The role of high frequency three-dimensional ultrasound coronal convergence sign in the diagnosis of breast masses / 中国医师杂志

Objective To explore the diagnostic value of high frequency three-dimensional (3D) ultrasound in breast masses.Methods Seventy-seven cases of breast lesions were selected by 2D ultrasonic scan,and all the cases had been examined by 3D ultrasound and accepted surgical treatment in Shenzhen People's Hospital.With pathological results as the gold standard for diagnosis,the convergence sign in diagnosis of breast masses was used as malignant standard for 3D ultrasound coronal plane.The sensitivity and specificity were analyzed of 3D ultrasound in the diagnosis of benign and malignant breast tumors.Results A total of 77 cases of breast lesions included 46 malignant and 31 benign.3D ultrasound convergence sign was used to judge the benign and malignant breast tumors with statistical significance (x2 =26.790,P ＜ 0.01).The diagnostic sensitivity and specificity were 69.7％,and 90.3％,respectively.Conclusions High frequency 3D ultrasonography has certain value in differential diagnosis of benign and malignant breast tumors,and has important significance for the formulation of treatment plan.

Ultrasonic features of triple-negative breast cancer / 中国医师杂志

Objective To investigate the ultrasonic features of triple-negative breast cancer (TN-BC).Methods Ultrasonographic findings of 299 patients with pathologically confirmed breast cancer were analyzed retrospectively.Patients were divided into TNBC group (46 cases) and non-triple-negative breast cancer(NTNBC) group (253 cases) according to the expression of estrogen receptor (ER),progesterone receptor (PR),and human epidermal growth factor receptor 2 (HER2) that were determined with immunohistochemical staining.Each patient was ultrasonically analyzed.Results The ultrasonic images showed that TNBC group had a greater proportion in the mass with regular shape,clear boundary,or microlobulated relative to NTNBC group (P ＜ 0.01).Calcification was significantly less in TNBC than NTNBC (P ＜0.01).Eight (17.3％)of 46 Cases of TNBC had BI-RADS sonographic features that favored the diagnosis of a benign condition.Conclusions Some of sonographic criteria for TNBC are more likely to be associated with benign lesions,ultrasound-guided biopsy should be recommended for such lesions.

Observer Agreement Using the ACR Breast Imaging Reporting and Data System (BI-RADS)-Ultrasound, First Edition (2003)

OBJECTIVE: This study aims to evaluate the degree of inter- and intraobserver agreement when characterizing breast abnormalities using the Breast Imaging Reporting and Data System (BI-RADS)-ultrasound (US) lexicon, as defined by the American College of Radiology (ACR). MATERIALS AND METHODS: Two hundred ninety three female patients with 314 lesions underwent US-guided biopsies at one facility during a two-year period. Static sonographic images of each breast lesion were acquired and reviewed by four radiologists with expertise in breast imaging. Each radiologist independently evaluated all cases and described the mass according to BI-RADS-US. To assess intraobserver variability, one of the four radiologists reassessed all of the cases one month after the initial evaluation. Inter- and intraobserver variabilities were determined using Cohen's kappa (k) statistics. RESULTS: The greatest degree of reliability for a descriptor was found for mass orientation (k = 0.61) and the least concordance of fair was found for the mass margin (k = 0.32) and echo pattern (k = 0.36). Others descriptive terms: shape, lesion boundary and posterior features (k = 0.42, k = 0.55 and k = 0.53, respectively) and the final assessment (k = 0.51) demonstrated only moderate levels of agreement. A substantial degree of intraobserver agreement was found when classifying all morphologic features: shape, orientation, margin, lesion boundary, echo pattern and posterior feature (k = 0.73, k = 0.68, k = 0.64, 0.68, k = 0.65 and k = 0.64, respectively) and rendering final assessments (k = 0.65). CONCLUSION: Although BI-RADS-US was created to achieve a consensus among radiologists when describing breast abnormalities, our study shows substantial intraobserver agreement but only moderate interobserver agreement in the mass description and final assessment of breast abnormalities according to its use. A better agreement will ultimately require specialized education, as well as self-auditing practice tests.

Breast Imaging Reporting and Data System (BI-RADS) US lexicon and Final Assessment Category for Solid Breast Masses: the Rates of Inter- and Intraobserver Agreement

PURPOSE: To evaluate the rates of inter- and intraobserver agreement of the BI-RADS US lexicon. MATERIALS AND METHODS: Two radiologists reviewed 60 sonograms of solid breast masses to evaluate interobserver agreement. After four weeks, the radiologists reinterpreted the series to evaluate the intraobserver agreement. The radiologists described shape, orientation, margin, lesion boundary, echo pattern, posterior acoustic features and microcalcifications. Final assessment categories and management plans were suggested for each case. The rates of inter- and intraobserver agreements were measured by the use of kappa statistics. RESULTS: Interobserver agreement ranged from the highest for orientation (k=0.65) and shape (k=0.61) to the lowest for posterior acoustic features (k=0.42). For the final assessment categories (k=0.46) and management (k=0.49), interobserver agreements were moderate. Intraobserver agreement ranged from the highest for microcalcifications in mass (k=0.90, 0.82) and orientation (k=0.87, 0.83) and the lowest for echo patterns (k=0.62, 0.57) and posterior acoustic features (k=0.59, 0.65). In the final assessment category and management, intraobserver agreements were substantial or nearly complete (k=0.65-0.83). CONCLUSION: There were variable ranged inter- and intraobserver agreements in the description of the BI-RADS US lexicon of solid breast masses. Among them, margin and lesion boundary showed lower agreements. A modification of the BI-RADS US lexicon with more detailed guidelines, followed by continuous education, are suggested.

Sonograhphic Features of Adenosis Tumor

PURPOSE: We wanted to evaluate the sonographic features of adenosis tumor of the breast. MATERIALS AND METHODS: We evaluated the sonographic findings of 9 lesions in 9 patients who had a diagnosis of adenosis tumor after excision. The mean age of the patients was 32 years. All the masses were palpable. The sonographic features were interpreted by the ACR-BI-RADS (American College of Radiology Breast Imaging Reporting and Data System). Three of the women underwent mammography. RESULTS: The mean size of the lesion was 2.4 cm, and the shape of the masses was oval (n=9). The orientation was parallel (n=9). The margin was circumscribed (n=7), angular (n=1) and microlobulated (n=1). The lesion boundary was an abrupt interface (n=9). The echo pattern was hypoechoic (n=8) and isoechoic (n=1). Posterior acoustic enhancement was seen in 7 masses, and the other 2 masses showed combined shadowing and enhancement. The final assessment categories were classified into category 3 (n=7) and category 4 (n=2). Mammograms performed in 3 patients revealed a circumscribed mass in 2 patients and negative findings in 1 patient. CONCLUSION: Adenosis tumor of the breast usually shows as an oval, parallel oriented, circumscribed, hypoechoic mass with posterior acoustic enhancement on sonography.

Quality Assurance of Ultrasonic Diagnosis in Breast

Sonography is a subjective diagnostic method which is highly dependent on the experience of the operator and the equipment quality which requires real-time adjustments. Breast screening examination currently consists of clinical examination and mammography. Breast sonography, either supplementary to mammography or independently, is indicated for the dense breast, especially in younger women. Breast sonography is especially applicable for Korean women because of the denser breast parenchyma and the approximately 10-year younger incidence rate of breast cancer of Korean women compared to western women. To avoid unnecessary breast biopsy because of the high rate of false positive lesions in breast parenchyma, which is different from other body organs such as the liver or the kidney, a quality assurance program for breast sonography is essential. The quality assurance of breast ultrasound involves quality assurance of the equipment, imaging display and acquisition of clinical images, personnel qualifications and other aspects such as unification of lexicon, guideline of diagnostic examination and reporting system; US BI-RAD reporting system, assessment items and organization, education program, medical audit, certification issues, and medicolegal issues. A breast sonographic quality assurance system should be established before a scheme to initiate governmental medical insurance for breast sonography.

Usefulness of Ultrasound-guided Mammotome Biopsy for Microcalcification

PURPOSE: To evaluate the usefulness of ultrasound-guided mammotome biopsy for microcalcification and to suggest a new approach for the localization of microcalcifications which are not detected on ultrasound. MATERIALS AND METHODS: Twenty-one calcific lesions in 21 women (aged 33-56 years) underwent ultrasound-guided, vacuum-assisted, mammotome biopsy and a mean of 14 specimens per lesion were obtained. Calcification retrieval was defined as identification of calcifications on specimen radiographs. In the 13 cases of calcifications which were not detected on ultrasound imaging, mammotome biopsy was performed after localization of one or two needles at the microcalcifications under mammography-guidance. Radiographs of the specimens and histologic findings were reviewed and scheduled follow-up imaging was performed for evaluation of the complications of biopsy. RESULTS: Ultrasound-guided, vacuum-assisted, mammotome biopsy removed all calcifications in 21 lesions. Eight (38%) lesions showed visible calcification on the ultrasound while 13 (62%) lesions were invisible, which underwent mammotome biopsy after needle localization under mammography-guidance. Surgery revealed DCIS in 1 (4.8%) of 21 lesions, infiltrating ductal carcinoma in two (9.5%), fibroadenomas with calcifications in 6 (28.6%), fibroadenomas with adenosis in 2 (9.5%), and fibrocystic change with calcifications in 10 (47.6%). Clinical significant complications did not occur on follow-up examination in any of the cases. CONCLUSION: Ultrasound-guided, vacuum-assisted, mammotome biopsy was an effective method for microcalcifications on mammogram. The results suggested that mammotome biopsy after mammogram-guided, needle localization is a good alternative method for the diagnosis of microcalcifications which are undetectable in the ultrasound images.

Abnormal Imaging Findings of the Breast Related to Hormone Replacement Therapy: Analysis of Surgically Excised Cases

PURPOSE: To correlate the mammographic and ultrasonographic findings with the pathologic results in women undergoing hormone replacement therapy (HRT), and to determine the characteristic clinical, mammographic or histologic findings of breast cancer in these patients. MATERIALS AND METHODS: Twenty-five breast lesions in 25 patients aged 44-65 (mean, 55.5) years undergoing HRT were surgically removed due to abnormal mammographic findings or the presence of palpable masses. Mammograms in all patients and ultrasonograms in 23 were retrospectively analyzed in terms of the shape and margin of the mass, and microcalcifications, and the imaging findings were correlated with the pathologic results. As a control group, 45 cancer patients not undergoing HRT were selected. Using the student t test, detection methods, tumor size, mammographic findings, and the proportion of intraductal cancers were compared between the two groups. RESULTS: Surgical excision revealed ten benign lesions (four fibroadenomas and six cases of fibrocystic change) and 15 cancers (three intraductal and twelve invasive ductal cancers). Abnormal findings at mammography were a mass in 16 cases, clustered microcalcifications in seven, and a mass with microcalcifications in two. Mammography showed that all four circumscribed masses were benign. Five of seven ill-defined masses (71%) and all six spiculated masses were malignant. Three of seven cases (43%) with microcalcification, and both with a mass and microcalcification, were malignant. In two cases in which ultrasonography revealed cystic lesions, histologic examination showed that fibrocystic change had occurred. Compared to non-HRT-related cancers, HRT-related cancers were more often detected by mammography (60% vs 16%; p <0.001), smaller (17 mm vs 24 mm, p <0.01), showed microcalcification only (20% vs 13%; p <0.05), and were intraductal (20% vs 7%; p <0.01). CONCLUSION: In patients with HRT, mammographic findings of an ill-defined or spiculated mass, or one with microcalcifications, were associated with breast cancer. Compared to non-HRT-related cancers, breast cancers in patients undergoing HRT tend to manifest more frequently as a mammographic abnormality, and to be intraductal.

Glycogen-Rich Carcinoma of the Breast: A Case Report

Glycogen-rich carcinoma of the breast, defined as one in which more than 90% of neoplastic cells have abundant clear cytoplasm containing glycogen, is very rare. We report a case occurring in a 50-year old woman, and include the mammographic and ultrasonographic findings.

Value of Real-time Compound US in Diagnosis of Malignant Tumor in Breast Comparing with Conventional US, and Pulse Inversion Harmonic Images

PURPOSE: To compare the usefulness of real-time compound US (RCUS) with that of conventional US (CUS) and pulse inversion harmonic (PIH) imaging in the diagnosis of malignant breast tumors. MATERIALS AND METHODS: In 22 female patients whose mean age was 49 years, we evaluated the RCUS findings of pathologically proven [core biopsy (n=9), mammotome tissue bigpsy (n=10), excisional bispsy (n=3)] malignant breast tumors, comparing them with the findings of CUS and PIH imaging. Evaluation of these masses was in terms of their marginal distinction, internal echogenicity, boundary and posterior echo pattern, relationship with the adjacent lactiferous ductal system, and the presence of necrosis (12/22) and calcification (6/22). RESULTS: In terms of marginal distinction, internal echogenicity, boundary echo patterns, and the relationship with adjacent ductal system, RCUS was superior to both conventional US and PIH Imaging (p<0.05). CONCLUSION: For the diagnosis of malignant breast tumors RCUS was more useful than CUS or PIH imaging.

Muscular Hamartoma of the Breast: A Case Report

Muscular hamartoma is a variant of breast hamartoma shown at microscopic examination to be composed of abundant smooth muscle cells. We report a case of muscular hamartoma occurring in a 35-year-old woman with an incidentally discovered breast mass, and confirmed by excisional biopsy. We also describe the radiologic and pathologic findings.

The Role of Sonography in Patients with Breast Cancer Presenting as an Axillary Mass

OBJECTIVE: To compare sonography and mammography in terms of their diagnostic value in breast cancer cases which initially presented as an axillary mass without a palpable mass or other clinical symptoms. MATERIALS AND METHODS: Seven patients with enlarged axillary lymph nodes who first presented with no evidence of palpable breast lesions and who underwent both mammography and sonography were enrolled in this study. In six of the seven, the presence of metastatic adenocarcinoma was confirmed preoperatively by axillary needle aspiration biopsy; in four, subsequent sonographicallyguided breast core biopsy performed after careful examination of the primary site indicated that primary breast cancer was present. In each case, the radiologic findings were evaluated by both breast sonography and mammography. RESULTS: Breast lesions were detected mammographically in four of seven cases (57%); in three of the four, the lesion presented as a mass, and in one as microcalcification. In three of these four detected cases, fatty or scattered fibroglandular breast parenchyma was present; in one, the parenchyma was dense. In the three cases in which lesions were not detected, mammography revealed the presence of heterogeneously dense parenchyma. Breast sonography showed that lesions were present in six of seven cases (86%); in the remaining patient, malignant microcalcification was detected at mammography. Final pathologic examination indicated that all breast lesions except one, which was a ductal carcinoma in situ, with microinvasion, were infiltrating ductal carcinomas whose size ranged from microscopic to greater than 3 cm. At the time of this study, all seven patients were alive and well, having been disease free for up to 61 months after surgery. CONCLUSION: In women with a palpable axillary mass confirmed as metastatic adenocarcinoma, breast sonography may be a valuable adjunct to mammography.

Diagnostic Accuracy of Mammography and Ultrasonography in Detection of Early Breast Cancer

PURPOSE: To determine the value of mammography and ultrasonography in the detection of early breast cancer, and the usefulness of combining the two modalities for the diagnostic study of this condition. MATERIALS AND METHODS: The mammographic and ultrasonographic features of 47 female patients aged 23-68 (average, 46) years with pathologically proven early breast cancer were analyzed retrospectively. Mammography was performed in 46 patients and ultrasonography in 38, and 37 underwent both mammography and ultrasonography. Analysis of the mammographic and/or ultrasonographic features focused on mass, microcalcification, mass with microcalcification, multiple nodules, duct dilatation, and architectural distortion. RESULTS: Mammography revealed microcalcification in 29 (63%) patients, mass in 13 (28%) patients, mass with microcalcification in 8 (17%) patients, multiple nodules in 2 (4%) patients, architectural distortions in 1 (2%) patient, and negative finding in 9 (20%) patients. Ultrasonography revealed mass in 25 (66%) patients, microcalcifcation in 9 (24%) patients, mass with microcalcification in 8 (21%) patients, multiple nodules in 2 (5%) patients, duct dilatation in 3 (8%) patients, and negative finding in 7 (18%) patients. On combined study of mammography and ultrasonography of the 37 patients, mammography or ultrasonography revealed mass in 25 (68%) patients, microcalcification in 20 (54%) patients, multiple nodules in 2 (5%) patients, duct dilatation in 3 (8%) patients, and architectural distortion in 1 (3%) patient. In one (3%) patient among them, both mammography and ultrasonography revealed negative findings. The false negative rate of mammography, ultrasonography or both was 20%, 18%, and 3%, respectively, which was statistically significant difference (p < 0.05). CONCLUSION: Combined study of mammography and ultrasonography is the most useful as a diagnostic study for early breast cancer. So, ultrasonography seems to be the important additional method for detection of early breast cancer.

Tubular Carcinoma of the Breast: Clinical and Imaging Findings

PURPOSE: To evaluate the clinical and imaging findings of tubular carcinoma of the breast. MATERIALS AND METHODS: We retrospectively assessed the clinical and imaging findings of ten lesions of pathologically proven tubular carcinoma in nine patients, also evaluating the mammographic findings and categorizing the mass according to the ACR BI-RADS classification. The ultrasonographic findings were assessed in terms of shape, echogenicity, margin and posterior shadowing, and in four cases the size of nodules at physical examination was compared with the mammographic, ultrasonographic and pathologic findings. RESULTS: Nine lesions were palpable at physical examination. Bilateral tubular carcinoma of the breast was found in one patient, and unilateral single lesions in the others. There was no metastasis and no death within an average of 666 (range, 163) days of surgery. At mammography, masses were detected in six cases; the features, observed were a lobular or irregular shape (6/6), a spiculated margin (3/6) and high density (5/6). Ultrasonography showed that all unilateral lesions were hypoechoic (8/8), with a lesion height-to-width ratio of greater than 1.0 in seven of these, an ill-defined margin in sis, and posterior acoustic shadowing in seven. Mean nodule diameter was 1.17 cm at physical examination, 1.09 cm at mammography, 0.86 cm at ultrasonography and 0.80 cm at pathological evaluation. CONCLUSION: Most tubular carcinomas were palpable in spite of their small size, and their postoperative prognosis was good. Ultrasonography is useful in the detection of mammographically occult tubular carcinoma and for measuring the size of lesions.

The Value of Ultrasonography Combined with Compression Technique in Differentiation between Benign and Malignant Breast Masses

PURPOSE: To determine whether the compression technique is a valuable additional method for differentiating between benign and malignant breast masses. MATERIALS AND METHODS: The ultrasonographic findings of 95 benign and 53 malignant masses, all pathologically proven, were prospectively analyzed with regard to five diagnostic criteria: shape (regular/irregular), retrotumoral acoustic phenomena (posterior enhancement/posterior attenuation), internal echo pattern (homogeneous/inhomogeneous), compression effect on shape (distortion/no change), and compression effect on internal echo pattern (more homogeneous/no change). RESULTS: The number of cases of benign and malignant masses, respectively, was as follows: regular / irregular shape: 84/11, 9/44; posterior acoustic enhancement/posterior attenuation: 82/13, 16/37; homogeneous/inhomogeneous internal echo pattern: 78/17, 14/39; distortion/no change in shpae: 76/19, 5/48; and more homogeneous/ no change in internal echo pattern: 71/24, 3/50. For all diagnostic criteria for the differentiation of benign and malignant masses, the differences were statistically significant (p<.05). CONCLUSION: Ultrasonography is helpful for differentiating between benign and malignant breast masses. The compression technique is a valuable additional diagnostic method.

Mucocele-like Tumor of the Breast: A Case Report

Mucocele-like tumor(MLT) is a rare benign neoplasm occurring in the breast. Differentiation of MLT from mucinous carcinoma of the breast on the basis of fine-needle aspiration biopsy specimens is difficult, and in Korea, the radiologic findings of these lesions have not been reported. We describe a case of MLT of the breast, and review of the literature.

Pathologic Correlation To Internal Echogenicity of Atypical Breast Fibroadenoma

PURPOSE: To understand the cause of atypical sonograpic findings by analyzing their pathologic correlation tointernal echogenicity of breast fibroadenoma. MATERIALS AND METHODS: Between January 1995 and April 1997, thepresence of 91 fibroadenomas in 81 patients was histopathologically proven. These mass lesions weresonographically interpreted and their descriptive criteria-internal echo content (both strength and homogeneity),the presence of septum, bilateral shadowing, and posterior echo pattern-were tabulated. A pathologist reviewedeach case and independently recorded the following data : cell type, the presence of septum, duct dilatation,calcification, fibrosis, hyalinization, and vascularity. We analyzed the correlation of sonographic withpathologic findings. RESULT: There was significant correlation between increased vascularity and increasedinternal echo strength and between increased fibrosis and decreased internal echo strength. There was nosignificant correlation between internal echo homogeniety or posterior shadowing and vascularity or stromalfibrosis, nor between hyalinization or cell type and internal echo strength, homogeneity or posterior shadowing.There was correlation between absent or thin capsule and the absence of bilateral shadowing. CONCLUSION: Increased vascularity or decreased stromal fibrosis might be the cause of atypical fibroadenoma.

Metastatic Granulocytic Sarcoma in the Breast: A Case Report

Granulocytic sarcoma is an extramedullary tumor composed of immature granulocytic cells ; metastasis to thebreast is extremely rare. We describe a case of metastatic granulocytic sarcoma of the breast. The primary site ofthe lesion was the sixth thoracic vertebra ; there was no evidence of leukemia in peripheral blood or bone marrow. Mammography showed a 2cm-sized high-density mass lesion in the upper portion of the left breast, while breastultrasonography revealed an oval-shaped mixed heterogeneous hypoechoic mass with mild posterior enhancement.

Solid Breast Lesions: Evaluation with Power versus Conventional Color Doppler Sonography

PURPOSE: To compare power and conventional color Doppler sonography for depiction of the vasculature of solidbreast lesions, and to evaluate the usefulness of power Doppler sonography for differential diagnosis of malignantbreast lesions. MATERIALS AND METHODS: In order to detect vascularity, 82 cases of solid breast lesions wereevaluated by power and color Doppler sonography. Fifty-eight pathologically proven cases (37 benign and 21malignant lesions) were analyzed for the amount and patterns of Doppler signals, morphology of vessels, and thediagnostic accuracy. RESULTS: In 45 of 82 cases, power Doppler sonography depicted flow better than did colorDoppler sonography, while in 37 cases, depiction was equal. On power Doppler sonography, the incidence of markedblood flow in malignant lesions was three times higher than in benign lesions. The pattern of vasculature was morepredominantly central (85.5 %) and penetrating (61.9 %) in malignant lesions than in benign lesions. Branching(57.1 %) and disordered vessels (33.3 %) were more frequent in malignant lesions than in benign. For the diagnosisof malignancy, sensitivity for power Doppler sonography was 65 %, specificity was 79 % and diagnostic accuracy was74.1 % ; for color Doppler sonography, the corresponding figures were 76.9 %, 75.6 % and 75.9 %. CONCLUSION: Power Doppler sonography was more sensitive than color Doppler sonography for the detection of flow in solidbreast lesions. For the differentiation of benign from malignant lesions, however, there was no difference indiagnostic accuracy between the two modalities. findings of central and penetrating distribution patterns ofDoppler signals, and branching and disordered shapes of vessels, along with other sonographic criteria, arehelpful for predicting malignancy.

Metaplastic Carcinoma of the Breast: A Case Report

Metaplastic carcinoma of the human mammary gland is a very rare disease that undergoes metaplastic changes,including squamous cell, spindle cell, and heterologous mesenchymal growth. We report a case of metaplasticcarcinoma of the breast, together with its radiologic and pathologic findings.