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Schopp JG, Polat DS, Arjmandi F, Hayes JC, Ahn RW, Sullivan K, Sahoo S, Porembka JH. Imaging Challenges in Diagnosing Triple-Negative Breast Cancer. Radiographics 2023; 43:e230027. [PMID: 37708071 DOI: 10.1148/rg.230027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Triple-negative breast cancer (TNBC) refers to a heterogeneous group of carcinomas that have more aggressive biologic features, faster growth, and a propensity for early distant metastasis and recurrence compared with other breast cancer subtypes. Due to the aggressiveness and rapid growth of TNBCs, there are specific imaging challenges associated with their timely and accurate diagnosis. TNBCs commonly manifest initially as circumscribed masses and therefore lack the typical features of a primary breast malignancy, such as irregular shape, spiculated margins, and desmoplastic reaction. Given the potential for misinterpretation, review of the multimodality imaging appearances of TNBCs is important for guiding the radiologist in distinguishing TNBCs from benign conditions. Rather than manifesting as a screening-detected cancer, TNBC typically appears clinically as a palpable area of concern that most commonly corresponds to a discrete mass at mammography, US, and MRI. The combination of circumscribed margins and hypoechoic to anechoic echogenicity may lead to TNBC being misinterpreted as a benign fibroadenoma or cyst. Therefore, careful mammographic and sonographic evaluation with US image optimization can help avoid misinterpretation. Radiologists should recognize the characteristics of TNBCs that can mimic benign entities, as well as the subtle features of TNBCs that should raise concern for malignancy and aid in timely and accurate diagnosis. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Jennifer G Schopp
- From the Departments of Radiology (J.G.S., D.S.P., F.A., J.C.H, R.W.A., K.S., J.H.P.) and Pathology (S.S.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Dogan S Polat
- From the Departments of Radiology (J.G.S., D.S.P., F.A., J.C.H, R.W.A., K.S., J.H.P.) and Pathology (S.S.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Firouzeh Arjmandi
- From the Departments of Radiology (J.G.S., D.S.P., F.A., J.C.H, R.W.A., K.S., J.H.P.) and Pathology (S.S.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Jody C Hayes
- From the Departments of Radiology (J.G.S., D.S.P., F.A., J.C.H, R.W.A., K.S., J.H.P.) and Pathology (S.S.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Richard W Ahn
- From the Departments of Radiology (J.G.S., D.S.P., F.A., J.C.H, R.W.A., K.S., J.H.P.) and Pathology (S.S.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Kirbi Sullivan
- From the Departments of Radiology (J.G.S., D.S.P., F.A., J.C.H, R.W.A., K.S., J.H.P.) and Pathology (S.S.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Sunati Sahoo
- From the Departments of Radiology (J.G.S., D.S.P., F.A., J.C.H, R.W.A., K.S., J.H.P.) and Pathology (S.S.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Jessica H Porembka
- From the Departments of Radiology (J.G.S., D.S.P., F.A., J.C.H, R.W.A., K.S., J.H.P.) and Pathology (S.S.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
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Xu M, Li F, Yu S, Zeng S, Weng G, Teng P, Yang H, Li X, Liu G. Value of Histogram of Gray-Scale Ultrasound Image in Differential Diagnosis of Small Triple Negative Breast Invasive Ductal Carcinoma and Fibroadenoma. Cancer Manag Res 2022; 14:1515-1524. [PMID: 35478712 PMCID: PMC9038159 DOI: 10.2147/cmar.s359986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the value of gray-scale ultrasound (US) image histogram in the differential diagnosis between small (≤2.00 cm), oval, or round triple negative breast invasive ductal carcinoma (TN-IDC) and fibroadenoma (FA). Methods Fifty-five cases of triple negative breast invasive ductal carcinoma (TN-IDC group) and 57 cases of breast fibroadenoma (FA group) confirmed by pathology in Hubei cancer hospital from September 2017 to September 2021 were analyzed retrospectively. The gray-scale US images were analyzed by histogram analysis method, from which some parameters (including mean, variance, skewness, kurtosis and 1st, 10th, 50th, 90th and 99th percentile) can be obtained. Intraclass correlation coefficient (ICC) was used to evaluate the inter observer reliability of histogram parameters. Histogram parameters between the TN-IDC and FA groups were compared using independent Student’s t-test or Mann-Whitney U-test, respectively. In addition, the receiver operating characteristic (ROC) curve analysis was used for the significant parameters to calculate the differential diagnosis efficiency. Results All the histogram parameters showed excellent inter-reader consistency, with the ICC values ranged from 0.883 to 0.999. The mean value, 1st, 10th, 50th, 90th and 99th percentiles of TN-IDC group were significantly lower than those of FA group (P < 0.05). The area under ROC curve (AUC) values of mean and n percentiles were from 0.807 to 0.848. However, there were no significant differences in variance, skewness and kurtosis between the two groups (P > 0.05). Conclusion Histogram analysis of gray-scale US images can well distinguish small, oval, or round TN-IDC from FA.
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Affiliation(s)
- Maolin Xu
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
| | - Fang Li
- Department of Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Shaonan Yu
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
| | - Shue Zeng
- Department of Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Gaolong Weng
- Department of Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Peihong Teng
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
| | - Huimin Yang
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
| | - Xuefeng Li
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
- Correspondence: Xuefeng Li, Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Xiantai Street, Changchun, 130033, People’s Republic of China, Email
| | - Guifeng Liu
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
- Guifeng Liu, Department of Radiology, China-Japan Union Hospital of Jilin University, Xiantai Street, Changchun, 130033, People’s Republic of China, Email
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Clinical practice guideline for breast fibroadenoma: Chinese Society of Breast Surgery (CSBrS) practice guideline 2021. Chin Med J (Engl) 2021; 134:1014-1016. [PMID: 33859107 PMCID: PMC8116029 DOI: 10.1097/cm9.0000000000001462] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Watanabe T, Yamaguchi T, Tohno E, Tsunoda H, Kaoku S, Ban K, Watanabe R, Umemoto T, Hirokaga K, Ito T. B-mode ultrasound diagnostic flowchart for solid breast masses: JABTS BC-01 study. J Med Ultrason (2001) 2021; 48:71-81. [PMID: 33389372 PMCID: PMC7882583 DOI: 10.1007/s10396-020-01072-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/06/2020] [Indexed: 11/26/2022]
Abstract
Purpose Breast ultrasound has been widely used as an essential examination for diagnosing breast cancer. However, standardized diagnostic criteria are as yet lacking. This study aimed to develop a simple diagnostic flowchart for beginners learning breast ultrasonography. The diagnostic flowchart was developed based on the recall criteria widely used in Japan. Methods We conducted a multicenter study to examine recall criteria usefulness in the diagnostic phase of breast disease. Women with ultrasound-visible breast masses who underwent B-mode breast ultrasound examination were recruited from 22 hospitals in Japan between September 2009 and January 2010. B-mode images were evaluated by members of the centralized image interpretation committee. We developed the new diagnostic flowchart based on the results. The usefulness of the diagnostic flowchart was assessed by employing datasets from the current study and another study which we conducted (BC-04 study). Results We evaluated 1045 solid masses (malignant: 495, benign: 550). Multivariate analysis showed that shape, margin, echogenic halo, interruption of the mammary gland interface, and depth width ratio were significant findings for distinguishing between benign and malignant masses. We modified the recall criteria and developed our novel diagnostic flowchart using these findings. The sensitivity and specificity of the new flowchart (current study: 0.97, 0.45; BC-04 study dataset: 0.95, 0.45) were similar to those of experts (current study: 0.96, 0.54; BC-04 study dataset: 0.98, 0.38). Conclusion We developed a simple diagnostic flowchart for breast ultrasound. This flowchart is anticipated to be applicable to educating beginners learning breast ultrasound.
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Affiliation(s)
- Takanori Watanabe
- Department of Breast Surgery, National Hospital Organization Sendai Medical Center, 2-11-12 Miyaginohara, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Eriko Tohno
- Tsukuba International Breast Clinic, 2F Tsukuba CITYIA Bldg., 2-8-8 Azuma, Tsukuba, Ibaraki, 305-0031, Japan
| | - Hiroko Tsunoda
- Department of Radiology Diagnostic Breast Imaging, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Setsuko Kaoku
- Department of Ultrasonics, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Kanako Ban
- Department of Cancer Detection and Diagnosis, Tokyo Health Service Association, 1-2 Ichigaya-sadohara-cho, Shinjuku-ku, Tokyo, 162-8402, Japan
| | - Ryoji Watanabe
- Department of Breast Center, Itoshima Medical Association Hospital, 532-1 Urashi, Itoshima, Fukuoka, 819-1112, Japan
| | - Takeshi Umemoto
- Department of Senology, Moriya Keiyu Hospital, 980-1 Tatsuzawa, Moriya, Ibaraki, 302-0118, Japan
| | - Koichi Hirokaga
- Department of Breast Surgery, Hyogo Cancer Center, 13-70 Kitaoji, Akashi, Hyogo, 673-8558, Japan
| | - Toshikazu Ito
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
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Fibroadenomas: a multidisciplinary review of the variants. Clin Imaging 2020; 71:83-100. [PMID: 33186871 DOI: 10.1016/j.clinimag.2020.10.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/02/2020] [Accepted: 10/26/2020] [Indexed: 11/21/2022]
Abstract
Fibroadenomas are the most common benign breast lesions in women. Hormonal activities, particularly an increase in oestrogenic activity, have an important role in the aetiology of fibroadenomas. They are commonly detected incidentally. Most fibroadenomas have similar imaging findings and these lesions can be defined as simple fibroadenomas (SFAs). However, due to different histopathologic characteristics and components, variants of fibroadenomas have been described. These variants include; juvenile, giant, complex, myxoid, cellular, and hyalinised fibroadenomas. The diagnoses of these variants are important. They have different clinical behaviours, potential for malignant transformation, and treatment strategies. We present imaging findings of SFAs and other variants of fibroadenomas. To our knowledge, there is no review in which imaging findings of all fibroadenoma variants are presented together.
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Cheema HS, Mehta R, Slanetz PJ. Imaging and management of fibroepithelial breast lesions on percutaneous core needle biopsy. Breast J 2020; 26:1216-1220. [PMID: 31925856 DOI: 10.1111/tbj.13749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/14/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Abstract
The purpose of this study is to review the clinical presentation, multi-modality appearance, and management of the most common benign and malignant fibroepithelial lesions of the breast. Fibroepithelial lesions of the breast may exhibit characteristic features on mammography, ultrasound, and MRI, although definitive diagnosis most often requires biopsy and at times, surgical excision. Knowledge of the imaging features can assist in refining the differential diagnosis and guiding appropriate management.
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Affiliation(s)
- Hena S Cheema
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rashmi Mehta
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Priscilla J Slanetz
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
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Lee S, Mercado CL, Cangiarella JF, Chhor CM. Frequency and outcomes of biopsy-proven fibroadenomas recommended for surgical excision. Clin Imaging 2018; 50:31-36. [DOI: 10.1016/j.clinimag.2017.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/23/2017] [Accepted: 12/12/2017] [Indexed: 11/16/2022]
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Choi EK, Im JJ, Park CS, Chung YA, Kim K, Oh JK. Usefulness of feature analysis of breast-specific gamma imaging for predicting malignancy. Eur Radiol 2018; 28:5195-5202. [DOI: 10.1007/s00330-018-5563-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/30/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
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The differences in ultrasound and clinicopathological features between basal-like and normal-like subtypes of triple negative breast cancer. PLoS One 2015; 10:e0114820. [PMID: 25734578 PMCID: PMC4348341 DOI: 10.1371/journal.pone.0114820] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/17/2014] [Indexed: 12/31/2022] Open
Abstract
Purpose The aim of this study was to identify the ultrasound features and clinicopathological characteristics of basal-like subtype of triple negative breast cancers (TNBCs). Materials and Methods This study was approved by the ethical board of the Second Affiliated Hospital of Harbin Medical University. The patients’ clinicopathological information was available. The ultrasound features of 62 tumors from 62 TNBC patients were interpreted. The immunohistochemical results of cytokertain5/6 (CK5/6) and Epidermal Growth Factor Receptor (EGFR) were used to classify the tumor into basal-like and normal-like groups. The association of the ultrasound features interpreted by experienced ultrasound doctors with the immunohistochemical classification was studied. Results Of the 62 TNBC cases, 42 (67.7%) exhibited the basal-like phenotype and 20 (32.3%) exhibited the normal-like phenotype based on the immunohistochemical CK5/6 and EGFR markers. Of all the tumors, 90.3% were invasive carcinomas. The basal-like tumors were significantly associated with a maximum diameter on ultrasound of more than 20 mm (36, 85.7%) (P = 0.0014). The normal-like tumors usually exhibited lateral shadows (15, 75%) (P = 0.0115) as well as microlobulated margins (12, 60%) (P = 0.0204) compared to the basal-like subtype. Other ultrasound features showed no significant differences between the two groups. Conclusions Although ultrasound cannot yet be used to differentiate between the basal-like subtype and normal-like subtype of TNBC, ultrasound can be used to provide some useful information to the clinicians.
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Xu C, Wei S, Xie Y, Guan X, Fu N, Huang P, Yang B. Combined use of the automated breast volume scanner and the US elastography for the differentiation of benign from malignant lesions of the breast. BMC Cancer 2014; 14:798. [PMID: 25366878 PMCID: PMC4228072 DOI: 10.1186/1471-2407-14-798] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/22/2014] [Indexed: 12/21/2022] Open
Abstract
Background Automated breast volume scanner (ABVS) and US elastography (UE) have been useful for the differentiation of benign and malignant lesions. However, combining these two methods applied in diagnosis of breast lesions has not yet been reported. The aim of this study is to analyze the inter-examiner reliability of ABVS and UE, and compare diagnostic performance among ABVS, UE, and the combination of these two methods. Methods Forty-one patients (forty-six lesions) underwent both ABVS and UE examinations. ABVS images were acquired by medial and lateral scans for each breast and classified a BI-RADS category based on the distribution, size, shape, echogenicity and microcalcification of the lesions. UE images were assigned an elasticity score according to the distribution of strain induced by light compression. Kappa statistics was used to examine the reproducibility between examiners with ABVS and UE, and the concordance between pathology and ABVS, UE, and the combination of these two methods. χ2 test was used to compare diagnostic performance among these three methods. Two examiners blinded to the patients’ history evaluated the results of breast imaging independently. Results Inter-examiner reliability with ABVS (κ = 0.62, 95% confidence interval (CI): 0.44-0.80) and UE (κ = 0.65, 95% CI: 0.48-0.82) was substantial. With respect to the pathology results, the inter-rater coefficient of concordance was κ = 0.81 (95% CI: 0.64-0.98) for ABVS, κ = 0.77 (95% CI: 0.58-0.96) for UE, and κ = 0.90 (95% CI: 0.77-1.00) for combination of ABVS and UE. Examiner variability was reduced from UE to ABVS, and to the combination of ABVS with UE. The diagnostic accuracy, sensitivity, and specificity for the combination of ABVS and UE were 95.7% (95%CI: 84.0-99.2), 100% (95% CI: 85.9-100), and 87.5% (95% CI: 60.4-97.8), respectively. When comparing, the diagnostic performance of ABVS combined with UE was better than, or at least equal to, that of ABVS (accuracy 91.3% (95% CI: 78.3-97.2), sensitivity 100% (95% CI: 85.0-1.00), specificity 77.8% (95% CI: 51.9-92.6)) or UE (accuracy 89.1% (95% CI: 75.6-95.9), sensitivity 96.4% (95% CI: 79.8-99.8), specificity 77.8% (95% CI: 51.9-92.6)) alone, though the improvement was no statistically significance. Conclusions Both ABVS and UE demonstrated substantial inter-examiner reliability. With high diagnostic performance for differentiation of benign and malignant lesions in the breast, the combination of ABVS and UE are useful to improve the diagnostic accuracy and specificity.
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Affiliation(s)
| | | | | | | | | | | | - Bin Yang
- Department of Ultrasound Diagnostics, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing, Jiangsu 210002, China.
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Kim SJ, Park YM, Jung SJ, Lee KH, Kim OH, Ryu JH, Choi GB, Lee SJ, Choo HJ, Jeong HW. Sonographic appearances of juvenile fibroadenoma of the breast. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1879-1884. [PMID: 25336474 DOI: 10.7863/ultra.33.11.1879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate characteristic features of juvenile fibroadenoma of the breast on sonography. METHODS Our study included 34 juvenile fibroadenomas confirmed by surgical biopsy or sonographically guided 8-gauge vacuum-assisted biopsy in 23 patients (age range, 15-47 years; mean age, 25 years). Sonographic findings of the lesions were analyzed retrospectively by 2 radiologists in consensus according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon. The BI-RADS final assessment category was also established. RESULTS On sonography, all fibroadenomas presented as masses. The mean size was 30 mm. Regarding shape, there were 29 oval, 2 round, and 3 irregular masses. The margins were circumscribed in 24, indistinct in 5, microlobulated in 4, and angular in 1. Regarding echogenicity, 16 masses were hypoechoic, 16 isoechoic, and 2 complex echoic. Posterior acoustic characteristics included posterior acoustic enhancement in 22 masses (65%), posterior shadowing in 1, and no posterior acoustic features in 9; this information was not available in 2. The lesion boundary presented as an abrupt interface in 32 and an echogenic halo in 2. The orientation was parallel in 32 and nonparallel in 2. Calcifications were present in 3 cases and absent in 31. On color Doppler sonography, the masses were usually hypervascular with vessel counts of 5 or more (87%). The BI-RADS final assessment categories were 3 in 24 and 4a in 10. CONCLUSIONS The dominant sonographic presentation of juvenile fibroadenoma is a circumscribed oval hypoechoic or isoechoic mass, which resembles that of simple fibroadenoma. Juvenile fibroadenomas frequently show posterior acoustic enhancement and hypervascularity on color Doppler sonography.
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Affiliation(s)
- Suk Jung Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (S.J.K., K.H.L., O.H.K., J.H.R., G.B.C.); and Departments of Radiology (Y.M.P., S.J.L., H.J.C., H.W.J.) and Pathology (S.J.J.), Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young Mi Park
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (S.J.K., K.H.L., O.H.K., J.H.R., G.B.C.); and Departments of Radiology (Y.M.P., S.J.L., H.J.C., H.W.J.) and Pathology (S.J.J.), Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
| | - Soo Jin Jung
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (S.J.K., K.H.L., O.H.K., J.H.R., G.B.C.); and Departments of Radiology (Y.M.P., S.J.L., H.J.C., H.W.J.) and Pathology (S.J.J.), Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kwang Hwi Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (S.J.K., K.H.L., O.H.K., J.H.R., G.B.C.); and Departments of Radiology (Y.M.P., S.J.L., H.J.C., H.W.J.) and Pathology (S.J.J.), Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ok Hwa Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (S.J.K., K.H.L., O.H.K., J.H.R., G.B.C.); and Departments of Radiology (Y.M.P., S.J.L., H.J.C., H.W.J.) and Pathology (S.J.J.), Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji Hwa Ryu
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (S.J.K., K.H.L., O.H.K., J.H.R., G.B.C.); and Departments of Radiology (Y.M.P., S.J.L., H.J.C., H.W.J.) and Pathology (S.J.J.), Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Gi Bok Choi
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (S.J.K., K.H.L., O.H.K., J.H.R., G.B.C.); and Departments of Radiology (Y.M.P., S.J.L., H.J.C., H.W.J.) and Pathology (S.J.J.), Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sun Joo Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (S.J.K., K.H.L., O.H.K., J.H.R., G.B.C.); and Departments of Radiology (Y.M.P., S.J.L., H.J.C., H.W.J.) and Pathology (S.J.J.), Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hye Jung Choo
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (S.J.K., K.H.L., O.H.K., J.H.R., G.B.C.); and Departments of Radiology (Y.M.P., S.J.L., H.J.C., H.W.J.) and Pathology (S.J.J.), Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hae Woong Jeong
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (S.J.K., K.H.L., O.H.K., J.H.R., G.B.C.); and Departments of Radiology (Y.M.P., S.J.L., H.J.C., H.W.J.) and Pathology (S.J.J.), Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Skenderi F, Krakonja F, Vranic S. Infarcted fibroadenoma of the breast: report of two new cases with review of the literature. Diagn Pathol 2013; 8:38. [PMID: 23445683 PMCID: PMC3598275 DOI: 10.1186/1746-1596-8-38] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 02/25/2013] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Fibroadenomas are the most common benign breast tumors in young women. Infarction is rarely observed in fibroadenomas and when present, it is usually associated with pregnancy or lactation. Infarction can exceptionally occur as a complication of previous fine-needle aspiration biopsy or during lactation and pregnancy. MATERIALS AND METHODS Retrospective review of 650 cases of fibroadenomas diagnosed at our institution during the 8-years period identified two cases of fibroadenomas with infarction (rate ~0.3%). RESULTS Two partially infarcted fibroadenomas were diagnosed on core biopsy and frozen section in an adolescent girl (13 years old) and in a young woman (25 years old), respectively. No preceding fine-needle aspiration biopsy was performed in these cases, nor were the patients pregnant or lactating at the time of the diagnosis. CONCLUSION Spontaneous infarction within fibroadenoma is a rare phenomenon in younger patients. The presence of necrosis on core biopsy or frozen section should be cautiously interpreted and is not a sign of malignancy. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1556060549847356.
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Affiliation(s)
- Faruk Skenderi
- Department of Pathology, Clinical Center of the University of Sarajevo, Bolnička 25, Sarajevo, Bosnia and Herzegovina
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Xu H, Varghese T, Jiang J, Zagzebski JA. In vivo classification of breast masses using features derived from axial-strain and axial-shear images. ULTRASONIC IMAGING 2012; 34:222-36. [PMID: 23160475 PMCID: PMC3662535 DOI: 10.1177/0161734612465520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Breast cancer is currently the second leading cause of cancer deaths in women. Early detection and accurate classification of suspicious masses as benign or malignant is important for arriving at an appropriate treatment plan. In this article, we present classification results for features extracted from ultrasound-based, axial-strain and axial-shear images of breast masses. The breast-mass stiffness contrast, size ratio, and a normalized axial-shear strain area feature are evaluated for the classification of in vivo breast masses using a leave-one-out classifier. Radiofrequency echo data from 123 patients were acquired using Siemens Antares or Elegra clinical ultrasound systems during freehand palpation. Data from four different institutions were analyzed. Axial displacements and strains were estimated using a multilevel, pyramid-based two-dimensional cross-correlation algorithm, with final processing block dimensions of 0.385 mm × 0.507 mm (three A-lines). Since mass boundaries on B-mode images for 21 patients could not be delineated (isoechoic), the combined feature analysis was only performed for 102 patients. Results from receiver operating characteristic (ROC) demonstrate that the area under the curve was 0.90, 0.84, and 0.52 for the normalized axial-shear strain, size ratio, and stiffness contrast, respectively. When these three features were combined using a leave-one-out classifier and support vector machine approach, the overall area under the curve improved to 0.93.
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Affiliation(s)
- Haiyan Xu
- Department of Medical Physics, University of Wisconsin–Madison, Madison, WI, USA
- Department of Electrical and Computer Engineering, University of Wisconsin–Madison, Madison, WI, USA
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin–Madison, Madison, WI, USA
- Department of Electrical and Computer Engineering, University of Wisconsin–Madison, Madison, WI, USA
| | - Jingfeng Jiang
- Department of Medical Physics, University of Wisconsin–Madison, Madison, WI, USA
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | - James A. Zagzebski
- Department of Medical Physics, University of Wisconsin–Madison, Madison, WI, USA
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Taskin F, Koseoglu K, Ozbas S, Erkus M, Karaman C. Sonographic features of histopathologically benign solid breast lesions that have been classified as BI-RADS 4 on sonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:261-265. [PMID: 22508447 DOI: 10.1002/jcu.21923] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 02/23/2012] [Indexed: 05/31/2023]
Abstract
PURPOSE To describe the sonographic (US) features associated with ultrasonography BI-RADS category 4 lesions that have a benign histopathological outcome. METHODS One hundred seventy-two histopathologically proven benign lesions in 169 patients, which had been classified as BI-RADS category 4 with ultrasonography, were retrospectively evaluated. Ultrasonography and histopathology findings were analyzed. The frequency of sonographic findings according to the histopathological diagnosis was determined. RESULTS Among the 172 lesions, there were 66 (38%) fibroadenomas, 31 (18%) sclerosing adenoses, 24 (14%) fibrocystic changes, 16 (9%) mastitis/inflammations, 9 (5.5%) intraductal papillomas, 8 (5%) focal fibroses, 4 (2.5%) atypical ductal hyperplasias, 4 (2.5%) fat necroses, 2 (1%) phyllodes tumors, 1 (0.5%) tubular adenomas, 1 (0.5%) epidermal inclusion cysts, and 6 (3.5%) "other benign lesions." The most frequent sonographic findings were heterogeneity, indistinct margin, microlobulation in fibroadenomas; heterogeneity, irregular-indefinite margin, and antiparallel orientation in sclerosing adenosis; heterogeneity, microlobulation, and acoustic shadowing in fibrocystic changes. CONCLUSIONS BI-RADS category 4 lesions demonstrate more than one suspicious ultrasonography feature, and biopsy is necessary to diagnose malignancy captured in 33% of lesions in this study. At this time, any lesion with more than one suspicious BI-RADS US feature cannot avoid a diagnostic biopsy.
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Affiliation(s)
- Fusun Taskin
- Adnan Menderes University Faculty of Medicine Department of Radiology, Aydin, Turkey
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16
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Chu B, Crystal P. Imaging of Fibroepithelial Lesions: A Pictorial Essay. Can Assoc Radiol J 2012; 63:135-45. [DOI: 10.1016/j.carj.2010.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 08/05/2010] [Indexed: 11/16/2022] Open
Affiliation(s)
- Bonnie Chu
- Department of Medical Imaging, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Pavel Crystal
- Department of Medical Imaging, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
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Abstract
Benign breast diseases constitute a heterogeneous group of lesions arising in the mammary epithelium or in other mammary tissues, and they may also be linked to vascular, inflammatory or traumatic pathologies. Most lesions found in women consulting a physician are benign. Ultrasound (US) diagnostic criteria indicating a benign lesion are described as well as US findings in the most frequent benign breast lesions.
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Affiliation(s)
- N. Masciadri
- IRCCS Multimedica, Sesto S. Giovanni, Milan, Italy
| | - C. Ferranti
- Fondazione IRCCS Istituto Nazionale Tumori, Unit of Diagnostic Radiology 3, Senology, Milan, Italy
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Gatta G, Iaselli F, Parlato V, Di Grezia G, Grassi R, Rotondo A. Differential diagnosis between fibroadenoma, giant fibroadenoma and phyllodes tumour: sonographic features and core needle biopsy. Radiol Med 2011; 116:905-18. [DOI: 10.1007/s11547-011-0672-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 05/20/2010] [Indexed: 11/29/2022]
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Xu H, Rao M, Varghese T, Sommer A, Baker S, Hall TJ, Sisney GA, Burnside ES. Axial-shear strain imaging for differentiating benign and malignant breast masses. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1813-24. [PMID: 20800948 PMCID: PMC3033738 DOI: 10.1016/j.ultrasmedbio.2010.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Revised: 06/22/2010] [Accepted: 07/04/2010] [Indexed: 05/08/2023]
Abstract
Axial strain imaging has been utilized for the characterization of breast masses for over a decade; however, another important feature namely the shear strain distribution around breast masses has only recently been used. In this article, we examine the feasibility of utilizing in vivo axial-shear strain imaging for differentiating benign from malignant breast masses. Radio-frequency data was acquired using a VFX 13-5 linear array transducer on 41 patients using a Siemens SONOLINE Antares real-time clinical scanner at the University of Wisconsin Breast Cancer Center. Free-hand palpation using deformations of up to 10% was utilized to generate axial strain and axial-shear strain images using a two-dimensional cross-correlation algorithm from the radio-frequency data loops. Axial-shear strain areas normalized to the lesion size, applied strain and lesion strain contrast was utilized as a feature for differentiating benign from malignant masses. The normalized axial-shear strain area feature estimated on eight patients with malignant tumors and 33 patients with fibroadenomas was utilized to demonstrate its potential for lesion differentiation. Biopsy results were considered the diagnostic standard for comparison. Our results indicate that the normalized axial-shear strain area is significantly larger for malignant tumors compared with benign masses such as fibroadenomas. Axial-shear strain pixel values greater than a specified threshold, including only those with correlation coefficient values greater than 0.75, were overlaid on the corresponding B-mode image to aid in diagnosis. A scatter plot of the normalized area feature demonstrates the feasibility of developing a linear classifier to differentiate benign from malignant masses. The area under the receiver operator characteristic curve utilizing the normalized axial-shear strain area feature was 0.996, demonstrating the potential of this feature to noninvasively differentiate between benign and malignant breast masses.
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Affiliation(s)
- Haiyan Xu
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53706, USA
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53706, USA
| | - Min Rao
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53706, USA
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53706, USA
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53706, USA
| | - Amy Sommer
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53706, USA
| | - Sara Baker
- Ultrasound Technology School, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53706, USA
| | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53706, USA
| | - Gale A Sisney
- Department of Radiology, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53706, USA
| | - Elizabeth S Burnside
- Department of Radiology, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53706, USA
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An HY, Kim KS, Yu IK, Kim KW, Kim HH. Image presentation. The nipple-areolar complex: a pictorial review of common and uncommon conditions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:949-962. [PMID: 20498469 DOI: 10.7863/jum.2010.29.6.949] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this presentation is to show the radiologic findings of normal variants and benign and malignant diseases that affect the nipple-areolar complex. METHODS We evaluated the imaging findings of nipple-areolar complex lesions, using multiple breast imaging modalities including mammography, sonography, galactography, contrast-enhanced magnetic resonance imaging (MRI), and positron emission tomography/computed tomography. RESULTS Radiologic features of nipple-areolar complex lesions, including Montgomery tubercles, nipple inversion, benign calcifications, inflammation, duct dilatations, intraductal papillomas, fibroadenomas, neurofibromatosis, dermatosis of the nipple, and breast malignancy, have been illustrated. CONCLUSIONS A clinical examination is essential and an appropriate imaging evaluation with multiple modalities is often necessary to accurately diagnose an underlying abnormality of the nipple-areolar complex. Given the limitations of conventional mammography, supplemental mammographic views often are needed, and sonography may be performed to further characterize a mammographic or clinical finding. Also, contrast-enhanced MRI may be useful for additional evaluation.
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Affiliation(s)
- Hee Yeon An
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
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21
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Chung EM, Cube R, Hall GJ, González C, Stocker JT, Glassman LM. From the archives of the AFIP: breast masses in children and adolescents: radiologic-pathologic correlation. Radiographics 2009; 29:907-31. [PMID: 19448124 DOI: 10.1148/rg.293095010] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The spectrum of breast lesions in children and adolescents varies markedly from that for adults, with the former lesions being overwhelmingly benign. A breast mass in a young boy or girl may arise from normal and abnormal breast development. Other causes of masses include infection, trauma, and cyst formation. After onset of puberty, most cases of breast enlargement arise from benign fibroadenoma in girls and gynecomastia in boys. These conditions have specific imaging appearances, although juvenile (often giant) fibroadenoma cannot be distinguished from phyllodes tumor, which can be benign or malignant. In children, both conditions usually appear as well-circumscribed, hypoechoic masses at sonography and show diffuse enhancement except for nonenhancing septations at magnetic resonance imaging. A diagnosis of juvenile papillomatosis (a benign lesion) portends later development of breast cancer, and patients with this condition should be closely monitored. Malignant lesions of the breast in children are rare. The most common malignant lesions are metastases and are usually associated with widespread disease. The most common primary breast malignancy is malignant phyllodes tumor. Primary breast carcinoma is exceedingly rare in the pediatric age group, but its imaging appearance in children is the same as seen in adults and is different from that of almost all benign lesions. In girls, diagnostic interventions may injure the developing breast and cause subsequent disfigurement. Given this risk and the low prevalence of malignant disease in this population, a prudent course should be followed in the diagnosis of breast lesions. Imaging findings are very helpful for selecting patients for further diagnostic procedures. Although malignancy is rare, lesions with suspicious imaging findings or progressive growth should be subjected to cytologic or histologic examination.
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Affiliation(s)
- Ellen M Chung
- Department of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA.
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22
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Abstract
In this article we investigate the generation of shear strain elastograms induced using a lateral shear deformation. Ultrasound simulation and experimental results demonstrate that the shear strain elastograms obtained under shear deformation exhibit significant differences between bound and unbound inclusions in phantoms, when compared to shear strain images induced upon an axial compression. A theoretical model that estimates the decorrelation between pre- and postdeformation radio frequency signals, as a function of extent of shear deformation, is also developed. Signal-to-noise ratios of shear strain elastograms obtained at different shear angles are investigated theoretically and verified using ultrasound simulations on a uniformly elastic phantom. For the simulation and experiment, a two-dimensinal block-matching-based algorithm is used to estimate the axial and lateral displacement. Shear strains are obtained from the displacement vectors using a least-squares strain estimator. Our results indicate that the signal-to-noise ratio (SNR) of shear strain images increases to reach a maximum and saturates, and then decreases with increasing shear angle. Using typical system parameters, the maximum achievable SNR for shear strain elastography is around 8 (18 dB), which is comparable to conventional axial strain elastography induced by axial compression. Shear strain elastograms obtained experimentally using single inclusion tissue-mimicking phantoms with both bound and unbound inclusions (mimicking cancerous masses and benign fibroadenomas, respectively) demonstrate the characteristic differences in the depiction of these inclusions on the shear strain elastograms.
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Affiliation(s)
- Min Rao
- Department of Medical Physics, The University of Wisconsin-Madison, 1300 University Avenue, 1530 MSC, Madison, Wisconsin 53706, USA.
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Ichikawa K, Mizukami Y, Takayama T, Takemura A, Miyati T, Taniya T. A case of adenoid cystic carcinoma of the breast. J Med Ultrason (2001) 2007; 34:193-6. [PMID: 27278481 DOI: 10.1007/s10396-007-0157-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2007] [Accepted: 08/29/2007] [Indexed: 11/29/2022]
Abstract
A 57-year-old woman was referred to our institution 4 months after she noticed a palpable, painless mass in her left breast. Physical examination revealed a mobile and elastic mass. An axillary or subclavicular lymph node was not palpable. Mammography revealed a lobulated mass with a partially ill-defined border. Ultrasonography depicted a 2.5 × 1.5 cm irregularly shaped mass with heterogeneous internal echo and posterior acoustic enhancement. The border of the mass was poorly defined at the anterior and lateral aspects of the mass. Results of ultrasonography-guided fine-needle aspiration cytology were strongly suggestive of a malignant tumor. Thus, the patient underwent breast-conserving surgery with axillary lymph node dissection. The gross resected specimen revealed a gray-to-white and well-demarcated solid tumor measuring 3 × 2 × 2.5 cm, with an irregular border and heterogeneous internal structure. Histological examination showed the characteristic patterns of adenoid cystic carcinoma of the breast. Immunohistochemical studies for both estrogen receptors (ER) and progesterone receptors (PgR) were negative. The patient remains well and has no clinical recurrence of the disease after 5 years of follow-up without radiotherapy or adjuvant therapy.
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Affiliation(s)
- Katsuhiro Ichikawa
- Department of Health Sciences, Graduate School of Medical Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan.
| | - Yuji Mizukami
- Department of Health Sciences, Graduate School of Medical Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
| | - Teruhiko Takayama
- Department of Health Sciences, Graduate School of Medical Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
| | - Akihiro Takemura
- Department of Health Sciences, Graduate School of Medical Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
| | - Tosiaki Miyati
- Department of Health Sciences, Graduate School of Medical Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
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Chao TC, Chao HH, Chen MF. Sonographic features of breast hamartomas. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:447-52; quiz 453. [PMID: 17384041 DOI: 10.7863/jum.2007.26.4.447] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE The purpose of this study was to elucidate the sonographic characteristics of breast hamartomas. METHODS Data and sonographic images of 14 breast hamartomas were retrospectively reviewed. RESULTS All patients had clinically palpable lumps. The median patient age was 39.5 years (range, 24-60 years). Eleven (78.6%) tumors occurred in the right breast, and 3 (21.4%) were in the left. The median tumor size measured by sonography was 2.8 cm (range, 1.2-4.9 cm). The median longest transverse dimension-anteroposterior diameter ratio of the tumors was 2.44 (range, 1.52-3.73). All tumors were oval and compressible with transducer pressure. Thirteen (92.9%) tumors were well circumscribed with smooth tumor margins, and 1 (7.1%) had indistinct margins. The internal echo texture was hyperechoic in 6 (42.9%), mixed (heterogeneous) echogenicity in 5 (35.7%), and isoechoic in 3 (21.4%). Four (28.6%) tumors had echogenic halos, and 2 (14.3%) had anechoic halos. Ten (71.4%) tumors had no retrotumor acoustic phenomena. Two (14.3%) had bilateral edge shadowing; 1 (7.1%) had posterior enhancement; and 1 (7.1%) had a mixture of enhancement and shadowing. CONCLUSIONS Breast hamartomas were well-circumscribed, solid, oval tumors without intratumor microcalcification. The internal echo texture of most hamartomas is either hyperechoic or composed of mixed echogenicity. Retrotumor acoustic phenomena were absent in most hamartomas.
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Affiliation(s)
- Tzu-Chieh Chao
- Division of General Surgery, Department of Surgery, Chang Gung University College of Medicine and Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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25
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Abstract
Patients often present to plastic surgeons with breast asymmetry of unknown etiology. Many patients are females in late adolescence and present complaining of a hypoplastic breast on the smaller side. However, full evaluation may reveal that the larger breast contains the abnormality. Fibroadenomas typically present as firm, mobile, painless, easily palpable breast nodules. However, giant fibroadenomas can present as unilateral macromastia without definable borders or texture differences. Diagnosis is essential since fibroadenomas tend to persist and grow. However, physical examination and standard radiographic evaluations (mammograms and ultrasounds) fail to clarify the diagnosis in many cases. Magnetic resonance imaging (MRI) has improved preoperative diagnosis, but tissue diagnosis is frequently necessary and resection of giant fibroadenomas is essential as they enlarge to the point of causing psychological detriment or mass effects, including venous congestion, glandular distortion, pressure necrosis, and occasionally ulceration. In this article we review nine patients presenting with unilateral macromastia to a tertiary breast care center with a review of the pertinent literature. The differential diagnosis, evaluation modalities, and treatment options of breast asymmetry and unilateral breast masses are presented. Postexcision breast reconstruction is discussed.
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Affiliation(s)
- Christopher A Park
- Department of Plastic and Reconstructive Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA.
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Abstract
Ultrasound is an important imaging modality in evaluating the breast. One of the most common uses of ultrasound is to help distinguish benign from malignant breast disease, primarily with gray-scale ultrasound but also with Doppler ultrasound. Another common use is to provide guidance for interventional procedures. Less common uses include assisting in staging of breast cancer and evaluating patients with implants. Recently there has been an interest in using ultrasound to screen asymptomatic women for breast cancer, as is done with mammography. Further studies must be performed to assess if this reduces mortality from breast cancer. Although primarily used to image the female breast, ultrasound also can be used to evaluate breast-related concerns in men. Uses of contrast-enhanced ultrasound are still experimental and would add an invasive component to an otherwise noninvasive study.
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Affiliation(s)
- Tejas S Mehta
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
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Abstract
In a retrospective study of giant breast masses over a period of 20 years (1980-2000), we encountered 18 patients with fibroadenomas. Most of them were adolescents and young adults. The bimodal age incidence seen in Caucasians was not observed. The masses ranged from 6 to 15 cm in size and in the youngest patient, they were bilateral. All 18 patients were examined by mammography and 10 of them by ultrasonography (US) as well. The right breast was involved in 12 patients and the left in six. The diagnosis was confirmed pathologically in all patients, by excision biopsy in 17 patients and by fine needle aspiration cytology and excision biopsy in one patient. The radiological findings were the same as those previously described. All patients were treated by simple enuculation. There was only one recurrence over a follow-up period from 2 months to 3 years.
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Affiliation(s)
- R M Hanna
- Department of Diagnostic Radiology and Imaging, Al-Sabah Hospital, Kuwait.
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28
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Chao TC, Lo YF, Chen SC, Chen MF. Sonographic features of phyllodes tumors of the breast. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 20:64-71. [PMID: 12100421 DOI: 10.1046/j.1469-0705.2002.00736.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The aim of this study was to examine the sonographic features of phyllodes tumors of the breast. METHODS Retrospective analysis of prospectively recorded sonographic features was performed on 2268 patients with phyllodes tumors or fibroadenomas during 1995-98. Data from 110 phyllodes tumors (76 benign, 11 borderline, 23 malignant) and 2204 fibroadenomas were analyzed. RESULTS The patients with phyllodes tumors were older than the patients with fibroadenoma (mean +/- standard error, 39.7 +/- 1.1 years vs. 33.4 +/- 0.3 years; P < 0.0001). Sixty-four percent of patients with phyllodes tumors were aged 31-50 years, while 68.5% of those with fibroadenoma were aged 21-40 years. Phyllodes tumors were larger than fibroadenomas (5.90 +/- 0.43 cm vs. 1.95 +/- 0.03 cm; P < 0.0001). The ratio of length to anteroposterior diameter of phyllodes tumors was smaller than the ratio of length to anteroposterior diameter of fibroadenomas (1.72 +/- 0.06 vs. 1.89 +/- 0.02; P = 0.0105). Seventy-seven percent of phyllodes tumors were lobulated and 79.5% of fibroadenomas were oval. Lobulated shape of the tumor, heterogeneous echo pattern and absence of microcalcification are significant independent sonographic features in multiple logistic regression analysis to distinguish between phyllodes tumors and fibroadenoma. Benign, borderline and malignant phyllodes tumors displayed no significant differences in tumor size or the ratio of length to anteroposterior diameter. CONCLUSIONS There is a substantial overlap in the sonographic characteristics between phyllodes tumors and fibroadenoma of the breast. If lobulation and heterogeneous hypoechoic internal echoes are observed and calcifications are absent, a diagnosis of phyllodes tumors should be considered. Sonography cannot distinguish between malignant, borderline and benign phyllodes tumors.
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Affiliation(s)
- T-C Chao
- Division of General Surgery, Department of Surgery, Chang Gung University College of Medicine and Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Taylor KJW, Merritt C, Piccoli C, Schmidt R, Rouse G, Fornage B, Rubin E, Georgian-Smith D, Winsberg F, Goldberg B, Mendelson E. Ultrasound as a complement to mammography and breast examination to characterize breast masses. ULTRASOUND IN MEDICINE & BIOLOGY 2002; 28:19-26. [PMID: 11879948 DOI: 10.1016/s0301-5629(01)00491-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study was designed to determine if complementary ultrasound (US) imaging and Doppler could decrease the number of biopsies for benign masses. A total of 761 breast masses were sequentially scored on a level of suspicion (LOS) of 1-5, where 1 represented low, and 5 was a high suspicion of malignancy, for mammography, US, and color flow with pulse Doppler (DUS). After biopsy, the results were analyzed using 2 x 2 contingency tables and ROC analysis, for mammography alone and in combination with US and DUS. The addition of US increased the specificity from 51.4% to 66.4% at a prevalence of 31.3% malignancy. ROC analysis showed that the addition of US significantly improved the performance over mammography alone in women < 55 years old (p = 0.049); > 55 years old (p = 0.029); masses < 1 cm (p = 0.016) and masses > 1 cm (p = 0.016). These results show that the addition of US to mammography alone could substantially reduce the number of breast biopsies for benign disease.
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Affiliation(s)
- Kenneth J W Taylor
- Radiology, Ob/Gyn & Surgery, Yale University School of Medicine, New Haven, CT 06520, USA.
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30
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Seo BK, Oh YW, Kim HR, Kim HW, Kang CH, Lee NJ, Kim JH, Park BJ, Cho KR, Lee JY, Lee KY, Bae JW. Sonographic evaluation of breast nodules: comparison of conventional, real-time compound, and pulse-inversion harmonic images. Korean J Radiol 2002; 3:38-44. [PMID: 11919477 PMCID: PMC2713985 DOI: 10.3348/kjr.2002.3.1.38] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare the use of conventional, real-time compound, and pulse-inversion harmonic imaging in the evaluation of breast nodules. MATERIALS AND METHODS Fifty-two breast nodules were included in this study, conducted between May and December 2000, in which conventional, real-time compound, and pulse-inversion harmonic images were obtained in the same plane. Three radiologists, each blinded to the interpretations of the other two, evaluated the findings, characterizing the lesions and ranking the three techniques from grade 1, the worst, to grade 3, the best. Lesion conspicuity was assessed, and lesions were also characterized in terms of their margin, clarity of internal echotexture, and clarity of posterior echo pattern. The three techniques were compared using Friedman's test, and interobserver agreement in image interpretation was assessed by means of the intraclass correlation coefficient. RESULTS With regard to lesion conspicuity, margin, and internal echotexture of the nodules, real-time compound imaging was the best technique (p < 0.05); in terms of posterior echo pattern, the best was pulse-inversion harmonic imaging (p < 0.05). Real-time compound and pulse inversion harmonic imaging were better than conventional sonography in all evaluative aspects. Interobserver agreement was greater than moderate. CONCLUSION Real-time compound and pulse-inversion harmonic imaging procedures are superior to conventional sonography in terms of both lesion conspicuity and the further characterization of breast nodules. Real-time compound imaging is the best technique for evaluation of the margin and internal echotexture of nodules, while pulse-inversion harmonic imaging is very effective for the evaluation of the posterior echo patterns.
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Affiliation(s)
- Bo Kyoung Seo
- Department of Diagnostic Radiology, Korea University Anam Hospital, 126-1 Anam-dong 5-ga, Sungbuk-gu, Seoul 136-705, Korea.
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Yilmaz E, Sal S, Lebe B. Differentiation of phyllodes tumors versus fibroadenomas. Mammographic and sonographic features. Acta Radiol 2002. [DOI: 10.1034/j.1600-0455.2002.430107.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ribau M, García-Toro E, Velasco A. Carcinoma intraductal en un fibroadenoma. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2001. [DOI: 10.1016/s0210-573x(01)77134-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Huber S, Danes J, Zuna I, Teubner J, Medl M, Delorme S. Relevance of sonographic B-mode criteria and computer-aided ultrasonic tissue characterization in differential/diagnosis of solid breast masses. ULTRASOUND IN MEDICINE & BIOLOGY 2000; 26:1243-1252. [PMID: 11120360 DOI: 10.1016/s0301-5629(00)00274-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We aimed to evaluate the differential diagnostic value of a method of computer-assisted texture analysis in comparison to established ultrasonographic B-mode characteristics in the examination of solid breast masses. At two centers, 77 patients presenting with a solid mass on B-mode scan were studied at 7.5 MHz. Description of B-mode appearance included assessment of tumor shape, borders, presence of an echogenic rim, tissue architecture, internal echo structure, absorption and elasticity. For statistical pattern recognition, the following parameters were used: form factor, mean grey level, signal-to-noise ratio, mean gradient and correlation from the co-occurrence matrix. At center 1, the most decisive parameter for differential diagnosis was distortion of tissue architecture (sensitivity, SN, 83%; specificity, SP, 92%) and, at center 2, relation to the adjacent tissue (SN 93%, SP 92%). Among texture parameters, best discrimination was achieved for correlation from the co-occurrence matrix at center 1 (SN 58%, SP 73%) and for form factor at center 2 (SN 93%, SP 77%). Among sonographic criteria, the highest contribution to the diagnosis was found for an unsharp border (odds ratio, OR, 12.2), architectural distortion (OR, 8.6), fixation to skin or chest wall (OR, 9.0) and fixation to adjacent breast parenchyma (OR, 8.8), according to texture analysis for parameters form factor (OR 4.0) and correlation from the co-occurrence matrix (OR 4.7). Ultrasonographic texture analysis can be helpful as an additional parameter in differential diagnosis of breast tumors, but did not reach differential diagnostic accuracy of sonomorphologic features.
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Affiliation(s)
- S Huber
- Departments of Department of Radiology, Lainz Hospital, Wolkersbergenstr.1, Vienna, Austria
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Thibault F, Meunier M, Klijanienko J, El Khoury C, Nos C, Vincent-Salomon A, Asselain B, Neuenschwander S. Diagnostic accuracy of sonography and combined sonographic assessment and sonographically guided cytology in nonpalpable solid breast lesions. JOURNAL OF CLINICAL ULTRASOUND : JCU 2000; 28:387-398. [PMID: 10993966 DOI: 10.1002/1097-0096(200010)28:8<387::aid-jcu3>3.0.co;2-t] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE The aim of this study was to assess the diagnostic accuracy of sonography alone and combined sonographic assessment and sonographically guided fine-needle aspiration cytology in solid, nonpalpable lesions of the breast. METHODS We retrospectively evaluated the sonograms from a series of 174 consecutive nonpalpable masses that were cytologically diagnosed using fine-needle aspiration under sonographic guidance and then histologically verified through surgical excision. We examined the relationships between the findings from sonography, combined sonographic assessment and cytopathology, and histology. RESULTS Histologically, 95 lesions (55%) were malignant and 79 (45%) were benign. The overall sensitivity of sonography alone for diagnosing cancer was 98. 9% (94 of 95 lesions), and the specificity was 45.6% (36 of 79 lesions). One (3%) of 37 masses considered at sonography to be benign was correctly diagnosed on cytologic examination to be cancer. By establishing the benign status of 11 of 13 masses that were indeterminate at sonography, cytology increased the specificity of the combined method (to 56.3%). Cytology appropriately suspected or confirmed malignancy in 79 (84%) of 94 carcinomas considered at sonography to be suspicious or malignant. CONCLUSIONS In this study, sonography alone demonstrated a high sensitivity but limited specificity in evaluating nonpalpable breast masses. The addition of sonographically guided cytology substantially increased the specificity of the combined method without compromising sensitivity.
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Affiliation(s)
- F Thibault
- Department of Radiology, Institut Curie, 26 Rue d'Ulm, 75231 Paris Cedex 05, France
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Mehta TS, Raza S, Baum JK. Use of Doppler ultrasound in the evaluation of breast carcinoma. Semin Ultrasound CT MR 2000; 21:297-307. [PMID: 11014252 DOI: 10.1016/s0887-2171(00)90024-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ultrasound is an imaging modality commonly used to evaluate breast lesions in hopes to distinguish benign from malignant solid masses. Angiogenesis, defined as the emergence of new vessels to further the growth of tumor, has stimulated interest in the potential uses of Doppler ultrasound in patients with breast cancer. This article describes different forms of Doppler ultrasound, including color Doppler (CD), power Doppler (PD), and spectral Doppler (SD), as well as 3-dimensional (3D) ultrasound and ultrasound contrast media. We review the role of Doppler ultrasound in distinguishing benign from malignant solid breast masses. We also discuss the role of ultrasound in predicting tumor grade, histology, node status, and lymphatic vascular invasion, and in monitoring breast cancer treatment.
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Affiliation(s)
- T S Mehta
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Abstract
Many investigators have attempted to use ultrasound imaging to differentiate benign from malignant solid breast masses. Studies have evaluated several generations of gray-scale imaging, Doppler, color Doppler, and power Doppler imaging, and several unconventional ultrasound techniques. Although various individual studies have shown promise, ultrasound criteria for avoiding biopsy of solid lesions have not been widely adopted. Considerable observer variability also remains an important obstacle. This article reviews the results, strengths, and weaknesses of some of the key studies addressing this issue. Fundamental criteria for a successful ultrasound model are also specified.
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Affiliation(s)
- J A Baker
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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Abstract
The American College of Radiology Breast Imaging and Reporting Data System (ACR BI-RADS) defines a mass as a space-occupying lesion seen in at least two projections. This article focuses on the management of breast masses with mammography and ultrasonography. Recommended work-up pathways are modified for nonpalpable masses, palpable masses in women over the age of 30, and palpable masses in women under the age of 30. The suggested protocols are based on scientific peer-reviewed literature whenever possible, but when evidence based studies are not available, the author relies on expert opinion.
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Affiliation(s)
- L W Bassett
- Department of Radiological Sciences, University of California Los Angeles School of Medicine, USA.
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Leung JW, Sickles EA. Multiple bilateral masses detected on screening mammography: assessment of need for recall imaging. AJR Am J Roentgenol 2000; 175:23-9. [PMID: 10882241 DOI: 10.2214/ajr.175.1.1750023] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE When multiple bilateral partially circumscribed masses having a similar appearance are detected on screening mammography, some radiologists recommend recall examination to identify imaging features suggestive of malignancy that are not evident on standard screening views. This study assesses the need for such recall imaging. SUBJECTS AND METHODS Cases of multiple masses were identified by reviewing the mammographic reports of 84,615 consecutive screening examinations. Each case of multiple masses was prospectively interpreted as benign, with recommendations for follow-up mammography in 1 year and for aspiration of any palpable masses if clinically indicated. Subsequently diagnosed cancers were identified through data linkage with our regional tumor registry and through our institution's computer-based outcomes tracking system. RESULTS Among 84,615 consecutive screening examinations, we identified 1440 (1.7%) cases of multiple masses. Among the multiple-masses cohort, two interval cancers were found. Both were early-stage (T1bN0M0; T1cN0M0) and low-grade (histologic grade 1) cancers. The interval cancer rate among the multiple-masses cohort was 0.14%, which is somewhat lower than the age-matched United States incident cancer rate of 0.24%. CONCLUSION The frequency of cancer development and the stage at cancer diagnosis among nonrecalled cases of multiple masses are similar to those observed in the general screening mammography population. Therefore, recall imaging for women with multiple masses does not appear to be justified.
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Affiliation(s)
- J W Leung
- Department of Radiology, University of California San Francisco Medical Center 94143-1667, USA
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Rahbar G, Sie AC, Hansen GC, Prince JS, Melany ML, Reynolds HE, Jackson VP, Sayre JW, Bassett LW. Benign versus malignant solid breast masses: US differentiation. Radiology 1999; 213:889-94. [PMID: 10580971 DOI: 10.1148/radiology.213.3.r99dc20889] [Citation(s) in RCA: 227] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the general applicability and interobserver variability of ultrasonographic (US) features in differentiating benign from malignant solid breast masses. MATERIALS AND METHODS One hundred sixty-two consecutive solid masses with a tissue diagnosis were reviewed. Three radiologists reviewed the masses without knowledge of clinical history or histologic examination results. RESULTS US features that most reliably characterize masses as benign were a round or oval shape (67 of 71 [94%] were benign), circumscribed margins (95 of 104 [91%] were benign), and a width-to-anteroposterior (AP) dimension ratio greater than 1.4 (82 of 92 [89%] were benign). Features that characterize masses as malignant included irregular shape (19 of 31 [61%] were malignant), microlobulated (four of six [67%] were malignant) or spiculated (two of three [67%] were malignant) margins, and width-to-AP dimension ratio of 1.4 or less (28 of 70 [40%] were malignant). If the three most reliable criteria had been strictly applied by each radiologist, the overall cancer biopsy yield would have increased (from 23% to 39%) by 16%. When US images and mammograms were available, the increase in biopsy yield contributed by US was not statistically significant (2%, P = .73). However, in independent reviews, one to three reviewers interpreted four carcinomas as benign at US. CONCLUSION The data confirm that certain US features can help differentiate benign from malignant masses. However, practice and interpreter variability should be further explored before these criteria are generally applied to defer biopsy of solid masses.
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Affiliation(s)
- G Rahbar
- Iris Cantor Center for Breast Imaging, Department of Radiological Sciences, UCLA School of Medicine 90095-6952, USA
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Abstract
OBJECTIVE To identify from the literature and clinical experience a rational approach to management of fibroadenomas of the breast. METHOD Recent literature on detection, diagnosis, and natural history of fibroadenomas was reviewed. Experience with over 4,000 women evaluated in the breast clinic at the Tel-Aviv Medical Center contributed to the management strategies suggested by review of the literature. RESULTS Fibroadenomas of the breast are common, accounting for 50% of all breast biopsies performed. Physical examination, sonography, and fine needle aspiration are effective in distinguishing fibroadenomas from breast cancer. Transformation from fibroadenoma to cancer is rare; regression or resolution is frequent, supporting conservative approaches to follow-up and management. CONCLUSION Age-based algorithms that allow for conservative management and that limit excision to patients whose fibroadenomas fail to regress are presented.
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Affiliation(s)
- R Greenberg
- Department of Surgery A, Tel-Aviv Medical Center, and the Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Abstract
Quality mammography remains the primary modality used to image the breast. Sonography currently is the most useful adjunctive technique to mammography, having roles in differentiating cystic from solid masses and in guiding interventional procedures. This article reviews these and other indications for breast ultrasound studies, including evaluation of palpable masses not visible in radiographically dense breasts, masses not completely evaluable with mammography, young patients especially susceptible to radiation damage, and abscesses. Ultrasound interpretation of cysts and solid masses are discussed, as are the relative disadvantages of ultrasound as a breast cancer screening tool.
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Affiliation(s)
- V P Jackson
- Department of Radiology, Indiana University School of Medicine, Indianapolis 46202, USA
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Hunter TB, Roberts CC, Hunt KR, Fajardo LL. Occurrence of fibroadenomas in postmenopausal women referred for breast biopsy. J Am Geriatr Soc 1996; 44:61-4. [PMID: 8537592 DOI: 10.1111/j.1532-5415.1996.tb05639.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To examine the occurrence of breast fibroadenomas in postmenopausal patients referred for breast biopsy. DESIGN A retrospective review of breast biopsy outcome and of patient demographics, including menstrual and hormonal status. SETTING The Tucson Breast Center, a large outpatient breast cancer detection clinic affiliated with the University of Arizona Health Sciences Center in Tucson, Arizona. PARTICIPANTS All women seen at the Tucson Breast Center between 1985 and 1990 who were referred for breast biopsy. RESULTS A total of 100 fibroadenomas were found in 709 breast biopsies whose results were known. Fifty-two of these were in premenopausal women and 44 in postmenopausal women; the menopausal status of four women was unknown. In postmenopausal women, 11 of the 44 patients reported hormone use. Fibroadenomas constituted 20% (39 of 195) of the benign masses and 12% (39 of 339) of all breast masses in postmenopausal women. Fibroadenomas constituted 10% (44 of 447) of all biopsies in postmenopausal women, including those with breast masses, abnormal calcifications, or other lesions. CONCLUSION Noncalcified fibroadenomas of the breast are not confined to young women and may constitute a small but noteworthy proportion of lesions coming to breast biopsy in postmenopausal women.
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Affiliation(s)
- T B Hunter
- Department of Radiology, University of Arizona Health Sciences Center, Tucson 85724, USA
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Jackson VP. THE CURRENT ROLE OF ULTRASONOGRAPHY IN BREAST IMAGING. Radiol Clin North Am 1995. [DOI: 10.1016/s0033-8389(22)00650-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Guyer PB, Dewbury KC, Warwick D, Smallwood J, Taylor I. Direct contact B-scan ultrasound in the diagnosis of solid breast masses. Clin Radiol 1986; 37:451-8. [PMID: 3530601 DOI: 10.1016/s0009-9260(86)80053-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Our experience of breast ultrasound in the differentiation of benign and solid malignant breast masses indicates a specificity of 93% for carcinoma; 7% of cancers were regarded as benign. Eight of 89 proven fibroadenomas were considered possibly malignant. Typical, and overlapping, features are described, and the world literature is discussed. Whereas most previous workers have used a water-path technique, we employ direct contact B-scanning, which is quick, simple, and apparently at least as successful. The small group of solid masses where there is overlap between fibroadenoma and carcinoma needs further study; this might be helped by histological correlation with the ultrasound appearances of malignancy, the causes of which are still debated. The exclusion of a focal solid mass in a patient with a breast lump can reduce the biopsy rate.
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Abstract
Our preliminary experience of direct-contact B-scan sonomammography in 500 patients is recorded and is compared with X-ray mammography. The technique has been of considerable value in the radiologically dense breast and, since standard equipment can be used, the practice should become more widespread, in the anticipation that identification and exclusion of malignancy can be increased above that achievable by X-ray mammography alone.
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