OBJECTIVE: We have developed breast tumor image retrieval system using content-based retrieval method. It compares the breast tumor image with Fibrocystic Change images, Ductal Carcinoma in Situ images and Invasive Ductal Carcinoma images and find most similar one. Since the final diagnosis for breast tumor image is done only by pathologist manually, this system can provide the objectivity and the reproducibility for determining and diagnosing the breast tumor. METHODS: The breast tumor image features used in the content-based image retrieval are color feature, texture feature and texture features of wavelet transformed images. And the system can be accessed through the internet. We used Windows 2003 as an operating system, Internet Information Server 6.0 as Web a server and ms-sql server 2000 as a database server. Also we use ActiveX Data Object to connect database easily. RESULT: We evaluated the recall and precision performance of the system according to the combinations of feature types and usage of partial or whole image. Results showed that the use of multiple features and whole image gave consistently higher rates compared to the use of single feature and partial image. CONCLUSION: This retrieval system can help pathologist determine the type of breast tumor more efficiently. Also it is working based on the internet, we can use it for researching and teaching in pathology later.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis ; Internet* ; Pathology ; Wavelet Analysis

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

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

PURPOSE: Absorbable retaining thread (ART) needle localization utilizes a guiding needle with a thread; this technique was invented to reduce patient discomfort and wire migration. We investigated the feasibility of ultrasound (US)-guided ART needle localization for nonpalpable breast lesions. METHODS: ART needle localization was performed for 26 nonpalpable breast lesions in 26 patients who were scheduled to undergo surgical excision the day after localization. Seventeen breast lesions were initially diagnosed as invasive ductal carcinoma, six as ductal carcinomas in situ, and one as fibrocystic change. The other two cases without an initial pathologic diagnosis had suspicious US features, and excision was planned concomitantly with contralateral breast cancer surgery. The primary outcome was the technical success rate of ART needle localization confirmed by US immediately after the procedure, and the secondary outcomes were the percentage of clear margins on pathology and the complication rate of ART needle localization. RESULTS: The technical success rate of ART needle localization was 96.2% (25 of 26 patients), and the ART was located 1 cm away from the mass in one patient (3.8%). The lesions were successfully removed with clear margins in all 26 patients. No significant complications related to ART needle localization were observed. CONCLUSION: ART needle localization can be an alternative to wire needle localization for nonpalpable breast lesions.
Breast Neoplasms ; Breast ; Carcinoma, Ductal ; Diagnosis ; Humans ; Needles ; Pathology ; Surgery, Computer-Assisted ; Ultrasonography

OBJECTIVE: To investigate the early diagnosis of breast cancer with nonpalpable tumor. METHODS: Forty-six cases of clinical nonpalpable tumor were examined by mammography and sonography.The cases of nipple discharge were also examined by fiberoptic ductoscopy. RESULTS: Breast cancer in 46 cases was diagnosed by pathological examination. Of them, 34 diagnosed with breast cancer were found with nodus, calcification or confused structure, and so on, 5 were considered benign tumor, and 7 were not found lesion by mammography. Thirty-one cases were diagnosed with breast cancer, 6 with benign tumor, and 9 were not found occupying lesion by sonography. Occupying lesions were found in 6 cases of nipple discharge by fiberoptic ductoscopy and were finally diagnosed by biopsy. CONCLUSION Mammography and sonography are important methods in early discovering breast cancer. Early diagnosis rate of breast cancer can be elevated by signs of early breast cancer and combined examination of mammograply and sonography.
Adult ; Aged ; Breast Neoplasms ; diagnosis ; pathology ; Carcinoma, Ductal, Breast ; diagnosis ; pathology ; Female ; Humans ; Mammography ; Middle Aged ; Ultrasonography, Mammary

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

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

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

Breast ; pathology ; Breast Neoplasms ; diagnosis ; Carcinoma, Ductal, Breast ; diagnosis ; Endometrium ; pathology ; Eosine Yellowish-(YS) ; Female ; Hematoxylin ; Humans ; Lymph Nodes ; pathology ; Staining and Labeling ; methods

OBJECTIVETo compare the effectiveness and accuracy of the use of vacuum-assisted biopsy (VAB) versus wire localization (WL) in the diagnosis of non-palpable breast lesions (NPBL).

METHODSNinety-seven consecutive women with NPBL were randomized into VAB group and WL group. All specimens were identified by mammography. The patients were requested to score the cosmetic appearance of their breast after operation, and a numerical rating scale was used to measure pain on the first postoperative day. Underestimation rates for atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) were recorded if open surgical biopsy revealed DCIS and invasive cancer, respectively. Clear margins were also recorded in the two groups.

RESULTSVAB and WL located all the NPBL successfully. In the VAB group, the specimen volume was smaller than that of the WL group (2.3 cm(3) vs. 18.4 cm(3), P = 0.03). Underestimation rates of ADH and DCIS in the VAB group were 16.7% and 11.1%, respectively. The diagnostic accordance rate of VAB was 97.9%, the false negative rate was 2.1%, and there was no false positive case. The means of the numerical rating pain scale were different in both groups (1.7 for VAB vs. 2.5 for WL, P = 0.02). When cosmetic results were taken into account, 40 VAB patients had excellent outcomes and 8 good outcomes, compared with 25 excellent and 24 good for the WL group. There were better cosmetic outcomes with the VAB procedure (P < 0.05).

CONCLUSIONVAB is highly reliable and may avoid diagnostic open surgery in the majority of patients with benign lesions. However, because of the underestimation of histologic diagnosis and tumor margin involvement, VAB can not be used to completely substitute wire localization.

Adult ; Biopsy, Needle ; instrumentation ; methods ; Breast ; pathology ; Breast Neoplasms ; diagnosis ; pathology ; Carcinoma in Situ ; diagnosis ; pathology ; Carcinoma, Ductal, Breast ; diagnosis ; pathology ; Diagnostic Errors ; Female ; Fibroadenoma ; diagnosis ; pathology ; Humans ; Hyperplasia ; Middle Aged ; Precancerous Conditions ; diagnosis ; pathology ; Stereotaxic Techniques ; instrumentation ; Vacuum