INTRODUCTIONThis study aimed to evaluate the vascular pattern of solid breast lesions using power Doppler ultrasonography (PDUS) and assess whether the presence of intratumoural penetrating vessels can predict breast cancer malignancy.

METHODSGreyscale ultrasonography (US) and PDUS were prospectively performed on 91 women in Malaysia with histopathologically proven breast lesions. The diagnostic accuracy of greyscale US, PDUS, and both greyscale US and PDUS was calculated and compared.

RESULTSThe 91 women had 102 breast lesions (55 benign, 47 malignant). Of the 47 malignant lesions, 36 demonstrated intratumoural penetrating vessels. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of greyscale US findings in diagnosing malignancy were 100.0%, 71.4%, 74.1% and 100.0%, respectively. The presence of calcification in the breast lesion and the margin, shape and posterior acoustic features of the lesion were significant parameters in predicting malignancy (p < 0.01). The sensitivity, specificity, PPV and NPV of the presence of intratumoural penetrating vessels in predicting malignancy were 76.5%, 80.0%, 76.5% and 80.0%, respectively. When both greyscale US and PDUS were used, there was a significant correlation in predicting malignancy (p < 0.05). The specificity and PPV values of the combined greyscale US and PDUS method (89.0% and 85.7%, respectively) were higher than those of greyscale US or PDUS alone.

CONCLUSIONFlow patterns revealed by PDUS can be useful for differentiating benign and malignant breast lesions. The visualisation of penetrating vessels in solid breast lesions can be used to complement greyscale US findings in predicting malignancy.

Adolescent ; Adult ; Aged ; Biopsy ; Breast Diseases ; diagnostic imaging ; Breast Neoplasms ; diagnostic imaging ; pathology ; Contrast Media ; Diagnosis, Differential ; Female ; Humans ; Malaysia ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Reproducibility of Results ; Sensitivity and Specificity ; Ultrasonography, Doppler ; Ultrasonography, Mammary ; Young Adult

PURPOSE: The purpose of this study was to describe the breast ultrasonography (US) features and to investigate whether performing a core biopsy is warranted in young women having palpable solid breast masses. METHODS: A total of 76 solid palpable masses in 68 consecutive women (< or =25 years old) underwent tissue diagnosis by percutaneous core biopsy. Two radiologists, who were blinded to the clinical history and histopathology, independently evaluated the US features according to Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The frequency of benign and malignant descriptor terms that were used to characterize the lesions were compared to the final pathology. RESULTS: All 76 palpable solid masses yielded benign pathology. On the US, the shape of the mass was described by radiologists 1 and 2 as oval or round (63.2% and 71.1%), margin as circumscribed (68.4% and 77.6%) and orientation as parallel (85.5% and 90.8%); the frequency of using all three benign descriptors was 61.8% and 68.5%, respectively. Suspicious descriptors were used less frequently by radiologists 1 and 2 including irregular shape (9.2% and 13.1%), non-circumscribed margin (31.6% and 22.4%) and non-parallel orientation (14.5% and 9.2%); the frequency of using all three suspicious descriptors was 9.2% and 11.8%, respectively. CONCLUSION: Despite the variable US features, breast malignancy seems extremely low in 25 years or younger women for palpable breast lesions. Using the BI-RADS lexicon, US accurately predicted benignity in about two thirds of our patients, supporting US surveillance as a safe alternative to invasive tissue sampling in this setting.
Biopsy ; Breast Diseases ; Breast* ; Diagnosis ; Female ; Humans ; Information Systems ; Pathology ; Subject Headings ; Ultrasonography ; Ultrasonography, Mammary ; Young Adult

OBJECTIVE: To evaluate the additional effect of sonoelastography on the radiologist's ability for distinguishing benign from malignant complex breast masses and to decide whether to perform biopsy by B-mode US. MATERIALS AND METHODS: One hundred eighteen complex breast masses (15 malignant lesions, 103 benign lesions) were included. Five blinded readers independently assessed the likelihood of the malignancy score from 1 to 5 for two data sets (B-mode ultrasound alone and B-mode ultrasound with sonoelastography). Elasticity scores were categorized as 0, 1, or 2 based on the degree and distribution of strain of the echogenic component within complex masses. The readers were asked to downgrade the likelihood of the malignancy score when an elasticity score of 0 was assigned and to upgrade the likelihood of the malignancy score when an elasticity score of 2 was assigned. The likelihood of the malignancy score was maintained as it was for the lesions with an elasticity score of 1. The Az values, sensitivities, and specificities were compared. RESULTS: The Az value of B-mode ultrasound with sonoelastography (mean, 0.863) was greater than that of B-mode ultrasound alone (mean, 0.731; p = 0.001-0.007) for all authors. The specificity of B-mode ultrasound with sonoelastography (mean, 37.1%) was greater than that of B-mode ultrasound alone (mean, 3.8%; p < 0.001) for all readers. The addition of sonoelastography led to changes in decisions. A mean of 33.6% of benign masses were recommended for follow-up instead of biopsy. CONCLUSION: For complex breast masses, sonoelastography allows increase in both the accuracy in distinguishing benign from malignant lesions and the specificity in deciding whether to perform biopsy.
Adult ; Aged ; Biopsy/*methods ; Breast Diseases/pathology/*ultrasonography ; Breast Neoplasms/diagnosis ; Diagnosis, Differential ; Elasticity Imaging Techniques/*methods ; Female ; Humans ; Middle Aged ; Pregnancy ; Reproducibility of Results ; Retrospective Studies ; *Ultrasonography, Mammary ; Young Adult

Amyloidosis is a rare disease characterized by the formation of pathological protein deposits in organs or tissues. It is typically a systemic disease which can occur in a localized form. Amyloidosis of the breast is uncommon. Common mammographic findings of breast amyloidosis are multiple nodules with or without calcifications. We report a case of primary localized breast amyloidosis presenting suspicious microcalcifications on mammography without associated masses. Mammography in a 72-year-old woman displayed multiple, linearly distributed, irregular and rod-like calcifications in the subareolar area of the left breast. The patient underwent surgical excision under mammo-guided needle localization and the pathology was confirmed to be breast amyloidosis.
Aged ; Amyloidosis/pathology/*ultrasonography ; Breast/pathology ; Breast Diseases/pathology/*ultrasonography ; Calcinosis/*diagnosis ; Diagnosis, Differential ; Female ; Humans ; Ultrasonography, Mammary

OBJECTIVE: The aim of this study is to evaluate the clinical characteristics and ultrasonographic findings of band-like interposing fat as well as to identify additional approaches for its diagnosis. MATERIALS AND METHODS: This study included 26 confirmed cases of band-like interposing fat from June 2008 to June 2010. A retrospective analysis was performed to evaluate the clinical characteristics and ultrasonographic findings in these cases. Five radiologists analyzed the ultrasonographic findings, which correlated with the mammographic and MRI findings when available, according to Breast Imaging Reporting and Data System classification. RESULTS: None of the 26 patients had any symptoms. In 92.3% of the patients, the lesion was located in the upper outer quadrant of the breast. The mean distance of the lesion from the nipple was 2.4 +/- 0.7 cm (1.1-4.5). The mean depth of the lesion from the skin was 1.3 +/- 0.3 cm (0.8-2.1). The mean maximal length of the lesion was 0.8 +/- 0.4 cm (0.3-1.8). The following were the most frequent ultrasonographic findings of lesions: irregular shape, not parallel orientation, indistinct margins, abrupt interface, hypoechogenicity, no posterior feature, no calcification, and presence of vascularity. The most frequent BI-RADS category was 4a. There were no suspicious findings on the mammography or MRI. CONCLUSION: Ultrasonographic findings may lead to misclassification of band-like interposing fat as a malignancy. A better understanding of the clinical and ultrasonographic characteristics of band-like interposing fat would facilitate its differentiation from a true mass.
Adipose Tissue/*ultrasonography ; Adult ; Biopsy, Fine-Needle ; Breast Diseases/pathology/*ultrasonography ; Diagnosis, Differential ; Diagnostic Errors ; Female ; Humans ; Mammary Arteries/*ultrasonography ; Middle Aged ; Pregnancy ; Retrospective Studies ; Ultrasonography, Mammary/*methods ; Young Adult

Cholesterol granuloma of the breast is a rare, benign disease. Here, we present the unique ultrasonographic findings of breast cholesterol granuloma manifesting as an intracystic mass. The findings of this case report may help expand existing knowledge regarding differential diagnosis of intracystic breast masses, which are found on ultrasonographic examination.
Biopsy, Needle ; Breast Diseases/pathology/surgery/*ultrasonography ; *Cholesterol ; Diagnosis, Differential ; Female ; Granuloma, Foreign-Body/pathology/surgery/*ultrasonography ; Humans ; Mammography ; Middle Aged ; *Ultrasonography, Mammary

The purpose of this paper is to show the clinical and radiologic features of a variety of diffuse, infiltrative breast lesions, as well to review the relevant literature. Radiologists must be familiar with the various conditions that can diffusely involve the breast, including normal physiologic changes, benign disease and malignant neoplasm.
Adult ; Aged ; Aged, 80 and over ; Breast Diseases/*diagnosis/pathology ; Breast Neoplasms/diagnosis/pathology/secondary ; Female ; Humans ; Magnetic Resonance Imaging ; Mammography ; Middle Aged ; Tomography, X-Ray Computed ; Ultrasonography, Mammary

A tumoral pseudoangiomatous stromal hyperplasia (PASH) that causes huge breast enlargement is very rare. Only two cases of huge tumoral PASHs have been reported in the English medical literature. We report here on a surgically confirmed case of bilateral huge tumoral PASH in a 47-year-old woman, and we present the imaging and histopathology findings. We also review the relevant medical literature.
Angiomatosis/*pathology/surgery/ultrasonography ; Biopsy, Needle ; Breast/cytology/pathology/surgery ; Breast Diseases/*pathology/surgery/ultrasonography ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Female ; Gadolinium DTPA/diagnostic use ; Humans ; Hyperplasia ; Image Enhancement/methods ; Magnetic Resonance Imaging/methods ; Mammography/methods ; Middle Aged ; Stromal Cells/pathology

Inflammatory pseudotumor, also known as inflammatory myofibroblastic tumor and plasma cell granuloma, is an uncommon low-grade lesion composed of spindle cells admixed with mature plasma cells and other inflammatory cells, such as histiocytes, lymphocytes, and eosinophils. Here, we describe the mammographic and ultrasonographic findings of a case of an inflammatory pseudotumor of the breast in a 60-year-old woman. With the suspicion of malignancy, core needle biopsy and surgical excision confirmed the mass as being an inflammatory pseudotumor of the breast.
Biopsy ; Breast Diseases/pathology/*radiography/*ultrasonography ; Diagnosis, Differential ; Female ; Granuloma, Plasma Cell/pathology/*radiography/*ultrasonography ; Humans ; Mammography ; Middle Aged ; Ultrasonography, Mammary

OBJECTIVETo investigate the value of ultrasonographic grading with high-frequency probes in differentiating benign and malignant breast tumors.

METHODSSixty-four women (mean age 44.5-/+13.7 years) with 79 breast tumors underwent high-frequency ultrasonography to examine the tumor number, size, aspect ratio, shape, boundaries, encapsulation, pseudopod, internal and rear echoes, calcifications, blood perfusion, abnormality lymph nodes in the axilla. The tumors were graded based on these findings using a 10-point grading system.

RESULTSBetween the 46 women with benign tumors and 18 with malignant tumors, no significant differences were found in the mean tumor number (1.5-/+1.3 vs 1.1-/+0.3, P>0.05) or size (55.0-/+19.2 mm vs 19.8-/+8.3 mm, P>0.05), but the mean age (41.4-/+12.4 years vs 52.4-/+14.1 years) and ultrasonographic grade (2.8-/+2.2 vs 7.3-/+1.7, P<0.05) differed significantly. The ultrasonographic grade of the breast tumors showed an obvious correlation to the nature of the tumors (r=0.695, P<0.001).

CONCLUSIONGrading of breast tumors with high-frequency ultrasonography helps evaluate the nature of the tumors, and a higher score suggests increased probability of malignancy.

Adult ; Aged ; Breast Diseases ; diagnostic imaging ; pathology ; Breast Neoplasms ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Neoplasm Grading ; Ultrasonography, Mammary ; methods ; Young Adult