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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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Clinicopathological and Imaging Features of Breast Papillary Lesions and Their Association with Pathologic Nipple Discharge. Diagnostics (Basel) 2023; 13:diagnostics13050878. [PMID: 36900021 PMCID: PMC10000596 DOI: 10.3390/diagnostics13050878] [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: 02/06/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
No studies have evaluated whether any clinicopathological or imaging characteristics of breast papillary lesions are associated with pathological nipple discharge (PND). We analyzed 301 surgically confirmed papillary breast lesions diagnosed between January 2012 and June 2022. We evaluated clinical (age of patient, size of lesion, pathologic nipple discharge, palpability, personal/family history of breast cancer or papillary lesion, location, multiplicity, and bilaterality) and imaging characteristics (Breast Imaging Reporting and Data System (BI-RADS), sonographic, and mammographic findings) and compared malignant versus non-malignant lesions and papillary lesions with versus without PND. The malignant group was significantly older than the non-malignant group (p < 0.001). Those in the malignant group were more palpable and larger (p < 0.001). Family history of cancer and peripheral location in the malignant group were more frequent than in the non-malignant group (p = 0.022 and p < 0.001). The malignant group showed higher BI-RADS, irregular shape, complex cystic and solid echo pattern, posterior enhancement on ultrasound (US), fatty breasts, visibility, and mass type on mammography (p < 0.001, 0.003, 0.009, <0.001, <0.001, <0.001, and 0.01, respectively). On multivariate logistic regression analysis, peripheral location, palpability, and age of ≥50 years were factors significantly associated with malignancy (OR: 4.125, 3.556, and 3.390, respectively; p = 0.004, 0.034, and 0.011, respectively). Central location, intraductal nature, hyper/isoechoic pattern, and ductal change were more frequent in the PND group (p = 0.003, p < 0.001, p < 0.001, and p < 0.001, respectively). Ductal change was significantly associated with PND on multivariate analysis (OR, 5.083; p = 0.029). Our findings will help clinicians examine patients with PND and breast papillary lesions more effectively.
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Tierney SN. Intraductal Papillomas. Surg Clin North Am 2022; 102:965-972. [DOI: 10.1016/j.suc.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Corvino A, Varelli C, Catalano F, Cocco G, Delli Pizzi A, Boccatonda A, Corvino F, Basile L, Catalano O. Use of High-Frequency Transducers in Breast Sonography. J Pers Med 2022; 12:jpm12121960. [PMID: 36556182 PMCID: PMC9786615 DOI: 10.3390/jpm12121960] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/15/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Sonography companies have recently developed high-frequency transducers (20-30 MHz) to image the skin and small joints. In this pictorial review, we present a number of settings where these probes can be usefully employed to scan the breast. These include skin abnormalities of the breast and axilla; nipple-areolar complex abnormalities; superficial breast parenchyma abnormalities; breast parenchyma abnormalities in subjects with implants; very small female breasts; peripheral areas in breasts of any size; pre-puberal breasts; male breasts; post-mastectomy chest wall; and intraoperative breast sonography. Comparatively, side-by-side images obtained with conventional breast frequencies and high frequencies are shown.
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Affiliation(s)
- Antonio Corvino
- Movement Sciences and Wellbeing Department, University of Naples “Parthenope”, Via Medina 40, I-80133 Naples, Italy
- Correspondence:
| | - Carlo Varelli
- Radiology Unit, Varelli Diagnostic Institute, I-80126 Naples, Italy
| | - Fabio Catalano
- Radiology Unit, Varelli Diagnostic Institute, I-80126 Naples, Italy
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, University “G. d’Annunzio”, I-66100 Chieti, Italy
| | - Andrea Delli Pizzi
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio”, I-66100 Chieti, Italy
| | - Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, I-40010 Bologna, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, I-80131 Naples, Italy
| | - Luigi Basile
- Advanced Biomedical Sciences Department, University Federico II of Naples, I-80138 Naples, Italy
| | - Orlando Catalano
- Radiology Unit, Varelli Diagnostic Institute, I-80126 Naples, Italy
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Kayadibi Y, Bulut IN, Aladag Kurt S, Erginöz E, Ozturk T, Velidedeoglu M, Taskin F, Esen Icten G. The Role of Superb Microvascular Imaging and Shearwave Elastography in the Evaluation of Intraductal Papilloma-Like Lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:995-1008. [PMID: 34862641 DOI: 10.1002/jum.15907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/12/2021] [Accepted: 11/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the role of quantitative values obtained by superb microvascular imaging (SMI) and shearwave elastography (SWE) in the prediction of malignancy in intraductal papilloma-like lesions (IDPL). METHODS In the study, 61 patients between the ages of 14 to 73 years (mean age 44) diagnosed with IDPL on ultrasound (US) examination between the years 2020 and 2021 were included. The B-Mode US findings (shape, margins, size, echo pattern, and accompanying ductal dilatation), SMI vascular index (SMIvi), E-mean, and SWE-ratio values were recorded. RESULTS There was a statistically significant difference between malignant (n = 14) and benign (n = 47) groups in terms of symptoms (P = .005), size (P = .042), shape (P = .002), margins (P = .001), echogenicity (P = .023), microcalcifications (P = .009), SMIvi (P = .031), E-mean (P < .005), and SWE-ratio (P = .007). According to receiver operating characteristic (ROC) curve analysis, sensitivity, specificity, accuracy, area under the curve (AUC), positive predictive values (PPV), and negative predictive values (NPV) were 57.1%, 87.2%, 80%, 0.722, 57.1%, 87.2% for US; 71.4%, 49%, 55.7%, 0.692, 30.3%, 85.7% for SMIvi; 85.7%, 71%, 74%, 0.864, 46%, 94.3% for E-mean, and 50%, 75.4%, 83%, 0.707, 91.5%, and 50% for SWE-ratio, respectively. Best results were obtained when SMI and SWE values were used together, achieving a sensitivity, specificity, accuracy, AUC, PPD, NPD of 78.6%, 93.6%, 93.4%, 0.872, 91.7%, and 93.9%, respectively. CONCLUSIONS The SMI and SWE examinations are successful in the differentiation of benign and malignant intraductal lesions. They complement each other and contribute to B-mode US in managing IDPLs especially when used together. Our study is the first to compare the quantitative data of SWE and SMI in the differentiation of IDPLs.
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Affiliation(s)
- Yasemin Kayadibi
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Iclal Nur Bulut
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Seda Aladag Kurt
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ergin Erginöz
- Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Tulin Ozturk
- Department of Pathology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Mehmet Velidedeoglu
- Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Fusun Taskin
- Senology Research Institute, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Gul Esen Icten
- Senology Research Institute, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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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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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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Crnogorac M, Ivanac G, Tomasović-Lončarić Č, Žic R, Kelava T, Brkljačić B. SONOELASTOGRAPHIC FEATURES OF HIGH-RISK BREAST LESIONS AND DUCTAL CARCINOMA IN SITU - A PILOT STUDY. Acta Clin Croat 2019; 58:13-22. [PMID: 31363320 PMCID: PMC6629205 DOI: 10.20471/acc.2019.58.01.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to evaluate the quantitative sonoelastographic values recorded on shear-wave sonoelastography (SWE) of high-risk breast lesions and ductal carcinoma in situ (DCIS). We retrospectively analyzed histopathologic and SWE data (quantitative maximum, minimum and mean stiffness, lesion-to-fat ratio (E-ratio), lesion size) of 228 women referred to our Department for core needle breast biopsy during a four-year period. Among 230 lesions, histopathologic findings showed 34 high-risk breast lesions and 29 DCIS, which were compared with 167 ductal invasive carcinomas. High-risk lesions had lower values of all sonoelastographic features than ductal in situ and invasive carcinoma, however, only E-ratio showed a statistically significant difference in comparison to DCIS (3.7 vs. 6, p<0.001). All sonoelastographic features showed significant difference between in situ and invasive carcinoma. There was a significant correlation between lesion size and stiffness (r=0.36; p<0.001). Stiffness measured by SWE is an effective predictor of the histopathologic severity of sonographically detectable breast lesions. Elasticity values of high-risk lesions are significantly lower than those of malignant lesions. Furthermore, we showed that along with the sonographic appearance, which in most cases shows typical microcalcifications, DCIS had significantly different elasticity parameters than invasive carcinoma.
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Affiliation(s)
| | - Gordana Ivanac
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Čedna Tomasović-Lončarić
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Rado Žic
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Tomislav Kelava
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Boris Brkljačić
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
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Magnetic resonance imaging features for differentiating breast papilloma with high-risk or malignant lesions from benign papilloma: a retrospective study on 158 patients. World J Surg Oncol 2018; 16:234. [PMID: 30558621 PMCID: PMC6298003 DOI: 10.1186/s12957-018-1537-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/30/2018] [Indexed: 02/07/2023] Open
Abstract
Background Benign breast papilloma is currently managed with conservative management with close observation. In contrast, papilloma with high-risk or malignant lesions warrants surgical excision. The purpose of our study was to investigate magnetic resonance imaging (MRI) features of breast papilloma and to identify imaging diagnostic indicators for papilloma with high-risk or malignant lesions. Methods MRI features of 175 surgically confirmed papillomas on 158 patients were retrospectively reviewed. The 175 cases included 132 cases of benign papilloma and 43 cases of papilloma with high-risk or malignant lesions. The MRI features of these lesions were classified into three types: mass, non-mass enhancement (NME), and occult lesion. The occult lesion was defined as the presence of only ductal dilation without any enhanced lesions on MRI. For a mass lesion, the mixed mass-NME lesion was considered if linear, segmental or regional enhanced lesion was found adjacent to the mass. Clinical and MRI features were compared by univariate and multivariate analysis between the benign papilloma and the papilloma with high-risk or malignant lesions. Results Multivariate logistic regression analysis demonstrated that clinical characteristics including being or older than 50 years (odds ratio [OR] = 4.506), having bloody nipple discharge (OR = 4.499), and concurrent breast cancer (OR = 5.083) were significant indicators for papilloma with high-risk or malignant lesions. On MRI, most papillomas presented as mass (n = 135, 77.1%), and fewer as NME (n = 37, 21.1%) and occult lesion (n = 3, 1.7%). For the mass lesion, the logistic regression analysis demonstrated that a mass size exceeding 10 mm (OR = 2.956) and mixed mass-NME lesion (OR = 4.143) were independent risk indicators for a papilloma with high-risk or malignant lesions. For the NME lesion, the segmental or regional distribution was more commonly observed in the papilloma with high-risk or malignant lesions (61.5%) than the benign papilloma (12.5%) (P = 0.006). All the cases of occult lesions were benign papillomas. Conclusions MRI features including a mass size exceeding 10 mm, mixed mass-NME lesion, and NMEs with segmental or regional distribution indicate a papilloma with high-risk or malignant lesions.
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Boufelli G, Giannotti MA, Ruiz CA, de Barros N, Chala LF, Maesaka JY, Goncalves R, Bresciani BH, Vianna P, Soares JM, Baracat EC, Filassi JR. Papillomas of the breast: factors associated with underestimation. Eur J Cancer Prev 2018; 27:310-314. [PMID: 28296665 PMCID: PMC6012041 DOI: 10.1097/cej.0000000000000343] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/13/2017] [Indexed: 11/26/2022]
Abstract
The distinction between benign and malignant papilloma of the breast through percutaneous needle biopsy can be difficult because of limited samples; the underestimation rate can be up to 25%. The aim of this study is to identify clinical and histological factors associated with underestimation, invasive ductal carcinoma, or ductal in-situ carcinoma (DCIS) of the breast found in surgical specimens from papillary lesions. This may contribute toward selection of patients for a follow-up strategy without the need for surgical excision. From a database of 3563 patients, we identified 85 with intraductal papilloma between 2007 and 2013 who had undergone breast-imaging studies, percutaneous needle biopsy, and surgical resection of the lesion. Central papillomas normally present with a palpable mass, whereas peripheral papillomas generally do not have clinical manifestations (microcalcifications); both central and peripheral papillomas were related to atypical lesions, 13.5 and 15.4%, respectively. Among the 59 cases of central papillomas, there were four cases of underestimation, three DCIS and one invasive ductal carcinoma (6.8%). Among the 26 cases of peripheral papillomas, there was one case of DCIS (3.8%), with a total underestimation rate of 5.8%; all underestimated lesions measured more than 1 cm. The median size was 11 mm at mammography and 19 mm at ultrasound. Our data suggest that lesions less than 1 cm in size, without atypia and concordant imaging and clinical findings, may not require surgical resection.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy, Needle
- Breast Neoplasms/diagnosis
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/diagnostic imaging
- Carcinoma, Papillary/surgery
- Cohort Studies
- Female
- Follow-Up Studies
- Humans
- Mammography/methods
- Middle Aged
- Prognosis
- Risk Assessment/methods
- Risk Factors
- Ultrasonography, Mammary/methods
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Affiliation(s)
| | - Marcelo A. Giannotti
- Department of Pathology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | - Paula Vianna
- Department of Pathology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Browne JE, Cannon LM, McDermott R, Ryan M, Fagan AJ. Pilot Investigation into the Use of an Anthropomorphic Breast Sonography Phantom as a Training and Assessment Tool. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2733-2740. [PMID: 28843619 DOI: 10.1016/j.ultrasmedbio.2017.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 07/12/2017] [Accepted: 07/19/2017] [Indexed: 06/07/2023]
Abstract
A device for the training and quantitative assessment of the competency of trainee radiologists in the technically challenging area of breast sonography was developed and evaluated. Currently, suitable commercially available devices are lacking, and there is a growing realization that the reliance on direct exposure to patients for learning may not represent best practice from either the trainees' or patients' perspective. Three devices (PI, PII and PIII) were designed to produce very realistic sonographic images of breast morphology with a range of embedded pathologies. The pilot evaluation used a case study research design to evaluate the role of the anthropomorphic breast sonography training device in training and assessment in a clinical environment. Through the case study, it was possible to evaluate the process and relationships when using this type of training intervention for a small group of radiology resident trainees. The investigation involved a baseline assessment of trainees' (n = 4) ability to detect and characterize all lesions in PI, followed by a 4-wk training period on PII and a post-training assessment using PIII. The evaluation revealed an improvement of 30% ± 8% in the trainee's performance from pre- to post-training. It was expected that the performance of the trainees would improve as the training phantom described in this study aligns with the learning theory of constructivism and fits the ideal specifications of a medical training device in terms of its realism and facilitation of self-directed learning and deliberate practice of the trainees. The device provides a useful platform upon which training and assessment can be facilitated.
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Affiliation(s)
- Jacinta E Browne
- School of Physics and Clinical & Optometric Sciences, & Medical Ultrasound Physics and Technology Group, Centre of Industrial Engineering Optics, FOCAS, Dublin Institute of Technology, Dublin, Ireland.
| | - Louise M Cannon
- School of Physics and Clinical & Optometric Sciences, & Medical Ultrasound Physics and Technology Group, Centre of Industrial Engineering Optics, FOCAS, Dublin Institute of Technology, Dublin, Ireland
| | - Ronan McDermott
- Diagnostic Imaging Department, St. James's Hospital, Dublin, Ireland
| | - Max Ryan
- Diagnostic Imaging Department, Cork University Hospital, Cork, Ireland
| | - Andrew J Fagan
- National Centre for Advanced Medical Imaging (CAMI), St. James's Hospital/School of Medicine, Trinity College Dublin, Dublin, Ireland
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Choi HJ, Ko KH, Jung HK. Shear Wave Elastography for Surgically Verified Breast Papillary Lesions: Is It Effective for Differentiation Between Benign and Malignant Lesions? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2007-2014. [PMID: 28708299 DOI: 10.1002/jum.14293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/26/2016] [Accepted: 12/28/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of shear wave elastography (SWE) for differentiating benign from malignant breast papillary lesions METHODS: B-mode ultrasound (US) and SWE were available in 56 surgically confirmed papillary lesions (48 [85.7%] benign and 8 [14.3%] malignant). The diagnostic performances of US, SWE parameters, and combined US with SWE parameters were calculated by receiver operating characteristic curve analysis and compared. RESULTS The highest area under the receiver operating characteristic curve (Az ) value for US was 0.500 (95% confidence interval [CI], 0.363, 0.637). The sensitivity was 100% (8 of 8), and the specificity was 0% (0 of 48). False-positive biopsy results were obtained in 48 (85.7%) of 56 lesions. The Az value for mean elasticity (0.721; 95% CI, 0.585, 0.833) was higher than that for B-mode US (P < .01) and the highest with the optimal cutoff value of 44.3 kPa (sensitivity, 75%; specificity, 75%). By adding the mean elasticity cutoff value of 44.3 kPa to B-mode US, the performance was increased (Az , 0.781; 95% CI, 0.585, 0.833) with sensitivity of 87.5% and specificity of 68.8%, and false-positive biopsy results were reduced to 26.8%. CONCLUSIONS The additional use of SWE to B-mode US may be effective for differentiating benign and malignant breast papillary lesions, with a significant decrease in the false-positive biopsy rate.
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Affiliation(s)
- Hye Jeong Choi
- Department of Radiology, CHA Bundang Medical Center, CHA University, Bundang-gu, Korea
| | - Kyung Hee Ko
- Department of Radiology, CHA Bundang Medical Center, CHA University, Bundang-gu, Korea
| | - Hae Kyoung Jung
- Department of Radiology, CHA Bundang Medical Center, CHA University, Bundang-gu, Korea
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