Breast ultrasound and mammography are established procedures for the diagnosis of breast masses while new technology is opening the door for early cancer diagnosis. The limitation of ultrasound and mammography is that they are only based on physical properties. Recently, using a color doppler system, detection of color flow signal and a resistance index that depend on the blood flow and the blood velocity was applied for diagnosis of breast malignancy. Sixty-five patients admitted for breast surgery were studied. The final diagnosis was made by pathology for thirty malignancies and thirty-five benign lesions. The color doppler measurements on the breast lesions were made preoperatively. The following parameter were assessed :flow velocity, color signal grade and resistance index. The results are as follows: 1) Color signals were detected in twenty-four of the thirty malignancies and in seven of thirty-five benign lesions. 2) Malignant lesions showed a significantly higher maximum velocity (mean=12.52 cm/sec vs 6.34 cm/sec). 3) The resistance index values in the malignancies was higher compared to that in the benign lesions (P < 0.01), a cutoff point 0.6 was used. 4) The color signal grade was grade 0 and I in thirty-four cases of the benign breast lesions (97%) and grade II and III in fifteen of the malignant breast lesions (50%). 5) In breast cancer, the color signal was detected more often in large masses above 2 cm is size,but the result was not statistically significant (P > 0.05). Color doppler flow examination is a useful method for evaluation of benign and malignant breast lesions.
Breast Neoplasms* ; Breast* ; Diagnosis* ; Humans ; Mammography ; Pathology ; Ultrasonography

Humans ; Female ; Diagnosis, Differential ; Breast/pathology* ; Carcinoma, Intraductal, Noninfiltrating/pathology* ; Breast Neoplasms/pathology*

Breast Neoplasms ; diagnosis ; pathology ; Female ; Humans ; Leiomyosarcoma ; diagnosis ; pathology ; Middle Aged ; Skin Neoplasms ; pathology ; secondary

OBJECTIVETo find out the most effective and combined cytomorphologic criteria trying to set up an effective diagnostic model for breast ductal lesion in fine needle aspiration cytology (FNAC).

METHODSA total of 400 breast FNAC cases were collected with follow-up information of more than six years. A retrospective analysis including 104 non-proliferative breast diseases, 163 proliferative breast diseases and 133 carcinomas basing on the diagnostic results of surgical biopsies. Altogether, 60 cytomorphologic variables were counted for the evaluation of each case, including 4 main categories: the cellularity and components, natures of background, cellular arrangements and the cellular features. According to the quantity or the classification stage, the variables were semi-quantitatively scored. Multiple step-wise logistic regression (SPSS) and classification tree model (SAS) were performed to determine the significant and combined variables predictive for the diagnosis of non-proliferative lesion, proliferative breast diseases and carcinoma, respectively.

RESULTS(1) Among 400 benign and malignant cases studied, and basing on the result of analyses of multiple step-wise logistic regression system, intermingling of myoepithelial cells within the epithelial cluster (P < 0.05), presence of large epithelial cell cluster (P < 0.05), presence of small epithelial cell cluster (P < 0.05), cytoplasmic vacuoles (P < 0.05) and figures of "progressive intussusception" of cells (P < 0.1) were selected as the effectively differential diagnostic criteria for the benign and malignant lesions. However, according to the classification tree model, the most useful variable selected associating with the benign lesion was intermingling of myoepithelial cells within epithelial cluster. The diagnostic accuracy will be increased to 94.4%, if another criterion, presence of a big amount of large epithelial clusters, was used as the second useful variable in combination. Presence of a moderate to large amount of small epithelial cell clusters were indicative of proliferative lesion. If the criterion of myoepithelial cells intermingling within epithelial cluster was not found in the sample and associating with presence of small epithelial cell clusters, cytoplasmic vacuoles and figures of "progressive intussusception" of cells, mostly (81.3%), it would be considered as a case of carcinoma. (2) Among 267 benign non-proliferative and proliferative breast diseases studied, both the multiple step-wise logistic regression and classification tree model, presence of irregular intercellular spaces within the epithelial clusters (P = 0.001), loose epithelial clusters (P < 0.05) and hyperchromasia (P < 0.1) were selected as the significant differential diagnostic criteria for the proliferative lesion. The architectural variables and the amount of the abnormal cell features such as cell cluster formation were considered to be more important. A high frequency of presence of irregular intercellular spaces within the epithelial clusters and the amount of loose epithelial clusters indicated a higher possibility of a proliferative lesion. Presence of a single variable of irregular intercellular spaces within the epithelial clusters had the possibility of a benign lesion diagnosis up to 70.1% in all the proliferative breast disease cases collected in this series. If the frequency of irregular intercellular spaces increased to a moderate degree or even higher, the possibility of a benign lesion would be increased to 82.7%. The possibility of a proliferative breast disease would be reached to 87.5%, if both the criteria of irregular intercellular spaces and loosely arranged epithelial cell clusters were counted in combination. (3) The histological results of 35 lesions with atypical cytological features in FNAC specimens were predominantly a proliferative lesion of the breast (26 cases), and most of them were fibroadenoma with ductal hyperplasia. Occasionally, there might be a few benign cases complicating with lesions of atypical hyperplasia or carcinoma.

CONCLUSIONSIn breast FNAC diagnosis, a combined evaluation of significant variables and the amount of the variable involved are effective for the differential diagnosis between benign/malignant and non-proliferative/proliferative lesions. Lesion accompanying with atypical cellular features should avoid to be overdiagnosed as carcinoma, and biopsy for a histological diagnosis is indicative.

Biopsy, Fine-Needle ; methods ; Breast ; pathology ; Breast Diseases ; diagnosis ; pathology ; Breast Neoplasms ; diagnosis ; pathology ; Carcinoma, Ductal, Breast ; diagnosis ; pathology ; Cytodiagnosis ; Diagnosis, Differential ; Epithelial Cells ; pathology ; Female ; Fibroadenoma ; diagnosis ; pathology ; Follow-Up Studies ; Humans ; Hyperplasia ; Precancerous Conditions ; diagnosis ; pathology ; Retrospective Studies

OBJECTIVETo study the clinical and pathological features of mucocele-like lesions in the breast.

METHODSNine cases of mucocele-like lesions in the breast were reported for the morphological and immunohistochemical features, the differential diagnosis, and a literature review.

RESULTSAll nine cases were from female patients, aged 23 to 43 years (mean 34 years), clinically presented with palpable breast masses. Grossly, the lesions were multi-cystic with colloidal appearances. Histologically, the lesions consisted of multiple cysts filled with colloid, these cysts were lined with tubular, cuboidal or columnar epithelium. There were superimposed papillary epithelial hyperplasia in three cases and atypical ductal hyperplasia in one. Extravasated mucinous lakes were seen in the stroma, but without cellular component.

CONCLUSIONMucocele-like lesions of the breast is a group of mostly benign disease, and the differential diagnosis should include mucinous carcinoma.

Adenocarcinoma, Mucinous ; diagnosis ; pathology ; Breast ; pathology ; Breast Neoplasms ; diagnosis ; pathology ; Carcinoma in Situ ; diagnosis ; Carcinoma, Ductal, Breast ; diagnosis ; pathology ; Diagnosis, Differential ; Female ; Gene Expression Regulation, Neoplastic ; physiology ; Humans ; Hyperplasia ; pathology ; Intestinal Neoplasms ; pathology ; Mucocele ; diagnosis ; pathology

Breast/pathology* ; Breast Neoplasms/pathology* ; Carcinoma in Situ/pathology* ; Carcinoma, Lobular/pathology* ; Diagnosis, Differential ; Female ; Humans ; Hyperplasia/pathology*

OBJECTIVEThe aim of this study was to evaluate the value of diffusion weighted imaging (DWI) in the diagnosis of patients with breast diseases.

METHODSFifty-three consecutive patients were scanned with GE signa HDx 1.5 T magnetic resonance system equipped with 8-channel breast coil. DWI was scanned by SE-EPI sequence in b values of 500 s/mm(2) and 800 s/mm(2), respectively. The apparent diffusion coefficients (ADC) of these lesions were measured. The mean apparent diffusion coefficients (ADC) of these lesions were calculated in b values of 500 s/mm(2) and 800 s/mm(2), respectively. These lesions' ADC value (rADC) was counted respectively and the result of the rADC was equal to the lesion's ADC divided by the ADC of the ipsilateral normal breast tissue. Threshold of ADC and rADC for differential diagnosis was acquired by ROC (receiver operating characteristic curve) analysis. Different imaging technologies were evaluated emphasizing their sensitivity, specificity and accuracy.

RESULTSSixty-six lesions of 53 cases were confirmed by pathology, including 39 malignant lesions and 27 benign lesions. (1) b = 500 s/mm(2), the threshold of ADC value was 1.435 x 10(-3) mm(2)/s, with a sensitivity of 82.1% and a specificity of 81.5%. The threshold of rADC value was 0.62, with a sensitivity of 76.9% and a specificity of 100%. (2) b = 800 s/mm(2), the threshold of ADC value was 1.295 x 10(-3) mm(2)/s, with a sensitivity of 79.5% and a specificity of 81.5%. The threshold of rADC value was 0.71, with a sensitivity of 89.7% and specificity of 88.9%. (3) The area under the ROC curve was increased for the four diagnostic indicators (ADC(500), ADC(800), rADC(500), rADC(800)).

CONCLUSIONDWI spends short time, and it doesn't need contrast material. ADC value and rADC value have a high sensitivity and specificity as a diagnostic indicator. DWI is helpful in improving the specificity of MR and may become one of valuable conventional procedures for breast tumor diagnosis.

Adult ; Breast ; pathology ; Breast Neoplasms ; diagnosis ; pathology ; Carcinoma, Ductal, Breast ; diagnosis ; pathology ; Carcinoma, Intraductal, Noninfiltrating ; diagnosis ; pathology ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging ; methods ; Female ; Fibroadenoma ; diagnosis ; pathology ; Fibrocystic Breast Disease ; diagnosis ; pathology ; Humans ; Middle Aged ; ROC Curve ; Sensitivity and Specificity

BACKGROUNDThis study researched the electric impedance properties of breast tissue and demonstrated the different characteristic of electrical impedance scanning (EIS) images.

METHODSThe impedance character of 40 malignant tumors, 34 benign tumors and some normal breast tissue from 69 patients undergoing breast surgery was examined by EIS in vivo measurement and mammography screening, with a series of frequencies set between 100 Hz - 100 kHz in the ex vivo spectroscopy measurement.

RESULTSOf the 39 patients with 40 malignant tumors, 24 showed bright spots, 11 showed dark areas in EIS and 5 showed no specific image. Of the 30 patients with 34 benign tumors there were almost no specific abnormality shown in the EIS results. Primary ex vivo spectroscopy experiments showed that the resistivity of various breast tissue take the following pattern: adipose tissue > cancerous tissue > mammary gland and benign tumor tissue.

CONCLUSIONSThere are significant differences in the electrical impedance properties between cancerous tissue and healthy tissue. The impedivity of benign tumor is lower, and is at the same level with that of the mammary glandular tissue. The distinct growth pattern of breast lesions determined the different electrical impedance characteristics in the EIS results.

Breast Neoplasms ; diagnosis ; pathology ; Electric Impedance ; Female ; Humans ; Mammography

Pancreatic metastases from primary breast cancer are very rare. We report a case of pancreatic metastasis from invasive ductal carcinoma 13 years after the initial diagnosis of breast cancer. When the pancreatic mass was discovered, it was believed to be a primary pancreatic cancer due to the long interval from the initial diagnosis of breast cancer to metastasis. However, it was confirmed as metastatic breast cancer based on the pathology after surgical removal. Follow-up imaging has shown no recurrence.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Diagnosis ; Follow-Up Studies ; Neoplasm Metastasis* ; Pancreatic Neoplasms ; Pathology ; Recurrence

Primary primitive neuroectodermal tumors (PNET) are rare malignant tumors, affecting mostly children and adolescents. Only three cases of primary breast PNETs have been reported in the medical literature, with none in Korea. We present a case of a primary PNET of the breast in a 33-year-old woman, with imaging and immunohistopathology findings.
Adult ; Breast Neoplasms/*diagnosis/pathology ; Female ; Humans ; Immunohistochemistry ; Mammography ; Neuroectodermal Tumors/*diagnosis/pathology ; Positron-Emission Tomography