PURPOSE: For the accurate diagnosis of non-palpable breast lesions with microcalcification, a localization and biopsy procedure should be performed by using mammography. Recently, a stereotactic vacuum-assisted biopsy has been reported as a convenient and accurate method for a procedure. This study was performed to determine whether the upright add-on type stereotactic biopsy was suitable for the diagnosis of microcalcified breast lesions in Korean women. METHODS: Between April 2002 and March 2003, an upright add-on type stereotactic vacuum-assisted biopsy was performed in 21 cases with microcalcification; that had been categorized from 2 to 5 according to the BI-RADS (Breast Imaging Reporting and Data System). The microcalcified lesions in biopsy specimens were confirmed with tissue mammogram and a pathological review performed. RESULTS: The pathological findings revealed fibrocystic changes in 15 cases, intraductal papilloma in 1 and ductal carcinoma in situ (DCIS) in 5. There were no malignancy among the BI-RADS category 2 & 3 cases, but DCIS was found in 2 (25%) out of 8 BI-RADS category 4 cases, and in all 3 (100%) of BI-RADS category 5 cases. The malignancy detection rate among the cases with microcalcification with a BI-RADS category above 4 was 45.4% (5/11). CONCLUSION: An upright add-on type stereotactic vacuum assisted biopsy is an accurate, safe and very convenient tool for the diagnosis of breast lesions with microcalcification.
Biopsy* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis* ; Female ; Humans ; Mammography ; Papilloma, Intraductal ; Vacuum

PURPOSE: It is well recognized that distinguishing benign papillary lesions from malignant papillary lesions on core needle biopsy may pose difficult diagnostic problems. This study was conducted to define the potential role of ultrasoundguided core biopsy for the diagnosis of papillary lesions of the breast. METHODS: Twelve hundred and seventy nine women consecutively underwent 14-gauge core biopsy between January 2004 and December 2006. Of the 1,279 patients, 42 patients (3.2%) had papillary lesions of the breast on core needle biopsy. Of these 42 patients, 35 patients underwent surgical excision or sono-guided vacuum assisted excision. We compared the pathologic results of the excised specimens with the pathologic results on core needle biopsy. RESULTS: Of the 35 patients, 23 patients underwent surgical excision and 12 patients underwent sono-guided vacuum assisted excision. Three patients with intraductal papilloma without atypism on the core needle biopsy were confirmed to have intraductal papilloma accompanied with atypism by the final pathology. All 4 patients with papillomatosis or intraductal papilloma with atypism at core needle biopsy were confirmed to have intraductal papilloma with atypism by the final pathology. There were no patients identified to have breast cancer. CONCLUSION: Our results revealed the accuracy of core needle biopsy for making the diagnosis of papillary lesions of the breast. Surgical excision may not always be necessary for papillary lesion of the breast that is diagnosed on core needle biopsy. Surgical excision is considered in patients with papillomatosis or papillary lesions with atypism seen on core needle biopsy.
Biopsy ; Biopsy, Large-Core Needle* ; Breast Neoplasms ; Breast* ; Diagnosis ; Female ; Humans ; Papilloma ; Papilloma, Intraductal ; Pathology ; Vacuum

The discovery of a breast lump is one of the most anxiety-provoking occurrences in a woman's life. The initial purpose of a surgical consultation is to determine whether a true mass exists. The majority of breast masses are self-discovered or are identified by a primary care provider. Once a breast mass has been identified, the first determination to be made is whether it is benign or malignant by using breast imaging techniques or pathologic examination. Once a breast lesion has been shown to be benign on pathologic examination, the most improtant clinical consideration is the risk of subsequent breast cancer associated with that lesion. The diagnosis of a fibroadenoma can be made using excisional biopsy or the combined modalities of CBE, ultrasound, and FNA. A true intraductal papilloma develops in one of the major subareolar ducts and is the most common lesion causing a serous or serosanguinous discharge. A mass may be felt on examination in as many as one-third of cases. The treatment of choice is microdochectomy. Hamartomas can produce a classic mammographic image that is virtually diagnostic. Because the clinical and radiologic characteristics of fat necrosis resemble those of carcimoma in the majority of cases, a needle localization or excisional biopsy is required.
Biopsy ; Breast Neoplasms ; Breast* ; Diagnosis ; Fat Necrosis ; Fibroadenoma ; Hamartoma ; Needles ; Papilloma, Intraductal ; Primary Health Care ; Ultrasonography

PURPOSE: To evaluate the value of breast MRI in analysis of papillomas of the breast. MATERIALS AND METHODS: From 1996 to 2004, 94 patients underwent surgery due to papillomas of the breast. Among them, 21 patients underwent 3D fast low angle shot (FLASH) dynamic breast MRI. Eight masses were palpable and 11 of 21 patients had nipple discharge. Two radiologists indifferently analyzed the location, size of the lesions and shape, margin of the masses, multiplicity and ductal relation. The MRI findings were categorized according to breast imaging reporting and data system (BI-RADS) lexicon. The amount and pattern of enhancement and associated findings were also evaluated according to BI-RADS. We then compared the MRI findings with galactography, mammography and breast ultrasonography (US) and examined histopathologic correlation. RESULTS: On breast MRI, the lesion size was 0.4-1.59 cm, and 18 patients showed subareolar location. On 4.25 cm (mean 1.54) dynamic enhanced images, imaging findings showed mass (n = 10), intracystic mass (n = 3), focus (n = 5), ductal enhancement (n = 2), and segmental enhancement (n = 1). In cases of the masses, the shapes of the masses were round (n = 4), lobulated (n = 3), and irregular (n = 6), and margins were circumscribed (n = 6), microlobulated (n = 5), and indistinct (n = 2). The enhancement patterns were homogeneous enhancement (n = 7), heterogeneous (n = 3) or rim enhancement (n = 3). CONCLUSION: The contrast enhanced dynamic breast MRI was highly sensitive for diagnosis of breast papillomas. MRI could play a key role in the pre-operative work-up for multiple papillomas and papillomatosis.
Adult ; Aged ; Breast Neoplasms/*diagnosis ; Female ; Humans ; Magnetic Resonance Imaging/*methods ; Middle Aged ; Papilloma, Intraductal/*diagnosis ; Sensitivity and Specificity

PURPOSE: Nipple discharge is a disturbing symptom due to the fear of breast cancer, although approximately 95% of incidents of nipple discharge arise from benign causes. This study was designed to determine a proper approach for referrals with nipple discharge. METHODS: One hundred and ten patients who underwent surgery due to nipple discharge were included in the study. Clinical parameters, including age, characteristics of nipple discharge, clinical breast examination findings, mammographic findings and ultrasonographic findings were analyzed in association with the pathologic diagnosis of malignancy. A chi-square test and logistic regression test were used to assess the statistical significance of the results. RESULTS: The mean age of the patients was 44.8 year-old (range: 19-84). The most common cause diagnosed was intraductal papilloma of 58 (52.7%), followed by 18 fibrocystic changes (16.4%), 17 infiltrating ducal carcinomas (15.5%), 14 intraductal carcinomas (12.7%) and 3 duct ectasias (2.7%). The number of incidences of malignancy was 31 (28.2%). Bloody nipple discharge, nipple discharge with accompanying mass, abnormal mammographic finding and abnormal ultrasound finding were associated with malignancy in 43.2%, 55.6%, 50% and 66.7%, respectively, as compared with 11.5% in serous discharge, 22.6% in discharge without accompanying mass, 21.9% in normal mammographic finding and 52.9% in normal ultrasonographic finding, respectively. In a multivariate analysis of factors predicting malignancy, nipple discharge with accompanying mass and bloody nipple discharge were the independent risk factors. CONCLUSION: Triple examinations including physical examination, mammogram and ultramammography would be necessary for the complete evaluation of nipple discharge and surgical excision is mandatory in cases with suspicion of cancer.
Breast ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis ; Dilatation, Pathologic ; Humans ; Incidence ; Logistic Models ; Multivariate Analysis ; Nipples* ; Papilloma, Intraductal ; Physical Examination ; Referral and Consultation ; Risk Factors ; Ultrasonography

BACKGROUND: Papillary lesions of the breast exhibit bloody nipple discharge, often with no evidence of a palpable tumor. These lesions occasionally present some difficult diagnostic and therapeutic problems as they may be histologically benign, borderline or malignant. The types of surgery should be selected according to the different lesion characteristics. A favorable result of appropriate surgery is no recurrence. METHODS: The authors performed a retrospective study of 60 patients treated for the papillary lesions of the breast over the period from January 1990 to July 1998 at Inje University Pusan Paik Hospital. The study examined clinical characteristics by comparative analysis of clinical features, diagnostic methods (mammogram, ultrasound, galactogram & fine needle aspiration cytology) and surgical procedures among the various types of papillary lesions of the breast diagnosed histologically. RESULTS: The patients with a papillary carcinoma or papillomatosis were all older than the mean age of 45 for the 60 patients. Nipple discharges were most frequent in multiple central papilloma patients & intraductal papilloma patients. The incidence of nipple discharge alone was 26.1% in intraductal papilloma patients. Palpable masses were most frequent in the patients with a papillary carcinoma, intraductal papilloma, or papillomatosis. Ultrasound and galactograms had the highest sensitivity (90.9%, 87.5%) in all the patients with papillary lesions. Galactograms had the highest sensitivity (89%) in the patients with nipple discharge alone. The diagnostic methods with the highest sensitivity according to the type of papillary lesion were the galactogram (84.6%) for intraductal papillomas; ultrasound (100%) for multiple central papillomas; galactogram (100%), ultrasound (100%), and FNAC (100%) in papillomatosis; and the mammogram (100%) and ultrasound (100%) for papillary carcinomas. Breast cancers (DCIS, ipsilateral/contralateral invasive ductal carcinoma, papillary carcinoma) or ADH were associated with 14 cases (23.3%) of papillary lesions of the breast, in particular, 8 cases (42.1%) of papillomatosis. The most common surgical procedures were excisional biopsies & microdochectomies for intraductal papillomas, microdochectomies for multiple central papillomas, excisional biopsies & major duct excisions for papillomatosis, and mastectomies for papillary carcinomas. The incidence of postsurgical residual lesions and the recurrence were 10% & 1.7% in all the patients with papillary lesions of the breast, and were especially high in patients with papillomatosis. CONCLUSIONS: 1) Ultrasonography & galactography seem to be the most useful diagnostic methods for papillary lesions of the breast. 2) Major duct excision is recommended as an effective treatment for papillomatosis.
Biopsy ; Biopsy, Fine-Needle ; Breast* ; Busan ; Carcinoma, Ductal ; Carcinoma, Papillary ; Diagnosis* ; Humans ; Incidence ; Mastectomy ; Nipples ; Papilloma ; Papilloma, Intraductal ; Recurrence ; Retrospective Studies ; Ultrasonography

PURPOSE: We wished to determine the usefulness of ultrasound-guided vacuum-assisted biopsy (mammotome) for the removal of the breast lesions that had displayed benign evidence on sonography. METHODS: During an 11 month period, vacuum-assisted breast biopsy was performed for 186 probably benign lesions on sonography using 11-gauge (127 cases) and 8-gauge (59 cases) devices. The age of the patients ranged from 19 to 65 years, and the size of the lesions ranged from 0.4 to 3 cm. We retrospectively analyzed the clinical findings and medical history of the patients who underwent vacuum- assisted breast biopsy, and we then evaluated the complications, the histopathologic results, and the follow-up US findings. RESULTS: Of the 186 cases, the lesions were palpated in 95 cases (51%), and lesions were detected in women during a screening examination in 40 cases (36%), and lesions were detected in women having a history of benign breast biopsy or having a cancer operation in the remaining 18 cases (10%). Severe bleeding during or after the procedures was noted in 4 cases (2.2%). The lesions were pathologically proved as benign in 185 cases and malignant in 1 case. With vacuum-assisted breast biopsy, high-risk benign disease was found in 7 cases, but none of the lesions was pathologically upgraded on the subsequent open surgical biopsy. On the 3-month follow-up US, variable sized hematomas were observed in 6 of 24 cases (25%). We performed incidental treatment on four of the vacuum- assisted breast biopsy patients for nipple discharge that was caused by intraductal papilloma. CONCLUSION: US-guided vacuum-assisted breast biopsy is a minimally invasive, fast and convenient biopsy technique. In addition, it is safe and accurate to use for the histological diagnosis because it would remove all the sonographically demonstrated evidence of a probable benign lesion. This technique can potentially be a useful alternative to some forms of surgical biopsy for the properly selected patients.
Biopsy* ; Breast* ; Diagnosis ; Female ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Mass Screening ; Nipples ; Papilloma, Intraductal ; Retrospective Studies ; Ultrasonography

PURPOSE: To review MR imaging finding of papillary lesion identified as additional suspicious lesion on MR image in women with biopsy-proven breast cancer and to evaluate upgrading rates after subsequent surgical histopathological diagnosis. MATERIALS AND METHODS: Among 1729 preoperative MR image of women with biopsy proven breast cancer, US-guided CNB-proven 22 papillary lesions from 21 patients, which showed additional suspicious contrast enhancement other than index cancer on MR image, were subjected to the study. Some of these lesions underwent surgery, thus the comparisons between the histopathologic results were able to be compared to the results of US guided CNB. Also retrospective analysis was done for MR findings of these lesions by BI-RADS MRI lexicon. RESULTS: On MR imaging, 8 mass lesions, 7 non-mass lesions, 7 focus lesions were detected. All of the focus lesion (100%, 7/7) was diagnosed as benign lesion and showed plateau and washout pattern in dynamic MR image. After excisional biopsy, one of 9 benign papilloma (11.1%), 3 of 3 papillary neoplasm with atypia component (100%), 3 of 5 papillary neoplasm (60%) were upgraded to malignancy such as ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC). CONCLUSION: The MR images of papillary lesions diagnosed by US-guided CNB exhibit no significant differences between malignancy and benign lesion. Also 41.2% of the lesion (7/17) was upgraded after subsequent surgery. Thus all of the papillary lesions require excisional biopsy for definite diagnosis and the MR imaging, it's just not enough by itself.
Biopsy ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Papilloma ; Retrospective Studies

OBJECTIVE: To explore the feasibility and to sum up the experience of breast intraductal neoplasm resection under breast fiberoptic ductoscopy (FDS). METHODS: FDS was performed on 548 patients with nipple discharge from Sep.2004 to Nov.2006. The clinical data of breast intraductal neoplasm found by FDS in patients who underwent tumor resection were analyzed, and the breast intraductal neoplasm image characteristics, diagnosis, operative type and postoperative pathological results were analyzed. RESULTS: Of the 548 patients with nipple discharge, intraductal neoplasm was found in 187 cases (34.1%), intraductal papilloma in 159 cases (29.0%), intraductal papillomatosis in 12 cases (2.2%), and breast carcinoma in 16 cases (2.9%). One hundred thirty-five patients were operated on in our hospital, of whom 91 were performed tumor resection or segmentectomy under the localization by FDS, and the other 44 were performed segmentectomy after breast duct infusion of methylene blue. The diagnostic rate under FDS in the FDS group (97.8%) was higher than that in the breast duct infusion methylene group (86.4%) (chi2=6.96, P=0.008). CONCLUSION FDS is not only an accurate diagnosis for breast intraductal lesion, but also an assistance to localize the breast intraductal neoplasm and to remove them in the operation.
Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; diagnosis ; surgery ; Carcinoma, Ductal, Breast ; diagnosis ; surgery ; Endoscopy ; methods ; Female ; Fiber Optic Technology ; methods ; Humans ; Middle Aged ; Papilloma, Intraductal ; diagnosis ; surgery

OBJECTIVETo investigate the value of automated breast volume scanning (ABVS) in the diagnosis of breast intraductal papilloma (IDP).

METHODSTotally 239 lesions in 213 women who were scheduled for open biopsy were investigated in this study. The patients underwent both ABVS and conventional ultrasound (US). According to the imaging diagnostic standards of IDP, the diagnostic accuracy for ABVS was calculated, and then compared with US, using histopathological examination as the gold standard.

RESULTSAmong the 239 breast lesions studied, 85 were pathologically proved to be malignancies and 154 benign lesions, among which there were 26 cases of IDP. ABVS found 41 cases of IDP (17.2%), with the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy being 88.5%, 91.5%, 56.1%, 98.5%, and 91.2%, respectively. In contrast, US found 32 cases of IDP (13.4%), with the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy being 73.1%, 93.9%, 59.4%, 96.6%, and 91.6%, respectively.

CONCLUSIONABVS coronal images can better display the structures of dilated lactiferous ducts and the intraluminal echoes, increase the diagnostic accuracy of IDP, and thus provide more information for the diagnosis and differential diagnosis of IDP.

Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; diagnosis ; Female ; Humans ; Image Enhancement ; Imaging, Three-Dimensional ; methods ; Middle Aged ; Papilloma, Intraductal ; diagnosis ; Sensitivity and Specificity ; Young Adult