OBJECTIVETo evaluate the diagnostic value of mammography, computed tomography (CT), and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for axillary lymph node staging in breast cancer patients.

METHODSFrom February, 2014 to October, 2015, 109 women with breast cancer received examinations with preoperative mamography, CT, and DCE-MRI. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the 3 modalities were evaluated using histopathologic assessments as the gold standard.

RESULTSIn total, 39.4% (43/109) of the patients had axillary lymph node metastasis. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of mamography for determining lymph node metastasis were 14.0%, 84.8%, 56.9%, 37.5% and 60.0%, respectively; those of CT were 93.0%, 57.6%, 71.6%,58.8% and 92.7%, and those of DCE-MRI were 95.3%, 65.2%, 77.1%, 64.1% and 95.6%, respectively. Compared with the histopathologic result, the Kappa coefficients of mamography, CT, and DCE-MRI were -0.13, 0.459 and 0.558, respectively. The specificity of mamography was significantly higher (P<0.05), but its sensitivity, accuracy, positive predictive value, and negative predictive value were significantly lower than those of CT and DCE-MRI (P<0.05). Compared with CT, DCE-MRI had significantly higher sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for diagnosis of lymph node metastasis (P<0.05).

CONCLUSIONDCE-MRI has a greater diagnostic power than CT and mammography, and CT has a greater diagnostic power than mammography for axillary lymph node metastasis in breast cancer patients. Mamography alone should be used cautiously for the diagnosis of lymph node metastasis.

Axilla ; Breast Neoplasms ; pathology ; Female ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; diagnosis ; Magnetic Resonance Imaging ; Mammography ; Predictive Value of Tests ; Sensitivity and Specificity ; Tomography, X-Ray Computed

This study was aimed to evaluate the ability of imaging parameters measured on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted MRI (DWI) and positron emission tomography/computed tomography (PET/CT) to serve as response markers in breast cancer after neoadjuvant chemotherapy (NAC). In 20 patients with breast cancer, DCE-MRI and DWI using a 3 T scanner and PET/CT were performed before and after NAC. DCE-MRI was analyzed using an automatic computer-aided detection program (MR-CAD). The response imaging parameters were compared with the pathologic response. The areas under the curve (AUCs) for DCE-MRI using MR-CAD analysis, DWI and PET/CT were 0.77, 0.59 and 0.76, respectively. The combination of all parameters measured by MR-CAD showed the highest diagnostic performance and accuracy (AUC = 0.77, accuracy = 90%). The combined use of the parameters of PET/CT with DCE-MRI or DWI showed a trend toward improved specificity and negative predictive value (100%, 100%, accuracy = 87.5%). The use of DCE-MRI using MR-CAD parameters indicated better diagnostic performance in predicting the final pathological response compared with DWI and PET/CT, although no statistically significant difference was observed. The combined use of PET/CT with DCE-MRI or DWI may improve the specificity for predicting a pathological response.
Adult ; Aged ; Antineoplastic Agents/*therapeutic use ; Breast Neoplasms/*diagnosis/*drug therapy ; Chemotherapy, Adjuvant/methods ; Female ; Humans ; Image Interpretation, Computer-Assisted/methods ; Magnetic Resonance Imaging/*methods ; Mammography/methods ; Middle Aged ; Multimodal Imaging/methods ; Neoadjuvant Therapy/methods ; Positron-Emission Tomography/*methods ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Treatment Outcome

OBJECTIVETo compare the performance of full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) in the assessment of the lesions in dense breast, and to estimate the difference in diagnosis of breast disease by FFDM images alone and FFDM plus DBT images.

METHODSAccording to the breast imaging reporting and data system (BIRADS), 134 patients were selected. The morphology of the lesions shown on FFDM and DBT were evaluated and compared, and the maximum diameter of the lesions was measured. At first, doctors made the diagnosis of a patient by reading FFDM only. Then they made another diagnosis by combining with DBT images of the same patient. The two diagnoses were compared and analyzed according to the pathology results.

RESULTSOne hundred and thirty-four patients were included in this study, and all of them were confirmed by histology (65 benign cases, 69 malignant cases). DBT could show more details about the morphology of the lesions, including the border of the masses, spiculation and vessels. The numbers of those signs detected by DBT were 46, 30 and 3, respectively, while only 33 case with circumscribed masses and 14 cases with spiculation were detected by FFDM. Only the difference of spiculation in heterogeneously dense breast detected by DBT and FFDM was statistically significant (P < 0.05). Of the cases with calcifications, DBT images (reconstructed as a 1-mm-thick slice) showed calcifications superior to FFDM in 2 cases, equal to FFDM in 23 cases, and inferior to FFDM in 11 cases. The difference was statistically significant (P < 0.05). But when thickness was changed into 1 cm, the visibility of calcifications in those cases was equal between FFDM and DBT. The maximum diameter of lesions was 2.46 ± 1.64 cm in DBT image, and 2.58 ± 1.62 cm in FFDM image, with a significant difference (P < 0.05). Comparing with reading FFDM images only, the accuracy of FFDM combining with DBT was increased from 88.8% to 91.8%. For FFDM, the AUC of ROC was 0.887, while for DBT it was increased to 0.912, with a non-significant difference (P > 0.05).

CONCLUSIONSDBT is superior to FFDM in the morphological characterization and small calcification in the lesions in dense breast. Combining FFDM and DBT improves the accuracy of diagnosis, but the difference is not statistically significant.

Adolescent ; Adult ; Breast Diseases ; diagnostic imaging ; Breast Neoplasms ; diagnostic imaging ; Calcinosis ; diagnostic imaging ; Carcinoma in Situ ; diagnostic imaging ; Carcinoma, Ductal, Breast ; diagnostic imaging ; Female ; Fibroadenoma ; diagnostic imaging ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Mammography ; methods ; Middle Aged ; Radiographic Image Enhancement ; Tomography, X-Ray Computed ; Young Adult

A 47-year-old Korean woman with right middle lobe lung adenocarcinoma, malignant pleural effusion, and multiple lymph node and bone metastases, after three months of lung cancer diagnosis, presented with a palpable right breast mass. Images of the right breast demonstrated architectural distortion that strongly suggested primary breast cancer. Breast biopsy revealed metastatic lung cancer with a negative result for estrogen receptor (ER), progesterone receptor (PR) and mammaglobin, and a positive result for thyroid transcription factor-1 (TTF-1). We present a case of breast metastasis from a case of lung cancer with an extensive micropapillary component, which was initially misinterpreted as a primary breast cancer due to unusual image findings with architectural distortion.
Adenocarcinoma/drug therapy/*secondary ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Biopsy, Needle ; Bone Neoplasms/secondary ; Breast Neoplasms/drug therapy/*secondary ; Diagnosis, Differential ; Female ; Humans ; Lung Neoplasms/*pathology ; Lymphatic Metastasis ; Mammography ; Middle Aged ; Neoplasm Staging ; Tomography, X-Ray Computed ; 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

OBJECTIVE: The purpose of this study was to evaluate the ultrasonographic features of benign adenomyoepithelioma of the breast. MATERIALS AND METHODS: Between 2005 and 2009, five patients had histologically confirmed adenomyoepithelioma of the breast. We retrospectively evaluated the ultrasonographic findings of the tumors in correlation with the pathology, and reviewed medical records. RESULTS: The clinical manifestations included a palpable mass in three patients, while mammographic screening helped detect abnormalities in two patients. Ultrasonograms showed masses with an oval (n = 3) or irregular (n = 2) shape, with uncircumscribed (n = 4) or relatively well-circumscribed (n = 1) margins, as well as with a hypoechoic (n = 3) or a complex echoic (n = 2) internal echo texture. Three patients had focal ductectasia adjacent to the mass. The ultrasonographic assessments were classified as Breast Imaging Reporting and Data System (BI-RADS) category 4A, with low suspicion of malignancy in two cases, and as category 4B, with intermediate suspicion of malignancy in three cases. The pathology revealed benign adenomyoepithelioma in all patients. CONCLUSION: Benign adenomyoepitheliomas appear as solid or complex echoic masses with suspicious malignant ultrasonographic features, which may be associated with adjacent ductectasia. Although adenomyoepithelioma is a rare breast tumor, awareness of its sonographic features will be helpful for the differential diagnosis from other tumors.
Adenomyoepithelioma/pathology/surgery/*ultrasonography ; Adult ; Aged ; Breast Neoplasms/pathology/surgery/*ultrasonography ; Female ; Humans ; Magnetic Resonance Imaging ; Mammography ; Middle Aged ; Neoplasm Staging ; Positron-Emission Tomography ; Retrospective Studies ; Tomography, X-Ray Computed ; *Ultrasonography, Mammary

Primary breast lymphoma is a rare disease entity, particularly the T-cell type. There have been many case reports of primary breast lymphomas; however, these are mostly pathologic reports, with only a few reports in radiology literature. To the best of our knowledge, this is the first report on the radiologic features of primary T-cell type breast lymphoma, including mammography, ultrasonography, MR imaging, and 18 fluorodeoxyglucose positron emission tomography/computed tomography scan. The radiologic findings are rather unique for this T-cell lymphoma compared to B cell type.
Breast ; Breast Neoplasms ; Electrons ; Lymphoma ; Lymphoma, T-Cell ; Lymphoma, T-Cell, Peripheral ; Magnetic Resonance Imaging ; Mammography ; Rare Diseases ; T-Lymphocytes ; Tomography, X-Ray Computed ; Ultrasonography, Mammary

Positron emission tomography combined with computed tomography (PET/CT) has been receiving increasing attention during the recent years for making the diagnosis, for determining the staging and for the follow-up of various malignancies. The PET/CT findings of 58 breast cancer patients (age range: 34-79 years old, mean age: 50 years) were retrospectively compared with the PET or CT scans alone. PET/CT was found to be better than PET or CT alone for detecting small tumors or multiple metastases, for accurately localizing lymph node metastasis and for monitoring the response to chemotherapy in breast cancer patients.
Adult ; Aged ; Bone Neoplasms/*diagnosis/pathology/secondary ; Breast/pathology/radionuclide imaging ; Breast Neoplasms/*diagnosis/pathology/radionuclide imaging ; Carcinoma, Ductal, Breast/diagnosis/pathology ; Carcinoma, Intraductal, Noninfiltrating/*diagnosis/pathology/radionuclide imaging ; Contrast Media/administration & dosage ; Female ; Humans ; Lymphatic Metastasis ; Mammography/methods ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis/pathology ; Neoplasm Staging/methods ; Positron-Emission Tomography/*methods ; Radiographic Image Enhancement/methods ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Ultrasonography, Mammary

Background: Breast cancer is not only the most popular in women but is also one of the main causes of death among them in many countries. In Hanoi 1999, the prevalence of breast cancer was 21.8 per 100,000 of the population and was the main cause of death in women. In Ho Chi Minh city that prevalence was 17.1 per 100,000 of the population and was the second highest cause of death in women. Objectives: To assess the value of X-ray mammography and cytopathology test for breast cancer diagnosis of early stage Tis and T1. Subjects and method: A retrospective study was conducted among 103 breast cancer patients with malignant tumor size \uf0a32cm, who were admitted to K Hospital and Thanh Nhan Hospital from 01/2003 to 02/2008. Results:Breast malignant tumor was usually found most frequently at the upper outer quadrant. Around 86.4% of patients who were suspected with malignant lesion by X-ray mammography. Using biopsy test for breast cancer diagnosis, the results shows that 78.6% of patients were positive, 15.6% of cases were suspected and 5.8% had wrong diagnosis. Pathologic classifications were as followed: invasive lobular carcinoma: 78.6%, intraductal carcinoma in situ (Tis): 4.9%. Conclusion: X-ray mammography and cytopathology test are useful tools for the diagnosis of breast cancer.
X-ray mammography ; cytopathology test ; breast cancer ; Tis ; T1

The purpose of this study was to evaluate imaging findings of metastatic disease to the breast. We analyzed 15 cases that had been previously examined by radiographic study (comprising a total of 11 mammograms, 13 ultrasounds and 3 chest CT). Primary malignancies included the following: 6 breast cancers, 5 stomach cancers, 2 melanomas, 1 cervical cancer, and 1 lung cancer. Radiologic findings were analyzed and the 15 cases were divided into two groups: hematogeneous and lymphangitic metastasis. Eleven cases were classified as lymphangitic metastasis (73.3%) and 4 cases were hematogeneous metastasis (26.7%). Multiple masses were shown in 13 cases (86.7%), and 12 cases displayed unilateral lesions (80%). There was no evidence of calcification. In the 11 cases with available mammogram, 7 cases (63.6%) revealed multiple masses with well-defined (2 cases, 28.6%) or ill-defined margin (5 cases, 71.4%) and 6 cases (54.5%) showed diffuse increased density and skin thickening. Among the 11 cases that revealed mass lesions on ultrasound, 2 cases showed a well-defined margin (18.2%) and 9 cases showed an ill-defined margin (81.8%). Posterior shadowing of the mass was seen in only 1 case. Four cases (36.3%) showed a minimal echogenic boundary around the mass. Eight cases showed diffuse skin thickening (53.3%). Three cases with chest CT showed multiple masses and/or diffuse skin and trabecular thickening of the breast. In conclusion, the characteristic imaging findings of metastatic disease to the breast are multiple ill-defined masses with a lack of desmoplastic reaction and no calcification, as compared to primary breast carcinoma. The diffuse lesions without evidence of breast mass on mammogram and US could be distinguishable from inflammatory carcinoma of breast origin.
Adult ; Breast Neoplasms/*diagnosis/*secondary ; Female ; Human ; Mammography ; Radiography, Thoracic ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography