The value of ultrasound classification in BI-RADS category 4 of breast complex cystic masses / 中华肿瘤杂志

Objective@#To analyze the feature of breast complex cystic masses and to classify it at ultrasonography (US), which applied to the Breast Imaging Reporting and Data System (BI-RADS) categories 4a to 4c with pathological results as the golden standards.@*Methods@#The ultrasonographic data and clinical features of 78 patients with complex cystic masses confirmed by pathology in Cancer Hospital from July 2014 to June 2017 were retrospectively reviewed. The complex cystic breast masses were divided into four classes on the basis of their US features: type 1 [thick wall and (or) thick septa (> 0.5 mm)], type 2 (one or more intra-cystic masses), type 3 (mixed cystic and solid components with cystic components more than 50%) and type 4 (mixed cystic and solid components with solid components more than 50%). Positive values (PPVs) were calculated for each type. Multiple linear regression analysis was used to analyze the ultrasonographic features of the masses (lesion size, margins, blood flow resistance index, calcification, and axillary lymph nodes, etc.) with malignant correlation.@*Results@#There were 81 lesions in 78 patients. Among the 81 masses based on US appearance, 14 (17.3%) were classified as type Ⅰ, 18 (22.2%) as type Ⅱ, 18 (22.2%) as type Ⅲ, and 31 (38.3%) as type Ⅳ. The positive predictive values of the malignant lesions of type Ⅰ, type Ⅱ, Ⅲ and Ⅳ were 7.1%, 16.7%, 61.1% and 48.3%, respectively (P=0.040). In all the 81 masses, 14 were BI-RADS categories 4a, 18 were BI-RADS categories 4b and 49 were BI-RADS categories 4c. Masses with maximum diameter equal to or larger than 2.0 cm, unclear margins, RI≥0.7 and presence of abnormal axillary nodes assessment had a high probability of malignancy (P=0.030, 0.038, <0.001 and 0.025, respectively).@*Conclusion@#Ultrasound typing is helpful for differentiating benign and malignant breast complex cysts and classifying BI-AIDS 4a to 4c, thus providing clearer treatment for clinical practice.

Analysis of postoperative hematoma formation factors after ultrasound-guided minimally invasive surgery for benign breast massesY / 中华医学超声杂志（电子版）

Objective To analyze the influencing factors of hematoma complicated from ultrasound-guided minimally invasive surgery for benign breast masses.Methods Retrospective analysis was performed in 412 patients with a total of 516 masses underwent the ultrasound-guided minimally invasive surgery for benign breast masses from January 2011 to December 2015 in Xiaoshan Hospital. Theχ2 test was used to univariately analyze risk factors of hematoma formation after ultrasound-guided minimally invasive surgery for benign breast masses. Logistic regression analysis was used to multivariately analyze risk factors of hematoma formation.Results All masses were resected completely, however, hematomas with long diameter≥1.0 cm were formed in 43 masses one week after surgery, and all hematomas were completely absorbed after six months. There were significant differences in the incidence of hematoma between the groups of different needle sizes, numbers of needle cutting, masses sizes, blood flow grades, depth, resection numbers and effective compression time of postoperative bandages (χ2=16.917, 14.548, 39.971, 23.333, 29.137, 36.819 and 39.864, respectively, allP<0.001). The needle sizes, the numbers of needle cutting, the masses sizes, blood flow grades, depth, resection numbers and the effective compression time constituted the risk factors of hematoma formation after the minimally invasive surgery.Conclusions The risk factors of the hematoma formation after ultrasound-guided minimally invasive surgery for benign breast masses included the different size of the needle, the number of different cutting needles, different size of the masses, the grade of blood flow, the number of resection and the different effective compression time of postoperative bandages. We could prevent the occurrence of hematoma in advance by screening patients and take corresponding measures.

Discrete Breast Masses in Female Children and Adolescents: Is there a Place for Non-operative Management by Pediatric Surgeons.

Background: The treatment of breast masses in female children and adolescents is controversial. While some advocate for early surgical removal others prefer the conservative non operative approach. The aim of this study is ascertain the evidence for the current protocol of early surgical removal in our centre. Materials and Methods: Retrospective observational study to highlight the epidemiology of discrete breast masses in female children and adolescents <18years seen at the Lagos University Teaching Hospital, Nigeria. Main outcome measure was to find out if there is a malignancy in excised tissue specimens. Results: Fifty three girls with 76 breast masses were evaluated. Median age at presentation was 16years (4 –17 years). Mean size of lumps was 3.6 cm (±2.1). All the breast masses had benign clinical characteristics and were confirmed histologically to be benign. There was no case of primary or secondary malignancy in any of the histological specimens. Family history, nipple discharge or ingestion of oral contraceptives did not affect presentation, diagnosis and outcome (p>0.05). Conclusion: This series show that breast masses in children and adolescents are almost always benign. It is advocated that conservative non-operative management (with close follow up with imaging such as breast ultrasound and/or MRI) should be adopted by paediatric surgeons in cases of breast masses in children except when surgery is specifically indicated. These indications which should be individualized include: cosmesis, bloody nipple discharge, persistent history of pain in the mass, rapid growth of the mass and malignancies with predilection for the breasts.

Ultrasound Elastography in the Differential Diagnosis of Benign and Malignant Breast Lesions / 华中科技大学学报(医学版)

Objective To assess the value of ultrasound elastography (UE) in the differential diagnosis of benign and ma‐lignant breast masses.Methods Clinical data of 180 female patients with breast masses were collected. A total of 180 masses in these patients were detected by ultrasound (US) and UE to primarily identify the benign or malignant masses before surgery. The diagnostic coincidence rate and values of ROC curve were compared based on the postoperative pathologic results between the two diagnosis methods.Results Forty‐eight benign masses and 127 malignant masses were correctly diagnosed by UE ,and 38 benign masses and 112 malignant masses by US. The sensitivity ,specificity ,accuracy ,positive predictive value and negative predictive value were higher in UE group than in US group ,and there were significant statistical differences (P<0.05 for all). Furthermore ,the value of area under the ROC curve (AUC) in UE group was 0.926 ,significantly higher than that in US group (0.899) (Z=2.8 ,P<0.05).Conclusion UE has the advantages of high sensitivity ,specificity and accuracy in differential di‐agnosis of the nature of breast masses. In terms of some disadvantages of UE ,UE should be combined with US in the diagnosis of benign and malignant breast diseases.

The clinical analysis of ultrasound-guided Mammotome resection of breast lumps through the retromammary space / 中国综合临床

Objective To evaluate the effect of ultrasound-guided vacuum-assisted minimal invasive resection(Mammotome procedure)of breast lumps through the retromammary space. Methods Seven hundred and eighty-seven patients in Obstetrics and Gynecology Hospital Affiliated to Fudan University from Jan. 2011 to May 2012 were underwent ultrasound-guided Mammotome operation through the retromammary space (retromammary space group,385 cases),or adjacent the lumps,and followed by post-operation visits regularly (Mammotome operation adjacent the lumps group,402 cases). The operation effects were compared between the two groups. Results All cases were followed up for 12 months. The period of Mmmotome operation through the retromam mary space and the rate of resection were(48 ± 6)min and(52 ± 4)min,99. 48%(383 / 385), 99. 25%(399 / 402),perspectively,in group of Mammotome operation through the retromammary space and Mammotome operation adjacent lumpsand. There was no significant difference between the two groups( P> 0. 05). The amount of procedural bleeding,the incidence of ecchymosis,local hematoma and the number of incision in group of Mammotome operation through the retromammary space were(8 ± 3)ml,2. 34%(9 / 385), 0. 52%(2 / 385),(1. 3 ± 0. 6)respectively,which were significantly lower than those in Mammotome operation adjacent the lumps group((14 ± 6)ml,8. 71%(35 / 402),2. 74%(11 / 402),(2. 4 ± 0. 3)respectively). There were statistical difference between two groups( P = 0. 003,P < 0. 001,P = 0. 001,P = 0. 006). The rate of satisfaction in group of Mammotome operation through the retro-mammary space was 98. 70%(380 / 385),which is significantly higher than in group of Mammotome operation adjacent the lumps(89. 30%(359 / 402),P< 0. 01). Conclusion The therapy approach of ultrasound-guided Mammotome operation through the retromammary space has lower hemorrhagic complication,as well as the better effect with special advantages. Therefore it has prospective clinical application.

DNA image cytometry in breast fine needle aspiration cytology / 肿瘤研究与临床

Objective To discuss the diagnosis value of DNA imaging cytometry (DNA-ICM) analysis in fine needle aspiration cytology (FNAC).Methods Conventional cytopathology and DNA-ICM were used to detect 95 fine needle aspiration patients with breast masses.The results were analyzed according to the histopathological diagnosis.Results There was not significant difference between conventional cytopathology and DNA-ICM [88.4 ％(84/95) vs.94.7 ％(90/95)] (x2 =2.457,P =0.117).Two false positive cases had been found in conventional cytopathologic diagnosis,but not in DNA-ICM.There was a positive correlation between the nucleus area and its DNA content (r =0.744,P =0.000).By DNA-ICM,the detectable rate of abnormal DNA content in the infiltrating ductal carcinoma was higher than that in the infiltrating lobular carcinoma [90.3 ％(65/72) vs.50.0 ％(4/8)] (P =0.011).Conclusion The detection of DNA-ICM can reduce the false positive rate of FNAC,but it has limitations in diploid tumors.

Quantitative DNA analysis in diagnosis of benign and malignant breast masses / 中国综合临床

Objective To explore the application of quantitative DNA analysis in differential diagnosis of benign and malignant breast masses to aid the surgery plan formation.Methods Four hundred and eighty-eight patients with breast mass were enrolled into this study.Tissues of breast mass in patients were gained by fine-needle aspiration puncture.Two sections were made from each sample,one was stained by Papanicolaou for regular cytology analysis and another was stained with Feulgen for quantitative DNA analysis.Pathological results were confirmed in each case after surgery.Results One hundred and sixty-four cases were classified as patients with benign neoplasm,while the other 324 cases were classified as malignant neoplasm,according to the pathological examination results.The sensibility and specificity were 91.4%(296/324) and 92.7%(152/164) for regular cytological method,90.1%(292/324) and 100.0%(164/164) for quantitative DNA analysis method.Meanwhile the positive predictive and negtive value of quantitative DNA analysis was 100.0%(292/292) and 83.7%(164/164),of which regular cytological methods were 96.1%(296/308) and 84.4%(152/180).Conclusion The quantitative DNA analysis might assistant differential diagnosis of benign and malignant breast tumor.

Diagnostic Value of Digital Mammography, Color Dopplor Ultrasonography and Physical Examination for Breast Masses / 实用放射学杂志

Objective To evaluate the diagnostic value of physical examination,digital mammography and color Dopplor ultrasonography for breast masses.Methods The materials of clinic,digital mammography and color Dopplor ultrasonogrpahy(US)in 92 women(raged from 18～80 years old in age,with average of 49.8 years old)with breast masses confirmed by pathology were retrospectively analysed,including benign in 43 and malignant in 49.Digital mammographic findings including the location,shape,margins,calcifications and the lymph node of axillary of the breast lesions,and color Dopplor ultrasonographic findings including mainly the characteristics of lesions on two-dimensional sonography,the distribution of the internal and peripheral vessels of the lesions were observed,the physical examination mainly observed the skin and nipple,and the margins,texture and movement of the lesions.Results In diagnosing breast masses,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 85.71%,79.07%,82.35%,82.93% and 82.61%,respectively with digital mammography,79.59%,83,72%,84.78%,78.26% and 81.52%,respectively with US,71.42%,76.74%,77.78%,70.21%,73.91%,respectively with physical examination,while were 91.84%,93.02%,93.75%,93.3% and 90.91%,respectively in combination with three methods,which were significantly higher than that of each single examination(P＜0.05),but there were no differences between each examination(P＞0.05).Conclusion It can improve the diagnosing accuracy of breast masses by suitable combination of three of digital mammography,color Dopplor ultrasonography and physical examination.

Analysis of the Mammotome system minimally invasive excision of breast lesions in 1081 patients / 中国介入影像与治疗学

Objective To evaluate the clinical application of ultrasound-guided Mammotome system in the treatment of breast lesions.Methods A total of 1081 patients with 1913 breast lesions received Mammotome minimally invasive excision,and the efficacy of treatment and follow-up results were retrospectively analyzed.Results All 1913 lesions in 1081 patients were treated with the Mammotome system.The duration of operation was 4 minutes,and the average excision times was 15 for every lesion,1894 lesions (99.01%) in 1063 patients were benign breast masses,19 lesions (0.99%) in 18 patients were breast carcinoma.Complication occurred in 39 lesions (2.04%).Conclusion Ultrasound-guided Mammotome system is one of the effective ways in the clinical diagnosis and treatment of breast lesions.

Application of ultrasound guided mammotome minimally invasive biopsy system in 42 cases of breast mass / 中国癌症杂志

Purpose:To evaluate the Application of Ultrasound Guided Mammotome Minimallay Invasive Biopsy System in diagnosis and treatment of breast masses. Methods:68 breast lesions in 42 patients were performed by Ultrasound Guided Mammotome Minimallay Invasive Biopsy System in order to evaluateits diagnostic and therapeutic ifficacy. Results:40 lesions were diagnosed as fibroadenoma , 19 lesions as fibroadenomatoid hyperplasia, 7 lesions as breast adenosis,2 lesions diagnosed as galactocele in operation but fibre and fat tissue after operation by pathology. 67 lesions were excised by mammotome system. 1 lesion was stopped duete hmorrage,1 case had serious hematoma. 1 case had machine failure but was resolved. The excision times were on the average 28 in every lesion,the lengh of incision is only 3mm,and the duration of operation was 30 minutes. No evidence of recurrence was found by physical examination and the ultrasound evaluation during the follow up 1~6 monthes. Conclusions:Ultrasound guided mammotome minimallay invasive biopsy system excision for benign breast mass was complete and the postoperative breast appearance was satisfactory.

High-Frequency Ultrasonography Combined with Color Doppler Velocimeter for Differential Diagnosis of Breast Masses / 广州中医药大学学报

[ Objective ] To evaluate the significance of high-frequency ultrasonography (HFU) combined with color Doppler velocimeter (CDV) for the differential diagnosis of breast masses (BM) . [Methods] HFU and CDV findings in 113 cases of BM were compared with their pathological findings. [Results] There was a certain relationship between HFU findings and pathological findings. The detectable rate for the blood flow accounted 97.80% in breast cancer examined with HFU, resistance index (RI) being 0.77?0.06; detectable rate for benign BM was 61.76%, RI being 0.52?0.05. The difference was significant between the two detectable rates (P

Tc-99m MIBI scintimammography (SMM) in the evaluation of palpable breast masses.

Radionuclide breast imaging, also called scintimammography (SMM) was performed using Tc-99m MIBI in 37 patients with palpable breast masses. A total of 38 lesions were analyzed. Twenty cases subsequently underwent modified radical mastectomy while the remainder underwent only biopsy or fine needle aspiration for histologic proof. The average size of the masses were 3.03+1.61 x 4.10+2.89 cm in diameter. Twenty-six lesions were malignant and 12 were benign; 23 malignancies showed positive MIBI uptake but three did not. The false negative cases were all invasive ductal carcinomas. Nine benign lesions were true negatives and three were false positives. They were mastitis, foreign-body granuloma and fat necrosis which chronic inflammation. Of 14 cases which histologically proved to have axillary node metastasis, only 7 revealed positive MIBI uptake. The sensitivity and spectively. However, in the detection of axillary node metastasis, the sensitivity was only 50 percent. Thus, Tc-99m MIBI SMM is helpful in the diagnosis of routine mammography. However, the imaging is not accurate enough for the detection of axillary node metastasis. In addition, Tc-99m MIBUI SMM also plays an important role in terms of prognosis and therapeutic planning in patients with breast cancer.

Breast masses: A histological review of 3,560 cases.

A histological review was made of 3,560 cases of breast masses in the Department of Pathology, Siriraj Hospital during the period of January, 1978 to December, 1980. The diagnosis of lesions was based on internationally accepted WHO’s classification of breast tumours. Benign lesions were found in 3,036 cases (85.28 percent) and malignant disease in 524 cases (14.72 percnet). Fibrocystic diseases. Less in order of frequency were fibroadenoma (34.32 percent), female carcinoma (14.18 percent) and gynaecomastia (6.80 percent). In the age group between 10 to 30 years, the most common lesion was fibroadenoma which was found in 50 percent of this group. In the age group between 31 to 50 years, fibrocystic disease was the most frequent disease; it comprised 49 percent of this group. Carcinoma of the female breast was the most common condition in the age group over 50 years; it was comprised 58 percent of the cases. The most common type of carcinoma was invasive ductal carcinoma which comprised 83 percent of the cases. The average age of the patients having fibroadenoma, fibrocystic disease and female carcinoma was 25, 33 and 50 years respectively. Gynaecomastia was the most common lesion in male breast; it comprised 93 percent of breast masses in males. Male breast carcinoma was rare and it occurred at a later age than carcinoma of the female breast.