PURPOSE: To compare the feasibility of 9 9 mTc-MIBI scintimammography as a tumor localizing agent in breast lesions in comparison with that of mammography and ultrasonography, and to evaluate the efficacy of these three modalities. MATERIALS AND METHODS: Sixty-four breast lesions were classified as benign or malignant on the basis of sono-graphic and mammographic criteria and were further analyzed by means of 99mTc-MIBI scintimammography. The classifications thus obtained were compared with the biopsy findings, and in order to compare the three techniques, the sensitivity, specificity, accuracy, and negative and positive predictive values were calculated for each individual modality. RESULTS: Of 64 histologically proven lesions, 33 were malignant and 31 were benign. Sensitivities and specificities for malignancy were 86.2% and 64.5% for mammography, 87.9% and 76.7 % for sonography, and 78.8% and 74.2% for 99mTc-MIBI scintimammography. CONCLUSION: Mammography and ultrasonogrphy are reliable diagnostic modalities for the detection of breast cancer. 99mTc-MIBI scintimammography has a higher specificity than mammography and it may help to reduce unnecessary biopsies.
Biopsy ; Breast Neoplasms* ; Breast* ; Classification ; Diagnosis* ; Mammography* ; Sensitivity and Specificity ; Ultrasonography*

BACKGROUNDMicrocalcifications play a very important role in detection of breast cancer, especially early stage breast cancer. However, ambiguity still exists in understanding the relationship between radiological and pathological characteristics of microcalcifications. The definitive indication of a biopsy has not been established. The purpose of this study is to evaluate the relationship of classification of breast microcalcifications using full-field digital mammography to the pathological characteristics.

METHODSFor all the women an open biopsy had been conducted. One hundred and three mammographs showing clustered microcalcifications from 98 consecutive patients were reviewed along with their pathological records. To investigate the value of each criterion for the detection of cancer, univariate and multivariate analyses were performed on the entire sample and then on morphological subgroups.

RESULTSPathological examination showed 67 malignant lesions (65.05%) and 36 benign lesions (34.95%). In the univariate analysis, four radiological variables were significant: morphological type (P = 0.001), complicated by a mass (P = 0.002), number of microcalcifications per cluster (P = 0.02) and linear or triangular distribution of clusters (P = 0.009). In the multivariate analysis, two criteria remained significant: morphological type (P < 0.001) and complicated by a mass (P = 0.001). The percentage of malignancy was 37.0%, 60.0%, 78.8%, and 88.9%, respectively, for type 2 (regularly punctiform), type 3 (dusty), type 4 (irregularly punctiform) and type 5 (vermicular) microcalcifications (Le Gal's classification). The malignancy was 78.6% for microcalcifications complicated by a mass and 48.9% without a mass. The difference was significant (P < 0.05). The relationship between morphological types of microcalcifications and the pathological characteristics was also studied. In subgroups, type 3 (dusty) microcalcifications complicated by a mass (P = 0.001) or with the number of microcalcifications more than 10 (P = 0.024); and type 2 (regularly punctiform) with a diameter of the area over 20 mm (P = 0.024) or complicated by a mass (P = 0.025) were statistically significant as criteria for malignant tumour.

CONCLUSIONSMost cases of microcalcifications of type 4 or 5; type 3 complicated by a mass or with the number of microcalcifications more than 10; type 2 complicated by a mass or with a diameter of the area over 20 mm; are indicative of cancer. Open biopsy is recommended to acquire definitive pathological diagnosis for these cases. For the remainder of the morphological types, stereotaxic biopsy or followup should be considered.

Adult ; Aged ; Breast ; pathology ; Breast Diseases ; classification ; Breast Neoplasms ; diagnosis ; Calcinosis ; classification ; Female ; Humans ; Mammography ; Middle Aged ; Multivariate Analysis

PURPOSE: This study was undertaken to investigate X-ray mammographic findings which correlated with histopathologic classification of breast carcinomas. MATERIALS AND METHODS: In 114 cases (113 patients) weeviewed X-ray mammographic findings of breast carcinoma and their histopathologic classification, and the findings were analysed to define mass, calcification, and spiculation. RESULTS: According to histopathologic classifications of breast carcinomas, infiltrating ductal carcinoma was the most common(78.9%). X-rays mammographyrevealed that irregular mass was found in 43.9% of cases, calcification in 47.4 %, and radiating spiculation in75.4%. Mass with spiculation accounted for 41.2%, and mass with calcification and spiculation for 34.2%. A commonfinding of ductal carcinoma in situ was an ill-defined mass with malignant clustered microcalcification. Infiltrating ductal and infiltrating lobular carcinomas showed irregular masses with spiculation and colloid or medullary carcinomas had well-defined masses. CONCLUSION: Mass with spiculation, and mass with calcification and spiculation were common findings of breast carcinoma. The differences in X-ray mammographic findings among each different histopathologic type of breast carcinoma are helpful for differential diagnosis.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Classification* ; Colloids ; Diagnosis, Differential

PURPOSE: Increased technologic capabilities have allowed for the expanded use of ultrasound beyond simple differentiation of a lesion as solid versus cystic nature, allowing us to classify lesions into various categories based on a number of descriptive features. The purpose of this study was to investigate whether to predict the preoperative prognosis of breast cancer through the correlation between ultrasonographic images and the grade of malignancy. MATERIALS AND METHODS: The patient population for this study consisted of 107 patients with infiltrative ductal carcinoma who were evaluated using ultrasound technology. Ultrasonographic findings were divided as follows: Type I, round or oval shape and regular border; Type II, partially round or oval shape and partially irregular border; and Type III, irregular shape and irregular border. RESULTS: 1. The frequency of grade 1 (G1) was significantly higher in the Type I group than the othergroups. 2. In the 2.0 cm sized mass, the lymph node metastasis rate was significantly lower in the Type I group than the other groups. 3. In all the groups, Estrogen receptor (ER) positivity was insignificant regardless of tumor size and type. 4. In the 2.0 cm sized mass, c-erbB-2 positivity was significantly lower in the Type I than the other groups. There was no clear difference among the three groups in tumors greater than 2.0 cm in size. CONCLUSION: These results show that our classification of ultrasonographic images reflect the grade of malignancy in terms of clinicopathological features in breast cancers less than 2.0 cm in size. Therefore, ultrasonographic findings may help predict the preoperative prognosis in T1 size breast cancer, although further study is required.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Classification ; Diagnosis ; Estrogens ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Pathology ; Prognosis ; Ultrasonography

Breast thermography produces a picture of the heat emitted from the surface of the breast. And abnormal temperature over the breast has been suggested as an indicator of malignancy. The mechanisms for the heat production at the area of the skin over the breast are suggested hypermetabolism, hypervascularization, and hyperfusion of the affected regions of the breast. The purpose of this study was to evaluate the diagnostic accuracy of breast thermography in breast cancer. One hundred thirty breast cancers and one hundred ten benign breast masses were examined by a digital infrared thermographic system (NEC San-ei, Therm Tracer 6T67) between January 1991 and December 1995. In this study, thermograms were classified as normal (Th-1), equivocal (Th-2), or abnormal (Th-3). Normal thermograms were those with normal symmetric vascularity, equivocal thermograms were those with only heat in the area of mass, and abnormal thermograms were those with heat and increased vascularity in the area of mass. Among the 110 benign breast masses, there were 98 Th-1 cases (89.1%), 2 Th-2 cases (1.8%) and 10 Th-3 cases (9.1%). Among the 130 breast cancers, there were 98 Th-3 cases (75.4%), 20 Th-2 cases (16.2%), and 12 Th-1 cases (9.2%). The sensitivity of the breast thermograms was 90%, the specificity 89.1%, and the diagnostic accuracy 89.6%. A thermal difference(deltaT) of less than 1oC was seen in 10 cases (7.7%) of breast cancer, and a deltaT of more than 1oC was seen in 120 cases (92.3%). Among the latter of a deltaT of more than 3oC was seen in 67 cases(51.4%). The correlation of the breast-cancer tumor size with deltaT was highly significant(p<0.0001). The classification of the thermographic diagnosis was found to be statistically correlated with tumor size (p<0.0001), axillary node status (p<0.001) and nuclear grade (p<0.05), but not with the presence or abscence of estrogen receptor. These results suggest that thermography is useful as a diagnostic tool for breast cancer. And that a deltaT of more than 2oC of on a breast thermogram strongly suqqests a malignancy.
Breast Neoplasms* ; Breast* ; Classification ; Diagnosis* ; Estrogens ; Hot Temperature ; Sensitivity and Specificity ; Skin ; Thermogenesis ; Thermography*

It is well known that the medullary carcinoma of the breast is one of the special types of breast carcinoma with a good prognosis. At present, the medullary carcinoma of the breast is subclassified into 3 types: typical medullary, atypical medullary and nonmedullary carcinoma. Among them, the former has the best prognosis. We reviewed the film mammographic and ultrasonomammographic findings of 13 patients according to the reevaluated histopathologic diagnosis. Typical medullary carcinoma shows a well circumscribed mass with surrounding halo on film mammogram, and well defined mass with central intermediate echogenicity and peripheral low echogenicity and posterior acoustic enhancement on ultrasonomammogram. Atypical medullary carcinoma shows relatively well circumscribed mass with partial marginal obliteration on film mammogram, and irregular bordered mass with inhomogeneous echogenicity due to focal necrosis in the mass and associated findings of thick boundary, asymetrical lateral shadowing on ultrasonomammogram. Nonmedullary carcinoma shows lobulated mass with surrounding parenchymal distortion and skin thickening on film mammogram, and relatively well defined lobulating mass with surrounding parenchymal distortion and marked heterogeneous internal echogenicity on ultrasonomammogram. Therefore, differentiation between typical medullary carcinoma with good prognosis and atypical medulary or nonmedullary carcinoma with poor prognosis, may be possible by various diagnostic imaging modalities preoperatively. But further collective study shall be needed in near future.
Acoustics ; Breast Neoplasms ; Breast* ; Carcinoma, Medullary* ; Classification* ; Diagnosis ; Diagnostic Imaging ; Humans ; Necrosis ; Prognosis ; Shadowing (Histology) ; Skin

PURPOSE: To evaluate the morphologic differential diagnosis of benign and malignant ductal breast tumors, as seen on US. MATERIALS AND METHODS: US findings in 29 pathologically proven cases of ductal breast tumor were retrospectively reviewed. All patients were female and their mean age was 42 years. Nineteen tumors were benign and ten were malignant, and all ductal or cystic lesions showed solid masses. According to the location of the mural nodule, we classified the sonographic appearance of these tumors into three types : intraductal, intracystic and amorphic. The intraductal type was divided into three subtypes: incompletely obstructive, completely obstructive and multiple mural nodules. For the intracystic type, too, three subtypes were designated : the intracystic mural nodule (mural cyst), intracystic mural nodule with the duct (mural cyst+duct) and intracystic multiple mural nodules. The amorphic type is defined as an atypical ductal tumor with the mural nodule extending into adjacent parenchyma. RESULTS: The margin of the duct or cyst was smooth in 68.4% of benign, and irregular in 90% of malignant ductal tumors. Internal echogeneity of the duct or cyst usually showed homogeneity in both benign and malignant tumors. 73.7% of tumors connecting the duct were benign and 50% were malignant. In benign tumors, 52.6% of mural nodule had an irregular margin, while in malignant tumors, the corresponding proportion was 100% ; both types usually showed heterogeneous hypoechogeneity. Among benign tumors, the most common morphologic type was the intraductal incompletely obstructive subtype (36.8%) ; among those that were malignant, the amorphic type was most common, accounting for 40% of tumors. No amorphic type was benign and no incompletely obstructive subtype was malignant. CONCLUSION: When ductal breast tumors are morphologically classified on the basis of sonographic findings, the intraductal incompletely obstructive subtype suggests benignancy, and the amorphic type, malignancy. The morphologic classification of ductal breast tumors based on sonography is therefore useful for the differential diagnosis of benignancy and malignancy.
Breast Neoplasms* ; Breast* ; Classification* ; Diagnosis, Differential* ; Female ; Humans ; Retrospective Studies ; Ultrasonography*

BACKGROUND: In Korea, the incidence of breast cancer is relatively lower than in western country, but it is in increasing slope. However the mammographic patterns of Korean breast cancer patients are not well known. METHODS: The authors collected the clinical and radiologic data from new breast cancer patients between January 1992 and December 1997, and analysed the mammographic pattern. RESULTS: Of the 418 patients, the age-specific incidences were 153 (37.0%) for 40 to 49 years of age, 99 (23.9%) for 30 to 39 years, 81 (19.6%) for 50 to 59 years, 55 (13.3%) for 60 to 69 years, 14 (3.3%) for over 70 years, and 12 (2.9%) for 20 to 29 years. According to the TNM staging system, there were 2 (0.6%) with stage 0, 102 (24.9%) with stage I, 147 (35.9%) with stage IIA, 72 (17.6%) with stage IIB, 85 (20.8%) with stage IIIA, 1 (0.2%) with stage IV. The non-palpable lesions were 7.5% on physical examination. According to Wolfe's classification, there were 78 (19.0%) for N1, 78 (19.0%) for P1, 133 (32.4%) for P2, and 122 (29.7%) for DY pattern. On mammography, lumps were found in 312 cases (75.8%). Among mammographic lumps, 51.9% was not clearly defined margin. The mammographic calcifications were found in 48.3% of all patients. In the distribution of calcification, 20.6% was diffuse type and 79.4% was localized type. The size of calcifications was variable in 92.9% and the shape of calcifications was amorphous pattern in 85.6%. We could not suspect cancer in 14.7% of patients on mammography, and 10.1% of patients on ultrasound examination. CONCLUSION: We believe that these baseline mammographic data of Korean breast cancer patients may contribute to the accurate diagnosis of breast cancer, but more data will be needed.
Breast Neoplasms* ; Breast* ; Classification ; Diagnosis ; Humans ; Incidence ; Korea ; Mammography ; Neoplasm Staging ; Physical Examination ; Ultrasonography

Biomarkers, Tumor ; Breast Neoplasms ; classification ; diagnosis ; genetics ; pathology ; Carcinoma, Basal Cell ; classification ; diagnosis ; genetics ; pathology ; Genes, BRCA1 ; Humans ; Mutation

Breast cancer is a heterogeneous disease. The formation and progression of tumor and the sensitivity to treatment differs from patient to patient. In addition to the widely used molecular subtype, novel markers are needed to better personalize the treatment of breast cancer. Tumor infiltrating lymphocyte (TIL) have been consistently documented in breast cancer lesions especially in triple negative and human epidermal growth factor receptor-2 positive breast cancer. Several clinical trials have revealed that TIL are associated with prognosis and can predict therapeutic efficacy of special therapy. TIL could be divided to different subtypes including CD8 + TIL, CD4 + TIL, cytotoxic T lymphocyte-associated antigen-4 + TIL, programmed death-1 + TIL. They play different roles in the process of anti-tumor immunity and can predict different prognosis. Screening out special TIL subtype which is well associated with prognosis and therapeutic efficacy and developing targeting immunotherapy can help to improve outcomes of breast cancer patients.
Breast Neoplasms ; diagnosis ; immunology ; Humans ; Lymphocytes, Tumor-Infiltrating ; classification ; cytology ; Prognosis