitative parameter of maximal shear wave velocity (SWV) were obtained. The diagnosis performances of US and combination of US and 2D SWE were evaluated, including sensitivity, specificity and the area under the receiver operating characteristic curve (AUROC). The AUROC of US and the combined method were also evaluated in subgroups with different diameters. RESULTS Pathologically, 26 breast lesions were confirmed to be mastitis and 79 were malignant. The cut-off value for maximal SWV was 6.75 m/sec. The AUROC of stiff rim sign and maximal SWV were 0.701 (95% CI: 0.587-0.815) and 0.753 (95% CI: 0.659-0.832) respectively. Compared with US, the specificity and AUROC of the combined method increased significantly (specificity: 11.5% vs. 96.1%, AUROC: 0.520 vs. 0.752; both P < 0.05). CONCLUSIONS The combination of US and 2D SWE improved the diagnostic performance in the differential diagnosis between mastitis and breast malignancy in comparison with the conventional US alone.
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Affiliation(s)
- Shui-Qing Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Suzhou University, Changzhou, China
| | - Yan-Ping Liu
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Suzhou University, Changzhou, China
| | - Bang-Guo Zhou
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Suzhou University, Changzhou, China
| | - Xiao-Hong Deng
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Li-Hua Xiang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Wei-Wei Ren
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
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Leong PW, Chotai NC, Kulkarni S. Imaging Features of Inflammatory Breast Disorders: A Pictorial Essay. Korean J Radiol 2018; 19:5-14. [PMID: 29353994 PMCID: PMC5768507 DOI: 10.3348/kjr.2018.19.1.5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/18/2017] [Indexed: 12/03/2022] Open
Abstract
Inflammatory breast disorders include a wide array of underlying causes, ranging from common benign infection, non-infectious inflammation and inflammation resulting from underlying breast malignancy. Because it is at times difficult to distinguish mastitis and breast cancer based on clinical features, awareness of detailed imaging features may be helpful for better management of inflammatory breast disorders. Therefore, this pictorial essay intends to demonstrate radiologic findings of a variety of inflammatory breast disorders, using selected cases with mammography, ultrasound and magnetic resonance images.
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Affiliation(s)
- Po Wey Leong
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Niketa Chandrakant Chotai
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Supriya Kulkarni
- Princess Margaret Hospital, Department of Medical Imaging, Toronto, ON M5G 2M9, Canada
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An Apparent Diffusion Coefficient Histogram Method Versus a Traditional 2-Dimensional Measurement Method for Identifying Non–Puerperal Mastitis From Breast Cancer at 3.0 T. J Comput Assist Tomogr 2018; 42:776-783. [DOI: 10.1097/rct.0000000000000758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Subareolar breast abscess in male patients: a report of two patients with a literature review. Surg Case Rep 2017; 3:128. [PMID: 29260424 PMCID: PMC5736504 DOI: 10.1186/s40792-017-0402-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/03/2017] [Indexed: 11/23/2022] Open
Abstract
Background Subareolar breast abscess (SBA) is a rare infectious disease of the breast in male patients. Case presentation Herein, we report two male patients with SBA. Patient 1 was initially diagnosed with a malignant tumor based on imaging findings; ultrasonography revealed a hypoechoic mass with blood flow. Patient 2 was diagnosed with inflammatory changes to his nipple; ultrasonography findings supported the diagnosis with an irregular hypoechoic mass with blood flow. Both patients received a cytological or histological biopsy preoperatively, which showed an abscess without malignant cells. Conclusion These cases serve as an important reminder to consider complete resection of the tumor including the responsible mammary duct (tumor and duct resection (TDR)) for curative therapy of SBA.
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Zhang L, Hu J, Guys N, Meng J, Chu J, Zhang W, Liu A, Wang S, Song Q. Diffusion-weighted imaging in relation to morphology on dynamic contrast enhancement MRI: the diagnostic value of characterizing non-puerperal mastitis. Eur Radiol 2017; 28:992-999. [PMID: 28956122 PMCID: PMC5811586 DOI: 10.1007/s00330-017-5051-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/10/2017] [Accepted: 08/22/2017] [Indexed: 02/05/2023]
Abstract
Objectives To demonstrate the value of diffusion-weighted imaging (DWI) in the characterisation of mastitis lesions. Methods Sixty-one non-puerperal patients with pathologically confirmed single benign mastitis lesions underwent preoperative examinations with conventional MRI and axial DWI. Patients were categorised into three groups: (1) periductal mastitis (PDM), (2) granulomatous lobular mastitis (GLM), and (3) infectious abscess (IAB). Apparent diffusion coefficient (ADC) values of each lesion were recorded. A one-way ANOVA with logistic analysis was performed to compare ADC values and other parameters. Discriminative abilities of DWI modalities were compared using the area under the receiver operating characteristic curve (AUC). P < 0.05 was considered statistically significant. Results ADC values differed significantly among the three groups (P = 0.003) as well as between PDM and IAB and between PDM and GLM. The distribution of non-mass enhancement on dynamic contrast-enhanced (DCE) MRI differed significantly among the three groups (P = 0.03) but not between any two groups specifically. There were no differences in lesion location, patient age, T2WI or DWI signal intensity, enhancement type, non-mass internal enhancement, or mass enhancement characteristics among the three groups. Conclusions ADC values and the distribution of non-mass enhancement are valuable in classifying mastitis subtypes. Key points • Mastitis subtypes exhibit different characteristics on DWI and DCE MRI. • ADC values are helpful in isolating PDM from other mastitis lesions. • Distribution of non-mass enhancement also has value in comparing mastitis subtypes.
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Affiliation(s)
- Lina Zhang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China
| | - Jiani Hu
- Department of Radiology, Wayne State University, 540 East Canfield Street, Detroit, MI, 48201, USA
| | - Nicholas Guys
- Department of Radiology, Wayne State University, 540 East Canfield Street, Detroit, MI, 48201, USA
| | - Jinli Meng
- Department of Radiology, Chengban Branch of West China Hospital, 37 Guoxue Alley, Wuhou, Chengdu, Sichuan, 610041, China
| | - Jianguo Chu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China
| | - Weisheng Zhang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China
| | - Ailian Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China.
| | - Shaowu Wang
- Department of Radiology, Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Shahekou, Dalian, Liaoning, 116023, China.
| | - Qingwei Song
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China
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Radiologic-Pathologic Correlation for Benign Results After MRI-Guided Breast Biopsy. AJR Am J Roentgenol 2017; 209:442-453. [PMID: 28537753 DOI: 10.2214/ajr.16.17048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The majority of MRI-guided breast biopsies yield benign pathology. The purpose of this article is to provide a comprehensive overview of benign pathologic entities commonly encountered at MRI-guided breast biopsy. CONCLUSION Proper radiologic-pathologic correlation is an integral component of MRI-guided breast biopsy. Familiarity with the spectrum of MRI findings and key histopathologic features of common benign entities will enhance the radiologist's confidence in determining concordance and lead to improved patient management recommendations.
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Belonenko GA, Grintsov AG, Osipov AG, Pilyugin GG, Lutsenko YG, Aksenova EG, Aksenov AA. [Diagnosis and treatment of inflammatory diseases of the mammary ducts]. Khirurgiia (Mosk) 2016:54-58. [PMID: 27905374 DOI: 10.17116/hirurgia20161154-58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM The analysis and popularization of the own experience of ultrasonic diagnostics and minimal invasive interventions for inflammatory diseases of the mammary ducts. PATIENTS AND METHODS 249 women were observed: 182 (73.1%) cases of periductal mastitis and 67 (26.9%) cases of purulent galactophoritis. Patients with purulent galactophoritis were divided into 2 groups (main and control). The main group consisted of 50 patients after minimal invasive interventions, control - 17 women after traditional surgery. RESULTS The main US signs of periductal mastitis and purulent galactophoritis were detected. Purulent galactophoritis is associated with the diameter of mammary duct less than 4 mm, ductal content flotation and stream-effect (coloring of dilated duct in Doppler mode). It was proposed the method of US-assisted mini-invasive retrograde drainage of mammary ducts with aspiration of purulent content through the natural orifice in the nipple. This method doesn't demand hospital stay, reduces duration of treatment by 14 days and doesn't cause the cosmetic defects in comparison with traditional surgical approach. CONCLUSION Inflammatory diseases of the mammary ducts are represented by the different nosological forms - periductal mastitis (73.1%) and purulent galactophoritis (26.9%). In view of typical ultrasonic picture in patients with purulent galactophoritis US-assisted mini-invasive retrograde drainage of mammary ducts with aspiration of purulent content through the natural orifice in the nipple is advisable. This method has significant advantages in comparison with traditional surgery and may be recommended for widespread clinical use.
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Affiliation(s)
- G A Belonenko
- Donetsk Clinical Territorial Medical Association of Gorky Donetsk National Medical University, Ukrainian Scientific-Practical Center of Endocrine Surgery and Transplantation of endocrine organs and tissues
| | - A G Grintsov
- Donetsk Clinical Territorial Medical Association of Gorky Donetsk National Medical University, Ukrainian Scientific-Practical Center of Endocrine Surgery and Transplantation of endocrine organs and tissues
| | - A G Osipov
- Donetsk Clinical Territorial Medical Association of Gorky Donetsk National Medical University, Ukrainian Scientific-Practical Center of Endocrine Surgery and Transplantation of endocrine organs and tissues
| | - G G Pilyugin
- Donetsk Clinical Territorial Medical Association of Gorky Donetsk National Medical University, Ukrainian Scientific-Practical Center of Endocrine Surgery and Transplantation of endocrine organs and tissues
| | - Yu G Lutsenko
- Donetsk Clinical Territorial Medical Association of Gorky Donetsk National Medical University, Ukrainian Scientific-Practical Center of Endocrine Surgery and Transplantation of endocrine organs and tissues
| | - E G Aksenova
- Donetsk Clinical Territorial Medical Association of Gorky Donetsk National Medical University, Ukrainian Scientific-Practical Center of Endocrine Surgery and Transplantation of endocrine organs and tissues
| | - A A Aksenov
- Donetsk Clinical Territorial Medical Association of Gorky Donetsk National Medical University, Ukrainian Scientific-Practical Center of Endocrine Surgery and Transplantation of endocrine organs and tissues
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Sousaris N, Barr RG. Sonographic Elastography of Mastitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1791-1797. [PMID: 27353071 DOI: 10.7863/ultra.15.09041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/03/2015] [Indexed: 06/06/2023]
Abstract
Sonographic elastography has been shown to be a useful imaging modality in characterizing breast lesions as benign or malignant. However, in preliminary research, mastitis has given false-positive findings on both strain and shear wave elastography. In this article, we review the findings in mastitis with and without abscess formation on both strain and shear wave elastography. The elastographic findings in all cases were suggestive of a malignancy according to published thresholds. In cases of mastitis with abscess formation, there is a characteristic appearance, with a central very soft area (abscess cavity) and a very stiff outer rim (edema and inflammation). This appearance should raise the suspicion of mastitis with abscess formation, since these findings are rare in breast cancers.
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Affiliation(s)
- Nicholas Sousaris
- Department of Radiology, Northeast Ohio Medical University, Rootstown, Ohio USA. Department of Diagnostic Radiology, Beaumont Health System, Royal Oak, Michigan USA
| | - Richard G Barr
- Department of Radiology, Northeast Ohio Medical University, Rootstown, Ohio USA. Radiology Consultants, Southwoods Imaging, Youngstown, Ohio USA
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Machida Y, Tozaki M, Shimauchi A, Yoshida T. Two Distinct Types of Linear Distribution in Nonmass Enhancement at Breast MR Imaging: Difference in Positive Predictive Value between Linear and Branching Patterns. Radiology 2015; 276:686-94. [DOI: 10.1148/radiol.2015141775] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Nodular fasciitis is a benign proliferation of myofibroblasts which presents clinically as a rapidly growing mass with nonspecific features on imaging and high cellular activity on histopathology. Nodular fasciitis can be mistaken for malignant fibrous lesions such as soft tissue sarcoma or breast carcinoma when located within breast tissue. This presents a problem for appropriate treatment planning as the natural history of nodular fasciitis is spontaneous regression. We present the mammographic, sonographic, computed tomography, and histopathologic characteristics of nodular fasciitis in a 68 year female initially presenting with a rapidly enlarging right axillary mass.
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Affiliation(s)
- Dejan Samardzic
- Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Alison Chetlen
- Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jozef Malysz
- Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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