Characteristics and chronologically changing patterns of late-onset breast cancer in Korean women of age ≥ 70 years: A hospital based-registry study.

BACKGROUND: Women from Asian and western countries have vastly different ages of onset of breast cancer, with the disease tending to occur at an older age in the West. Through an investigation of the patterns of old-onset breast cancer (OBC) in Korean women, we aimed to identify the characteristics of Korean OBC and evaluate whether these patterns are changing in relation to increasing westernization. METHODS: This study retrospectively evaluated 102,379 patients who underwent surgical treatment of primary breast cancer between January 1, 2000 and December 31, 2013 in Korea. We used hospital -based breast cancer registry and analyzed data from these patients using multiple linear regression analysis to compare the characteristics and chronologically changing patterns between OBC (70 years of age or older) and non-OBC (40-69 years of age) patients in Korea. RESULTS: A total of 6% of the 102,379 patients had OBC. Overall, OBC had more favorable biological features, such as a higher incidence of luminal A subtype, than did non-OBC, except for a higher incidence rate of triple-negative breast cancer (TNBC). However, OBC also presented with a higher overall disease stage, including higher T and M stages. Although the incidence rates of both OBC and non-OBC have increased overtime, the relative proportion of OBC patients has slightly increased, whereas that of non-OBC has slightly decreased. The increase in the incidence of both OBC and non-OBC was primarily due to the luminal A subtype. CONCLUSIONS: Based on a hospital-based registry, overall, Korean OBC had favorable biological features but showed a higher rate of TNBC and advanced cancer stages. The incidence trend of breast cancer in Korea is slowly shifting toward an older age at onset, largely due to the luminal A subtype. Our results may provide novel insights into OBC in Asia, and aid in the development of optimal management of the disease in Asia. TRIAL REGISTRATION: Retrospectively registered.

Relationship Between Breast Ultrasound Background Echotexture and Magnetic Resonance Imaging Background Parenchymal Enhancement and the Effect of Hormonal Status Thereon.

We studied the relationship between breast ultrasound background echotexture (BET) and magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) and whether this relationship varied with hormonal status and amount of fibroglandular tissue (FGT) on MRI. Two hundred eighty-three Korean women (52.1 years; range = 27-79 years) with newly diagnosed primary breast cancer who underwent preoperative breast ultrasound and MRI were retrospectively studied. Background echotexture, BPE, and FGT were classified into 4 categories, and age, menopausal status, menstrual cycle regularity, and menstrual cycle stage at MRI were recorded. Background echotexture and BPE relationship was assessed overall, and in menopausal, FGT, menstrual cycle regularity, and menstrual cycle stage subgroups. Background echotexture and BPE correlated in women overall, and menopausal, FGT, and menstrual cycle subgroups and those in the first half of the cycle (all P < 0.001). Background echotexture reflects BPE, regardless of menopausal status, menstrual cycle regularity, and FGT and may be a biomarker of breast cancer risk.

Breast cancer in elderly Korean women: clinicopathological and biological features.

BACKGROUND: With an aging society, Korean women ≥70 years of age are increasingly being diagnosed with breast cancer. OBJECTIVE: To investigate the clinicopathological and biological characteristics of breast cancer in elderly Korean women and compare them with breast cancer in elderly (≥70 years) women globally and in Korean women of all ages. METHODS: We retrospectively reviewed the clinicopathological and biological features of breast cancer in elderly Korean women (≥70 years; n = 87) who sought treatment during 2004-2014 from a single institution. These data were indirectly compared with data of Korean women of all ages (nationwide Korean Breast Cancer Registry) or elderly women globally (meta-analysis). RESULTS: Compared to elderly women with breast cancer globally, Korean elderly women had a more symptomatic presentation, lower ER expression, and overexpression or amplification of human epidermal growth factor receptor 2. Compared to Korean women of all ages with breast cancer, elderly Korean women presented with advanced tumor stages, larger tumor size, more lymph node involvement, and more luminal B and basal-like subtypes. CONCLUSIONS: Breast cancer had a more aggressive clinicopathological and biological characteristics in elderly Korean women than in Korean women of all ages or elderly women globally.

Ultrasound Features and Rate of Upgrade to Malignancy in Atypical Apocrine Lesions of the Breast.

OBJECTIVES: To evaluate the ultrasound (US) features and rate of upgrade to malignancy in atypical apocrine lesions (AALs) of the breast, diagnosed on percutaneous needle biopsy. METHODS: This retrospective study included 17 AALs diagnosed by needle biopsy in 15 patients. For 16 of the 17 AALs, subsequent surgical excision (n = 14) or 8-gauge vacuum-assisted biopsy (n = 2) was performed. Ultrasound features were retrospectively analyzed according to the American College of Radiology Breast Imaging Reporting and Data System lexicon. RESULTS: Of 17 AALs, 13 (76.5%) were atypical apocrine hyperplasia; 3 (17.6%) were atypical apocrine adenosis; and 1 (5.9%) was combined atypical apocrine hyperplasia and atypical apocrine adenosis on needle biopsy. Subsequently, 4 of 16 AALs (25%) were upgraded to malignancy at surgical excision. On US imaging, all 17 lesions presented as masses, which were mainly irregular and noncircumscribed (n = 8) or oval/round and noncircumscribed (n = 7) with isoechogenicity or hypoechogenicity. Rarely, an AAL would show complex cystic and solid echogenicity (n = 1) or appear as a hypoechoic mass with oval shape and a circumscribed margin (n = 1). CONCLUSIONS: Atypical apocrine lesions of the breast often showed suspicious malignant features on US imaging. Given the high upgrade rate (25%), the diagnosis of an AAL by needle biopsy warrants subsequent surgical excision.

Intraobserver and interobserver reliability in sonographic size measurements of gallbladder polyps.

OBJECTIVES: To evaluate the intraobserver and interobserver reliability of gallbladder polyp measurements using transabdominal US and the factors that affect reliability. METHODS: From November 2017 to February 2018, two radiologists measured the maximum diameter of 91 gallbladder polyps using transabdominal US. Intraobserver and interobserver agreement were determined using 95% Bland-Altman limits of agreement and intraclass correlation coefficients (ICCs). The effects of image settings, polyp location, and polyp size were evaluated by comparing ICCs using z tests. RESULTS: The intraobserver agreement rates were 0.960 (95% confidence interval [CI], 0.939-0.973) for observer 1 and 0.962 (95% CI, 0.943-0.975) for observer 2. The ICCs between the two observers were 0.963 (95% CI, 0.926-0.979) for the first measurement and 0.973 (95% CI, 0.950-0.984) for the second measurement. The 95% limits of agreement on repeated measurements were 22.3-25.2% of the mean, and those between the two observers were 25.5-34.2% of the mean. ICCs for large polyps (≥ 5 mm) were significantly higher than those for small polyps (< 5 mm). There were no significant differences in the ICCs between image settings and polyp location. CONCLUSIONS: Polyp size measurements using transabdominal US are highly repeatable and reproducible. Polyp size significantly affects the reliability of measurement. Diameter changes of approximately less than 25% may fall within the measurement error; this should be considered while interpreting the change in size during follow-up US, especially for small polyps. KEY POINTS: • Gallbladder polyp size measurement using transabdominal US is highly repeatable and reproducible. • Diameter changes of approximately less than 25% should be interpreted carefully, especially in small polyps.

Reflector Localization of Breast Lesions and Parameters Associated with Positive Surgical Margins in Women Undergoing Breast Conservation Surgery.

OBJECTIVE: To evaluate our experience with reflector localization of breast lesions and parameters influencing surgical margins in patients with a malignant diagnosis. METHODS: A retrospective institution review board-approved review of our institutional database was performed for breast lesions preoperatively localized from September 1, 2016, through December 31, 2017. Wire localizations were excluded. From electronic medical records and imaging, the following data was recorded: breast density, lesion type and size, reflector placement modality and number placed, reflector distance from lesion and skin, excision of lesion and reflector, tissue volume, margin status, and final pathology. Statistical analysis was performed with a Fisher's exact test, Mann-Whitney test, and logistic regression. P < 0.05 was significant. RESULTS: A total of 111 reflectors were deployed in the breasts of 103 women with 109 breast lesions. Ninety (81.1%) reflectors were placed under mammographic guidance and 21 (18.9%) under US. The lesions consisted of 68 (62.4%) masses, 17 (15.6%) calcifications, 2 (1.8%) architectural distortions, and 22 (20.2%) biopsy markers. Fourteen (21.2%) of 66 cases with a preoperative malignant diagnosis had a positive surgical margin. Final pathology, including 6 lesions upgraded to malignancy on excision, demonstrated 72 (66.0%) malignant, 22 (20.2%) high-risk, and 15 (13.8%) benign lesions. Univariate and multivariate analysis revealed no statistically significant parameters (lesion type or size, placement modality, reflector distance to skin or lesion, specimen radiography or pathology) were associated with a positive surgical margin. CONCLUSION: Reflector localization is an alternative to wire localization of breast lesions. There were no lesion-specific or technical parameters affecting positive surgical margins.

An Unusual Cutaneous Recurrence of Carcinoma in the Mastectomy Bed and Its Imaging Features: A Case Report.

BACKGROUND Chest wall recurrences of carcinoma after mastectomy usually involve subcutaneous tissue or the deep muscular layer. Recurrences arising in the skin are rare, and there are few reports of the associated radiologic features. This report presents an unusual case of cutaneous recurrence in the mastectomy bed and demonstrates its radiologic features using sonography and magnetic resonance imaging (MRI). CASE REPORT A 44-year-old woman presented with a palpable lump in the inferomedial area of the right chest wall. Six years ago, she had undergone total mastectomy for ductal carcinoma in situ in her right breast. Sonography showed an indistinct, oval, heterogeneous echoic mass measuring 0.9 cm, confined within the skin layer, corresponding to the palpable lump. A color Doppler sonogram showed minimal, spotted vascularity in and around the mass. Sonography-guided fine-needle aspiration biopsy was performed, revealing multiple clusters of atypical cells, suggestive of ductal carcinoma. On subsequent breast MRI, the mass, measuring 1.3 cm, was again localized to the skin; dynamic contrast-enhanced scans showed a circumscribed margin, oval shape, and rim enhancement (morphology) and slow initial enhancement and persistent delayed enhancement (kinetics). The mass was surgically excised and the pathological examination confirmed the diagnosis as recurrent invasive ductal carcinoma in the dermis. CONCLUSIONS Cutaneous recurrence in the mastectomy bed can manifest as a mass with suspicious radiologic features: indistinct margin on the sonogram and rim enhancement on the MRI. Awareness of such radiologic features may aid in differentiating between the various cutaneous manifestations encountered after mastectomy.

Unusual Changing Calcification Patterns on the Mammogram in a Pure Mucocele-Like Lesion of the Breast: A Case Report.

BACKGROUND Mucocele-like lesions are rare breast lesions composed of mucin filled cysts and extravasated mucin that frequently undergo calcification. The most common radiologic feature of a mucocele-like lesion is mammographic microcalcifications of indeterminate nature. The present report demonstrated unusual fluctuation of calcification number and a changing pattern of calcification morphology on mammography in a benign mucocele-like lesion. CASE REPORT A 39-year-old female was referred to our breast clinic because of a screening mammography-detected abnormality in her right breast. The magnification mammogram of her right breast revealed approximately 8 cm of multiple adjacent masses accompanying regional coarse heterogeneous microcalcifications in the inner central area, which corresponded to multiple aggregated cystic lesions on sonography. Each cystic lesion had internal echoes of a complex cystic with solid and septated pattern. Although a biopsy was recommended, the patient refused the tissue diagnosis. During the first 12 months, the overall extent of mass and calcifications did not discernably change on magnification mammograms. However, minute focal changes in the calcification number were detected; single coarse calcification disappeared at 6-month follow-up, and new coarse calcification developed at 12-month follow-up. At 24-month follow-up magnification mammogram, coarse calcification overtly increased in number and size, and changed into a large bizarre dystrophic morphology. A pathologic diagnosis of a benign mucocele-like lesion without upgrade to atypia or malignancy was made using ultrasonography-guided vacuum-assisted biopsy and surgical excision. CONCLUSIONS When calcifications accompany cystic masses and chronologically change their morphologic pattern from indeterminate (coarse heterogeneous) to benign (dystrophic), a diagnosis of mucocele-like lesion should be considered.

Clinical and Imaging Features of a Ruptured Epidermal Inclusion Cyst in the Subareolar Area: A Case Report.

BACKGROUND Epidermal inclusion cysts rarely develop in the breast. The cysts that do develop within the breast typically present as cutaneous or subcutaneous cysts. They more rarely present in a subareolar location or in a ruptured state. Thus far, 5 cases of ruptured epidermal inclusion cysts in subareolar locations have been reported in the English literature. Furthermore, clinical presentation of nipple discharge is rare in epidermal inclusion cysts of the breast; only 4 such cases has been reported. CASE REPORT A 58-year-old female presented with a 1-month history of bloody discharge from her left nipple. Mammography showed focal asymmetry in the left subareolar region; sonography showed a left subareolar mass with irregular shape, indistinct margin, heterogeneous echogenicity, and posterior enhancement. The mass was surgically excised; a pathological diagnosis of ruptured epidermal inclusion cyst with foreign body reaction and abscess formation was established. In this case, the clinical presentation of bloody nipple discharge was peculiar; furthermore, mammographic and sonographic features were indistinguishable from breast malignancy or typical breast abscess. CONCLUSIONS A ruptured epidermal inclusion cyst can present in an unusual subareolar location, combined with bloody nipple discharge; importantly, this can radiologically resemble breast malignancy.

Sonographic Features of a Myeloid Sarcoma of the Breast as a Relapse of Acute Myeloid Leukemia After Stem-Cell Transplantation: A Case Report.

BACKGROUND Myeloid sarcoma is a rarely observed extramedullary presentation of myeloid leukemia that seldom manifests in the breast. Myeloid sarcoma can occur before, concurrently with, or following acute myeloid leukemia presentation. Few reports have focused on the imaging findings in cases of myeloid sarcoma of the breast, and the existing findings are variable and nonspecific; the present case report aimed to bridge this gap. CASE REPORT A 24-year-old female presented with a palpable lump at the upper outer quadrant of her right breast. She had noticed the mass 2 days prior to presentation. She was first diagnosed with acute myelogenous leukemia 18 months before the lump presentation and had undergone haploidentical stem cell transplantation 6 months prior. At the time of the breast lump presentation, she was undergoing chemotherapy for relapsed acute myeloid leukemia. Ultrasonography of her right breast revealed a circumscribed, oval mass corresponding to the palpable lump. Ultrasonography-guided 14-gauge core needle biopsy was performed on the breast mass, leading to a pathological diagnosis of myeloid sarcoma. CONCLUSIONS We reported a case of myeloid sarcoma involving the breast. On sonography, although the internal echotexture resembled that of breast hamartoma, the observed hard elasticity and high vascularity raised suspicions of malignancy.

Sonographic Features of Flat Epithelial Atypia Manifesting as a Non-Mass-Like Lesion: A Case Report.

BACKGROUND The incidence of flat epithelial atypia of the breast has been increasing owing to the increasing use of ultrasonography (US) and US-guided core needle biopsy. However, reports describing the sonographic features of flat epithelial atypia are fewer than those on its mammographic features. CASE REPORT A 47-year-old female had a regular 6 month-interval follow-up US for multiple bilateral breast masses detected on US. A new focal non-mass-like lesion measuring 2 cm in maximum diameter was noted in the 10 o'clock direction of the right breast on the follow-up US. Mammography was not performed during the follow-up period. The patient had no breast symptoms and no family history of breast cancer or other pertinent medical history. US-guided 14-gauge core needle biopsy yielded a pathological diagnosis of flat epithelial atypia without upgrade to malignancy, and this was further confirmed after complete excision of the non-mass-like lesion. CONCLUSIONS Flat epithelial atypia can present as a focal non-mass-like lesion on US, which has not been reported previously.

Increasing Size of Cholesterol Granuloma of the Breast in the Vicinity of a Previous Breast Biopsy: Imaging Features and Review of the Literature.

BACKGROUND Cholesterol granuloma is a benign condition that can occur in the breast following trauma, breast biopsy, or surgical procedures. Cholesterol granuloma can mimic breast cancer on imaging studies. This report is of a case of an enlarging breast mass due to a repeat needle biopsy in the vicinity of a previous biopsy that resulted in a cholesterol granuloma that appeared to increase in size on ultrasound imaging. The mammographic and high-resolution sonographic imaging features of cholesterol granuloma of the breast are described, with a review of the literature of published cases of cholesterol granuloma of the breast diagnosed on imaging. CASE REPORT A 52-year-old woman had undergone multiple rounds of breast ultrasound scans for multiple breast nodules. At six-month follow-up with a needle biopsy was performed that showed benign cystic change. At 18-months follow-up high-resolution sonographic imaging showed a circumscribed, oval, hypoechoic mass with a benign morphology in the vicinity of the biopsy site. The size of the hypoechoic nodule increased progressively, and histopathology confirmed the diagnosis of a benign cholesterol granuloma. CONCLUSIONS This case demonstrated that cholesterol granuloma of the breast can increase in size after repeats adjacent breast biopsy, and may retain benign morphological features on ultrasound imaging, despite increasing in size.

Initial Clinical Experience with Stationary Digital Breast Tomosynthesis.

RATIONALE AND OBJECTIVES: A linear array of carbon nanotube-enabled x-ray sources allows for stationary digital breast tomosynthesis (sDBT), during which projection views are collected without the need to move the x-ray tube. This work presents our initial clinical experience with a first-generation sDBT device. MATERIALS AND METHODS: Following informed consent, women with a "suspicious abnormality" (Breast Imaging Reporting and Data System 4), discovered by digital mammography and awaiting biopsy, were also imaged by the first generation sDBT. Four radiologists participated in this paired-image study, completing questionnaires while interpreting the mammograms and sDBT image stacks. Areas under the receiver operating characteristic curve were used to measure reader performance (likelihood of correctly identifying malignancy based on pathology as ground truth), while a multivariate analysis assessed preference, as readers compared one modality to the next when interpreting diagnostically important image features. RESULTS: Findings from 43 women were available for analysis, in whom 12 cases of malignancy were identified by pathology. The mean areas under the receiver operating characteristic curve was significantly higher (p < 0.05) for sDBT than mammography for all breast density categories and breast thicknesses. Additionally, readers preferred sDBT over mammography when evaluating mass margins and shape, architectural distortion, and asymmetry, but preferred mammography when characterizing microcalcifications. CONCLUSION: Readers preferred sDBT over mammography when interpreting soft-tissue breast features and were diagnostically more accurate using images generated by sDBT in a Breast Imaging Reporting and Data System 4 population. However, the findings also demonstrated the need to improve microcalcification conspicuity, which is guiding both technological and image-processing design changes in future sDBT devices.

Imaging and Clinical Features of an Unusual Unilateral Breast Enlargement Diagnosed as Fibrocystic Change: A Case Report.

BACKGROUND Breasts are assumed to be symmetrical bilaterally, and abnormal findings on breast imaging are largely based on such an assumption. Clinically noticeable breast asymmetry beyond that of normal range is rarely encountered. CASE REPORT A 38-year-old female presented with unilateral enlargement of her left breast for 3 months and complained of polymenorrhea twice a month. Mammography and ultrasonography revealed that the left breast had a larger volume of fibroglandular tissue than the right breast, without accompanying signs of malignancy or abnormality. Magnetic resonance imaging demonstrated unilateral, diffuse, stippled enhancement in the left breast, which was located peripherally in the early phase and propagated centrally in the delayed phase with a persistent kinetic pattern. Ultrasonography-guided core needle biopsy was performed for the left breast, leading to a pathological diagnosis of fibrocystic change. The condition could be presumably due to a different response of the breasts to imbalance in endogenous hormones. CONCLUSIONS Based on our findings, we believe that radiologists should consider that the breast has a unique dynamic physiology and that features on breast imaging can be affected by hormonal alteration.

Enhancing patterns of breast cancer on preoperative dynamic contrast-enhanced magnetic resonance imaging and resection margin in breast conserving therapy.

BACKGROUND: The association between enhancing patterns of preoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and resection margins after BCS has not been studied in detail before. OBJECTIVE: We investigated the association between surgical outcomes and enhancing patterns observed on DCE-MRI. METHODS: 269 enhancing patterns on DCE-MRI scans were selected, and subdivided into the following groups: (1) a single mass-like enhancement, (2) a single non-mass-like enhancement (NME), (3) mass-like enhancing breast cancer with other mass-like enhancing lesions, and (4) mass-like enhancing breast cancer with additional NMEs. Associations between enhancing patterns on DCE-MRI and re-excision rate, size of specimen, and ratio of tumor/specimen were evaluated retrospectively. RESULTS: The conversion rate from breast conserving therapy (BCT) to mastectomy as a result of MRI findings was 13.4%, re-excision rate during BCT was 8.2% and excision rate of another suspicious lesion was 7.4%. The single NME group had the highest re-excision rate after BCT (22.2%) (p = 0.02). The ratio of tumor/specimen (p = 0.61) and mean specimen size (p = 0.38) were not influenced by enhancement patterns. The false positive rate and positive predictive values of using DCE-MRI for defining the extension of breast cancer was 22.2% and 71.4%, respectively. CONCLUSION: Enhancement patterns on DCE- MRI, especially NME, could increase re-excision rates.

Cervical Lymph Node Imaging Reporting and Data System for Ultrasound of Cervical Lymphadenopathy: A Pilot Study.

OBJECTIVE: The objective of our study was to compare ultrasound (US) and real-time elastography (RTE) features of benign and malignant cervical lymphadenopathies and propose a structured reporting system for lymph nodes. MATERIALS AND METHODS: The study population for this retrospective study consisted of 291 consecutive patients who underwent US-guided biopsies for cervical lymphadenopathy between 2013 and 2014. The following imaging features were analyzed: shape, margin, echogenicity, echogenic hilum, gross necrosis, calcification, matting, intranodal vascular pattern, elasticity scores (four categories), and strain ratio. A score was assigned for each significant factor from a logistic regression analysis and was multiplied by the beta coefficient. The fitted probability of malignancy was calculated. The risk of malignancy was determined on the basis of the number of suspicious features. Interobserver agreement of the imaging features was retrospectively analyzed using a coefficient of interrater agreement. RESULTS: The imaging features that were significantly associated with malignant lymphadenopathy were round shape, noncircumscribed margin, hyperechogenicity, absence of hilum, gross necrosis, calcification, peripheral or mixed vascularity, high elasticity scores, and high level of strain ratio (p < 0.05). The fitted probability and risk of malignancy increased as the number of suspicious features increased. The risk of malignancy according to the Cervical Lymph Node Imaging Reporting and Data System categories was as follows: category 1, 3.3%; category 2, 10.9%; category 3, 26.7%; category 4, 51.8-74.4%; and category 5, 90.6-98.8%. An analysis of the overall interobserver agreement revealed that interobserver agreement was moderate to good. CONCLUSION: We propose the Cervical Lymph Node Imaging Reporting and Data System, which uses the number of suspicious US and RTE features to assess the risk of malignancy in cervical lymph nodes.

Clinical Importance and Sonographic Features of Nonpalpable Axillary Lymphadenopathy Identified on Breast Sonography in Patients Without Malignancy.

OBJECTIVES: The purpose of this study was to evaluate the clinical importance and sonographic features of nonpalpable axillary lymphadenopathy identified on breast sonography in patients without malignancy. METHODS: Our study included 71 women and 2 men (mean age, 47.5 years; range, 16-69 years) with axillary lymphadenopathy identified on breast sonography. None of the 73 patients had known malignancy or presented with palpable lymph nodes or symptoms of mastitis. The lesions were pathologically diagnosed in 53 patients by surgical biopsy (n = 8), ultrasound-guided core needle biopsy (n = 17), or ultrasound -guided fine needle aspiration (n = 28). Twenty patients underwent follow-up imaging for 6 to 60 months (mean, 17 months). The sonographic features of the axillary lymph nodes were analyzed for all patients. RESULTS: The final diagnoses included benign reactive hyperplasia (n = 45), Kikuchi disease (n = 4), tuberculosis (n = 3), and sarcoidosis (n = 1). None of the 20 patients who underwent follow-up imaging developed malignancy. Suspicious sonographic features were frequently observed (loss of the fatty hilum, round shape, abnormal cortical thickening, and marked hypoechogenicity: 79.5%, 75.3%, 82.1%, and 9.6%, respectively) and were mostly complex, with the most common combination being a round shape and loss of the fatty hilum in 61.6% patients. CONCLUSIONS: No malignancy was detected in all 73 patients, despite frequent manifestations of complex and extremely suspicious sonographic features. Short-term follow-up imaging rather than immediate biopsy can be recommended for nonpalpable lymphadenopathy in patients without known malignancy.

Gray-scale and color Doppler sonographic features of complex fibroadenomas of the breast.

PURPOSE: To investigate gray-scale and color Doppler sonographic (US) features of complex fibroadenoma (FA), according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. METHODS: From 2010 through 2013, 586 women with FAs were seen; 101 (17%) of those lesions were diagnosed as complex FAs on percutaneous needle biopsy or surgery. Among the patients with complex FAs, 67 who had US examination results available were included in this study. In addition, the results from 98 women who had simple FAs were included as controls. US features were retrospectively analyzed by two breast radiologists in consensus for shape, margin, echogenicity, posterior acoustic pattern, boundary, orientation, and associated findings. They also reassessed the BI-RADS category for FAs. Color Doppler US examination results were classified according to the amount of vascularity as absent, moderate, or marked. RESULTS: Complex FA were larger than simple FAs were (14.5 cm versus 12.1 cm, p > 0.05). On univariate analysis, a round to irregular shape, an uncircumscribed margin, the presence of associated findings, and BI-RADS categorization as 4a and 4b were more frequently revealed in complex than in simple FAs (p < 0.05). Multivariate analysis revealed that the tumor margin was a predictive factor for complex FA (odds ratio: 6.08; 95% confidence interval: 1.14-32.49, p < 0.05). On color Doppler US, the complex FAs had higher degrees of vascularity than simple FA (p < 0.05). CONCLUSIONS: Complex FAs, in comparison with simple FAs, tend to have more aggressive features and to be in higher BI-RADS categories on US examination.

Merkel Cell Carcinoma of the Axilla and Adrenal Gland: A Case Report with Imaging and Pathologic Findings.

Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine carcinoma of the skin. MCC is characterized by a high incidence of locoregional recurrence, and distant metastasis, and often requires short-term follow-up after treatment. In this present paper, we describe a rare case of MCC, which presented as a palpable axillary mass and an incidental adrenal mass, and report on the ultrasonography, computed tomography, and (18)F-fluorodeoxyglucose-positron emission tomography findings. The patient underwent surgery and adjuvant radiation therapy. Seven months after the initial diagnosis, distant metastasis was detected during a follow-up examination.

Apparent diffusion coefficient for lymph node characterization after chemoradiation therapy for locally advanced rectal cancer.

BACKGROUND: Because further treatment plans depends on lymph node (LN) status after neoadjuvant chemoradiation therapy (CRT), the accurate characterization of LN is important. PURPOSE: To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) for LN characterization after CRT and to compare the performance with that of LN size. MATERIAL AND METHODS: Fifty-three patients (36 men, 17 women; mean age, 58 years; age range, 34-79 years) who underwent CRT and subsequent surgery were included. All patients underwent 1.5-T magnetic resonance imaging (MRI). Each regional LN on post-CRT MRI was identified in consensus by two radiologists after reviewing the pre-CRT MRI. The ADC value and size in each LN was measured. To compare the mean ADC values and sizes of the metastatic and non-metastatic LNs after CRT, the t-test was used. To calculate the performance, a ROC curve analysis was performed. The histopathological examinations served as the reference standard. RESULTS: A total of 115 LNs (29 metastatic and 86 non-metastatic) were matched and analyzed. The mean ADC of the metastatic LNs was significantly higher than that of the non-metastatic LNs (1.36 ± 0.27 × 10(-3)mm(2)/s; 1.13 ± 0.23 × 10(-3)mm(2)/s, P < 0.0001). The mean size of the metastatic LNs was also significantly larger than that of the non-metastatic LNs (5.6 ± 3.1; 3.9 ± 1.2, P = 0.0078). There was no significant difference between the areas under the curve of the ADC and size (0.742 [95% CI, 0.652-0.819]; 0.680 [0.586-0.764], respectively, P = 0.4090). CONCLUSION: The performance of ADC for LN characterization after CRT was comparable to that of LN size.