Radio-histological correlations of subtle sonography images.

Breast lesions may, during their development, provide sonography signs can be difficult to view or are not very specific. They are called "subtle images". Proximal (ductal) lesions are differentiated from distal (ductal-lobular) lesions. Proximal lesions are mainly inflammatory or infectious, altering the duct walls that evolve into ectasia and then fibrosis with possible acute episodes of plasmocyte mastitis or bacterial mastitis. The fibrovascular stalks of the papilloma accounts for the Doppler flow. Certain secretory forms of intra-ductal carcinoma may distend the structure of the milk ducts. The sonography of lesions of the ductal-lobular units are related to the degree of fibrosis, the atrophy or cell proliferation, and the disorganisation of the architecture. The extent of the fibrosis, or the cell density of certain tumours may modify the tissue hardness in elastography.

[Breast pilomatrixoma manifested as microcalcifications on mammography: report of two cases]. / Pilomatricomes mammaires révélés par des microcalcifications à la mammographie: à propos de deux cas.

Pilomatricoma is a benign tumor of hair follicule origin corresponding to a firm subcutaneous nodule requiring histology for diagnosis. Only few breast pilomatricomas have been reported, with imaging showing well defined nodules with microcalcifications. We report two cases of intra-mammary pilomatricomas presenting as ACR BI-RADS 4 and 5 microcalcifications, suspicious for malignant tumors. Percutaneous biopsy confirmed the histological diagnosis. Malignant pilomatricomas have been reported, suggesting that all pilomatricomas should be resected.

[Value of vacuum assisted biopsies under sonography guidance: results from a multicentric study of 650 lesions]. / Place des macrobiopsies mammaires assistées par le vide sous guidage échographique: étude multi-centrique de 650 lésions.

OBJECTIVE: With this retrospective, multi-centric study, the authors are showing the technique of Vacuum assisted biopsies under ultrasound guidance and comparing it with the other widely used diagnostic techniques. Material and method. Six hundred and fifty biopsies were performed between May 2000 and December 2004, on 644 patients, in 3 centres, following a unique protocol. Lesions were categorized, using the classification from Stavros, between "probably benign", "indeterminate", "probably malignant" and "malignant" Histology was validated only after review of the clinical and radiological data, as well as surgical data when available. All benign cases were included in an on-going follow-up protocol. RESULTS: We have identified 471 benign lesions and 179 malignant lesions. The mean size of the lesions was 9 mm. Three cancers were diagnosed in the cases of "probably benign lesions" and in the cases of "probably malignant lesions" 18 (27%) were inflammatory disorders. In 5 cases vacuum biopsy underestimated the pathology with regard to surgery: 2 cases of atypical duct hyperplasia (HCA) were in situ ductal carcinoma (DCIS) at surgery and 3 cases of DCIS were infiltrative ductal carcinoma (DCI) at surgery. With this technique we have avoided surgery for 71% of all women who presented an "indeterminate" or "probably malignant" condition. Specificity is excellent with no cancer detected so far among the patients with benign findings, under follow-up. CONCLUSION: Ultrasound guided Vacuum assisted biopsy is a fairly recent minimally invasive technique, with short learning curve. The ability to collect a larger volume of tissue overcomes the targeting issues on small lesions and avoids underestimation of heterogeneous and larger abnormalities and some specific at-risk lesions such as papilloma. This technique thus appears indicated in such cases because it overcomes some of the limitations of core needle biopsy and should be considered as an alternative to surgical biopsy.