Stereotactic core breast biopsy of a minimal carcinoma complicated by a large hematoma: a management dilemma.

Stereotactic core biopsy of a 4-5-mm, suspicious mammographic lesion was complicated by substantial hematoma formation in a patient with subsequently diagnosed factor XI deficiency. As a result, the small infiltrating ductal carcinoma could no longer be identified at mammography to allow accurate needle localization for lumpectomy. Sufficient resorption of the hematoma at 3 months permitted successful needle localization and lumpectomy. In these cases, expectant management may obviate extensive surgery.

Stereotaxic 14-gauge breast biopsy: how many core biopsy specimens are needed?

PURPOSE: To determine the optimum number of specimens to obtain at stereotaxic core breast biopsy. MATERIALS AND METHODS: Stereotaxic biopsies were performed in 145 mammographically evident lesions by using a dedicated table with patients in the prone position. Samples were obtained with an automated gun and a 14-gauge needle. Indications for biopsy were calcifications (n = 53) and masses (n = 92). Three to 11 (mean, 5.4) core biopsy specimens were obtained per lesion and were analyzed separately. RESULTS: Diagnostic material was obtained in the first specimen in 102 (70%) of the 145 lesions. Obtaining two, three, four, five, and six core specimens yielded a diagnosis in 117 (81%), 129 (89%), 132 (91%), 137 (94%), and 140 (97%) of the 145 lesions, respectively. Obtaining five specimens yielded a diagnosis in 46 (87%) of the 53 calcifications and 91 (99%) of the 92 masses. Obtaining six specimens resulted in a diagnosis in 49 (92%) lesions evident as calcifications but did not improve the yield on masses. CONCLUSION: Stereotaxic 14-gauge core biopsy achieved a 99% diagnostic yield with five specimens for masses. Additional specimens may be necessary to diagnose some calcified lesions.

Non-Hodgkin lymphoma of the breast: imaging characteristics and correlation with histopathologic findings.

PURPOSE: To determine the imaging characteristics of non-Hodgkin lymphoma (NHL) of the breast and correlate these findings with histopathologic subtype. MATERIALS AND METHODS: The authors retrospectively reviewed records in 32 cases of histologically proved NHL in 29 women. Mammography was performed before biopsy in all cases, and breast sonography was performed before biopsy in eight. RESULTS: Mammary NHL was primary in 21 of the 32 cases (66%) and secondary in 11 (34%). Mammography revealed a solitary, uncalcified mass in 22 cases (69%), multiple masses in three (9%), and diffuse increased opacity with skin thickening in three (9%). Four cases (13%) had normal findings. Seven of the eight sonograms revealed masses, which were solitary in five and multiple in two. Histologic examination showed diffuse NHL in 26 cases (81%) and follicular NHL in six (19%). No mammographic or sonographic features were identified that helped distinguish primary from secondary disease or follicular from diffuse NHL. CONCLUSION: Although the imaging characteristics may suggest the possibility of breast NHL, none of the findings are pathognomonic. The imaging pattern of mammary NHL is unrelated to its histopathologic subtype.

Imaging of pregnancy-associated breast cancer.

PURPOSE: To assess the use of mammography in diagnosis of pregnancy-associated breast cancer (PABC). MATERIALS AND METHODS: A retrospective review of medical records between 1973 and 1993 was performed in 85 women with breast cancer diagnosed during pregnancy or within 1 year after pregnancy. In 21 of these women, mammography was performed before biopsy; the mammographic findings in this study group, which had 23 cases of invasive carcinoma, were reviewed for signs of malignancy. Breast sonography was performed in six cases in five women; sonographic findings were also reviewed. RESULTS: Mammographic findings were present in 18 of 23 cases (78%), including mass (n = 13) (nine cases with calcification), suspicious calcifications (n = 4), and diffusely increased parenchymal density (n = 1). Breast sonography revealed focal solid mass in six of six cases. Axillary lymph node metastases occurred in 15 of 23 cases (65%). Although symptoms occurred before or during pregnancy in 12 cases (52%), PABC was diagnosed after pregnancy in 19 cases (83%). CONCLUSION: PABC is often advanced at diagnosis and associated with poor prognosis. Breast imaging studies usually demonstrate focal findings due to clinically evident PABC.

Inflammatory breast carcinoma: mammographic findings.

PURPOSE: To identify and quantitate mammographic characteristics of inflammatory carcinoma (IC). MATERIALS AND METHODS: A retrospective analysis was made of the clinical and mammographic findings in 22 women (aged 31-66 years [mean, 51 years]) with IC, who were seen between 1980 and 1990 at the authors' institution. RESULTS: A palpable mass was present in 17 of the 22 women (77%); skin thickening, axillary adenopathy, nipple inversion, and erythema were common findings. At mammography, the findings in one woman with dense breasts were negative. A primary tumor, evident on the basis of a mass and/or malignant-type calcifications, was seen in all other cases. Skin thickening was present in 15 women, stromal coarsening in 11, diffusely increased breast density in nine, and axillary adenopathy in five. CONCLUSION: IC has a mammographic pattern of inflammatory changes: skin thickening and stromal coarsening and/or diffusely increased breast density, associated with evidence of a primary tumor mass and/or calcifications. In this series, inflammatory changes without an associated mass and/or malignant-type calcifications were not seen in women with IC.

Radiography of microcalcifications in stereotaxic mammary core biopsy specimens.

PURPOSE: To describe the technique of specimen radiography in stereotaxically guided core biopsies and evaluate its role in detection and diagnosis of microcalcifications in breast tissue. MATERIALS AND METHODS: Specimens from 361 stereotaxic breast core biopsies of 72 nonpalpable lesions with mammographic evidence of microcalcifications were obtained from 65 patients. Specimens were placed in saline on microscope slides and radiographed. RESULTS: Microcalcifications were detected radiographically in 146 of 361 (40%) cores. If calcifications were present on specimen radiographs, histologic detection of these calcifications was made in 114 of 146 (78%) specimens, and diagnosis was made in 118 of 146 (81%). If calcifications were not present on specimen radiographs, histologic detection was obtained in 27 of 215 (13%) specimens and specific diagnosis in 81 of 215 (38%). CONCLUSION: Specimen radiography should be routinely performed in stereotaxic core biopsies of breast microcalcifications to ensure appropriate tissue has been obtained and to direct pathologic diagnosis of the tissue specimens.

Microcalcifications on postoperative mammograms as an indicator of adequacy of tumor excision.

Mammograms, including microfocus spot magnification views, were obtained before reexcision of the tumor-ectomy site in 43 women with breast carcinoma. These studies were prospectively evaluated by radiologists experienced in breast imaging. All women had mammographically evident microcalcifications associated with their original tumors. In all, tumor was at or near the margin of resection or the status of margins was unknown, necessitating reexcision of the tumorectomy site. Of 29 women with residual microcalifications, 20 had residual tumor. The positive predictive value of residual microcalcifications was 0.69. The positive predictive value was greatest (0.90) in women with ductal carcinoma in situ, when more than five microcalifications were present. Residual microcalifications not due to carcinoma were secondary to sclerosing adenosis, fat necrosis, and foreign body granuloma. Of the 13 cases in which no residual calcifications were left after tumorectomy, residual tumor was found in four. The negative predictive value of the absence of calcifications for total excision of tumor was 0.64 for all tumor types and was 1.0 for the noncomedo subtype of ductal carcinoma in situ.

Screening mammography: value in women 35-39 years old.

OBJECTIVE: The value of screening mammography for detecting early breast cancer in younger women is not widely recognized. We review the results of screening mammography and of breast biopsies performed on the basis of mammographic findings in women 35-39 years old to determine the detection rate for breast cancer and the stage of breast cancers detected at mammographic screening in this age group. MATERIALS AND METHODS: Computer-tabulated results of mammography in women 35-39 years old who participated in a mobile mammographic screening program during the 36-month period from January 1989 to December 1991 were retrospectively reviewed with a standardized data collection form. Pathology reports from biopsies recommended on the basis of screening mammograms or follow-up examinations (coned views/sonograms) also were reviewed. Data were compared with results of mammographic screenings and pathologic findings at biopsy in women 40-49 years old who participated in this screening program during the same period. RESULTS: A total of 5105 screening mammograms were obtained in women 35-39 years old. Of these, 4654 (91%) showed no abnormalities. Biopsy was recommended in 36 (< 1%). Eight biopsies showed carcinoma, intraductal in five and stage I infiltrating ductal in three. Mammograms showed calcifications in all cancers detected; two infiltrating cancers also had an associated mass. The number of breast cancers detected was 1.6 per 1000 screenings, comparable to our rate of 1.4 cancers per 1000 screenings in women 40-49 years old. Because the number of cancers detected was small, the 95% confidence interval for the ratio of detection rates was wide, ranging from 2.56:1 to 1:2.29. CONCLUSION: Early stage tumors in women 35-39 years old can be detected on mammograms. The breast cancer detection rate in women 35-39 years old was comparable to that for women in their forties in our population; however, our data do not exclude a more than twofold difference in detection rates between these two groups. These data should be considered in determining the value of mammographic screening in women 35-39 years old.

Mammographic findings in men with breast cancer.

OBJECTIVE: Our objective was to identify the mammographic findings of breast cancer in men. MATERIALS AND METHODS: The mammograms of 23 men with proved breast cancer (mean age, 63 years; range, 44-86 years) were retrospectively reviewed. Medical histories included gynecomastia in five, prior cancer in three, and radiation exposure in two. The most common signs were a mass in 13 and bloody nipple discharge in eight. RESULTS: Carcinoma was evident mammographically as an uncalcified mass in 17 patients (74%) and as a mass with microcalcifications in two patients (9%). Three tumors were not evident on mammograms, including one that was obscured by gynecomastia. Tumors were largely subareolar (14/17, 82%), and all were ductal cancers, including six pure intraductal carcinomas. CONCLUSION: Mammograms of men with breast cancer usually show an uncalcified subareolar mass, which may mimic or be obscured by gynecomastia. If calcifications are present, they may not have a pattern usually associated with malignancy.

Primary adrenocortical carcinoma: CT evaluation with clinical correlation.

Clinical histories and CT findings were reviewed in 38 patients with primary adrenocortical carcinomas. The primary tumors exhibited central areas of low attenuation representing tumor necrosis (n = 26), irregular contrast enhancement (n = 16), detectable calcification (n = 9), and a thin, capsulelike rim surrounding the tumor (n = 7). Tumors metastasized to liver (n = 9), lung (n = 5), and lymph nodes (n = 5). In eight of nine cases of liver metastasis the primary tumor arose in the left adrenal gland. Evidence of endocrinopathy was present in each of nine patients with lesions 6 cm or less in diameter, but in only two of seven adults with lesions exceeding 15 cm in diameter. We conclude that, contrary to established concepts, adrenocortical carcinoma may present as a smooth, homogeneous, functioning mass 6 cm or less in diameter on CT.