Imaging Findings in Papillary Breast Lesions: An Analysis of Ductal Findings on Magnetic Resonance Imaging and Ultrasound.

PURPOSE: This study aims to analyze the imaging features of dilated ducts or ductal extension/relation of masses detected by ultrasound (US) and magnetic resonance imaging (MRI) and to correlate the results obtained through these 2 different imaging methods. Furthermore, the ability of the ductal relation pattern in differentiating benign and malignant lesions was explored. METHODS AND MATERIALS: Magnetic resonance imaging and US findings of 56 patients who had a pathologic diagnosis of papillary lesion were examined. Ductal findings were classified into four types for both imaging methods: intraductal form, extraductal form, mixed form, and no ductal relation. The correlation between MRI and US was then analyzed with respect to ductal findings. Statistical analyses were performed to determine the value of ductal patterns determined by these 2 imaging methods in the differentiation of benign and malignant papillary lesions. RESULTS: A total of 56 cases with papillomatosis (n = 11), papillomas (n = 29), and papillary breast carcinomas (n = 16) were included. There was a statistically significant correlation between all ductal patterns on US and the corresponding ductal signs on MRI. Palpable masses were statistically more common in patients with papillary breast carcinoma compared with other groups (P < 0.01). Segmental contrast enhancement occurred at a significantly higher rate in papillary breast carcinoma and papillomatosis patients, as compared with papilloma patients (P < 0.05). CONCLUSIONS: Actual resolution of MRI is close to that of US in terms of the ability to demonstrate the ductal relation of masses. Segmental contrast enhancement on MRI and nonmass-like heterogeneous hypoechoic area or mass with multiple ductal extensions on US can be used in discriminating benign versus malignant papillary lesions. The absence of ductal sign in MRI indicates benignity.

Efficiency of Imaging Modalities in Male Breast Disease: Can Ultrasound Give Additional Information for Assessment of Gynecomastia Evolution?

OBJECTIVE: The purpose of this study is to present mammography and ultrasound findings of male breast lesions and to investigate the ability of diagnostic modalities in estimating the evolution of gynecomastia. MATERIALS AND METHODS: Sixty-nine male patients who admitted to Taksim and Bakirkoy Education and Research Hospitals and underwent mammography (MG) and ultrasonography (US) imaging were retrospectively evaluated. Duration of symptoms and mammographic types of gynecomastia according to Appelbaum's classifications were evaluated, besides the sonographic findings in mammographic types of gynecomastia. RESULTS: The distribution of 69 cases were as follows: gynecomastia 47 (68.11%), pseudogynecomastia 6 (8.69%) primary breast carcinoma 7 (10.14%), metastatic carcinoma 1 (1.4%), epidermal inclusion cyst 2 (2.8%), abscess 2 (2.8%), lipoma 2 (2.8%), pyogenic granuloma 1 (1.4%), and granulomatous lobular mastitis 1 (1.4%). Gynecomastia patients who had symptoms less than 1 year had nodular gynecomastia (34.6%) as opposed to dendritic gynecomastia (61.5%) (p<0.01) based on mammography results according to Appelbaum's classifications. In patients having symptoms for 1 to 2 years, diffuse gynecomastia (70%) had a higher rate than the dendritic type (20%). Patients having the symptoms more than 2 years had diffuse gynecomastia (57.1%) while 42.9% had dendritic gynecomastia (p<0.001). With sonographic examination patients who had symptoms less than 1 year had higher rates of dendritic gynecomastia (92.3%) than noduler type (1.9 %). Patients having symptoms for 1 to 2 years had more dentritic gynecomastia (70%) than diffuse type (30%). Patients having symptoms more than 2 years had diffuse gynecomastia (57.1%) comparable to dendritic gynecomastia (42.9 %). CONCLUSION: Diagnostic imaging modalities are efficient tools for estimation of gynecomastia evolution as well as the diagnosis of other male breast diseases. There seems to be an incongruity between duration of clinical complaints and diagnostic imaging classification of gynecomastia. The use of these high resolution US findings may demonstrate an early phase fibrosis especially in patients visualized by mammography as with nodular phase.

Subcutaneous Oleomas Following Sunflower Oil Injection: A Novel Case and Review of Literature.

Liquid foreign material injection has been used as an early medical intervention since the end of nineteenth century for the augmentation of body shape. Nowadays, these types of procedures have been abandoned by health professionals due to late onset of serious complications. However, it is still misused by some subcultures such as bodybuilders, passive homosexuals, transsexuals, and patients with mental illness. This article discusses a male patient who injected himself with a large amount of sunflower oil, which became complicated by an inflammatory response-abscess formation and sclerosing lipogranuloma of breasts. The radiologic and pathologic signs of this entity are discussed with a review of the relevant literature. Lack of suspicion of this entity may cause a great delay in establishment of definitive diagnosis, giving rise to prominent morbidity and mortality. It is necessary to know the diagnosis and treatment of this phenomenon because illegal substances that cause factitial panniculitis are widely available on websites and threaten thousands of people, which is anecdotally referred in medical literature. Chronic or recurrent lesions of a bizarre or atypical morphology should alert the physician to this artificial phenomenon. Radiologic findings are most important criteria for diagnosis because self-injection is denied by the patient.

Effectiveness of additional diagnostic parameters in magnetic resonance mammography: a comparative study with the BI-RADS classification and scoring system.

OBJECTIVE: This study aims to evaluate the strength of magnetic resonance (MR) lesion descriptors for malignancy and to determine the effectiveness of a scoring system that combines BI-RADS parameters with additional criteria. MATERIALS AND METHODS: Three hundred thirty-nine histopathologically proven lesions that had undergone MR imaging were analyzed retrospectively. Based on the Fischer scoring system, an optimal cutoff value was calculated for combined parameters. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for all lesions with MR BI-RADS classification without using additional parameters. Finally, the results of the scoring system and MR BI-RADS classification were compared. RESULTS: The optimal cutoff value according to the total score was calculated as 5. The sensitivity and the specificity of BI-RADS classification were calculated to be 94.20% and 56.12%, respectively. The scoring system using a cutoff value of 5 resulted in a little loss of sensitivity (89.86%) but resulted in a reasonable increase in the specificity (88.49%). CONCLUSIONS: Additional parameters can improve the specificity of MR imaging. T2-weighted signal features, adjacent vessel sign, unilateral-focal edema, and hook sign were considered as effective parameters.

Magnetic resonance imaging features of papillary breast lesions.

PURPOSE: This study was aimed to assess the role of magnetic resonance imaging (MRI) in the evaluation of the papillary lesions of the breast and their morphological relationship with the mammary ducts. The potential diagnostic contributory role of ductal oriented protocols to conventional dynamic magnetic resonance examination was also explored. MATERIALS AND METHODS: Retrospective data were collected from 46 patients who had been diagnosed with papillary breast lesions and undergone magnetic resonance examination. The presence of dilated ducts and their morphological relation with the lesion were recorded. Lesions were classified as follows: papilloma, papillomatosis and malignant papillary lesion. Statistical difference between groups was studied for each morphological and dynamic lesion characteristic. RESULTS: Dilated ducts and characteristics of intraductal material can be identified by magnetic resonance imaging. Certain MRI findings such as a mass with crescentic peripheral fluid or focal intraductal mass on T2 weighted images may suggest the presence of an intraductal/papillary lesion. In this respect, non-fatsat T2 weighted images appear particularly useful. There was a significant difference between papilloma and papillomatosis with regard to segmental and heterogeneous contrast enhancement (p<0.05 for both comparisons). In addition, there was a significant difference between papillomas and carcinomas with regard to homogenous, heterogeneous and segmental contrast enhancement (p<0.05 for all). On the other hand, papillomatosis and carcinoma did not differ significantly in terms of any of the morphological or dynamical MR criteria compared. CONCLUSION: Papillary lesions can be detected by MRI. Despite some overlaps in MRI findings between carcinoma, papilloma and papillomatosis, MRI may help differentiate these lesions. Major benefit of retroareolar imaging appears to arise from its ability to demonstrate ductal relation and extension of contrast enhanced regions.

Comparison of ductoscopy, galactography, and imaging modalities for the evaluation of intraductal lesions: a critical review.

BACKGROUND: Today, in cases of nipple discharge of unclear origin, the abundance of diagnostic procedures - a, diagnostic dilemma' - becomes apparent, because unequivocal indications and a current, standardized examination sequence are presently not available. The diagnostic workup of patients with nipple discharge usually includes the clinical history, physical examination, mammography, ultrasonography, galactography, and nipple discharge cytology, but not ductoscopy. METHODS: In this review we analyze and discuss the possible role of ductoscopy in evaluating intraductal pathologies and its combined use with diagnostic imaging modalities. For this purpose, we reviewed and compared the results of the radiological, pathological, and surgical studies independently. CONCLUSIONS: Currently, there is no solitary accurate modality to reach our definitive purpose. Being aware of the capability of each diagnostic modality may take us closer to our target. Therefore, adjunct and appropriate use of multiple imaging modalities and ductoscopy is necessary to evaluate patients with nipple discharge.

Evaluation of nipple-areola complex with ultrasonography and magnetic resonance imaging.

Because both benign and malignant nipple periareolar region lesions may present with similar clinical findings such as nipple discharge and retraction, they require a diagnostically specific imaging workup. Despite multidisciplinary clinical approaches, malignancy cannot be excluded without diagnostic modalities.Because of the intricacy of the anatomical structures and their superficial position, the diagnostic techniques routinely used to evaluate the different sides of the breast may often be inadequate. Adjunct use of multiple imaging modalities is necessary to evaluate this region.