Imaging of Dermatofibrosarcoma Protuberans of Breast
Shi-Zuo Liu, Tzu-Lung Ho, Soa-Min Hsu, Hui-Lun Zhan and Chen-Pin Chou
The Breast Journal 2010 16;5:541–543
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Dermatofibrosarcoma protuberans (DFSP) is a rare superficial soft tissue malignancy. We report a 45-year-old woman diagnosed with DFSP involving the breast. Ultrasound of DFSP revealed a heteroechogenetic breast mass, which showed normal adjacent dermis. Mammography disclosed a high-density mass without microcalcification. MRI showed an enhancing lobulated lesion with small area of cystic change and hemorrhage. The patient underwent excision biopsy and pathology revealed DFSP of the breast. DFSP involving the breast is rare and preoperative diagnosis by imaging could be a challenge for clinicians.
A solitary mixed echogenicity and ill-defined soft tissue with no microcalcification located in the subdermal region could indicate the presence of DFSP
Sunday, 12 September 2010
Lobular Neoplasia of the Breast
Lobular Neoplasia of the Breast
Ramachandran Venkitaraman
The Breast Journal 2010 16;5:519–528
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Lobular neoplasia is increasingly being detected, probably due to the widespread screening for breast malignancies. The understanding of lobular neoplasia is undergoing a paradigm shift, from being considered a predictor of recurrence to being considered a pre-invasive lesion, based on molecular studies suggesting a clonal link with invasive lobular cancer.
The management of patients diagnosed to have lobular neoplasia is in evolution, with the increasing need for risk stratification and hence the necessity to identify this entity separately as either lobular carcinoma in-situ and atypical lobular hyperplasia. The indications for wide local excision for patients diagnosed to have lobular neoplasia on biopsy are being defined.
The evidence for preventive strategies like hormonal treatment with Tamoxifen or aromatase inhibitors for high risk patients is increasing, with the results from prospective interventional trials. The role of screening magnetic resonance imaging for surveillance of high risk patients with lobular neoplasia is under evaluation
Ramachandran Venkitaraman
The Breast Journal 2010 16;5:519–528
Link to Journal
Lobular neoplasia is increasingly being detected, probably due to the widespread screening for breast malignancies. The understanding of lobular neoplasia is undergoing a paradigm shift, from being considered a predictor of recurrence to being considered a pre-invasive lesion, based on molecular studies suggesting a clonal link with invasive lobular cancer.
The management of patients diagnosed to have lobular neoplasia is in evolution, with the increasing need for risk stratification and hence the necessity to identify this entity separately as either lobular carcinoma in-situ and atypical lobular hyperplasia. The indications for wide local excision for patients diagnosed to have lobular neoplasia on biopsy are being defined.
The evidence for preventive strategies like hormonal treatment with Tamoxifen or aromatase inhibitors for high risk patients is increasing, with the results from prospective interventional trials. The role of screening magnetic resonance imaging for surveillance of high risk patients with lobular neoplasia is under evaluation
Imaging Characteristics of Male Breast Disease
Imaging Characteristics of Male Breast Disease
Zehra Hilal Adibelli, Ozgur Oztekin, Işil Gunhan-Bilgen, Hakan Postaci, Adam Uslu and Enver Ilhan
The Breast Journal 2010 16;5:510–518
Link to Journal
The purpose of the study was to describe the imaging findings of male breast disease. One hundred and sixty-four male patients, who underwent mammography and ultrasonography (US) between January 1999 and December 2008, were retrospectively evaluated. Seventy-five patients (46%) underwent biopsy, and 89 patients (54%) were diagnosed radiologically. The radiologic and pathologic diagnoses in 164 cases of this series were 13 cancers (8%), including one ipsilateral and one contralateral breast cancers, 147 cases of gynecomastia (90%), one fibroadenoma (0.6%), two cases of fibrocystic disease of the breast (1.2%), and one epidermoid inclusion cyst (0.6%).
Three mammographic patterns were adequate to describe all 147 cases of gynecomastia in our series: 53 patients (36%) had nodular gynecomastia, 46 patients (31%) had dendritic gynecomastia, and 48 patients (33%) had diffuse gynecomastia. Gynecomastia was unilateral in 65% of cases (n = 95), and bilateral in 35% of cases (n = 52). On physical examination, two of the malignant lesions had no clinic features of malignancy (15%). On mammography, 11 of 13 malignant masses were demonstrated (85%). A mass with microcalcifications was seen on mammograms in one case (9%). The contours of the masses were irregular in nine cases (82%), well-circumscribed in two cases (18%). The location of the masses was retroareolar in seven cases (64%) and eccentric to the nipple in four cases (36%). The size of the masses varied between 0.5 cm and 5 cm (mean 2.4 cm). Nipple retraction was evident in five cases (45%), and skin thickening in four cases (36%). All of the malignant masses were demonstrated on ultrasound; however, one of them was seen retrospectively after mammography. All of the masses were hypoechoic and solid, the contours were well-defined and smooth in two masses (15%), and irregular in 11 masses (85%), and five masses (39%) had posterior prominent shadowing. Axillary lymphadenopathia was detected in two cases (15%). One patient had a previous contralateral breast cancer, and one had an ipsilateral.
On mammography, breast cancer characteristically exhibits an irregular subareolar mass, nipple retraction, and skin ulceration or thickening, but sometimes breast cancer has a well-circumscribed contour and punctuated microcalcifications. Ultrasonography is essential and useful for further characterization and helpful for demonstrating lymphadenopathies of the axillary region
Zehra Hilal Adibelli, Ozgur Oztekin, Işil Gunhan-Bilgen, Hakan Postaci, Adam Uslu and Enver Ilhan
The Breast Journal 2010 16;5:510–518
Link to Journal
The purpose of the study was to describe the imaging findings of male breast disease. One hundred and sixty-four male patients, who underwent mammography and ultrasonography (US) between January 1999 and December 2008, were retrospectively evaluated. Seventy-five patients (46%) underwent biopsy, and 89 patients (54%) were diagnosed radiologically. The radiologic and pathologic diagnoses in 164 cases of this series were 13 cancers (8%), including one ipsilateral and one contralateral breast cancers, 147 cases of gynecomastia (90%), one fibroadenoma (0.6%), two cases of fibrocystic disease of the breast (1.2%), and one epidermoid inclusion cyst (0.6%).
Three mammographic patterns were adequate to describe all 147 cases of gynecomastia in our series: 53 patients (36%) had nodular gynecomastia, 46 patients (31%) had dendritic gynecomastia, and 48 patients (33%) had diffuse gynecomastia. Gynecomastia was unilateral in 65% of cases (n = 95), and bilateral in 35% of cases (n = 52). On physical examination, two of the malignant lesions had no clinic features of malignancy (15%). On mammography, 11 of 13 malignant masses were demonstrated (85%). A mass with microcalcifications was seen on mammograms in one case (9%). The contours of the masses were irregular in nine cases (82%), well-circumscribed in two cases (18%). The location of the masses was retroareolar in seven cases (64%) and eccentric to the nipple in four cases (36%). The size of the masses varied between 0.5 cm and 5 cm (mean 2.4 cm). Nipple retraction was evident in five cases (45%), and skin thickening in four cases (36%). All of the malignant masses were demonstrated on ultrasound; however, one of them was seen retrospectively after mammography. All of the masses were hypoechoic and solid, the contours were well-defined and smooth in two masses (15%), and irregular in 11 masses (85%), and five masses (39%) had posterior prominent shadowing. Axillary lymphadenopathia was detected in two cases (15%). One patient had a previous contralateral breast cancer, and one had an ipsilateral.
On mammography, breast cancer characteristically exhibits an irregular subareolar mass, nipple retraction, and skin ulceration or thickening, but sometimes breast cancer has a well-circumscribed contour and punctuated microcalcifications. Ultrasonography is essential and useful for further characterization and helpful for demonstrating lymphadenopathies of the axillary region
Computer-assisted Diagnosis in Full-field Digital Mammography—Results in Dependence of Readers Experiences
Computer-assisted Diagnosis in Full-field Digital Mammography—Results in Dependence of Readers Experiences
Christian Sohns, Besim Angic, Samuel Sossalla, Frank Konietschke and Silvia Obenauer
The Breast Journal 2010 16;5:490–497
Link to Journal
The object of this study was to assess the clinical usefulness of computer-assisted diagnosis (CAD) in the interpretation of early-research, benign and malignant mammograms in dependence on readers’ experience with CAD. CAD was applied on digital mammograms of 303 patients who were divided into three groups: early-research (n = 103), benign (n = 102) and malignant group (n = 98). Mammograms were analyzed by three readers with different experience in evaluating mammograms (medical student, an assistant and an attending physician specifically trained in mammography). All images were presented accidentally with and without the influence of CAD and from different patient groups. The mammograms were classified according to BI-RADS classification.
To evaluate readers’ sensitivity and specificity with and without the application of the CAD system, ROC analysis and the corresponding area under the curve (AUC) were evaluated for each reader. Afterwards significant differences of the accuracy according to readers experience and according to the assistance of the CAD system were calculated.
All readers have an account of accuracy by using CAD in both patient groups. The highest benefit has the student (10% increase of the AUC) followed by the resident (4%) and at least followed by the mammography fellow (3%). There are significant varieties of the accuracy in addiction to the readers’ experience and to the examination method with and without CAD system. Patient group has not a significant influence to the elevation of accuracy by using the CAD. All three readers have nearly the same increase of AUC in the examinations of malignant and early-research group summarized and of the malignant group only. Finally, the increase of accuracy depends on the readers’ experience. For all patient groups CAD-application causes a steeply increase of the ROC curve and consequently a gain of sensitivity
Christian Sohns, Besim Angic, Samuel Sossalla, Frank Konietschke and Silvia Obenauer
The Breast Journal 2010 16;5:490–497
Link to Journal
The object of this study was to assess the clinical usefulness of computer-assisted diagnosis (CAD) in the interpretation of early-research, benign and malignant mammograms in dependence on readers’ experience with CAD. CAD was applied on digital mammograms of 303 patients who were divided into three groups: early-research (n = 103), benign (n = 102) and malignant group (n = 98). Mammograms were analyzed by three readers with different experience in evaluating mammograms (medical student, an assistant and an attending physician specifically trained in mammography). All images were presented accidentally with and without the influence of CAD and from different patient groups. The mammograms were classified according to BI-RADS classification.
To evaluate readers’ sensitivity and specificity with and without the application of the CAD system, ROC analysis and the corresponding area under the curve (AUC) were evaluated for each reader. Afterwards significant differences of the accuracy according to readers experience and according to the assistance of the CAD system were calculated.
All readers have an account of accuracy by using CAD in both patient groups. The highest benefit has the student (10% increase of the AUC) followed by the resident (4%) and at least followed by the mammography fellow (3%). There are significant varieties of the accuracy in addiction to the readers’ experience and to the examination method with and without CAD system. Patient group has not a significant influence to the elevation of accuracy by using the CAD. All three readers have nearly the same increase of AUC in the examinations of malignant and early-research group summarized and of the malignant group only. Finally, the increase of accuracy depends on the readers’ experience. For all patient groups CAD-application causes a steeply increase of the ROC curve and consequently a gain of sensitivity
Axillary Ultrasound Assessment in Primary Breast Cancer: An Audit of 653 Cases
Axillary Ultrasound Assessment in Primary Breast Cancer: An Audit of 653 Cases
Pippa Mills, Ali Sever, Jenny Weeks, David Fish, Sue Jones and Peter Jones
The Breast Journal
Link to Journal
Axillary lymph node status is an important factor in determining the prognosis and treatment in patients with invasive breast cancer. The introduction of the sentinel lymph node biopsy technique in the axilla has significantly reduced the number of patients requiring an axillary clearance procedure. However, a proportion of patients will be found to have axillary metastases after a sentinel node biopsy and will then require a second axillary surgical procedure. A retrospective audit of 653 consecutive patients presenting with invasive breast cancer showed a preoperative diagnosis rate of axillary disease of 23% using axillary ultrasound and fine-needle aspiration (FNA) together. We performed 232 axillary FNAs to diagnose 150 positive axillae. This avoided the need for a second operation in 150 women.
The negative predictive value for axillary metastases using this technique was 79%. Overall accuracy was 84%.
Pippa Mills, Ali Sever, Jenny Weeks, David Fish, Sue Jones and Peter Jones
The Breast Journal
Link to Journal
Axillary lymph node status is an important factor in determining the prognosis and treatment in patients with invasive breast cancer. The introduction of the sentinel lymph node biopsy technique in the axilla has significantly reduced the number of patients requiring an axillary clearance procedure. However, a proportion of patients will be found to have axillary metastases after a sentinel node biopsy and will then require a second axillary surgical procedure. A retrospective audit of 653 consecutive patients presenting with invasive breast cancer showed a preoperative diagnosis rate of axillary disease of 23% using axillary ultrasound and fine-needle aspiration (FNA) together. We performed 232 axillary FNAs to diagnose 150 positive axillae. This avoided the need for a second operation in 150 women.
The negative predictive value for axillary metastases using this technique was 79%. Overall accuracy was 84%.
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