Underestimation of Ductal Carcinoma In situ on Sonographically Guided Core Needle Biopsy of the Breast

PURPOSE: The purpose of this study was to determine the underestimation rate of ductal carcinoma in situ (DCIS) on sonographically guided 14-gauge core needle biopsy of the breast and to investigate the factors associated with this underestimation. MATERIALS AND METHODS: We retrospectively reviewed 2990 consecutive lesions that underwent sonographically guided 14-gauge core needle biopsy between January 2005 and December 2008. Among them, 61 lesions were pathologically proven to be DCIS (2.04%). A total of 50 DCIS lesions (mean patient age: 50.7 years old, age range: 36-79 years old) that underwent surgical resection were included in this study. After surgery, the lesion proven to be invasive was defined as being in the underestimated group and the lesion proven to DCIS was defined as being in the correctly diagnosed group. We determined the underestimation rate of DCIS and we retrospectively reviewed and compared the clinical, pathologic and radiologic features of the two groups. RESULTS: The underestimation rate of DCIS was found to be 28% (14 of 50 lesions). The underestimation of DCIS was significantly frequent for a clinically palpable lesion (78.6% (11/14) vs. 30.5% (11/36), respectively, p = 0.002). The sonographically maximal diameter of a lesion was significantly larger in the underestimated group than that in the accurately diagnosed group (28.4 +/- 14.0 mm vs. 17.6 +/- 10.3 mm, respectively, p = 0.017) and underestimation was significantly frequent when the sonographic lesion size was > 20 mm (p = 0.012). There was no significant difference in terms of age, the lesion type, the Breast Imaging-Reporting and Data System (BI-RADS) category or the pathologic features between the two groups. CONCLUSION: The underestimation rate of DCIS was 28% for sonographically guided 14-gauge core needle biopsy of the breast. Clinical symptoms such as a palpable lesion and a sonographic lesion size > 20 mm were the factors related with the underestimation of DCIS.

Mass Forming Pseudoangiomatous Stromal Hyperplasia of the Breast: Sonographic Features

PURPOSE: The object of this study was to describe the sonographic findings of mass-forming pseudoangiomatous stromal hyperplasia. MATERIALS AND METHODS: A retrospective review of ten patients with breast sonography and five patients with mammography who had pseudoangiomatous stromal hyperplasia presenting as a breast mass. All cases were confirmed by surgical biopsy. RESULTS: The mean age of the 10 patients was 41 years old (21 -51) and the mean mass size was 4.7 cm (2.5-10). On sonography, all lesions were oval shaped and well circumscribed, hypoechoic masses. Nine of the ten lesions presented with homogeneous internal echogenicity and one lesion with a complex heterogeneous pattern with a small internal cyst. A mammogram was performed in five patients and all lesions were oval, well circumscribed, high density masses. CONCLUSION: Sonographic findings of mass-forming pseudoangiomatous stromal hyperplasia of the breast were similar with those of other benign breast masses, so biopsy should be performed for diagnosis.

Breast Lesions with Discordant Results on Ultrasound-guided Core Needle Biopsy

PURPOSE: We wanted to evaluate the characteristics of those lesions showing insufficient results on ultrasound-guided core needle biopsy. MATERIALS AND METHODS: We retrospectively reviewed the pathologic results of 131 lesions from patients who underwent ultrasound-guided core needle biopsy following Mammotome or surgical excisional biopsy from January 2004 to December 2004. RESULTS: Compared with excisional biopsy, ultrasound-guided core needle biopsy showed 14 lesions with discordant results and 9 lesions with indeterminate results. 5 lesions were overestimated and 9 lesions were underestimated on the core needle biopsies. According to the histological tumor types, the papillary tumors showed 66.6% discordance or indetermination, and the phyllodes tumors showed 50% discordance or indetermination. CONCLUSION: On the results of core needle biopsy, discordant or indeterminate results were frequently reported for papillary and phyllodes tumor. Therefore, excisional biopsy is recommended for these types of tumor.

Sonographic Findings of Breast Hamartoma: Emphasis on Compressibility

The characteristic features of hamartoma in terms of discrepancies in mammographic and sonographic shapes of the mass were evaluated. We reviewed 16 pathologically proven breast hamartomas, which had undergone preoperative mammography and ultrasonography. All masses were analyzed according to ACR-BIRADS on mammography. On sonography, each mass was analyzed for size, shape, margin, internal echogenicity, and posterior acoustic enhancement. We also analyzed the echogenicity of halo, and compared the characteristic changes in the shape of hamartomas attributable to compression in mammograms and sonograms. The most common sites were at 12 o'clock in the right breast and 2 o'clock in the left. The most common mammographic findings of the hamartomas were a round shape (11/16), a circumscribed margin (13/16), internal fat densities (D4) (16/16) and radiolucent halos (14/16). The most common sonographic findings of the hamartomas were an oval shape (16/16), circumscribed margins (10/16), heterogeneous internal echogenicity (14/16), echogenic (7/16) or echolucent halos (5/16), and posterior enhancements (12/16). The characteristic feature of hamartomas was a change of the mammographic round shape mass into an elongated oval shape mass by sonography (11/11), suggesting the compressibility of hamartomas. Three of the hamartomas contained a pathologically proven internal calcification. The presence of a hamartoma was suggested by a change in a mammographic round mass with a radiolucent halo into an oval heterogeneous mass surrounded by an echogenic or echolucent halo on the sonogram. This characteristic difference between the mammographic and sonographic findings was attributed to the hamartoma compressibility, and was associated with the over-proliferation of fat containing mature normal breast tissue.

Signet Ring Cell Carcinoma of the Breast: Clinical and Radiologic findings

PURPOSE: To evaluate the clinical and imaging findings of signet ring cell carcinoma of the breast. MATERIALS AND METHODS: We retrospectively evaluated the clinical, mammographic and ultrasonographic (US)findings of five patients aged 23 -49 (mean 37) years with signet ring cell carcinoma of the breast. Diagnosis involved US-guided core-needle biopsy. In all patients the stomach was evaluated endoscopically after confirmation of the breast lesion. Metastatic breast cancer was confirmed in four patients and primary breast cancer in one. RESULTS: Three of the four patients with metastatic signet ring cell carcinoma complained of breast pain and swelling or enlargement. Mammography indicated the presence showed of diffuse increased density and skin thickening, without calcifications, while US demonstrated diffuse marked skin thickening, lymphatic dilatation, and axillary lymph node enlargement. Neither modality revealed the presence of mass, however. In the remaining patient, an enlarged breast mass was observed; mammography showed no abnormality, but US revealed an illdefined hypoechoic mass. Mammographic and US findings in the patient with primary signet ring cell carcinoma of the breast indicated an ill-defined spiculated mass, resembling other breast carcinomas. CONCLUSION: Metastatic signet ring cell carcinoma of the breast showed clinical symptoms similar to these seen in inflammatory breast cancer, though the former condition occurred in younger women. Radiographs demonstrated diffuse increased density and skin thickening without associated microcalcifications or mass.

Analysis of 62 Cases with Stereotaxic Breast Biopsy with a Prone Table System: Emphasis on Lesions with micro calcifications

PURPOSE: To evaluate the efficacy of stereotaxic breast core biopsy using a prone table system, and theeffects of operator experience, lesion characteristics and number of samples on biopsy results in cases involvingnonpalpable breast lesions. MATERIALS AND METHODS: We performed stereotaxic core biopsies of 62 nonpalpablemammographic lesions in 61 patients. Subsequent surgical excision was performed in 11 cases with micro calcifications and one case with a mass. We equally divided patients with micro calcifications into two groups(early and late periods) and analyzed the mammographic findings. Correlation of the pathologic results of corebiopsy with those of surgical excision were investigated. RESULTS: In two patients, stereotaxic biopsy wasimpossible due to poor visibility of micro calcifications and thinness of the compressed breast. In 59 patients,core biopsy was successfully performed and specimens were adequate for pathologic examination. The average numberof micro calcifications seen on specimen mammography in the two groups was 1.8 (range: 0~8) and 2.5 (range:0~4)respectively. In patients from whom less than five and five or more samples were taken, the average number of micro calcifications seen on specimen mammography was 1.5 (range: 0~6) and 2.6 (range: 0~8), respectively,throughout the whole period. The pathologic findings were fibrocystic change in 50 cases, fibroadenoma in four,ductal carcinoma in situ in four, invasive ductal carcinoma in one, and atypical ductal hyperplasia in one. Theagreement rate of pathologic results between core biopsy and surgical excision was 83% (10/12) for malignancy and75% for histology. In three cases with disagreement between core and surgical pathologic results, the samplingnumber was small (3~4 times) and in two of the three cases, micro calcifications were not visible on mammography. CONCLUSION: Operator experience and sampling numbers larger than five results in an increased number of micro calcifications in specimens and more reliable core biopsy.

Usefulness of Mammography of Mastectomy Site for Breast Cancer

PURPOSE: To evaluate the usefulness of routine mammography in the detection of local recurrence of breast cancer after mastectomy. MATERIALS AND METHODS: The clinical and mammographic records of 45 patients whounderwent modified mastectomy due to breast cancer were prospectively reviewed. The methods of mastectomy wereAuchincloss (n=36), Patey (n=8) and simple resection (n=1). RESULTS:s Among the 45 patients, five palpable lesionswere detected on physical examination: two of the five were confirmed as tumor recurrence; on mammography, anodule with microcalcifications and low-density lesion was seen, but the other three were benign. In 40 patientsthe results of palpation were negative and during follow-up (mean, 10.9 months ) no newly developed lesions wereseen. On mammography, ten of 45(22.2%) patients showed abnormalities, namely local skin thickening(n=4,40%),increased density in subcutaneous tissue(n=2,20%), nodules(n=2,20%), benign calcification(n=1,10%) and focallow-density lesion(n=1,10%), but only one case with a nodule was confirmed to be recurrence. CONCLUSION: Routinemammography of a mastectomy site was not useful for the differentiation of palpable lesions.

Diagnostic Value of 3D-Gradient Echo Dynamic Contrast Enhanced MRI in Breast Cancer

PURPOSE: To assess the usefulness of 3D-gradient echo dynamic contrast enhanced MRI (3D-DMRI) in the diagnosis of breast cancer and to determine the most useful parameter for this diagnosis. MATERIALS AND METHODS: Using a 1.0T MR unit, (Magnetom, Siemens, Erlaugen, Germany), 3D-DMRI (TR/TE=30/12) with Gd-DTPA was performed in 38 cases of breast cancer, 22 of fibroadenoma, and in three normal volunteers. We retrospectively evaluated the findings according to the speed on dynamic study and maximal amount of contrast enhancement during the delayed phase; we calculated the contrast index and morphology of the cancers and compared diagnostic accuracy among these three diagnostic parameters. RESULTS: On conventional spin-echo T1- and T2-weighted images, there was no significant difference of signal intensity between benign fibroadenoma and breast carcinoma. Rapid contrast enhancement (within one minute) was noted in 35 breast cancer lesions (92.1%), but relatively low and slow contrast enhancement (after five minutes) was noted in three such lesions (7.9%). Gradual contrast enhancement was noted in 21 lesions of fibroadenoma (95.5%), but a moderate degree of rapid contrast enhancement (from three to five minutes) was noted in the other case (7.9%). of On the delayed enhanced phase of 3D-DMRI, the maximal amountof contrast enhancement showed no significant difference between fibroadenoma and cancer. On 3D-DMRI, an irregular, spiculated border, with high contrast enhancement was noted in all cases of breast cancer, in particular, irregular thick peripheral contrast enhancement with central necrosis was noted 11 cases (28.9%). CONCLUSION: For the diagnosis of breast cancer, 3D-DMRI is a useful technique. Among the diagnostic criteria of speed, maximal amount of contrast enhancement and morphology, morphologic change after contrast enhancement study was the most useful diagnostic parameter.