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Kubota K, Fujioka T, Tateishi U, Mori M, Yashima Y, Yamaga E, Katsuta L, Yamaguchi K, Tozaki M, Sasaki M, Uematsu T, Monzawa S, Isomoto I, Suzuki M, Satake H, Nakahara H, Goto M, Kikuchi M. Investigation of imaging features in contrast-enhanced magnetic resonance imaging of benign and malignant breast lesions. Jpn J Radiol 2024; 42:720-730. [PMID: 38503998 PMCID: PMC11217097 DOI: 10.1007/s11604-024-01551-1] [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: 12/01/2023] [Accepted: 02/20/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE This study aimed to enhance the diagnostic accuracy of contrast-enhanced breast magnetic resonance imaging (MRI) using gadobutrol for differentiating benign breast lesions from malignant ones. Moreover, this study sought to address the limitations of current imaging techniques and criteria based on the Breast Imaging Reporting and Data System (BI-RADS). MATERIALS AND METHODS In a multicenter retrospective study conducted in Japan, 200 women were included, comprising 100 with benign lesions and 100 with malignant lesions, all classified under BI-RADS categories 3 and 4. The MRI protocol included 3D fast gradient echo T1- weighted images with fat suppression, with gadobutrol as the contrast agent. The analysis involved evaluating patient and lesion characteristics, including age, size, location, fibroglandular tissue, background parenchymal enhancement (BPE), signal intensity, and the findings of mass and non-mass enhancement. In this study, univariate and multivariate logistic regression analyses were performed, along with decision tree analysis, to identify significant predictors for the classification of lesions. RESULTS Differences in lesion characteristics were identified, which may influence malignancy risk. The multivariate logistic regression model revealed age, lesion location, shape, and signal intensity as significant predictors of malignancy. Decision tree analysis identified additional diagnostic factors, including lesion margin and BPE level. The decision tree models demonstrated high diagnostic accuracy, with the logistic regression model showing an area under the curve of 0.925 for masses and 0.829 for non-mass enhancements. CONCLUSION This study underscores the importance of integrating patient age, lesion location, and BPE level into the BI-RADS criteria to improve the differentiation between benign and malignant breast lesions. This approach could minimize unnecessary biopsies and enhance clinical decision-making in breast cancer diagnostics, highlighting the effectiveness of gadobutrol in breast MRI evaluations.
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Affiliation(s)
- Kazunori Kubota
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamiko-Shigaya, Koshigaya, Saitama, 343-8555, Japan
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Tomoyuki Fujioka
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan.
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Mio Mori
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Yuka Yashima
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamiko-Shigaya, Koshigaya, Saitama, 343-8555, Japan
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Emi Yamaga
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Leona Katsuta
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Ken Yamaguchi
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga City, Saga, 849-8501, Japan
| | - Mitsuhiro Tozaki
- Department of Radiology, Sagara Hospital, 3-31 Matsubara-Cho, Kagoshima City, Kagoshima, 892-0833, Japan
| | - Michiro Sasaki
- Department of Radiology, Sagara Hospital, 3-31 Matsubara-Cho, Kagoshima City, Kagoshima, 892-0833, Japan
| | - Takayoshi Uematsu
- Division of Breast Imaging and Breast Interventional Radiology, Shizuoka Cancer Center Hospital, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Shuichi Monzawa
- Department of Diagnostic Radiology, Shinko Hospital, 1-4-47, Wakinohama-Cho, Chuo-Ku, Kobe City, Hyogo, 651-0072, Japan
| | - Ichiro Isomoto
- Department of Radiology, St. Francis Hospital, 9-20, Kominemachi, Nagasaki City, Nagasaki, 852-8125, Japan
| | - Mizuka Suzuki
- Department of Diagnostic Radiology, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Hiroko Satake
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroshi Nakahara
- Department of Radiology, Sagara Hospital Miyazaki, 2-112-1 Maruyama, Miyazaki City, Miyazaki, 880-0052, Japan
| | - Mariko Goto
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kamigyo-Ku, Kyoto City, 602-8566, Japan
| | - Mari Kikuchi
- Department of Imaging Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
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Wang S, Zhang Q, Zhang T, Mao X. Invasive papillary carcinoma of the breast: A case report. Oncol Lett 2024; 28:300. [PMID: 38765791 PMCID: PMC11099954 DOI: 10.3892/ol.2024.14433] [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: 01/23/2024] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Invasive papillary carcinoma (IPC) of the breast is a rare form of cancer. The current report documents a case of IPC characterized by a large tumor size and skin involvement. Surgical exploration revealed no evidence of axillary lymph node metastasis in breast cancer. Due to financial constraints, the patient opted solely for anastrozole endocrine therapy at a dosage of 1 mg/day for a period of 5 years post-surgery, foregoing other treatments such as radiotherapy and chemotherapy. Since discharge, 2.5 years have passed, during which the patient has been followed up via phone every 3 months, showing a good prognosis. A literature review indicated that IPC is prevalent amongst the elderly population and can be misdiagnosed due to its morphological, cytomorphological and immunophenotypic overlap with other types of papillary neoplasms. This tumor exhibits a more favorable prognosis compared with IDC, primarily attributed to its advantageous gene and molecular expression patterns, coupled with its decreased invasiveness. Despite limited evidence-based research on the treatment of IPC, the present case report, albeit with limitations, underscores the importance of avoiding over-treatment and suggests the feasibility of combining surgery with endocrine therapy for IPC.
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Affiliation(s)
- Shijing Wang
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Qingfu Zhang
- Department of Pathology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Tangbo Zhang
- Department of Pathology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Xiaoyun Mao
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. 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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Rahman NA, Arnaout I, Krimsti M, Mardini A, Rahme K, Ishkhanian S. Unusual presentation of intraductal papilloma on the nipple: A case report. Int J Surg Case Rep 2024; 117:109483. [PMID: 38493616 PMCID: PMC10958466 DOI: 10.1016/j.ijscr.2024.109483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION AND SIGNIFICANCE Intraductal papilloma (IDP) is a benign breast lesion characterized by a small, delicate wart-like growth found within the milk ducts. Typically located centrally behind the nipple, IDP often presents with a serous, serosanguinous, or bloody discharge from the nipple, making it a common cause of abnormal nipple discharge. Differential diagnosis is crucial as it can be mistaken for other conditions such as pigmented Paget's disease and pigmented basal cell carcinoma. CASE PRESENTATION This case study depicts a 35-year-old female with a painless, pigmented mass on the nipple of her right breast that had been present for four months. Physical examination revealed a well-defined blue nodule measuring 13 × 8 mm. Although mammography and ultrasound did not detect any abnormalities in the breast tissue, a biopsy confirmed the diagnosis of intraductal papilloma. The lesion was surgically excised under local anesthesia without complications. CLINICAL DISCUSSION In this case, IDP presented as a blue nodule near the nipple. Despite the patient's young age and unique presentation, the diagnosis of intraductal papilloma was made based on the identified risk factors for breast tumors. Differential diagnoses considered included mammary Paget disease, nipple duct adenoma, and erosive adenomatosis of the nipple. CONCLUSION This case report underscores the uncommon occurrence of IDP manifesting on the nipple. A thorough evaluation incorporating medical history, physical examination, imaging studies, and cytological analysis is essential for an accurate diagnosis and to exclude malignancy. Surgical excision was successful in removing the lesion.
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Affiliation(s)
- Noura Abdul Rahman
- Department of Dermatology and Venereology, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Ibrahim Arnaout
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic.
| | - Mariam Krimsti
- Department of Dermatology and Venereology, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Amira Mardini
- Department of Dermatology and Venereology, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Kanan Rahme
- Department of Pathology, The Specialized Center of Dermatology, Ministry of Health, Aleppo, Syrian Arab Republic
| | - Silva Ishkhanian
- Department of Dermatology and Venereology, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic
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Wang S, Zhang Q, Mao X. Invasive papillary carcinoma of the breast. Front Oncol 2024; 14:1374091. [PMID: 38601769 PMCID: PMC11004302 DOI: 10.3389/fonc.2024.1374091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
Invasive papillary carcinoma is a rare form of breast cancer that is more likely to occur in postmenopausal women. Previous studies have been limited to case reports and small retrospective studies, leading to low awareness of this type of tumor and difficult clinical management. According to the available literature, invasive papillary carcinoma exhibits unique pathological features and biological behaviors. Invasive papillary carcinoma is mostly luminal type, with a low rate of lymph node metastasis, which underlies its favorable prognosis. The effectiveness of adjuvant therapy in reducing tumor burden and improving prognosis in patients with invasive papillary carcinoma remains uncertain. Due to the rarity of the lesion, conducting prospective clinical trials is impractical. The use of biological models, such as organoids, can help alleviate the impact of the scarcity of this condition on research. In addition, invasive papillary carcinoma is affected by specific genomic events, and more extensive studies of gene expression profiling may provide molecular-level insights to make optimal therapeutic decisions.
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Affiliation(s)
- Shijing Wang
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Qingfu Zhang
- Department of Pathology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaoyun Mao
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
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Rubio IT, Wyld L, Marotti L, Athanasiou A, Regitnig P, Catanuto G, Schoones JW, Zambon M, Camps J, Santini D, Dietz J, Sardanelli F, Varga Z, Smidt M, Sharma N, Shaaban AM, Gilbert F. European guidelines for the diagnosis, treatment and follow-up of breast lesions with uncertain malignant potential (B3 lesions) developed jointly by EUSOMA, EUSOBI, ESP (BWG) and ESSO. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107292. [PMID: 38061151 DOI: 10.1016/j.ejso.2023.107292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Breast lesions of uncertain malignant potential (B3) include atypical ductal and lobular hyperplasias, lobular carcinoma in situ, flat epithelial atypia, papillary lesions, radial scars and fibroepithelial lesions as well as other rare miscellaneous lesions. They are challenging to categorise histologically, requiring specialist training and multidisciplinary input. They may coexist with in situ or invasive breast cancer (BC) and increase the risk of subsequent BC development. Management should focus on adequate classification and management whilst avoiding overtreatment. The aim of these guidelines is to provide updated information regarding the diagnosis and management of B3 lesions, according to updated literature review evidence. METHODS These guidelines provide practical recommendations which can be applied in clinical practice which include recommendation grade and level of evidence. All sections were written according to an updated literature review and discussed at a consensus meeting. Critical appraisal by the expert writing committee adhered to the 23 items in the international Appraisal of Guidelines, Research and Evaluation (AGREE) tool. RESULTS Recommendations for further management after core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB) diagnosis of a B3 lesion reported in this guideline, vary depending on the presence of atypia, size of lesion, sampling size, and patient preferences. After CNB or VAB, the option of vacuum-assisted excision or surgical excision should be evaluated by a multidisciplinary team and shared decision-making with the patient is crucial for personalizing further treatment. De-escalation of surgical intervention for B3 breast lesions is ongoing, and the inclusion of vacuum-assisted excision (VAE) will decrease the need for surgical intervention in further approaches. Communication with patients may be different according to histological diagnosis, presence or absence of atypia, or risk of upgrade due to discordant imaging. Written information resources to help patients understand these issues alongside with verbal communication is recommended. Lifestyle interventions have a significant impact on BC incidence so lifestyle interventions need to be suggested to women at increased BC risk as a result of a diagnosis of a B3 lesion. CONCLUSIONS These guidelines provide a state-of-the-art overview of the diagnosis, management and prognosis of B3 lesions in modern multidisciplinary breast practice.
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Affiliation(s)
- Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain; European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy; European Society of Surgical Oncology (ESSO), Brussels, Belgium.
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK; Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Lorenza Marotti
- European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy
| | | | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Giuseppe Catanuto
- Humanitas-Istituto Clinico Catanese Misterbianco, Italy; Fondazione G.Re.T.A., ETS, Napoli, Italy
| | - Jan W Schoones
- Research Policy & Graduate School Advisor, Leiden University Medical Center Leiden, the Netherlands
| | - Marzia Zambon
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - Julia Camps
- Breast Health Units in Ribera Salud Hospitals.Valencia, Spain
| | - Donatella Santini
- Department of Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Jill Dietz
- The American Society of Breast Surgeons, Columbia, MD, USA
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Zsuzsanna Varga
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Marjolein Smidt
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Nisha Sharma
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Beckett Street Leeds, West Yorkshire, LS9 7TF, UK
| | - Abeer M Shaaban
- Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Fiona Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, UK.
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Patil S, Chen C. Puzzling Papillomas: A Case of an Intraductal Papilloma Mimicking an Abscess. Cureus 2024; 16:e52393. [PMID: 38361683 PMCID: PMC10869130 DOI: 10.7759/cureus.52393] [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] [Accepted: 01/13/2024] [Indexed: 02/17/2024] Open
Abstract
Intraductal papillomas (IDPs) are benign tumors found within breast ducts. Clinicians should be familiar with IDPs given their association with atypical and neoplastic lesions. In our case, the patient was initially diagnosed with and treated for an abscess given clinical symptoms of breast pain, erythema, and swelling, but upon returning to the clinic a year later due to persistent symptoms, she was found to have an IDP. This case underscores the importance of atypical imaging features and close follow-up when evaluating breast lesions.
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Affiliation(s)
- Siya Patil
- Department of Diagnostic, Molecular and Interventional Radiology, Mount Sinai Medical Center, New York, USA
| | - Christine Chen
- Department of Diagnostic, Molecular and Interventional Radiology, Mount Sinai Medical Center, New York, USA
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Li J, Wei C, Ma X, Ying T, Sun D, Zheng Y. Maximum intensity projection based on high frame rate contrast-enhanced ultrasound for the differentiation of breast tumors. Front Oncol 2023; 13:1274716. [PMID: 37965464 PMCID: PMC10642959 DOI: 10.3389/fonc.2023.1274716] [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: 08/09/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
Objective We explored the role of maximum intensity projection (MIP) based on high frame rate contrast-enhanced ultrasound (H-CEUS) for the differentiation of breast tumors. Methods MIP imaging was performed in patients with breast tumors who underwent H-CEUS examinations. The microvasculature morphology of breast tumors was assessed. The receiver operating characteristic curve was plotted to evaluate the diagnostic performance of MIP. Results Forty-three breast tumors were finally analyzed, consisting of 19 benign and 24 malignant tumors. For the ≤30-s and >30-s phases, dot-, line-, or branch-like patterns were significantly more common in benign tumors. A tree-like pattern was only present in the benign tumors. A crab claw-like pattern was significantly more common in the malignant tumors. Among the tumors with crab claw-like patterns, three cases of malignant tumors had multiple parallel small spiculated vessels. There were significant differences in the microvasculature morphology for the ≤30-s and >30-s phases between the benign and malignant tumors (all p < 0.001). The area under the curve, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the ≤30-s phase were all higher than those of the >30-s phase for the classification of breast tumors. Conclusion MIP based on H-CEUS can be used for the differentiation of breast tumors, and the ≤30-s phase had a better diagnostic value. Multiple parallel small spiculated vessels were a new finding, which could provide new insight for the subsequent study of breast tumors.
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Affiliation(s)
| | | | | | - Tao Ying
- Department of Ultrasound in Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Di Sun
- Department of Ultrasound in Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanyi Zheng
- Department of Ultrasound in Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wells VA, Medeiros I, Shevtsov A, Fishman MDC, Selland DLG, Dao K, Rives AF, Slanetz PJ. Demystifying Breast Disease Markers. Radiographics 2023; 43:e220151. [PMID: 37676826 DOI: 10.1148/rg.220151] [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: 09/09/2023]
Abstract
Breast imaging radiologists regularly perform image-guided biopsies of suspicious breast lesions based on features that are associated with a likelihood of malignancy ranging from 2% to greater than 95% (Breast Imaging Reporting and Data System categories 4 and 5). As diagnostic partners, pathologists perform histopathologic assessment of these tissue samples to confirm a diagnosis. Correlating the imaging findings with the histopathologic results is an integral aspect of multidisciplinary breast care. Assessment of radiologic-pathologic concordance is vital in guiding appropriate management, as it enables identification of discordant results, minimizing the chance of misdiagnosis. Undersampling can lead to false-negative results, with the frequencies of false-negative diagnoses varying on the basis of multiple factors, including biopsy type (eg, core needle, vacuum-assisted needle), needle gauge, and type of lesion sampled at biopsy (ie, mass, calcifications, asymmetry, architectural distortion). Improving a radiologist's knowledge of macroscopic and microscopic breast anatomy and more common breast diseases and their expected imaging findings ensures more accurate radiologic-pathologic correlation and management recommendations. The histopathologic and molecular characteristics of biopsy-sampled breast lesions aid in making an accurate diagnosis. Hematoxylin-eosin staining provides critical morphologic details, whereas immunohistochemical staining enables molecular characterization of many benign and malignant lesions, which is critical for tailored treatment. The authors review commonly encountered benign and malignant breast diseases, their corresponding histopathologic phenotypes, and the histopathologic markers that are essential to clinching the diagnosis of these entities. As part of a multidisciplinary team that provides optimal patient care, radiologists should be knowledgeable of the foundations of histopathologic diagnosis and the implications for patient management to ensure appropriate radiologic-pathologic concordance. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Victoria A Wells
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
| | - Isabela Medeiros
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
| | - Artem Shevtsov
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
| | - Michael D C Fishman
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
| | - Donna-Lee G Selland
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
| | - Kevin Dao
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
| | - Anna F Rives
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
| | - Priscilla J Slanetz
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
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10
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Bai J, Wang G. Encapsulated Papillary Carcinoma of the Breast. Radiology 2023; 308:e231038. [PMID: 37668518 DOI: 10.1148/radiol.231038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Jiao Bai
- From the Department of Radiology (J.B.) and Department of General Surgery (Breast Surgery) (G.W.), the Affiliated Hospital of Southwest Medical University, No. 25 Taiping Rd, Jiangyang District, Luzhou 646000, China
| | - Guilin Wang
- From the Department of Radiology (J.B.) and Department of General Surgery (Breast Surgery) (G.W.), the Affiliated Hospital of Southwest Medical University, No. 25 Taiping Rd, Jiangyang District, Luzhou 646000, China
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11
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Hong F, Li N, Feng Z, Zhang F. A case of male breast encapsulated papillary carcinoma with ductal carcinoma in situ and invasive ductal carcinoma. Asian J Surg 2023; 46:3777-3778. [PMID: 36990811 DOI: 10.1016/j.asjsur.2023.03.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Affiliation(s)
- Fangcheng Hong
- Department of Thyroid and Breast Surgery, Hebei General Hospital Affiliated to Hebei North University, Shijiazhuang, 050051, Hebei Province, China
| | - Ning Li
- Department of Thyroid and Breast Surgery, Hebei General Hospital Affiliated to Hebei Medicine University, Shijiazhuang, 050051, Hebei Province, China
| | - Zheming Feng
- Department of Thyroid and Breast Surgery, Hebei General Hospital Affiliated to Hebei Medicine University, Shijiazhuang, 050051, Hebei Province, China
| | - Fenghua Zhang
- Department of Thyroid and Breast Surgery, Hebei General Hospital, No.348 Peace West Road, Shijiazhuang, 050051, Hebei Province, China.
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12
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Hodge E, Mirchandani A, Shah B. Mammographic and Sonographic Findings of Intraductal Papilloma of the Right Breast: A Case Report. Cureus 2023; 15:e37034. [PMID: 37143645 PMCID: PMC10153652 DOI: 10.7759/cureus.37034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2023] [Indexed: 04/07/2023] Open
Abstract
Intraductal papillomas are tumors that arise in the epithelial cells of the mammary duct. Common presenting symptoms for intraductal papilloma include serous or serosanguinous nipple discharge or a palpable mass. We present a case of a 48-year-old woman who presented with spontaneous right breast nipple discharge and a palpable mass. Diagnostic imaging for the patient included mammography and ultrasound with color doppler imaging that revealed a mass at eight o'clock in the right breast at a distance of 2 cm from the nipple and that corresponded to the area of palpable concern. Percutaneous ultrasound-guided biopsy of the mass confirmed a diagnosis of intraductal papilloma. Surgical excision may be required in many cases of an intraductal papilloma due to the variety of diagnoses that can be included on the differential, the increased risk for cellular atypia, and the treatment for spontaneous nipple discharge.
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13
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Tu S, Yin Y, Yuan C, Chen H. Management of Intraductal Papilloma of the Breast Diagnosed on Core Needle Biopsy: Latest Controversies. PHENOMICS (CHAM, SWITZERLAND) 2023; 3:190-203. [PMID: 37197642 PMCID: PMC10110831 DOI: 10.1007/s43657-022-00085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 05/19/2023]
Abstract
Intraductal papillomas (IDPs), including central papilloma and peripheral papilloma, are common in the female population. Due to the lack of specific clinical manifestations of IDPs, it is easy to misdiagnose or miss diagnose. The difficulty of differential diagnosis using imaging techniques also contributes to these conditions. Histopathology is the gold standard for the diagnosis of IDPs while the possibility of under sample exists in the percutaneous biopsy. There have been some debates about how to treat asymptomatic IDPs without atypia diagnosed on core needle biopsy (CNB), especially when the upgrade rate to carcinoma is considered. This article concludes that further surgery is recommended for IDPs without atypia diagnosed on CNB who have high-risk factors, while appropriate imaging follow-up may be suitable for those without risk factors.
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Affiliation(s)
- Siyuan Tu
- Department of Breast Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200030 China
| | - Yulian Yin
- Department of Breast Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200030 China
| | - Chunchun Yuan
- Spine Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200030 China
| | - Hongfeng Chen
- Department of Breast Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200030 China
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14
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Luigi B, Carlo V, Corrado C, Orlando C. The nipple-areolar complex: anatomy, methods and pathologic findings, between senologist and dermatologist. J Ultrasound 2023; 26:239-247. [PMID: 36085438 PMCID: PMC10063719 DOI: 10.1007/s40477-022-00722-y] [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: 04/30/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022] Open
Abstract
The purpose of this presentation is to show the ultrasonography findings of normal variants and benign and malignant diseases that affect the nipple-areolar complex. Many of which have unspecific clinical and radiological presentations that can present a challenge for medical specialists. Experienced specialists need to know the different imaging modalities used to study the nipple-areolar complex and the aspect not exactly senology, as well as dermatologist who approach the ultrasound must know the anatomy of this complex area. We will show you a combined clinical and radiological approach to evaluate the nipple-areolar complex, the findings for the normal morphology and the most common benign and malignant diseases that can affect this region. We discuss the characteristics of the different ultrasonography findings and provide guidance on how to avoid artifacts and pitfalls.
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Affiliation(s)
- Basile Luigi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini 5, 80138, Naples, Italy.
| | - Varelli Carlo
- Radiology Unit, Istituto Diagnostico Varelli, Naples, Italy
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15
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Badrawi N, AlSayegh AA. Ductal carcinoma in situ of the breast arising in a solitary intraductal papilloma. Radiol Case Rep 2023; 18:449-451. [DOI: 10.1016/j.radcr.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
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16
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Jones LI, Klimczak K, Geach R. Breast MRI: an illustration of benign findings. Br J Radiol 2023; 96:20220280. [PMID: 36488196 PMCID: PMC9975519 DOI: 10.1259/bjr.20220280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/24/2022] [Accepted: 09/29/2022] [Indexed: 12/13/2022] Open
Abstract
Despite its unparalleled sensitivity for aggressive breast cancer, breast MRI continually excites criticism for a specificity that lags behind that of modern mammographic techniques. Radiologists reporting breast MRI need to recognise the range of benign appearances on breast MRI to avoid unnecessary biopsy. This review summarises the reported diagnostic accuracy of breast MRI with particular attention to the technique's specificity, provides a referenced reporting strategy and discusses factors that compromise diagnostic confidence. We then present a pictorial review of benign findings on breast MRI. Enhancing radiological skills to discriminate malignant from benign findings will minimise false positive biopsies, enabling optimal use of multiparametric breast MRI for the benefit of screening clients and breast cancer patients.
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Affiliation(s)
- Lyn Isobel Jones
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Katherine Klimczak
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Rebecca Geach
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, United Kingdom
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17
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Papillary Carcinoma of Breast: Clinicopathological Characteristics, Management, and Survival. Int J Breast Cancer 2022; 2022:5427837. [PMID: 36275485 PMCID: PMC9584724 DOI: 10.1155/2022/5427837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/21/2022] Open
Abstract
Objective To study clinicopathological features, treatment strategies, and prognosis of papillary carcinoma of breast. Material and Methods. Data from 58 patients were retrospectively reviewed from January 2010 to December 2016. Four types of papillary carcinoma (on final resected specimen) were included, i.e., invasive papillary carcinoma (IPC), intracystic (encapsulated) papillary carcinoma (EPC), solid papillary carcinoma (SPC), and papillary DCIS (ductal carcinoma in situ). Various features of the four types were observed and compared. Results Of the 58 patients, 8 were males (13.7%). The mean age at presentation was 61 years; the mean tumor size was 33 mm. The frequency of each histological type was as follows: IPC (n = 22/38%), EPC (n = 22/38%), SPC (n = 12/20.6%), and papillary DCIS (n = 2/3.4%). Only two patients were ER negative (both IPC). HER-2 Neu was positive in 3 patients only, out of which 2 died of progressive disease (one EPC and one IPC). LN metastasis was present in 3 (5%) patients (one in each of 1st three types) and only one died of bone metastasis that was also Her-2Neu positive. All patients underwent upfront surgery except two patients who had synchronous IDC on the contralateral side. Breast conservation surgery (BCS) was performed in 34 (58.6%) and mastectomy in 22 (37.9%) patients. 13 patients did not undergo invasive axillary staging; the rest of 43 (74%) patients did (32 sentinel biopsy and 11 axillary dissection). Chemotherapy was given to 18 patients (31%), mostly to IPC (n = 12). Only 2 patients had bone metastasis (one was IPC and one EPC). Cancer-related death was observed in 3 patients. For all groups combined, 5-year OS was 98% and DFS was 92%. Conclusion Overall, papillary carcinoma of the breast has an excellent prognosis, even though less intense treatment modalities were used. It is still difficult to define the optimum management and avoid overtreatment, given the limited data in the literature.
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18
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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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19
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Lv W, Zheng D, Guan W, Wu P. Contribution of Diffusion-Weighted Imaging and ADC Values to Papillary Breast Lesions. Front Oncol 2022; 12:911790. [PMID: 35847891 PMCID: PMC9279724 DOI: 10.3389/fonc.2022.911790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to evaluate the role of apparent diffusion coefficient (ADC) values obtained from diffusion-weighted imaging (DWI) in the differentiation of malignant from benign papillary breast lesions. The magnetic resonance imaging (MRI) data of 94 breast papillary lesions confirmed by pathology were retrospectively analyzed. The differences in ADC values of papillary lesions under different enhancements in MRI and different pathological types were investigated, and the ADC threshold was determined by the receiver operating characteristic curve for its potential diagnostic value. The mean ADC values in borderline and malignant lesions (1.01 ± 0.20 × 10-3 mm2/s) were significantly lower compared to benign lesions (1.21 ± 0.27 × 10-3 mm2/s) (P < 0.05). The optimal threshold of the ADC value could be 1.00 × 10-3 mm2/s. The ADC values were statistically significant in differentiating between benign and malignant papillary lesions whether in mass or non-mass enhancement (P < 0.05). However, there were no statistical differences in the ADC values among borderline or any other histological subtypes of malignant lesions (P > 0.05). Measuring ADC values from DWI can be used to identify benign and malignant breast papillary lesions. The diagnostic performance of the ADC value in identifying benign and malignant breast lesions is not affected by the way of lesion enhancement. However, it shows no use for differential diagnosis among malignant lesion subtypes for now. The ADC value of 1.00 × 10-3 mm2/s can be used as the most appropriate threshold for distinguishing between benign and malignant breast papillary lesions.
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Affiliation(s)
- Wenjie Lv
- Department of Breast Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dawen Zheng
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenbin Guan
- Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Wu
- Department of Breast Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Ping Wu,
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20
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Chakrabarthi S, Panwar S, Singh T, Lad S, Srikala J, Khandelwal N, Misra S, Thulkar S. Best Practice Guidelines for Breast Imaging: Breast Imaging Society, India: Part—2. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2022. [DOI: 10.1055/s-0042-1744392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractBreast imaging is one of the prerequisites for providing high-quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease or the absence of it in women and men who present to health professionals for treatment. Patients with breast disease present to doctors of different subspecialties as well as general practitioners in our country. It is important, therefore, to provide uniform guidance to doctors in different health care setups of our country, urban and rural, and government and private, for breast diseases to be diagnosed and treated optimally. These guidelines framed by the task group set up by the Breast Imaging Society, India, have been formulated focusing primarily on the Indian patients and health care infrastructures. These guidelines aim to provide a framework for the referring doctors and practicing radiologists to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The guidelines encompass all aspects of breast imaging including mammography, breast ultrasound, breast magnetic resonance imaging, as well as breast interventions. Algorithms for the investigation of specific common breast symptoms and signs have been provided in this document. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases so that breast cancer is not missed. Breast screening is an integral part of breast imaging, and guidelines for the same have been incorporated in this document. In the absence of a population-based screening program in India, the guidelines to be followed for those women who wish to be screened by mammography have been provided. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India.
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Affiliation(s)
- Suma Chakrabarthi
- Department of Radiology and Imaging, Peerless Hospitex Hospital and Research Center Limited, Kolkata, West Bengal, India
| | - Shikha Panwar
- Department of Radiology, Mahajan Imaging, Delhi, India
| | - Tulika Singh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shilpa Lad
- Department of Radiology, NM Medical, Mumbai, Maharashtra, India
| | - Jwala Srikala
- Department of Radiology and Imaging, Krishna Institute of Medical Sciences, Secunderabad, India
| | - Niranjan Khandelwal
- Former Head, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sanjay Thulkar
- Department of Radiology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
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21
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Lee SC, Tchelepi H, Khadem N, Desai B, Yamashita M, Hovanessian-Larsen L. Imaging of Benign and Malignant Breast Lesions Using Contrast-Enhanced Ultrasound: A Pictorial Essay. Ultrasound Q 2022; 38:2-12. [PMID: 35239626 DOI: 10.1097/ruq.0000000000000574] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Contrast-enhanced ultrasound is a promising noninvasive imaging technique for evaluating benign and malignant breast lesions, as contrast provides information about perfusion and microvasculature. Contrast-enhanced ultrasound is currently off-label use in the breast in the United States, but its clinical and investigational use in breast imaging is gaining popularity. It is important for radiologists to be familiar with the imaging appearances of benign and malignant breast masses using contrast-enhanced ultrasound. This pictorial essay illustrates enhancement patterns of various breast masses from our own experience. Pathologies include subtypes of invasive breast cancer, fibroadenomas, papillary lesions, fibrocystic change, and inflammatory processes. Contrast-enhanced ultrasound pitfalls and limitations are discussed.
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Affiliation(s)
- Sandy C Lee
- Department of Radiology, Keck School of Medicine, University of Southern California
| | - Hisham Tchelepi
- Department of Radiology, Keck School of Medicine, University of Southern California
| | - Nasim Khadem
- Department of Radiology, VA Long Beach Medical Center, Long Beach, CA
| | - Bhushan Desai
- Department of Radiology, Keck School of Medicine, University of Southern California
| | - Mary Yamashita
- Department of Radiology, Keck School of Medicine, University of Southern California
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22
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Gültekina MA, Yabul FÇ, Temur HO, Sari L, Yilmaz TF, Toprak H, Yildiz S. Papillary Lesions of the Breast: Addition of DWI and TIRM Sequences to Routine Breast MRI Could Help in Differentiation Benign from Malignant. Curr Med Imaging 2022; 18:962-969. [PMID: 35184715 DOI: 10.2174/1573405618666220218101931] [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: 08/12/2021] [Revised: 11/17/2021] [Accepted: 12/20/2021] [Indexed: 11/22/2022]
Abstract
AIM We aimed to investigate the magnetic resonance imaging (MRI) features of benign, atypical or malignant papillary breast lesions and to assess additional value of diffusion-weighted imaging (DWI) and turbo inversion recovery magnitude (TIRM) sequences to routine breast MRI. BACKGROUND Differentiation between benign and malignant papillary breast lesions is essential for patient management. However, morphologic features and enhancement patterns of malignant papillary lesions may overlap with those of benign papilloma. METHODS Seventy two papillary breast lesions (50 benign, 22 atypical or malignant) were included in the current study, retrospectively. We divided the patients into two groups as benign papillary breast lesions and atypical or malignant papillary breast lesions. Morphologic, dynamic, turbo inversion recovery magnitude (TIRM) values and diffusion features of the papillary lesions were compared between two groups. RESULTS Benign papillary lesions were smaller in size (p=0.006 and p=0.005, for radiologist 1 and 2 respectively), closer to areola (p=0.045 and 0.049 for radiologist 1 and 2 respectively) and had higher ADC values (p=0.001 for two radiologists) than atypical or malignant group. ROC curves showed diagnostic accuracy for ADC (AUC=0.770 and 0.762, p<0.0001 for two radiologists) and showed a cut-off value of ≤957 x 10-6 mm2/s (radiologist 1) and ≤ 910 x 10-6 mm2/s (radiologist 2). CONCLUSION MRI is a useful method for differentiation between benign and malignant papillary breast lesions. Centrally located, lesser in size and higher ADC values should be considered benign, whereas peripherally located, larger in size and lower ADC values should be considered malignant.
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Affiliation(s)
- Mehmet Ali Gültekina
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatma Çelik Yabul
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Hafize Otçu Temur
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Lutfullah Sari
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Temel Fatih Yilmaz
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Hüseyin Toprak
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Seyma Yildiz
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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23
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Athanasiou A, Khomsi F, de Joliniere B, Feki A. Encapsulated Papillary Carcinoma: A Case Report and Review of the Literature. Front Surg 2022; 8:743881. [PMID: 35187043 PMCID: PMC8854492 DOI: 10.3389/fsurg.2021.743881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
Papillary neoplasms are a distinct assemblage of breast lesions whose main characteristic is the presence of fibrovascular cores which are surrounded by epithelial cells. Papillary lesions are of heterogenous nature, with similar clinical behavior and histomorphologic characteristics. Their biological patterns, however, can be quite different. According to the World Health Organization (WHO) (2019), breast tumors have been recently classified into five subdivisions of papillary neoplasms. They are namely: intraductal papilloma, papillary ductal carcinoma in situ, encapsulated papillary carcinoma (EPC), solid-papillary carcinoma and invasive papillary carcinoma. Despite the papillary architecture being easily recognized, histological variations are diagnostically challenging. The presence or absence of myoepithelial cells in the papillary cores can distinguish the malignant from the benign lesions respectively. EPC is a rare, histologically unique carcinoma type whose main characteristic is a thick fibrous capsule at the periphery and a prolific cell structure with fibrovascular stalk support. A characteristic feature is the absence of myoepithelial cells at the surrounding thick fibrous capsule. Usually, EPC maintains a slowly developing tumor despite the absence of myoepithelial cells. An EPC case presents diagnostic difficulties since it bears close resemblance to malignant and benign papillary breast lesions. Upon a clinical and radiological evaluation, EPC commonly appears as a benign lump. In mammography, the tumor is frequently found in a retroareolar position as a well-defined mass. On the other hand, in an ultrasound, the tumor will appear as a cystic lesion characterized by solid components. The clinical picture of EPC is usually an asymptomatic benign mass which at times can be felt through auto-palpation or screening mammography. A bloody nipple discharge is regarded as a common symptom. We report a case of an EPC of a 81-year-old woman who presented with a mass in the left breast.
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24
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Chen S, Du Y, Hu Y, Ling R, Huang D, Xiang J, Liang Y, Wei X, Tang W, Guo Y. Preoperative MRI of breast squamous cell carcinoma: diagnostic value of distinguishing between two subtypes. Clin Radiol 2022; 77:e321-e328. [PMID: 35093233 DOI: 10.1016/j.crad.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/03/2021] [Indexed: 11/03/2022]
Abstract
AIM To retrospectively analyse the clinical and MRI data of primary squamous cell carcinoma (SCC), particularly pure squamous cell carcinoma (PSCC) and mixed squamous cell carcinoma (MSCC). MATERIALS AND METHODS The MRI data and clinicopathological characteristics of 20 patients with histopathologically confirmed SCC of the breast, including eight PSCC patients and 12 MSCC patients, from multiple centres between January 2013 and December 2020 were analysed retrospectively. RESULTS Nine of 12 patients in the MSCC group showed hyperintensity on T1-weighted imaging (WI), while this feature was not observed in the PSCC group (p=0.001). Most of the PSCC group showed rim enhancement, whereas most of the MSCC group showed heterogeneous enhancement (p=0.007). In addition, there was no significant difference in the thickness of the rim enhancement and the percentage of necrotic components in the tumours between the two types of SCCs of the breast (p=0.545 and p=0.662, respectively). Four patients (4/12) in the MSCC group had sentinel lymph node metastasis, while only one patient (1/8) in the PSCC group showed lymph node metastasis (p=0.603). Metastatic disease occurred in 25% of patients with PSCC and in approximately 41.7% of patients with MSCC. CONCLUSION The signal on T1WI and internal enhancement characteristics were the key features for differentiating PSCC and MSCC. Therefore, MRI phenotypes may provide additional information for the pathological classification of breast SCC.
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Affiliation(s)
- S Chen
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, China
| | - Y Du
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, China
| | - Y Hu
- Breast Tumour Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - R Ling
- Department of Radiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, 1st Affiliated Hospital of Southern University of Science and Technology, Shenzhen 518020, China
| | - D Huang
- Department of Breast Surgery, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, China
| | - J Xiang
- Department of Radiology, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 510010, China
| | - Y Liang
- Department of Pathology, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, China
| | - X Wei
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, China.
| | - W Tang
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, China.
| | - Y Guo
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, China.
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Esmayil H, Abayazeed S, Hajaj M. Audit on Intraductal Papilloma of the Breast: Upgrade Rate, Management Pitfalls, and Updated Guidelines in a Tertiary Health Care Center. Cureus 2021; 13:e18763. [PMID: 34796058 PMCID: PMC8590086 DOI: 10.7759/cureus.18763] [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: 09/05/2020] [Accepted: 10/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intraductal papillomas (IDPs) are typically classified as B3 lesions in histology as they may show intralesional heterogeneity with a potential upgrade to malignancy. On core needle biopsy (CNB), a distinction between papilloma versus papillary ductal carcinoma in situ (DCIS) may be difficult. It is well known that otherwise benign papillomas may harbor foci of atypical ductal hyperplasia or DCIS. In this study, we aimed to calculate the radiological (mammogram and ultrasound) accuracy of IDP and to analyze the accuracy of CNB to diagnose IDP. Furthermore, we calculated the percentage of upgrade to malignancy after surgical excision. Any case that had a co-existing in-situ or invasive carcinoma during surgical excision was considered as an “upgrade” to malignancy. Finally, we analyzed the current management protocol for IDP in the institution and suggested changes, if needed. Methodology This is a retrospective cross-sectional study. A total of 112 cases diagnosed as IDP radiologically and/or by histopathology over a one-year time frame were included. A retrospective analysis of the accuracy of the radiological diagnosis was done by comparing it with CNB and/or surgical excision biopsy reports. The number of cases diagnosed with a co-existing in-situ or invasive carcinoma was calculated. This was considered as an “upgrade” from a B3 lesion in CNB to carcinoma in surgical excision. Current institutional management protocols were evaluated and compared with international benchmarks. Results Out of the 112 cases, 91 were suspected to be papilloma by imaging. The remaining 21 cases who were positive for papilloma on biopsy but were not diagnosed radiologically were also studied separately. Among the biopsied patients, eight were positive for IDP with atypia in CNB. Five out of these eight cases had an in-situ or invasive component during the surgical excision, with one invasive lobular carcinoma, three lobular carcinomas in situ, and one DCIS on surgical excision histopathology. The upgrade percentage was calculated to be 22.72%. Conclusions Due to the large upgrade potential of IDP, it is recommended to biopsy every radiologically suspected lesion and excise pathology-proved lesions. If the biopsy shows papilloma without atypia, vacuum excision is sufficient; otherwise, surgical excision with a clearance of margins is advocated. Annual mammograms/surveillance is recommended for biopsy-proven cases. IDP has a high upgrade potential, and, hence, care should be taken to biopsy suspicious lesions. An excision of biopsy-proven lesions must be done.
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Affiliation(s)
| | | | - Mohamad Hajaj
- Breast Imaging, Hamad Medical Corporation, Doha, QAT
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Alberty‐Oller JJ, Reyes S, Moshier E, Ru M, Weltz S, Santos A, Pisapati K, Port E, Jaffer S. Does previous history of cancer or atypia predict histologic upgrade for pure intraductal papillomas diagnosed via core biopsy? A study of 490 cases at a single institution. Cancer Rep (Hoboken) 2021; 5:e1481. [PMID: 34729946 PMCID: PMC8955065 DOI: 10.1002/cnr2.1481] [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: 12/18/2020] [Revised: 05/17/2021] [Accepted: 06/04/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Management of pure intraductal papillomas (IDP) without atypia diagnosed on core needle biopsy (CNB) remains controversial given highly variable rates of upgrade in the literature. AIM We sought to identify clinical and histologic factors that predict upgrade to atypia or malignancy in a large population. METHODS AND RESULTS A retrospective review was performed of all cases of pure IDP diagnosed on CNB and then surgically excised at a single institution from 2008 to 2018. Clinical, radiologic, and pathologic factors were compared in the no upgrade, upgrade to atypia, or upgrade to cancer groups. Univariate analysis was performed comparing no upgrade and upgrade to cancer or atypia. Four hundred and thirty nine patients were identified with a total of 490 IDP and a median age of 50 years (range 16-85). Of these patients, 54 (12.3%) were upgraded to atypia after surgical excision and five (1.1%) were upgraded to cancer. The presence of multiple papillomas in a single patient was a significant predictor of upgrade to cancer or atypia (p < .01), as well as age over ≥55 years (p < .01) and a prior history of cancer (p < .01). No other clinical, radiologic and histologic factors were found to be significant predictors of upgrade. 40/439 (9.1%) patients in the total cohort had prior history of cancer, and of these, 2/40 (5%) were found to have a new cancer after excision. CONCLUSIONS In patients with pure IDP on CNB, the upgrade rate to malignancy was 1.1%, while 12.3% were upgraded to atypia. The clinical significance of identifying atypia in a papilloma is unknown, especially in a patient with a prior history of atypia or cancer. However, the majority of patients who were upgraded to either atypia or cancer had no prior history of high-risk or malignant breast disease and are therefore considered true clinical upgrades. As such excision for IDP should be considered.
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Affiliation(s)
- J. Jaime Alberty‐Oller
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Sylvia Reyes
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Erin Moshier
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Meng Ru
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Sarah Weltz
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Antonio Santos
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Kereeti Pisapati
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Elisa Port
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Shabnam Jaffer
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Li B, Nguyen J, Williams CA, Cardenas K, Pidhorecky I. Rare Papillary Breast Carcinoma Incidentally Discovered After Trauma-Induced Hematoma. Cureus 2021; 13:e18215. [PMID: 34722027 PMCID: PMC8544644 DOI: 10.7759/cureus.18215] [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: 07/13/2021] [Accepted: 09/23/2021] [Indexed: 12/03/2022] Open
Abstract
Papillary carcinoma of the breast is rare, comprising only 0.5% incidence of all breast cancers. Clinically the disease presents in postmenopausal women as a painless breast lump with possible bloody nipple discharge. Prognosis is favorable due to its slow growth. We present a 61-year-old woman incidentally diagnosed with papillary breast carcinoma after presenting with a trauma-induced hematoma of the right breast. The patient presented to our surgery oncology clinic for persistent right breast swelling secondary to a fall, despite initial incision and drainage (I&D) six weeks prior. She had no history of breast cancer. On presentation, her right breast was distended demonstrating an approximately 20cm ill-defined solid mass with skin changes consistent with a tense hematoma. CT scan demonstrated a large complex cystic and solid breast mass measuring 15.2cmx11.8cmx15.2cm with irregular peripheral solid hyperdense polypoid components. She then underwent a right breast incisional biopsy and hematoma evacuation. Frozen sections of the mass outer cavity wall and papillary projections were consistent with encapsulated papillary carcinoma (EPC). The patient was lost to follow-up and did not obtain definitive treatment. Breast cancer rarely presents as a breast hematoma. However, as in this case, if the hematoma fails to resolve, further investigation is warranted. The prognosis of EPC is excellent when identified and treated appropriately.
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Affiliation(s)
- Becky Li
- Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Jackie Nguyen
- Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Caitlin A Williams
- Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | | | - Ihor Pidhorecky
- Surgical Oncology, Westside Regional Medical Center, Plantation, USA
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28
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Lee JY. Bloody nipple discharge caused by an intraductal papilloma of the breast in an adolescent girl: A case report. Radiol Case Rep 2021; 16:3346-3349. [PMID: 34484543 PMCID: PMC8408432 DOI: 10.1016/j.radcr.2021.08.006] [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: 07/15/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
Bloody nipple discharge in pediatric patients is rare and mostly associated with benign conditions.Despite the generally benign nature, a thorough investigation of the cause and treatment is required if a palpable lesion is present. Here, the author reports a case of bloody nipple discharge in an adolescent girl with no significant medical history. Breast ultrasound demonstrated a solid, oval-shaped, circumscribed mass in the left subareolar region that was categorized as category 4a according to the breast imaging reporting and data system (BI-RADS). An excisional biopsy and histological examination confirmed a diagnosis of intraductal papilloma. While intraductal papilloma is rare in the pediatric population, ultrasound evaluation and knowledge of characteristic findings are useful for noninvasive diagnostics and image-guided treatment planning.
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Affiliation(s)
- Ji Young Lee
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwa-ro, Ilsanseo-gu, Goyang, Gyeonggi-do 10380, Republic of Korea
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Abstract
Computed tomography (CT) and magnetic resonance (MR) imaging may demonstrate a wide variety of incidental findings in the breast, including primary breast carcinoma, the second most common cancer in women. It important to recognize the spectrum of pathologic conditions in order to properly assess the need for further workup. Some findings may be diagnosed as benign on the basis of CT/ MR imaging and clinical history alone, whereas others will require evaluation with dedicated breast imaging and possibly biopsy. This article serves to guide radiologists' management of the wide spectrum of incidental breast findings encountered on cross-sectional imaging.
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30
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Catanzariti F, Avendano D, Cicero G, Garza-Montemayor M, Sofia C, Venanzi Rullo E, Ascenti G, Pinker-Domenig K, Marino MA. High-risk lesions of the breast: concurrent diagnostic tools and management recommendations. Insights Imaging 2021; 12:63. [PMID: 34037876 PMCID: PMC8155169 DOI: 10.1186/s13244-021-01005-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/04/2021] [Indexed: 12/14/2022] Open
Abstract
Breast lesions with uncertain malignant behavior, also known as high-risk or B3 lesions, are composed of a variety of pathologies with differing risks of associated malignancy. While open excision was previously preferred to manage all high-risk lesions, tailored management has been increasingly favored to reduce overtreatment and spare patients from unnecessary anxiety or high healthcare costs associated with surgical excision. The purpose of this work is to provide the reader with an accurate overview focused on the main high-risk lesions of the breast: atypical intraductal epithelial proliferation (atypical ductal hyperplasia), lobular neoplasia (including the subcategories lobular carcinoma in situ and atypical lobular hyperplasia), flat epithelial atypia, radial scar and papillary lesions, and phyllodes tumor. Beyond merely presenting the radiological aspects of these lesions and the recent literature, information about their potential upgrade rates is discussed in order to provide a useful guide for appropriate clinical management while avoiding the risks of unnecessary surgical intervention (overtreatment).
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Affiliation(s)
- Francesca Catanzariti
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Daly Avendano
- Department of Breast Imaging, Breast Cancer Center TecSalud, ITESM Monterrey, Nuevo Leon, Mexico
| | - Giuseppe Cicero
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | | | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Emmanuele Venanzi Rullo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124, Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Katja Pinker-Domenig
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, Suite 705, 300 E 66th Street, New York, NY, 10065, USA. .,Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
| | - Maria Adele Marino
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
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31
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Niu RL, Li SY, Wang B, Jiang Y, Liu G, Wang ZL. Papillary breast lesions detected using conventional ultrasound and contrast-enhanced ultrasound: Imaging characteristics and associations with malignancy. Eur J Radiol 2021; 141:109788. [PMID: 34091133 DOI: 10.1016/j.ejrad.2021.109788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/11/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to evaluate the imaging features of papillary breast lesions detected using conventional ultrasonography (US) and contrast-enhanced ultrasound (CEUS) and to correlate the pathological results. Furthermore, the diagnostic efficiencies of these imaging features to predict the malignancy potential of papillary lesions were explored. METHODS The findings of the conventional US and CEUS of 74 consecutive papillary breast lesions were assessed retrospectively. The obtained data were analyzed using univariate and multivariate logistic regressions to evaluate the ability of each parameter and combined parameters in distinguishing the benign and atypical or malignant papillary lesions. RESULTS Among the imaging features of breast papillary lesions on conventional US and CEUS, two sonographic features (lesion size ≥1 cm and not circumscribed margin) on conventional US and four enhancement features (irregular enhancement, heterogeneous enhancement, enlargement of scope, and perfusion defect) on CEUS were found to be significantly different between the benign and atypical or malignant papillary lesions (P < 0.05). A multivariate logistic regression analysis further showed that only heterogeneous enhancement and enlarged enhancement scope were associated with malignancy. The sensitivity and specificity of heterogeneous enhancement, enlarged enhancement scope, and combined analysis for predicting atypical and malignant papillary lesions were 78.6 % and 39.1 %, 75 % and 37 %, and 75 % and 82.6 %, respectively. The combination of enhancement homogeneity and enhancement scope improved the diagnostic accuracy (AUC = 0.875). CONCLUSIONS The results suggested that the imaging features on conventional US and CEUS could help in identifying benign and malignant papillary lesions and predict their malignancy potential.
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Affiliation(s)
- Rui-Lan Niu
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, Beijing, China
| | - Shi-Yu Li
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, Beijing, China
| | - Bo Wang
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, Beijing, China
| | - Ying Jiang
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, Beijing, China
| | - Gang Liu
- Department of Radiology, the First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, Beijing, China.
| | - Zhi-Li Wang
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, Beijing, China.
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Analysis of 612 Benign Papillomas Diagnosed At Core Biopsy: Rate of Upgrade to Malignancy, Factors Associated with Upgrade, and A Proposal For Selective Surgical Excision. AJR Am J Roentgenol 2021; 217:1299-1311. [PMID: 34008998 DOI: 10.2214/ajr.21.25832] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Despite numerous published studies, management of benign papillomas without atypia remains controversial. Objective: To determine the malignancy upgrade rate of benign papillomas, identify risk factors for upgrade, and formulate criteria for selective surgery. Methods: This retrospective study included benign papillomas without atypia diagnosed on percutaneous biopsy between 12/01/2000 and 12/31/2019. Papillomas that did not undergo surgical excision or at least 2 years of imaging and/or clinical follow-up were excluded. Clinical, imaging, and histopathologic features were extracted from the electronic medical record. Features associated with upgrade to malignancy were identified. Multivariable logistic regression was performed. Results: The study included 612 benign papillomas in 543 women (mean age 54.5 ± 12.1 years); 466 papillomas were excised, and 146 underwent imaging/clinical surveillance. The upgrade rate to malignancy was 2.3% (14/612). Upgrade rate was associated (p<.05) with radiology-pathology correlation (50.0% if discordant vs 2.1% if concordant), patient age (5.6% for age ≥60 vs 0.7% for age <60), presenting symptoms (6.7% if palpable mass or pathologic nipple discharge vs 1.3% if no symptoms), and lesion size (7.3% if ≥10 mm vs 0.6% if <10 mm). Three of 14 upgraded papillomas were associated with ≥4 metachronous or concurrent peripheral papillomas. No incidental papilloma or papilloma reported as completely excised on core biopsy histopathologic analysis was upgraded. A predictive model combining radiology-pathology discordance, symptoms (palpable mass or nipple discharge), age ≥60, size ≥10 mm, and presence of ≥4 metachronous or concurrent peripheral papillomas achieved AUC 0.91, sensitivity 79%, and specificity 89% for upgrade. Selective surgery based on presence of any of these five factors, while excluding from surgery incidental papillomas and papillomas reported as completely excised on histopathology, would spare 294 of 612 lesions from routine excision, while identifying all 14 upgraded lesions. Conclusion: Benign non-atypical papillomas have a low malignancy upgrade rate; routine surgical excision may not be necessary. Selective excision is recommended for lesions satisfying any of the 5 criteria. Incidental papillomas or papillomas completely excised on histopathology may undergo imaging follow-up. Clinical Impact: The proposed criteria for selective surgery of benign papillomas on core biopsy would reduce surgeries without delaying diagnosis of malignancy.
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Fadzli F, Rahmat K, Ramli MT, Rozalli FI, Hooi TK, Fadzli AN, Hoong SM, Ramli NM, Taib NAM. Spectrum of imaging findings of papillary breast disease: A radiopathological review in a tertiary center. Medicine (Baltimore) 2021; 100:e25297. [PMID: 33879660 PMCID: PMC8078345 DOI: 10.1097/md.0000000000025297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 03/05/2021] [Indexed: 01/04/2023] Open
Abstract
To evaluate the clinical and imaging findings of papillary breast neoplasm and review the pathologic correlation at a tertiary center.Retrospective study of patients diagnosed with benign and malignant papillary lesions between 2008 to 2018. 147 patients were identified with histology diagnosis of papillary lesions. The clinical, imaging, and pathological characteristics were reviewed.Patient cohort included 147 women diagnosed with papillary lesions (mean age at diagnosis 53.8 years) and were divided into 3 histology groups (benign, atypical, and malignant). Common clinical presentations were breast lump (n = 60) and nipple discharge (n = 29), 48 patients were asymptomatic.Only 37 were detected as a mass lesion on mammogram. The presence of mass lesion on mammogram was the most common feature in all 3 papillary lesion groups, and with the presence of asymmetric density, were the 2 mammographic features significantly associated (P < .05) with malignancy.All lesions were detected on ultrasound. The most common sonographic features for all 3 groups were the presence of a mass and irregular shape. Among all the sonographic features assessed, larger size, presence of vascularity and absence of dilated ducts were significantly associated (P < .05) with malignancy.Feature pattern recognition of the variety of benign, atypical and malignant papillary neoplasm on ultrasound and mammogram, with emphasis on size, presence of vascularity and dilated ducts on ultrasound and presence of mass, and architectural distortion on mammogram, is important in the assessment of patients with suspected ductal lesions to facilitate optimal treatment and surgical care.
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Affiliation(s)
- Farhana Fadzli
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur
| | - Kartini Rahmat
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur
| | - Marlina Tanty Ramli
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur
- Radiology Department, Faculty of Medicine, University Teknologi MARA, Sungai Buloh Campus, Selangor
| | - Faizatul Izza Rozalli
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur
| | | | - Ahmad Nazran Fadzli
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - See Mee Hoong
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlisah Mohd Ramli
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur
| | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Sharma S, Nwachukwu C, Wieseler C, Elsherif S, Letter H, Sharma S. MRI Virtual Biopsy of T2 Hyperintense Breast Lesions. J Clin Imaging Sci 2021; 11:18. [PMID: 33880243 PMCID: PMC8053438 DOI: 10.25259/jcis_42_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 01/15/2023] Open
Abstract
A wide variety of benign and malignant breast processes may generate hyperintense signal at T2-weighted magnetic resonance imaging (MRI). MRI has been traditionally used in the pre-treatment planning of breast cancer, in assessing treatment response and detecting recurrence. In this comprehensive review, we describe and illustrate the MRI features of a few common and uncommon T2 hyperintense breast lesions, with an emphasis on MRI features that help to characterize lesions based on morphological features, specific appearances on T1-and T2-weighted imaging, and enhancement characteristics on the dynamic post-contrast phase that are either diagnostic or aid in narrowing the differential diagnosis.
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Affiliation(s)
- Swati Sharma
- Department of Radiology, University of Florida, Jacksonville, Florida, United States
| | - Chidi Nwachukwu
- Department of Radiology, University of Florida, Jacksonville, Florida, United States
| | - Carissa Wieseler
- Department of Radiology, University of Florida, Jacksonville, Florida, United States
| | - Sherif Elsherif
- Department of Radiology, University of Florida, Jacksonville, Florida, United States
| | - Haley Letter
- Department of Radiology, University of Florida, Jacksonville, Florida, United States
| | - Smita Sharma
- Department of Radiology, University of Florida, Jacksonville, Florida, United States
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35
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Limberg J, Kucher W, Fasano G, Hoda S, Michaels A, Marti JL. Intraductal Papilloma of the Breast: Prevalence of Malignancy and Natural History Under Active Surveillance. Ann Surg Oncol 2021; 28:6032-6040. [PMID: 33876349 DOI: 10.1245/s10434-021-09870-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The optimal management of intraductal papillomas (IPs) without atypia diagnosed on needle core biopsy (NCB) is unclear. This study analyzed the malignancy risk of immediately excised IPs and characterized the behavior of IPs under active surveillance (AS). METHODS We retrospectively reviewed the pathology and imaging records of patients diagnosed with IPs without atypia on NCB during a 10-year period (1999-2019). The malignancy upgrade rate was assessed in patients who had an immediate surgical excision, and the rates of both radiographic progression and development of malignancy were assessed in a cohort of patients undergoing AS. RESULTS The inclusion criteria were met in 152 patients with 175 IPs with a mean age of 51 ± 13 years. The average size of the IPs on initial imaging was 8 ± 4 mm. Most of the lesions (57%, n = 99) were immediately excised, whereas 76 (43%) underwent AS with interval imaging with a median follow-up period of 15 months (range, 5-111 months). Among the immediately excised IPs, surgical pathology revealed benign findings in 97% (n = 96) and ductal carcinoma in situ in 3% (n = 3). In the AS cohort, 72% (n = 55) of the IPs remained stable, and 25% (n = 19) resolved or decreased in size. At 2 years, 4% had increased in size on imaging and were subsequently excised, with ductal carcinoma in situ (DCIS, n = 1) and benign pathology (n = 1) noted on final pathology. CONCLUSIONS In a large series of breast IPs without atypia, no invasive carcinoma was observed after immediate excision, and 96% of the lesions had not progressed on AS. This suggests that patients with IP shown on NCB can safely undergo AS, with surgery reserved for radiographic lesion progression.
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Affiliation(s)
- Jessica Limberg
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Whitney Kucher
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Genevieve Fasano
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Syed Hoda
- Department of Pathology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Aya Michaels
- Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Jennifer L Marti
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
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Liu C, Han Y, Tong P, Kuang D, Li N, Lu C, Sun X, Wang W, Dai J. Genome-wide DNA methylome and whole-transcriptome landscapes of spontaneous intraductal papilloma in tree shrews. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:688. [PMID: 33987386 PMCID: PMC8106051 DOI: 10.21037/atm-21-1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Breast intraductal papilloma (IP) is mainly caused by the abnormal proliferation of ductal epithelial cells. Tree shrews have potential as an animal model for the study of breast tumours; however, little is known regarding the transcriptome and DNA methylome landscapes of breast IP in tree shrews. In this research, we conducted whole-genome DNA methylation and transcriptome analyses of breast IP and normal mammary glands in tree shrews. Methods DNA methylation profiles were generated from the whole-genome bisulfite sequencing and whole-transcriptome landscapes of IP and control groups of tree shrews through strand-specific library construction and RNA sequencing. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes functional enrichment analyses and gene set enrichment analysis were performed. Spearman’s correlation analysis was used to identify statistical relationships between gene expression and DNA methylation. Results A genome-wide perspective of the epigenetic regulation of protein-coding genes in breast IP in tree shrews was obtained. The methylation levels at CG sites were considerably higher than those at CHG or CHH sites, and were highest in gene body regions. In total, 3,486, 82 and 361 differentially methylated regions (DMRs) were identified in the context of CG, CHG, and CHH, respectively, and 701 differentially methylated genes (DMGs) were found. Further, through transcriptomic analysis, 62 differentially expressed genes, 50 long noncoding RNAs, and 32 circular RNAs were identified in breast IP compared to normal mammary glands. Correlation analysis between the DNA methylation and transcriptome data revealed that 25 DMGs were also differentially expressed genes, among which the expression levels of 9 genes were negatively correlated with methylation levels in gene body regions. Importantly, integrated analysis identified 3 genes (PDZ domain-containing 1, ATPase plasma membrane Ca2+ transporting 4 and Lymphocyte cytosolic protein 1) that could serve as candidates for further study of breast IP in tree shrews. Conclusions This research has unearthed the comprehensive landscape of the transcriptome and DNA methylome of spontaneous IP in tree shrews, as well as candidate tumorigenesis related genes in IP. These results will contribute to the use of tree shrews in animal models of breast tumours.
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Affiliation(s)
- Chengxiu Liu
- The Center of Tree Shrew Germplasm Resources, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Yuanyuan Han
- The Center of Tree Shrew Germplasm Resources, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Pinfen Tong
- The Center of Tree Shrew Germplasm Resources, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Dexuan Kuang
- The Center of Tree Shrew Germplasm Resources, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Na Li
- The Center of Tree Shrew Germplasm Resources, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Caixia Lu
- The Center of Tree Shrew Germplasm Resources, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Xiaomei Sun
- The Center of Tree Shrew Germplasm Resources, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Wenguang Wang
- The Center of Tree Shrew Germplasm Resources, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Jiejie Dai
- The Center of Tree Shrew Germplasm Resources, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
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Jamidi SK, Li JJX, Aphivatanasiri C, Chow MBCY, Chan RCK, Ng JKM, Tsang JY, Tse GM. Papillary lesions of the breast: A systematic evaluation of cytologic parameters. Cancer Cytopathol 2021; 129:649-661. [PMID: 33561323 DOI: 10.1002/cncy.22412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND The cytologic diagnosis of papillary lesions of the breast is challenging because of the diverse morphology, including epithelial hyperplasia, atypia, low-grade malignancy, and neuroendocrine differentiation; also, traditional malignant features such as necrosis and myoepithelial cell loss can be lacking. Thus, the diagnostic criteria for papillary lesions may differ from those for other breast lesions. This study evaluated various cytologic parameters in a large cohort to identify useful diagnostic features. METHODS Cytologic preparations of papillary lesions with histologic follow-up were reviewed for features related to cellularity, epithelial cohesiveness, cellular and stromal architecture, cytomorphology, and background. Corresponding histologic slides were also reviewed. RESULTS In all, 153 cases were included. Epithelial discohesion, solid and cribriform patterns, atypical nuclear features, and mitoses (P ≤ .001 to P = .017) were associated with malignancy. Cell balls, monolayer sheets, and features of cystic change (P < .001 to P = .016) were associated with benign lesions. Complex (P = .031) and slender (P = .026) papillae and neuroendocrine features (P < .001) were associated with malignancy. Hemorrhage, background, and infiltrating neutrophils (P < .001 to P = .025) were associated with malignancy; fibrotic broad papillary stromal fragments (naked papillary fronds [NPFs]; P = .043) were associated with benignity. The presence of any single parameter, including the absence of myoepithelial cells within epithelial structure, the presence of cytoplasmic granules, an increased amount of cytoplasm, and a nuclear to cytoplasmic (N/C) ratio greater than 0.7, which were identified by principal component analysis, yielded a sensitivity of 95.1% and a specificity of 100.0% in predicting malignancy. CONCLUSIONS Methodological assessment of multiple features is recommended. Myoepithelial cells, cytoplasmic granules, the amount of cytoplasm, and the N/C ratio are key features for diagnosis.
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Affiliation(s)
| | - Joshua J X Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Maria B C Y Chow
- Department of Pathology, North District Hospital, Sheung Shui, Hong Kong
| | - Ronald C K Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joanna K M Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Julia Y Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
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Samreen N, Madsen LB, Chacko C, Heller SL. Magnetic resonance imaging in the evaluation of pathologic nipple discharge: indications and imaging findings. Br J Radiol 2021; 94:20201013. [PMID: 33544650 DOI: 10.1259/bjr.20201013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pathologic nipple discharge (PND) is typically unilateral, spontaneous, involves a single duct, and is serous or bloody in appearance. In patients with PND, breast MRI can be helpful as an additional diagnostic tool when conventional imaging with mammogram and ultrasound are negative. MRI is able to detect the etiology of nipple discharge in 56-61% of cases when initial imaging with mammogram and ultrasound are negative. Advantages to using MRI in evaluation of PND include good visualization of the retroareolar breast and better evaluation of posterior lesions which may not be well evaluated on mammograms and galactograms. It is also less invasive compared to central duct excision. Papillomas and nipple adenomas are benign breast masses that can cause PND and are well visualized on MRI. Ductal ectasia, and infectious etiologies such as mastitis, abscess, and fistulas are additional benign causes of PND that are well evaluated with MRI. MRI is also excellent for evaluation of malignant causes of PND including Paget's disease, ductal carcinoma in-situ and invasive carcinoma. MRI's high negative predictive value of 87-98.2% is helpful in excluding malignant etiologies of PND.
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Affiliation(s)
- Naziya Samreen
- New York University Long Island Division, Long Island, NY, USA
| | | | - Celin Chacko
- New York University Long Island Division, Long Island, NY, USA
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Yang P, Shi X, Li J, Qian L. Imaging features of myopericytoma of the breast: A case report and review of the literature. Radiol Case Rep 2021; 16:98-102. [PMID: 33204380 PMCID: PMC7649600 DOI: 10.1016/j.radcr.2020.10.051] [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: 08/20/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 11/02/2022] Open
Abstract
Myopericytoma is a rare perivascular tumor commonly arising in the superficial soft tissue and subcutaneous tissue of the distal extremities. We report the first case of myopericytoma occurring in the breast, focusing on the imaging and histopathological characteristics of the tumor. From an imaging perspective, myopericytoma presents a well-circumscribed, marked hypervascularity, and intense enhancement after injection of contrast material. Imaging examinations, such as ultrasonography and magnetic resonance imaging, can contribute to the detection of tumor invasion to adjacent structures or distant metastases, and provide evidence for a treatment plan.
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Affiliation(s)
- PeiPei Yang
- Department of Ultrasound, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050, China
| | - XianQuan Shi
- Department of Ultrasound, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050, China
| | - JianMing Li
- Department of Ultrasound, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050, China
| | - LinXue Qian
- Department of Ultrasound, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050, China
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Nuñez DL, González FC, Ibargüengoitia MC, Fuentes Corona RE, Hernández Villegas AC, Zubiate ML, Vázquez Manjarrez SE, Ruiz Velasco CC. Papillary lesions of the breast: a review. BREAST CANCER MANAGEMENT 2020. [DOI: 10.2217/bmt-2020-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Papillary breast lesions are rare breast tumors that comprise a broad spectrum of diseases. Pathologically they present as mass-like projections attached to the wall of the ducts, supported by fibrovascular stalks lined by epithelial cells. On mammogram they appear as masses that can be associated with microcalcifications. Ultrasound is the most used imaging modality. On ultrasound papillary lesions appear as homogeneous solid lesions or complex intracystic lesions. A nonparallel orientation, an echogenic halo or posterior acoustic enhancement associated with microcalcifications are highly suggestive of malignancy. MRI has proven to be useful to establish the extent of the lesion. Core needle biopsy is the gold standard for diagnosis. Surgical excision is usually recommended, although treatment for papillomas without atypia is still controversial.
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Affiliation(s)
- Denny Lara Nuñez
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Candanedo González
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mónica Chapa Ibargüengoitia
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Mariana Licano Zubiate
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Carlos Casian Ruiz Velasco
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Bonnet SE, Carter GJ, Berg WA. Encapsulated Papillary Carcinoma of the Breast: Imaging Features with Histopathologic Correlation. JOURNAL OF BREAST IMAGING 2020; 2:590-597. [PMID: 38424859 DOI: 10.1093/jbi/wbaa068] [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] [Received: 05/11/2020] [Indexed: 03/02/2024]
Abstract
Encapsulated papillary carcinoma (EPC) is a rare, clinically indolent breast malignancy most common in postmenopausal women. Absence of myoepithelial cells at the periphery is a characteristic feature. Mammographically, EPC typically presents as a mostly circumscribed, noncalcified, dense mass that can have focally indistinct margins when there is associated frank invasive carcinoma. Ultrasound shows a circumscribed solid or complex cystic and solid mass, and occasional hemorrhage in the cystic component may produce a fluid-debris level; the solid components typically show intense washout enhancement on MRI. Color Doppler may demonstrate a prominent vascular pedicle and blood flow within solid papillary fronds. Encapsulated papillary carcinoma can exist in pure form; however, EPC is often associated with conventional ductal carcinoma in-situ and/or invasive ductal carcinoma, no special type. Adjacent in-situ and invasive disease may be only focally present at the periphery of EPC and potentially unsampled at core-needle biopsy. In order to facilitate diagnosis, the mass wall should be included on core-needle biopsy, which will show absence of myoepithelial markers. Staging and prognosis are determined by any associated frankly invasive component, with usually excellent long-term survival and rare distant metastases.
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Affiliation(s)
- Sarah E Bonnet
- Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
| | - Gloria J Carter
- Magee-Womens Hospital of UPMC, Department of Pathology, Pittsburgh, PA
| | - Wendie A Berg
- Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
- University of Pittsburgh School of Medicine, Department of Radiology, Pittsburgh, PA
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Tang WJ, Liang YS, Yan J, Hu Y, Sun ML, Liu GS, Pan XH, Wei XH, Jiang XQ, Guo Y. Magnetic Resonance Imaging (MRI) Phenotypes May Provide Additional Information for Risk Stratification for Encapsulated Papillary Carcinoma of the Breast. Cancer Manag Res 2020; 12:11751-11760. [PMID: 33239912 PMCID: PMC7680800 DOI: 10.2147/cmar.s277980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background Encapsulated papillary carcinoma (EPC) of the breast is a rare entity. EPC can be underappreciated on percutaneous biopsy, which may require additional procedures if invasion is not recognized preoperatively. We aimed to investigate the magnetic resonance imaging (MRI) phenotypes correlated with preoperative pathological risk stratification for clinical guidance. Materials and Methods The preoperative MRI scans of 30 patients diagnosed with 36 EPCs in multiple centers between August 2015 and February 2020 were reviewed by two breast radiologists. According to the WHO classification published in 2019, EPCs were classified into two pathological subtypes: encapsulated papillary carcinoma and encapsulated papillary carcinoma with invasion. Clinicopathological analysis of the two subtypes and MR feature analysis were performed. Results Evaluation of the MRI phenotypes and pathological subtype information revealed that not circumscribed (P=0.04) was more common in EPCs with invasion than in EPCs. There was a significant difference in the age of patients (P=0.05), and the risk increased with age. The maximum diameter of the tumor increased with tumor risk, but there was no significant difference (P=0.36). Nearly half of the EPC with invasion patients showed hyperintensity on T1WI (P=0.19). A total of 63.6% of the EPC with invasion group showed non-mass enhancement surrounding (P=0.85). In addition, 29 patients (96.7%) had no axillary lymph node metastasis, and only one patient with EPC with invasion had axillary lymph node metastasis. Further pathological information analysis of EPCs showed that higher Ki-67 levels were more common in patients with EPCs with invasion (P=0.04). A total of 29 patients (96.7%) had the luminal phenotype, and one patient with EPC with invasion had the Her-2-positive phenotype. Conclusion The margin, age and Ki-67 level were the key features for EPC risk stratification. In addition, these MRI signs, including a larger tumor, non-mass enhancement surrounding and axillary lymph node metastasis, may be suggestive of a high-risk stratification. Therefore, MRI phenotypes may provide additional information for the risk stratification of EPCs.
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Affiliation(s)
- Wen-Jie Tang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, People's Republic of China
| | - Yun-Shi Liang
- Department of Pathology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, People's Republic of China
| | - Jing Yan
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China
| | - Yue Hu
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital Sun Yat-Sen University, Guangzhou 510120, People's Republic of China
| | - Mei-Li Sun
- Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Guo-Shun Liu
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, People's Republic of China
| | - Xiao-Huan Pan
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, People's Republic of China
| | - Xin-Hua Wei
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, People's Republic of China
| | - Xin-Qing Jiang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, People's Republic of China
| | - Yuan Guo
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, People's Republic of China
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Lyons D, Wahab RA, Vijapura C, Mahoney MC. The nipple-areolar complex: comprehensive imaging review. Clin Radiol 2020; 76:172-184. [PMID: 33077158 DOI: 10.1016/j.crad.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
The nipple-areolar complex can be affected by a variety of benign and malignant entities that can present with non-specific symptoms. Benign pathologies commonly affecting the nipple-areolar complex include nipple calcifications, nipple adenoma, abscess of Montgomery tubercles, ductal ectasia, periductal mastitis, and papilloma. Malignant pathologies that affect the nipple-areolar complex include Paget's disease of the breast, ductal carcinoma in-situ, and invasive ductal carcinoma. Clinical history and examination, imaging, and tissue sampling when appropriate are co-dependent factors that guide the assessment of nipple-areolar pathologies. This article provides a review of the normal anatomy, common anatomical variants, benign and malignant pathologies, and imaging techniques to guide the diagnostic assessment of the nipple-areolar complex.
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Affiliation(s)
- D Lyons
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA.
| | - R A Wahab
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
| | - C Vijapura
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
| | - M C Mahoney
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
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Del Riego J, Pitarch M, Codina C, Nebot L, Andreu FJ, Aparicio O, Medina A, Martín A. Multimodality approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Insights Imaging 2020; 11:89. [PMID: 32757082 PMCID: PMC7406635 DOI: 10.1186/s13244-020-00896-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022] Open
Abstract
The anatomic and histologic characteristics of the nipple-areolar complex make this breast region special. The nipple-areolar complex can be affected by abnormal development and a wide spectrum of pathological conditions, many of which have unspecific clinical and radiological presentations that can present a challenge for radiologists. The nipple-areolar complex requires a specific imaging workup in which a multimodal approach is essential. Radiologists need to know the different imaging modalities used to study the nipple-areolar complex, as well as their advantages and limitations. It is essential to get acquainted with the acquisition technique for each modality and the spectrum of findings for the different conditions. This review describes and illustrates a combined clinical and radiological approach to evaluate the nipple-areolar complex, emphasizing the findings for the normal morphology, developmental abnormalities, and the most common benign and malignant diseases that can affect this region. We also present a diagnostic algorithm that enables a rapid, practical approach to diagnosing condition involving the nipple-areolar complex.
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Affiliation(s)
- Javier Del Riego
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain. .,Women's Imaging, Grup Duran Diagnòstic per la Imatge, Sabadell, Barcelona, Spain.
| | - Mireia Pitarch
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain
| | - Clara Codina
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain
| | - Laura Nebot
- Department of Pathology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Oscar Aparicio
- Department of Surgery, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | - Alexandra Medina
- Department of Gynecology and Obstetrics, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | - Amaya Martín
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain.,Women's Imaging, Grup Duran Diagnòstic per la Imatge, Sabadell, Barcelona, Spain
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Stachs A, Stubert J, Reimer T, Hartmann S. Benign Breast Disease in Women. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:565-574. [PMID: 31554551 DOI: 10.3238/arztebl.2019.0565] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Most clinical breast changes in women are benign; in only 3% to 6% of cases are they due to breast cancer. How- ever, there is a lack of up-to-date, evidence-based treatment recommendations for the various benign differential diagnoses. METHODS Selective literature search of PubMed from 1985 to May 2019, including current national (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften [Association of Scientific Medical Societies in Germany]) and inter- national guidelines. RESULTS Mastalgia and fibrocystic changes are common (around 50% of all women over the age of 30). Fibroadenomas occur in 25% of women; they are the most common benign tumors of the breast and do not require treatment. With most benign breast changes the risk of dedifferentiation is very low. However, it is important in the differential diagnosis to distinguish between such benign changes and breast cancer or changes that carry a risk of malignancy. Complex cysts, for example, carry a risk of malig- nancy of 23% to 31%, papillary lesions 16% , and radial scars 7%. Where there is doubt, histological confirmation should be sought by means of percutaneous biopsy. CONCLUSION Benign breast changes can be definitively distinguished from malignant lesions through the selective use of avail- able diagnostic investigations and interdisciplinary collaboration. When lesions of uncertain malignant potential are found (B3 in the biopsy classification), complete excision is indicated. Prospective studies on the early diagnosis of breast cancer in lesions carrying a risk of malignancy are desirable.
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Affiliation(s)
- Angrit Stachs
- Department of Obstetrics and Gynecology, University of Rostock
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Fatima K, Afzal S, Tariq MU. Outcome of Non-Malignant Papillary Lesions of the Breast on Core Biopsy: An Experience from a Tertiary Care Center in Pakistan. Cureus 2020; 12:e8364. [PMID: 32617235 PMCID: PMC7325390 DOI: 10.7759/cureus.8364] [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] [Indexed: 11/05/2022] Open
Abstract
Background Papillary lesions of the breast constitute a heterogeneous group ranging from non-malignant papillomas to papillary carcinoma. While surgical excision is recommended for atypical papilloma or papillary DCIS/ carcinoma on core biopsy, controversy persists in the management of benign papillomas which are diagnosed with core needle biopsy (CNB) since there are variable reported rates for tumor upgrade. The purpose of this study was to determine the outcome of papillary lesions of the breast diagnosed at image-guided CNB, after surgical excision or follow-up, and to identify potential predictors of high-risk lesions/malignancy on imaging. Materials and methods We retrospectively identified 52 non-malignant papillary lesions on core biopsy between January 2012 and June 2018. The outcome of surgical excision, as well as clinical and imaging features of these lesions, were assessed. The final histologic upgrade was recorded, and variables were compared between benign and atypical lesions on core biopsy as well as between upgraded and non-upgraded lesions after surgical excision. Results Thirty-six lesions out of 52 lesions were benign papillomas on core biopsy, while 16 were papillary lesions with ADH/DCIS. All of these lesions except four benign papillomas were excised. Of the 32 benign papillomas excised, 7 were upgraded to papilloma with ADH/DCIS and one to DCIS with the focus of invasion. Among the 16 atypical lesions excised, one was upgraded to papillary DCIS with a final upgrade rate of 17.3%. There was no statistically significant clinical or imaging feature among those that were upgraded on excision from those that were not upgraded. Conclusion Non-malignant papillary lesions have a significant upgrade rate. There are no reliable clinical or imaging features that can pre-surgically predict upgrade. Therefore, surgical excision of all papillary lesions is recommended for definitive diagnosis.
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Affiliation(s)
| | - Shaista Afzal
- Radiology, Aga Khan University Hospital, Karachi, PAK
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Filipe MD, Waaijer L, van der Pol C, van Diest PJ, Witkamp AJ. Interventional Ductoscopy as an Alternative for Major Duct Excision or Microdochectomy in Women Suffering Pathologic Nipple Discharge: A Single-center Experience. Clin Breast Cancer 2020; 20:e334-e343. [PMID: 32081573 DOI: 10.1016/j.clbc.2019.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Pathologic nipple discharge (PND) is, after palpable lumps and pain, the most common breast-related reason for referral to the breast surgeon and is associated with breast cancer. However, with negative mammography and ultrasound, the chance of PND being caused by malignancy is between 5% and 8%. Nevertheless, most patients with PND still undergo surgery in order to rule out malignancy. Ductoscopy is a minimally invasive endoscopic technique that enables direct intraductal visualization. The aim of this study was to evaluate (interventional) ductoscopy as an alternative to surgery in patients with negative conventional imaging. MATERIALS AND METHODS All patients with PND referred between 2010 and 2017 to our hospital for ductoscopy were retrospectively analyzed. Ductoscopy procedures were performed under local anesthesia in the outpatient clinic. The follow-up period was at least 3 months, and the primary outcome was the number of prevented surgical procedures. Furthermore, we evaluated possible complications after ductoscopy (infection and pain). RESULTS A total of 215 consecutive patients undergoing ductoscopy were analyzed. In 151 (70.2%) patients, ductoscopy was successful. In 102 procedures, an underlying cause for PND was visualized, of which 34 patients could be histologically proven and 82 patients treated. Sixty of the 215 patients were eventually operated, 8 owing to suspicious findings during ductoscopy, 42 owing to persistent PND, and 10 because of recurrent PND. In 7 patients, a malignancy was found (5 of them classified as suspicious at dusctoscopy). No serious side effects were seen. CONCLUSION Ductoscopy can be safely used as an alternative for surgery in the workup for PND.
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Affiliation(s)
- Mando Dyko Filipe
- Department of Surgery, Cancer Center, University Medical Centre, Utrecht, The Netherlands.
| | - Laurien Waaijer
- Department of Surgery, Cancer Center, University Medical Centre, Utrecht, The Netherlands
| | - Carmen van der Pol
- Department of Surgery, Cancer Center, University Medical Centre, Utrecht, The Netherlands
| | | | - Arjen Joost Witkamp
- Department of Surgery, Cancer Center, University Medical Centre, Utrecht, The Netherlands
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Tagliati C, Ercolani P, Marconi E, Simonetti BF, Giuseppetti GM, Giovagnoni A. Apparent diffusion coefficient value in breast papillary lesions without atypia at core needle biopsy. Clin Imaging 2019; 59:148-153. [PMID: 31821971 DOI: 10.1016/j.clinimag.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The main aim of the study was to assess if the mean apparent diffusion coefficient (ADC) value was significantly different between papillary lesions (PL) without atypia and PLs with atypical or malignant foci. A secondary objective was to evaluate if patients mean age, MRI BI-RADS® descriptors and assessment category were significantly different between these two PL groups. METHODS In this eight year retrospective study were included 122 patients (mean age, 51 years; range, 24-78) with 122 PLs without atypia at micro-histological examination after core needle biopsy (CNB) performed under sonographic guidance. All patients underwent surgical excision biopsy within 3 months after CNB. All patients underwent MRI examination before surgical excision, including STIR, DWI and Dynamic Contrast-Enhanced sequences. RESULTS Mean ADC value difference between PLs without and with atypia or malignant foci was statistically significant (p < 0.0001). Mean ADC value optimal threshold in order to distinguish the two groups was 1.418 × 10-3 mm2/s. A mean ADC value ≤ 1.418 × 10-3 mm2/s could predict atypical or malignant foci within a PL with 83.9% sensitivity and 75.8% specificity. No statistically significant difference was found with regard to patients mean age, MRI BI-RADS® descriptors and assessment category between these two PL groups. CONCLUSIONS Mean ADC value of PLs without atypia at CNB is an efficient tool in order to help distinguish between PLs without and with atypical or malignant foci at final pathology on surgical excision, and it could be used to help decide how to manage these lesions.
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Affiliation(s)
- Corrado Tagliati
- School of Radiology, Università Politecnica delle Marche, Ancona, Italy.
| | - Paola Ercolani
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Elisabetta Marconi
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Barbara Franca Simonetti
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Gian Marco Giuseppetti
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy.
| | - Andrea Giovagnoni
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy.
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Zaky MM, Hafez A, Zaky MM, Shoma A, Soliman NY, Elmokadem AH. MRI for assessment of pathologic nipple discharge: is it mandatory? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0105-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Benign breast lesions is the most common cause of nipple discharge; however, a rare but major cause is breast cancer. This study assesses the superadded value of MRI in diagnosing causes of pathologic nipple discharge. Ninety-three patients with pathologic nipple discharge were evaluated by sonomammography and DCE-MRI. Sonomammography and MR imaging features were analyzed and correlated with the histopathology.
Results
Histopathology revealed 69 benign, three high-risk, and 21 malignant lesions. Simply dilated ducts and presence of a mass on US examination as well as non-mass enhancement and STIR signal changes on MRI were of statistically significant probability in differentiation between benign and malignant causes of pathological nipple discharge (p value = 0.017 and 0.001) and (p value ≤ 0.001). Sensitivity and specificity of mammogram and ultrasound in differentiation between benign and malignant causes of pathologic nipple discharge were 71.4% and 54.2% respectively with positive predictive value of 31.2%,negative predictive value of 86.7%, and accuracy of 58.1%. MRI gave higher sensitivity and specificity of 100% and 83.3% with positive predictive value of 63.6%, negative predictive value of 100%, and accuracy of 87.1%.
Conclusion
Magnetic resonance imaging is superior to sonommagraphy in diagnosis of pathologic nipple discharge and we recommend it in special situations.
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Rosa M, Agosto-Arroyo E. Core needle biopsy of benign, borderline and in-situ problematic lesions of the breast: Diagnosis, differential diagnosis and immunohistochemistry. Ann Diagn Pathol 2019; 43:151407. [PMID: 31634810 DOI: 10.1016/j.anndiagpath.2019.151407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/22/2019] [Accepted: 09/02/2019] [Indexed: 12/11/2022]
Abstract
Core needle biopsy (CNB) is the most common sampling technique for the histologic evaluation of breast abnormalities. Diagnosing benign proliferative, borderline and some in-situ lesions in CNB is challenging and subject to a significant degree of interobserver variability. In addition, due to the inherent limitations of CNB, "upgrading" to a more significant pathology at excision is an important consideration for some lesions. Pathologists carry a major responsibility in patient diagnosis, risk stratification and management. Familiarity with the histologic features and the clinical significance of these common and problematic lesions encountered in CNB is necessary for adequate treatment and patient follow-up. This review will focus on benign, atypical and in-situ epithelial proliferations, papillary lesions, radial sclerosing lesions, adenosis and cellular fibroepithelial lesions. Highlights of histologic features, useful strategies for accurate diagnosis, basic immunohistochemistry and management will be presented.
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Affiliation(s)
- Marilin Rosa
- Department of Anatomic Pathology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, United States of America.
| | - Emmanuel Agosto-Arroyo
- Department of Anatomic Pathology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, United States of America.
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