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Zhang L, Wang L, Liang R, He X, Wang D, Sun L, Yu S, Su W, Zhang W, Zhou Q, Wang J, Jiang J. An Effective Ultrasound Features-Based Diagnostic Model via Principal Component Analysis Facilitated Differentiating Subtypes of Mucinous Breast Cancer From Fibroadenomas. Clin Breast Cancer 2024; 24:e583-e592.e3. [PMID: 38871576 DOI: 10.1016/j.clbc.2024.05.007] [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: 11/14/2023] [Revised: 04/20/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Mucinous breast carcinoma (MBC) is often misdiagnosed as fibroadenoma (FA),which can lead to inappropriate or delayed treatments. This study aimed to establish an efficient ultrasound (US)-based diagnostic model to distinguish MBC subtypes from FAs. METHODS Between January 2017 and February 2024, 240 lesions were enrolled, comprising 65 cases of pure mucinous breast carcinoma (PMBC), 47 cases of mixed mucinous breast carcinoma (MMBC), and 128 cases of FAs. Ten US feature variables underwent principal component analysis (PCA). Models were constructed based on components explaining over 75% of the total variation, with varimax rotation applied for interpretability. Comprehensive models were developed to distinguish PMBCs and MMBCs from FAs. RESULTS Six principal components were selected, achieving a cumulative contribution rate of 77.46% for PMBCs vs. FAs and 78.62% for MMBCs vs. FAs. The principal component of cystic-solid composition and posterior acoustic enhancement demonstrated the highest diagnostic value for distinguishing PMBCs from FAs (AUC: 0.86, ACC: 80.31%). Features including vascularization, irregular shape, ill-defined border, and larger size exhibited the highest diagnostic value for distinguishing MMBCs from FAs (AUC: 0.90, ACC: 87.43%). The comprehensive models showed excellent clinical value in distinguishing PMBCs (AUC = 0.86, SEN = 86.15%, SPE = 73.44%, ACC = 77.72%) and MMBCs (AUC = 0.92, SEN = 80.85%, SPE = 95.31%, ACC = 91.43%) from FAs. CONCLUSION This diagnostic model holds promise for effectively distinguishing PMBCs and MMBCs from FAs, assisting radiologists in mitigating diagnostic biases and enhancing diagnostic efficiency.
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Affiliation(s)
- Lin Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an Jiaotong University, Xi 'an, China
| | - Lirong Wang
- Department of Ultrasound, the Second Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an Jiaotong University, Xi 'an, China
| | - Runa Liang
- Department of Ultrasound, the Second Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an Jiaotong University, Xi 'an, China
| | - Xin He
- Department of Ultrasound, the Second Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an Jiaotong University, Xi 'an, China
| | - Dan Wang
- Department of Ultrasound, the Second Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an Jiaotong University, Xi 'an, China
| | - Lei Sun
- Department of Ultrasound, the Second Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an Jiaotong University, Xi 'an, China
| | - Shanshan Yu
- Department of Ultrasound, the Second Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an Jiaotong University, Xi 'an, China
| | - Wenxiu Su
- Department of Pathology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an Jiaotong University, Xi 'an, China
| | - Qi Zhou
- Department of Ultrasound, the Second Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an Jiaotong University, Xi 'an, China.
| | - Juan Wang
- Department of Ultrasound, the Second Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an Jiaotong University, Xi 'an, China.
| | - Jue Jiang
- Department of Ultrasound, the Second Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an Jiaotong University, Xi 'an, China.
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Yao Y, Zhao Y, Guo X, Xu X, Fu B, Cui H, Xue J, Tian J, Lu K, Zhang L. Deep Learning for Distinguishing Mucinous Breast Carcinoma From Fibroadenoma on Ultrasound. Clin Breast Cancer 2024:S1526-8209(24)00237-4. [PMID: 39317636 DOI: 10.1016/j.clbc.2024.09.001] [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: 11/13/2023] [Revised: 08/21/2024] [Accepted: 09/01/2024] [Indexed: 09/26/2024]
Abstract
PURPOSE Mucinous breast carcinoma (MBC) tends to be misdiagnosed as fibroadenomas (FA) due to its benign imaging characteristics. We aimed to develop a deep learning (DL) model to differentiate MBC and FA based on ultrasound (US) images. The model could contribute to the diagnosis of MBC for radiologists. METHODS In this retrospective study, 884 eligible patients (700 FA patients and 184 MBC patients) with 2257 US images were enrolled. The images were randomly divided into a training set (n = 1805 images) and a test set (n = 452 images) in a ratio of 8:2. First, we used the training set to establish DL model, DL+ age-cutoff model and DL+ age-tree model. Then, we compared the diagnostic performance of three models to get the optimal model. Finally, we evaluated the diagnostic performance of radiologists (4 junior and 4 senior radiologists) with and without the assistance of the optimal model in the test set. RESULTS The DL+ age-tree model yielded higher areas under the receiver operating characteristic curve (AUC) than DL model and DL+ age-cutoff model (0.945 vs. 0.835, P < .001; 0.945 vs. 0.931, P < .001, respectively). With the assistance of DL+ age-tree model, both junior and senior radiologists' AUC had significant improvement (0.746-0.818, P = .010, 0.827-0.860, P = .005, respectively). CONCLUSIONS The DL+ age-tree model based on US images and age showed excellent performance in the differentiation of MBC and FA. Moreover, it can effectively improve the performance of radiologists with different degrees of experience that may contribute to reducing the misdiagnosis of MBC.
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Affiliation(s)
- Yuan Yao
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Yang Zhao
- The School of Engineering Science, University of Chinese Academy of Science, Beijing, People's Republic of China
| | - Xu Guo
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Xiangli Xu
- The second hospital of Harbin, Harbin, People's Republic of China
| | - Baiyang Fu
- Department of Breast Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Hao Cui
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Jian Xue
- The School of Engineering Science, University of Chinese Academy of Science, Beijing, People's Republic of China
| | - Jiawei Tian
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.
| | - Ke Lu
- The School of Engineering Science, University of Chinese Academy of Science, Beijing, People's Republic of China; Peng Cheng Laboratory, Shenzhen, People's Republic of China.
| | - Lei Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.
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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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Bennett DL, Buckley A, Lee MV. Fibrocystic Change. Radiol Clin North Am 2024; 62:581-592. [PMID: 38777535 DOI: 10.1016/j.rcl.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] [Indexed: 05/25/2024]
Abstract
Fibrocystic changes are commonly seen in clinically symptomatic patients and during imaging workup of screening-detected findings. The term "fibrocystic changes" encompasses a broad spectrum of specific benign pathologic entities. Recognition of classically benign findings of fibrocystic changes, including cysts and layering calcifications, can prevent unnecessary follow-ups and biopsies. Imaging findings such as solid masses, nonlayering calcifications, and architectural distortion may require core needle biopsy for diagnosis. In these cases, understanding the varied appearances of fibrocystic change aids determination of radiologic-pathologic concordance. Management of fibrocystic change is typically conservative.
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Affiliation(s)
- Debbie L Bennett
- Department of Breast Imaging, Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Boulevard, Box 8131, St Louis, MO, USA.
| | - Arianna Buckley
- Department of Breast Imaging, Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Boulevard, Box 8131, St Louis, MO, USA
| | - Michelle V Lee
- Department of Breast Imaging, Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Boulevard, Box 8131, St Louis, MO, USA
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Thai JN, Lerwill MF, Chou SHS. Spectrum of Mucin-containing Lesions of the Breast: Multimodality Imaging Review with Pathologic Correlation. Radiographics 2023; 43:e230015. [PMID: 37792588 DOI: 10.1148/rg.230015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Mucin-containing lesions of the breast encompass a wide range of benign and malignant processes. The spectrum of histologic findings includes incidental mucus-filled benign cysts or ducts, mucocele-like lesions (MLLs), mucin-producing ductal carcinoma in situ, and invasive mucinous carcinoma. MLL is characterized by the presence of mucin-containing cysts that are typically associated with extravasated stromal mucin. MLL is often benign but can be associated with epithelial atypia or malignancy. Mucinous carcinoma represents the malignant end of the spectrum of mucinous lesions of the breast. Evidence-based literature supports a conservative approach for benign MLLs without associated atypia or malignancy, reserving excision for those lesions exhibiting such pathologic features. The most common imaging finding for MLL is microcalcifications at mammography. No specific imaging feature is predictive of malignant outcome at surgical excision. Invasive mucinous carcinoma is a heterogeneous breast tumor subtype, as defined according to the World Health Organization criteria. Mucinous carcinomas are categorized into pure (>90% mucinous component) or mixed (10%-90% mucinous component) subtypes. Pure mucinous carcinomas are generally associated with excellent prognosis and survival, with a few exceptions. Mixed mucinous carcinomas do not have the same favorable prognosis and instead behave similarly to invasive breast carcinomas of no special type. Characteristic diagnostic imaging features can be identified for mucinous carcinoma based on its mucinous and nonmucinous contents. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Janice N Thai
- From the Department of Radiology, Division of Breast Imaging (J.N.T, S.H.S.C), and Department of Pathology (M.F.L.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Melinda F Lerwill
- From the Department of Radiology, Division of Breast Imaging (J.N.T, S.H.S.C), and Department of Pathology (M.F.L.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Shinn-Huey S Chou
- From the Department of Radiology, Division of Breast Imaging (J.N.T, S.H.S.C), and Department of Pathology (M.F.L.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
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El Amrani S, Hiba Z, Hosni A, Omor Y, Latib R. Synchronous bilateral breast cancer: A first case with lobular and mucinous carcinoma. Radiol Case Rep 2023; 18:3218-3222. [PMID: 37448601 PMCID: PMC10336351 DOI: 10.1016/j.radcr.2023.05.004] [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: 11/01/2022] [Revised: 04/29/2023] [Accepted: 05/03/2023] [Indexed: 07/15/2023] Open
Abstract
This report describes a rare case of synchronous bilateral carcinoma of the breast in a postmenopausal female patient, with mucinous carcinoma measuring 5 cm in the left breast and multifocal multicentric lobular carcinoma in the right breast. The patient underwent a bilateral mastectomy with adjuvant chemotherapy. To the best of our knowledge, this is the first report of a case of mucinous carcinoma and infiltrating lobular carcinoma coexisting in distinct breasts.
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Affiliation(s)
- Soukaina El Amrani
- Corresponding author at: Radiology Department, National Institute of Oncology, Ibn Sina Hospital, Mohammed V University, X4FH+66Q, Avenue Allal El Fassi, 60010, Rabat, Morocco.
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Yang WS, Li Y, Gao Y. On Ultrasonographic Features of Mucinous Carcinoma with Micropapillary Pattern. BREAST CANCER (DOVE MEDICAL PRESS) 2023; 15:473-483. [PMID: 37484699 PMCID: PMC10361086 DOI: 10.2147/bctt.s415250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Abstract
Objective To describe the sonographic features of pure mucinous carcinoma with micropapillary pattern (MUMPC) and compare with different pathological type of mucinous breast carcinoma. Methods Subjects were retrospectively reviewed at Suzhou Municipal Hospital from January 2015 to June 2019. Sonographic features of 49 cases (9 MUMPC, 19cPMBC, and 21 MMBC) pathologically confirmed MBC were recorded according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon. The differences in sonographic features among different type of mucinous breast carcinoma were discussed, including clinical features and sonographic features, shape, lesion boundary, peripheral hyperechoic ring, echo pattern, posterior acoustic feature, thickness peripheral hyperechoic area, and blood flow. Results All MUMPC had no lymph node metastasis (88.9%, 8/9), and most of the MUMPC showed no thickness peripheral hyperechoic area (88.9%, 8/9) and blood flow (55.6%, 5/9) within the tumor. Furthermore, MUMPC had mixed cystic and solid components (33.3%, 3/9) and solid echoic (66.7%, 6/9) structures, with regular shape (66.7%, 6/9) and peripheral hyperechoic ring (66.7%, 6/9). Seven cases of the MUMPC showed circumscribed margin (77.8%, 7/9), and there was significant difference among the three groups (p < 0.05). In addition, there were 7 cases (77.8%, 7/9) of MUMPC tumor ≤2cm, which was significantly different from cPMBC (26.3%, 5/19) and MMBC (28.6%, 6/21) (p < 0.05). There was no significant difference in ultrasonographic features of MBC with different sizes when stratified by tumor size (p > 0.05). Conclusion Most of the MUMPC showed a circumscribed margin, peripheral hyperechoic ring, and without lymph node metastasis and thickness peripheral hyperechoic area. However, it is challenging to distinguish MUMPC from PMBC and MMBC on ultrasound. Future research should focus on developing novel analysis methods for ultrasound imaging, conducting studies with larger sample sizes and diverse population groups.
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Affiliation(s)
- Wei-Sen Yang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Yang Li
- Department of Radiology, Wuxi No.2 People’s Hospital, Wuxi, People’s Republic of China
| | - Ya Gao
- Center for Medical Ultrasound, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
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Kuzmiak CM, Calhoun BC. Pure Mucinous Carcinoma of the Breast: Radiologic-Pathologic Correlation. JOURNAL OF BREAST IMAGING 2023; 5:180-187. [PMID: 38416927 DOI: 10.1093/jbi/wbac084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Indexed: 03/01/2024]
Abstract
Mucinous carcinoma (MC) of the breast is a rare, specialized subtype of invasive breast carcinoma (IBC) accounting for approximately 1% to 4% of all primary breast malignancies. Mucinous carcinoma occurs predominantly in patients who are postmenopausal or elderly. It is usually detected on screening mammography, but occasionally the patient may present with a palpable mass. The most common mammographic appearance is an equal to high density, oval or round mass with circumscribed or indistinct margins; MC can mimic a benign lesion. Histologically, MC is a well-differentiated cancer characterized by pools of mucin around neoplastic cells. Depending on mucin content, the tumor is classified as pure (≥90% mucin) or mixed (>10% and <90% mucin). Pure MCs (PMCs) are of low or intermediate nuclear grade, and the vast majority are hormone receptor-positive and human epidermal growth factor-2 receptor-negative (luminal A subtype). Pure MCs may be classified as hypocellular (type A) or hypercellular (type B) and have a lower rate of axillary lymph node involvement and more favorable prognosis than IBCs, no special type. The purpose of this article is to review the clinical features, imaging appearances, associated histopathology, and management of PMC.
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Affiliation(s)
- Cherie M Kuzmiak
- University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Benjamin C Calhoun
- University of North Carolina, Department of Pathology & Laboratory Medicine, Chapel Hill, NC, USA
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9
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Esmer AC, Tazeoğlu D, Dağ A. Comparison of Clinical, Histopathological, and Survival Outcomes of Pure and Mixed Mucinous Breast Carcinoma. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03573-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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10
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Gibson AL, Watkins JE, Agrawal A, Tyminski MM, DeBenedectis CM. Shedding Light on T2 Bright Masses on Breast MRI: Benign and Malignant Causes. JOURNAL OF BREAST IMAGING 2022; 4:430-440. [PMID: 38416977 DOI: 10.1093/jbi/wbac030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Indexed: 03/01/2024]
Abstract
While T2 hyperintense masses on breast MRI are often benign, there are several malignant etiologies that can also be T2 hyperintense. Delineation between benign and malignant entities is important for the accurate interpretation of breast MRI. Common benign T2 hyperintense masses include cysts, fibroadenomas, and lymph nodes. Malignant processes that are T2 hyperintense include metastatic lymph nodes, mucinous breast carcinomas, papillary breast carcinomas, and breast cancers with central necrosis. Evaluation of the morphology and enhancement pattern of a T2 hyperintense mass can help to differentiate a benign process from a malignant one. This educational review will present both benign and malignant causes of T2 hyperintense masses on breast MRI and review common imaging findings and pertinent imaging characteristics that can be used to help accurately identify benign entities while also recognizing suspicious lesions that require additional evaluation.
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Affiliation(s)
- Averi L Gibson
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA, USA
| | - Jade E Watkins
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA, USA
| | - Anushree Agrawal
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA, USA
| | - Monique M Tyminski
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA, USA
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Achicanoy Puchana DM, Lasso Andrade FA, Achicanoy Puchana DF, Boada Fuentes MA, Álvarez Duarte MA, Angarita Acuña K, Jaime Aguirre AC, Muñoz Murillo JA, González Lago AM, Alegria Cuellar DA, Orozco Morales LK, Lasso Anacona MZZ, Alvarado Rengifo AE, Rosero Rosero JR. Mucinous carcinoma of the breast: Diagnosis and management of an unusually young patient. Radiol Case Rep 2022; 17:1445-1449. [PMID: 35265238 PMCID: PMC8899128 DOI: 10.1016/j.radcr.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/25/2022] Open
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12
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Zhang Q, Zhang Q, Liu T, Bao T, Li Q, Yang Y. Development and External Validation of a Simple-To-Use Dynamic Nomogram for Predicting Breast Malignancy Based on Ultrasound Morphometric Features: A Retrospective Multicenter Study. Front Oncol 2022; 12:868164. [PMID: 35463357 PMCID: PMC9021381 DOI: 10.3389/fonc.2022.868164] [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] [Received: 02/02/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background With advances in high-throughput computational mining techniques, various quantitative predictive models that are based on ultrasound have been developed. However, the lack of reproducibility and interpretability have hampered clinical use. In this study, we aimed at developing and validating an interpretable and simple-to-use US nomogram that is based on quantitative morphometric features for the prediction of breast malignancy. Methods Successive 917 patients with histologically confirmed breast lesions were included in this retrospective multicentric study and assigned to one training cohort and two external validation cohorts. Morphometric features were extracted from grayscale US images. After feature selection and validation of regression assumptions, a dynamic nomogram with a web-based calculator was developed. The performance of the nomogram was assessed with respect to calibration, discrimination, and clinical usefulness. Results Through feature selection, three morphometric features were identified as being the most optimal for predicting malignancy, and all regression assumptions of the prediction model were met. Combining all these predictors, the nomogram demonstrated a good discriminative performance in the training cohort and in the two external validation cohorts with AUCs of 0.885, 0.907, and 0.927, respectively. In addition, calibration and decision curves analyses showed good calibration and clinical usefulness. Conclusions By incorporating US morphometric features, we constructed an interpretable and easy-to-use dynamic nomogram for quantifying the probability of breast malignancy. The developed nomogram has good generalization abilities, which may fit into clinical practice and serve as a potential tool to guide personalized treatment. Our findings show that quantitative morphometric features from different ultrasound machines and systems can be used as imaging surrogate biomarkers for the development of robust and reproducible quantitative ultrasound dynamic models in breast cancer research.
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Affiliation(s)
- Qingling Zhang
- Depatment of Ultrasonography, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Qinglu Zhang
- Department of Ultrasonography, Shandong Provincial Third Hospital Affiliated to Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Taixia Liu
- Department of Ultrasonography, Linyi People's Hospital, Linyi, China
| | - Tingting Bao
- Depatment of Ultrasonography, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Qingqing Li
- Depatment of Ultrasonography, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - You Yang
- Depatment of Ultrasonography, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
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Liang T, Shen J, Zhang S, Cong S, Liu J, Pei S, Shang S, Huang C. Using Ultrasound-Based Multilayer Perceptron to Differentiate Early Breast Mucinous Cancer and its Subtypes From Fibroadenoma. Front Oncol 2021; 11:724656. [PMID: 34926246 PMCID: PMC8671140 DOI: 10.3389/fonc.2021.724656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Mucinous breast cancer (MBC), particularly pure MBC (pMBC), often tend to be confused with fibroadenoma (FA) due to their similar images and firm masses, so some MBC cases are misdiagnosed to be FA, which may cause poor prognosis. We analyzed the ultrasonic features and aimed to identify the ability of multilayer perceptron (MLP) to classify early MBC and its subtypes and FA. Materials and Methods The study consisted of 193 patients diagnosed with pMBC, mMBC, or FA. The area under curve (AUC) was calculated to assess the effectiveness of age and 10 ultrasound features in differentiating MBC from FA. We used the pairwise comparison to examine the differences among MBC subtypes (pure and mixed types) and FA. We utilized the MLP to differentiate MBC and its subtypes from FA. Results The nine features with AUCs over 0.5 were as follows: age, echo pattern, shape, orientation, margin, echo rim, vascularity distribution, vascularity grade, and tumor size. In subtype analysis, the significant differences were obtained in 10 variables (p-value range, 0.000–0.037) among pMBC, mMBC, and FA, except posterior feature. Through MLP, the AUCs of predicting MBC and FA were both 0.919; the AUCs of predicting pMBC, mMBC, and FA were 0.875, 0.767, and 0.927, respectively. Conclusion Our study found that the MLP models based on ultrasonic characteristics and age can well distinguish MBC and its subtypes from FA. It may provide a critical insight into MBC preoperative clinical management.
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Affiliation(s)
- Ting Liang
- Department of Ultrasound, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Junhui Shen
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shumei Zhang
- Department of Ultrasound, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shuzhen Cong
- Department of Ultrasound, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Juanjuan Liu
- Department of Ultrasound, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shufang Pei
- Department of Ultrasound, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shiyao Shang
- Department of Ultrasound, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chunwang Huang
- Department of Ultrasound, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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14
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Zhou W, Li YZ, Gao LM, Cai DM. Sonographic Features of Pure Mucinous Brelast Carcinoma With Micropapillary Pattern. Front Oncol 2021; 11:644180. [PMID: 34745931 PMCID: PMC8570766 DOI: 10.3389/fonc.2021.644180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 09/29/2021] [Indexed: 02/05/2023] Open
Abstract
Objective Previous studies have mostly discussed the clinical manifestations and prognosis of mucinous breast carcinoma with a micropapillary pattern. The purposes of this study were to investigate the sonographic features of pure mucinous breast carcinoma with micropapillary pattern (MUMPC) and to identify the role of ultrasound in the differential diagnosis between MUMPC and conventional pure mucinous breast carcinoma (cPMBC). Materials and Methods We obtained written informed consent from all patients, and the Ethics Committee of West China Hospital approved this retrospective study. The study was conducted between May and August 2020. We enrolled 133 patients with 133 breast lesions confirmed as mucinous breast carcinoma (MBC) histopathologically between January 2014 and January 2020.We retrospectively assessed sonographic features (margin, shape, internal echogenicity, calcification, posterior acoustic feature, invasive growth, blood flow grade, and rate of missed diagnosis) and clinical characteristics (age, tumor size, tumor texture, initial symptom, and lymph node metastasis). Bivariable analyses were performed using SPSS version 19.0. Results The 133 lesions included 11 MUMPCs, 65 cPMBCs, and 57 mixed MBCs (MMBCs). There were significant differences in margin, shape, calcification, posterior acoustic feature, invasive growth, rate of missed diagnosis, average tumor size, and lymph node metastasis among the three groups (p < 0.05). The subsequent pairwise comparisons showed that there were significant differences in lymph node metastasis, margin, and invasive growth between MUMPC and cPMBC (p < 0.05). In patients aged >45 years, there was a significant difference in tumor size among the three groups (p = 0.045), and paired comparison showed that the average tumor size in the cPMBC group was larger than that in the MMBC group (p = 0.014). Conclusion MUMPC showed a non-circumscribed margin and invasive growth more frequently than cPMBC did. Lymphatic metastasis was more likely to occur in MUMPC than cPMBC. Ultrasound is helpful to distinguish MUMPC from cPMBC.
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Affiliation(s)
- Wu Zhou
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Yong-Zhong Li
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Li-Min Gao
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Di-Ming Cai
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
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15
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Budzik MP, Fudalej MM, Badowska-Kozakiewicz AM. Histopathological analysis of mucinous breast cancer subtypes and comparison with invasive carcinoma of no special type. Sci Rep 2021; 11:5770. [PMID: 33707745 PMCID: PMC7952590 DOI: 10.1038/s41598-021-85309-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/01/2021] [Indexed: 11/28/2022] Open
Abstract
Mucinous breast cancer (MBC) is a rare histological type of breast cancer characterized primarily by mucin's production and extracellular presence. MBC is usually associated with a better prognosis than other invasive breast neoplasms. Because of the low prevalence, MBC biology is not well understood. The aim of the present study was to introduce the last 2-year experience regarding MBC pathological diagnostics in our clinical center and comparison of the obtained data with invasive breast carcinoma of no special type (NST) comprising the most common invasive breast cancer. We identified 24 MBC cases representing 3.09% of all 766 invasive breast cancers, including 15 cases of pure type and 9 mixed MBCs. The median MBC patients' age at presentation was 65.5 years. Compared to NST, MBC presented a higher T stage with a statistically larger tumor median size, although lower regional lymph node involvement, tumor histological grade and TNM stage. MBC is a rare type of breast cancer, accounting for about 4% of all diagnosed breast cancers. Our findings are consistent with those published in recent years and show significant differences between MBC and NST cancer patients and also highlight differences between pure and mixed MBC, emphasizing the essence of their differentiation. MBC is associated with a better long-term prognosis than NST and is characterized by the less aggressive biological behavior expressed through favorable clinicopathologic features in terms of tumor grade, regional lymph node involvement and hormone receptor status.
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Affiliation(s)
- Michał Piotr Budzik
- Department of Cancer Prevention, Medical University of Warsaw, 81 Zwirki i Wigury St, 02-091, Warsaw, Poland.
| | - Marta Magdalena Fudalej
- Department of Cancer Prevention, Medical University of Warsaw, 81 Zwirki i Wigury St, 02-091, Warsaw, Poland.,Doctoral School, Medical University of Warsaw, Warsaw, Poland
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16
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Pintican R, Duma M, Chiorean A, Fetica B, Badan M, Bura V, Szep M, Feier D, Dudea S. Mucinous versus medullary breast carcinoma: mammography, ultrasound, and MRI findings. Clin Radiol 2020; 75:483-496. [PMID: 32057415 DOI: 10.1016/j.crad.2019.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/31/2019] [Indexed: 12/26/2022]
Abstract
Mucinous and medullary breast cancers (BCs) have different histological substrates that manifest as different imaging features on mammography, ultrasound, and MRI. The aim of the present review is to demonstrate the differences between these two rare BC subtypes and to describe the microscopic features, review the imaging methods for detection of both cancer subtypes, illustrate the imaging findings and present useful pearls and pitfalls. Out of a total of 30 patients with mucinous BC and nine with medullary BC, we have selected typical and also unusual imaging features that best represent these cancers. The patients underwent a mammography and breast ultrasound followed by magnetic resonance imaging. We briefly exhibit histological characteristics for a better understanding of the imaging aspects.
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Affiliation(s)
- R Pintican
- Department of Radiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; Radiology and Medical Imaging Department, University Hospital, Cluj-Napoca, Romania.
| | - M Duma
- Department of Radiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; Micromedica Clinic, Piatra Neamt, Romania
| | - A Chiorean
- Department of Radiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; Medimages Breast Center, Cluj-Napoca, Romania
| | - B Fetica
- Pathology Department, University Hospital, Cluj-Napoca, Romania
| | - M Badan
- Pathology Department, University Hospital, Cluj-Napoca, Romania
| | - V Bura
- Radiology and Medical Imaging Department, University Hospital, Cluj-Napoca, Romania
| | - M Szep
- Medimages Breast Center, Cluj-Napoca, Romania
| | - D Feier
- Department of Radiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; Medimages Breast Center, Cluj-Napoca, Romania
| | - S Dudea
- Department of Radiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; Radiology and Medical Imaging Department, University Hospital, Cluj-Napoca, Romania
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17
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Gök M, Topal U, Öz B, Akgün H, Akcan AC, Sözüer EM. Comparison of Clinical Features and Treatment Results of Mix Mucinous Carcinomas and Other Atypical Carcinomas of the Breast. Eur J Breast Health 2019; 15:222-228. [PMID: 31620680 PMCID: PMC6776130 DOI: 10.5152/ejbh.2019.5032] [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: 05/27/2019] [Accepted: 07/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE There are multiple subtypes of breast cancer with different biological and pathological features and accordingly exhibit different clinical behaviors. The aim of this study was to compare the treatment modalities, clinical features and prognostic characteristics of Mix Mucinous Carcinomas (MMBC) and other rare tumors of the breast. MATERIALS AND METHOD A total of 2152 patients who were operated on for breast cancer in our clinic between 2010-2019, with pathological diagnoses of tubular, pure mucinous, mix mucinous or papillary carcinoma were enrolled in the study. Patients were divided into two groups as mix mucinous patients (Group1) and other rare tumors (Group2). The demographic, clinical and prognostic characteristics and treatment approaches were compared between Groups, and additionally between the subtypes of Group 2. RESULTS 42 patients participated in our study. Group 1 consisted of 7 patients, and Group2 consisted of 35 patients. The subtypes in Group2 were papillary (n=21), pure mucinous (n=10) and tubular (n=4). Progesterone Receptor Positivity was found to be significantly higher in Group 2 patients than in Group1 patients (p=0.005, p<0.05). Multicentricity rates in the tumors of the patients in Group1 were found to be statistically significantly higher than the patients in Group 2 (p=0.024, p<0.05). In subtype analysis in Group2, there were no statistically significant differences parameters in the subgroups (p>0.05). Mean survival was 19.5+5.6 (8.5-30.5) months in Group 1 and 46.3+5.2 (36.1-56.6) months, in Group2 when evaluated separately (p:0.002). CONCLUSION The prognosis of pure mucinosis (PMBC) and other atypical cancers of the breast compared to the (MMBC) is quite good. Rare pathological types of breast cancer can have favorable outcomes when treated with necessary oncological principles.
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Affiliation(s)
- Mustafa Gök
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey
| | - Uğur Topal
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey
- Department of Surgical Oncology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Bahadır Öz
- Department of Pathology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Hülya Akgün
- Department of Surgical Oncology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Alper Celal Akcan
- Department of Pathology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Erdoğan Mütevelli Sözüer
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey
- Department of Surgical Oncology, Erciyes University School of Medicine, Kayseri, Turkey
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