Relación ultrasonográfica y anatomopatológica de las lesiones quísticas complejas de la mama / Relationship between ultrasonography characteristics and histopathological diagnosis of breast complex cyst lesions

Introducción: los quistes mamarios son frecuentemente diagnosticados por ecografía. Los quistes complejos tienen una posibilidad sustancial de resultar malignos y se consideran como lesiones BIRADS IV o V, y, por tanto, se hace necesario su análisis citohistológico. Objetivo: determinar la relación entre las características ecográficas y el análisis anatomopatológico en las lesiones quísticas complejas. Material y Métodos: sSe realizó un estudio observacional, descriptivo, longitudinal. Se estudiaron las características ecográficas y resultados citohistológicos de 243 masas quísticas complejas. Los resultados se expresaron en sus respectivas medidas de resumen y se utilizó el Test de Chi Cuadrado. Resultados: el 56,0 % de las lesiones quísticas complejas resultaron benignas, mientras que 44,0% fueron malignas. Los quistes complejos que presentaron el mayor porcentaje de benignidad fueron los tipo I con contornos regulares (85,8%), márgenes circunscritos (91,7%) y orientación paralela (81,1%). La malignidad predominó en los tipo IV con contornos irregulares (77,8%), orientación no paralela (88,0%), y en los tipo I con márgenes no circunscritos (90%). El 63,8% de las lesiones complejas tipo IV fueron malignas. Conclusiones: el mayor porcentaje de positividad de células neoplásicas se encontró en las lesiones complejas tipo IV. Existió diferencia estadística en cuanto benignidad y malignidad, a predominio de benignidad, en las lesiones complejas con contornos regulares y márgenes circunscritos, y a predominio de malignidad, en los quistes con contornos irregulares, márgenes no circunscritos y orientación no paralela.

Introduction: breast cysts are diagnosed by ecography frecuently. Breast complex cysts have an important possibility of been malignant and they are classified as IV or V lesions in the BIRADS score. Thus, it is necessary its histological analisis. Objective: to prove relationship between ultrasonography characteristics and histopathological diagnosis of breast complex cyst lesions. Material and Methods: a descriptive-longitudinal study was carried out. Ecographical characteristics and histopathological diagnosis of 243 breast complex cyst masses were studied. Data were processed at statistic package SPSS 11.5 version for Windows and were expressed in percentages for descriptive statistics and Chi square test for inferential statistics. Results: the 56,0% of breast complex cysts were benign, meanwhile, 44,0% were malignant. Complex cysts with major percentages of benignancy were type I with regular edges (85,8%), circumscribe edges(91,7%), and paralell orientation(81,1%). Malignity prevailed in complex cysts Type IV with irregular edges (77,8%), antiparalell orientation (88,0%), and Type I with non circumscribe edges (90,0%). The 63,8% of Type IV complex lesions were malignant. Conclussions: major percentage of breast neoplasm were found in type IV complex cysts. There was statistic difference as benignancy and malignity, prevailing benignancy, in complex lesions with regular edges and circumscribe edges, and prevailing malignity, in complex cysts with irregular edges, non circumscribe edges and antiparallel orientation.

Complex Cysts of the Breast: Analysis using Sonographic Breast Imaging Reporting and Data System

PURPOSE: The purpose of this study was to evaluate the usefulness of sonographic BI-RADS in differentiation between benignity and malignancy of complex breast cysts. MATERIALS AND METHODS: Among 855 female patients who underwent ultrasound-guided core needle biopsy at our hospital from March 2012 through August 2012, 82 pathologically proven complex cysts detected on ultrasonography were included. The BI-RADS classification was made by radiologists prospectively and the imaging characterization of cystic lesions were classified retrospectively as cystic masses with a thick septa or thick wall, mixed solid and cystic masses, or solid masses with eccentric cystic foci. All lesions examined by ultrasonography were classified prospectively according to the BI-RADS lexicon. The pathologic findings were compared with sonographic appearance. We reviewed and compared the radiologic features between malignant lesions and benign lesions. RESULTS: Finally, according to biopsy results, there were 71 benign and 11 (13.4%) malignant lesions. The frequency of malignancy was significantly higher in solid masses with eccentric cystic foci (p value <0.025). The size of sonographic lesions was significantly larger in malignant lesions than in benign lesions (41.82 mm+/-34.36 vs 18.41 mm+/-16.8 respectively, p=0.049). No statistically significant difference was observed in the sonographic findings according to the BI-RADS lexicon, however, statistically significant difference in final assessment categories was observed between benign and malignant lesions (p value <0.001). CONCLUSIONS: The malignancy rate was higher in cystic lesions with predominantly solid masses and classified as suspicious malignancy using the BI-RADS lexicon.

Characterization of Cystic Breast Masses on Ultrasound: Comparative Study among Conventional, Tissue Harmonic, Compound, and a Combination of Tissue Harmonic and Compound Imaging

PURPOSE: This prospective study was to compare the image quality and diagnostic performance of breast cystic masses by conventional and advanced ultrasound (US) techniques including tissue harmonic, compound, and the combination of these techniques. MATERIALS AND METHODS: All 91 patients, collectively having 109 breast cystic masses were scanned using four US techniques (complicated cysts in 36, septated cysts in 33, and complex cysts in 40). Two breast radiologists independently assessed the image quality and possibility of malignancy. Image quality was evaluated in terms of contrast and clarity of the wall and internal echo pattern and then graded on a scale of 1 (poor) to grade 3 (satisfactory). The possibility of malignancy was graded on a scale of 1 (suggestive of benignancy) to 5 (suggestive of malignancy) using US images. The histopathological results and follow-up images were used as the reference standard for the assessment of diagnostic performance. Results were evaluated by Friedman's test and receiver operating characteristic (ROC) analyses. RESULTS: In terms of image quality, a grade of 3 was significantly more frequent in the three advanced US techniques than conventional US (p < 0.05). For assessment of diagnostic performance, areas under the ROC curves in three advanced techniques were significantly higher than in conventional US (p < 0.05). CONCLUSION: Advanced US techniques including compound and tissue harmonic US techniques provide a better image quality in breast cystic masses and also improve the diagnostic performance compared with conventional US.

Differentiation of Benign and Malignant Cystic Lesions of the Breast according to Sonographic Findings

PURPOSE: To classify the ultrasonographic findings of cystic lesions of the breast and correlated them with the pathology, to evaluate the characteristic features of cystic masses in benign and malignant tumors, and to determine the appropriate level of patient management according to the ultrasonographic findings. MATERIALS AND METHODS: From June 2002 through to June 2004, the ultrasonographic findings of 113 pathological proven cystic breast lesions were reviewed retrospectively. The cystic lesions were classified as simple acysts, clustered cysts, cysts with thin septa, complicated cysts, cystic masses with a thick wall/ septa or nodules, and complex solid and cystic masses. The ultrasonographic findings of each type of cystic lesion of the breast were compared with the pathology and evaluated according to whether they were benign or malignant. RESULTS: Of the 113 lesions, there were 17 simple cysts, 10 clustered cysts and 19 cysts with thin septa. Twenty four cases of complicated cysts were found to be benign. Five (31.3%) of the 16 cases of cystic masses with a thick wall / septa or nodules and 17 (63%) of the 27 cases of complex solid and cystic masses were found to be malignant. The shape and margin of the 43 cases of cystic masses with a solid component were analyzed. Seventeen out of 36 sonographical round or oval shaped masses and 10 out of 27 sonographical circumscribed margins were found to be malignant. CONCLUSION: The simple cysts, clustered cysts, cyst with thin septa and non-symptomatic complicated cysts detected by sonography were all benign. Symptomatic complicated cysts should be aspirated and treated appropriately. Cystic masses with a solid component should be examined by a biopsy with a pathological confirmation.

Morphologic Classification of Ductal Breast Tumors on Ultrasound: Differential Diagnosis of Benign and Malignant Tumors

PURPOSE: To evaluate the morphologic differential diagnosis of benign and malignant ductal breast tumors, as seen on US. MATERIALS AND METHODS: US findings in 29 pathologically proven cases of ductal breast tumor were retrospectively reviewed. All patients were female and their mean age was 42 years. Nineteen tumors were benign and ten were malignant, and all ductal or cystic lesions showed solid masses. According to the location of the mural nodule, we classified the sonographic appearance of these tumors into three types : intraductal, intracystic and amorphic. The intraductal type was divided into three subtypes: incompletely obstructive, completely obstructive and multiple mural nodules. For the intracystic type, too, three subtypes were designated : the intracystic mural nodule (mural cyst), intracystic mural nodule with the duct (mural cyst+duct) and intracystic multiple mural nodules. The amorphic type is defined as an atypical ductal tumor with the mural nodule extending into adjacent parenchyma. RESULTS: The margin of the duct or cyst was smooth in 68.4% of benign, and irregular in 90% of malignant ductal tumors. Internal echogeneity of the duct or cyst usually showed homogeneity in both benign and malignant tumors. 73.7% of tumors connecting the duct were benign and 50% were malignant. In benign tumors, 52.6% of mural nodule had an irregular margin, while in malignant tumors, the corresponding proportion was 100% ; both types usually showed heterogeneous hypoechogeneity. Among benign tumors, the most common morphologic type was the intraductal incompletely obstructive subtype (36.8%) ; among those that were malignant, the amorphic type was most common, accounting for 40% of tumors. No amorphic type was benign and no incompletely obstructive subtype was malignant. CONCLUSION: When ductal breast tumors are morphologically classified on the basis of sonographic findings, the intraductal incompletely obstructive subtype suggests benignancy, and the amorphic type, malignancy. The morphologic classification of ductal breast tumors based on sonography is therefore useful for the differential diagnosis of benignancy and malignancy.

Fibrocystic Change in Breast: Mammographic and Ultrasonographic Findings in Lower Risk Lesions

PURPOSE: We performed this study to define the characteristic mammographic and ultrasonographic findings in lower risk lesions of fibrocystic change and also tried to evaluate the role of both modalities in planning the treatment of these lesions. MATERIALS AND METHODS: We retrospectively reviewed 38 cases of mammography and 46 cases of ultrasonography in biopsy proven 55 cases of fibrocystic change, histologically showing the nonproliferative pattern or proliferative pattern without atypia. We analyzed the mammographic and ultrasonographic findings, final assessments, and compared the effectiveness of each modality. RESULTS: On mammography, there were no abnormalities in 20 cases(53%), nodules or masses in 9 cases(24%), microcalcifications in 6 cases(16%) and asymmetric density in 5 cases(14%). On ultrasonography, there were 40 cases(87%) of focalsonographic abnormality and no abnormality in 6 cases(13%). Most focal sonographic abnormalities were smooth(40cases, 93%), well-defined(21 cases, 49%) or ill-defined(22 cases, 51%) round or oval(36 cases, 84%) shaped, homogeneous(31 cases, 67%), hypoechoic(30 cases, 65%) lesions. Final assessment revealed that only 7 cases(18%) of mammography and 8 cases(18%) of ultrasound examinations were included into the category of indeterminate and malignancy groups which were recomended biopsy. Mammography was excellent to demonstrate the microcalcifications and ultrasonography was effective in depiction of the focal lesions. CONCLUSION: The mammography and ultrasonography findings were not specific in diagnosing lower risk group of fibrocystic change. But complementary study of both modalities in conjunction with clinical findings will be helpful in making decinion amary biopsy, fine needle aspiration, and simple close follow up of the lesions.