To investigate the magnetic resonance imaging (MRI) features for ductal carcinoma in situ (DCIS) and plasma cell mastitis (PCM) , and to improve diagnostic accuracy for DCIS and PCM. 
 Methods: The MRI morphology confirmed by surgical pathology and dynamic enhancement for 35 patients with DCIS and 45 patients with PCM were retrospectively analyzed, which included T1 pre-scan high signal, enhanced distribution characteristics, internal strengthening mode, whether centrifugation or centripetal diffusion, dynamic enhancement curve morphology, diffusion-weighted imaging (DWI) signal characteristics, and apparent diffusion coefficient (ADC) values. 
 Results: The segmental distribution, clustered ring, T1 pre-catheters diffusion and the dynamic delayed concentric diffusion were more common in DCIS than those in PCM (P<0.05). Regional distribution, internal heterogeneity enhancement, and enhanced delay period eccentric diffusion were more common in PCM than those in DCIS (P<0.05). In the PCM group, nipple repertoire, DWI center high signal, adjacent skin thickening, and sinus formation were significantly higher than those in the DCIS group (P<0.05).
 Conclusion: Both DCIS and PCM show a non-mass like enhancement on MRI. Images in DCIS mostly show duct-like, branch-like and segment-like distribution. The internal enhancement mode is centripetal diffusion. Images in PCM mostly show regional distribution, and the inside displays heterogeneity enhancement with the adjacent skin thickening and nipple subsided.
Breast Neoplasms ; diagnostic imaging ; Carcinoma, Ductal, Breast ; diagnostic imaging ; Contrast Media ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging ; Mastitis ; diagnostic imaging ; Plasma Cells ; pathology ; Retrospective Studies

PURPOSE: This retrospective study investigated if the initially assigned category 4A or 3 in concordant benign lesions, after ultrasound (US)-guided core needle biopsy, could affect follow-up compliance. METHODS: Eight hundred thirty-eight concordant benign lesions, after core needle biopsy (674, initial category 4A group and 164, category 3 group) and follow-up US, were included in our study. If an immediate surgical excision—a surgical excision before the next follow-up—exists, those cases with pathologic reports were collected. Statistical comparisons for the result of follow-up US compliance, additional biopsy, and malignant rates among 6-month, 12-month, and long-term intervals were performed by using the chi-square test. The log-rank test was used to compare compliance rates in the timing of first follow-up between the two groups, with a significance level of 0.05. RESULTS: The number of immediate surgical excision was higher in the category 4A group (11.1%) than in the category 3 group (6.1%); only one cancer was found in the category 4A group. The patients' compliance rate in a 6-month follow-up showed an increase (p=0.003) in the category 4A group. The additional biopsy rate was higher in the initial category 4A group (10.9%) than in the category 3 group (1.9%) with statistical significance (p=0.001); four cancers were found on additional biopsy in the category 4 group. No cancer was detected in the initial category 3 group, both on immediate surgical excision and follow-up. CONCLUSION: The initial category 4A or 3 of the Breast Imaging Reporting and Data System could be a significant factor that affects immediate surgical excision and follow-up compliance. Cancers were detected only in the initial category 4A group of concordant benign lesions. More attention should be paid to the concordant benign lesions from the initial category 4A group than from the category 3 group.
Biopsy ; Biopsy, Large-Core Needle ; Breast Neoplasms ; Breast* ; Compliance ; Diagnostic Imaging ; Follow-Up Studies* ; Information Systems* ; Pathology* ; Retrospective Studies ; Ultrasonography

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

Echogenic breast lesions are generally thought to be benign. We herein report four cases of echogenic breast lesions that were seen at our centre over 38 months. One patient had a prior history of wide excision and radiotherapy for breast cancer and was imaged as part of routine cancer surveillance, while the other three were recalled for further assessment following an abnormal screening mammogram. All four patients were assessed on ultrasonography, which demonstrated an echogenic lesion in each patient. All four lesions underwent ultrasonography-guided core biopsy, followed by excision biopsy. The indications for biopsy were interval increase in the size of lesion or indeterminate features demonstrated in the lesion. Three lesions were benign, while the lesion from the patient who had received previous radiotherapy was angiosarcoma. Not all echogenic lesions are benign and lesions with suspicious features on ultrasonography should undergo biopsy.
Adult ; Aged ; Biopsy, Needle ; Breast ; pathology ; Breast Neoplasms ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Female ; Humans ; Image Processing, Computer-Assisted ; Mammography ; Middle Aged ; Neoplasm Recurrence, Local ; Ultrasonography, Mammary

OBJECTIVETo explore the early detection of breast cancer by ultrasonic imaging and thermal tomography of luciferase or green fluorescent protein (GFP)-labeled MDA-MB-231 breast cancer cell line-xenografts in nude mice.

METHODSFluorescence-tagged lentiviral vectors were transfected into the triple-negative breast cancer cell line MDA-MB-231. These cells were implanted either subcutaneously under the right breast pad or intravenously into the tail vein of nude BALB/C mice. Thermal tomography and ultrasound imaging were used to detect tumor formation and to monitor tumor growth and metastasis in vivo.

RESULTSTriple negative breast cancer cell line-xenografts were used to successfully construct an orthotopic nude mice model of breast cancer metastasis in the peritoneum. Thermal tomography and ultrasound imaging were used together to detect small tumors. Thermal tomography imaging detected small tumors earlier than ultrasound imaging.

CONCLUSIONSThermal tomography can be used to monitor changes in tumor growth and detect abnormal tissue. Therefore, it can serve as a convenient,rapid,sensitive, and reliable technique for early screening of human breast cancer.

Animals ; Cell Line, Tumor ; Disease Models, Animal ; Humans ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Neoplasm Transplantation ; Tomography, X-Ray Computed ; Triple Negative Breast Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Ultrasonography

PURPOSE: To correlate tumor stiffness and lymphangiogenesis in breast cancer and to find its clinical implications. MATERIALS AND METHODS: A total of 140 breast cancer patients were evaluated. Tumor stiffness was quantitatively measured by shear-wave elastography in preoperative ultrasound examination, calculated as mean elasticity value (kPa). Slides of resected breast cancer specimens were reviewed for most fibrotic area associated with tumor. D2-40 immunohistochemical staining was applied for fibrotic areas to detect the lymphatic spaces. Microlymphatic density, tumor stiffness, and clinicopathologic data were analyzed. RESULTS: Higher elasticity value was associated with invasive size of tumor, microlymphatic density, histologic grade 3, absence of extensive intraductal component, presence of axillary lymph node metastasis, and Ki-67 labeling index (LI) in univariate regression analysis, and associated with Ki-67 LI and axillary lymph node metastasis in multivariate regression analysis. Microlymphatic density was associated histologic grade 3, mean elasticity value, and Ki-67 LI in univariate regression analysis. In multivariate regression analysis, microlymphatic density was correlated with mean elasticity value. CONCLUSION: In breast cancer, tumor stiffness correlates with lymphangiogenesis and poor prognostic factors.
Adult ; Aged ; Aged, 80 and over ; Breast/pathology ; Breast Neoplasms/*diagnostic imaging/*pathology ; Elasticity Imaging Techniques/*methods ; Female ; Humans ; Lymph Nodes/pathology ; Lymphangiogenesis/*physiology ; Lymphatic Metastasis/*pathology ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; Neoplasm Staging ; Regression Analysis

Pseudomyxoma peritonei is a very rare condition, and even rarer in patients with history of cancer. A 70-year old woman with a history of breast cancer was admitted with abdominal pain and distention. Abdominal computed tomography revealed ascites collection, diffuse engorgement and infiltration of the mesenteric vessel, suggesting peritonitis or peritoneal carcinomatosis. Diagnostic paracentesis was attempted several times, but a sufficient specimen could not be collected due to the thick and gelatinous nature of the ascites. Therefore, the patient underwent diagnostic laparoscopy for tissue biopsy of the peritoneum, which indicated pseudomyxoma peritonei. However, the origin of the pseudomyxoma peritonei could not be identified intraoperatively due to adhesions and large amount of mucoceles. Systemic chemotherapy was performed using Fluorouracil, producing some symptomatic relief. After discharge, abdominal pain and distention gradually worsened, so at 18 months after initial diagnosis the patient received palliative surgery based on massive mucinous ascites and palpable mass at the omentum. The patient expired after surgery due to massive bleeding.
Abdomen/diagnostic imaging ; Aged ; Antimetabolites, Antineoplastic/therapeutic use ; Ascites ; Breast Neoplasms/pathology ; Colonoscopy ; Female ; Fluorouracil/therapeutic use ; Humans ; Laparoscopy ; Peritoneal Neoplasms/*diagnosis/drug therapy/pathology ; Peritoneum/pathology ; Pseudomyxoma Peritonei/*diagnosis/drug therapy/pathology ; Tomography, X-Ray Computed

Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; diagnostic imaging ; pathology ; Female ; Humans ; Lactation ; Male ; Middle Aged ; Ultrasonography

OBJECTIVETo explore the correlation between pathological findings and mammographic features of microcalcification in calcified breast carcinoma without a mass.

METHODSThe morphology and distribution of the microcalcification lesions displayed by mammography were retrospectively analyzed in 108 cases of the calcified breast carcinoma without a mass in comparison with the pathological findings of the lesions.

RESULTSThe mammographic morphology or distribution of the microcalcification lesions did not differ significantly across different pathological types of calcified breast carcinoma without a mass (P>0.05). The microcalcification lesions showed no significant morphological difference between invasive and noninvasive breast carcinomas (P>0.05). Fine pleomorphic calcifications were frequently found in both invasive and noninvasive breast carcinomas, but fine linear and fine linear branching calcifications and mixed malignant calcifications were more common in invasive breast carcinoma. The distribution of the microcalcifications showed significantly different patterns between invasive and noninvasive breast carcinoma (P=0.006), characterized by segmental and cluttered distributions of the lesions, respectively.

CONCLUSIONThere is no specific mammographic features in correlation with the pathological types of microcalcification lesions in calcified breast carcinoma without a mass, but invasive and noninvasive calcified breast carcinomas have different mammographic features in the morphology and distribution of the microcalcifications to allow their preoperative differentiation.

Breast Neoplasms ; diagnostic imaging ; pathology ; Calcinosis ; diagnostic imaging ; pathology ; Carcinoma, Ductal, Breast ; diagnostic imaging ; pathology ; Female ; Humans ; Mammography ; methods ; Retrospective Studies

OBJECTIVETo compare the methods of delineating the whole breast target volume based on surface marks, palpation and glandular tissue on CT images, and to explore the contouring criteria after breast-conserving surgery.

METHODSIn 15 patients with breast cancer after breast-conserving surgery, the whole breast target was delineated in 3D CT simulation images each by three different methods. The target volume delineated according to anatomical marks were named CTVan, according to breast palpation named CTVpa, and according to glandular mammary tissue showing by CT images named CTVgl. The volumes of CTVan, CTVpa and CTVgl, and the degree of inclusion (DI) and conformal index (CI) between the targets were measured.

RESULTSThe mean volumes of CTVan, CTVpa and CTVgl were (792.23 ± 282.25) cm(3), (618.33 ± 295.90) cm(3) and (196.83 ± 117.62) cm(3), respectively. The differences among the three methods were statistically significant (P < 0.001). The difference between CTVan and CTVpa had no statistical significance (P = 0.08), and both the differences between CTVan and CTVgl, and between CTVpa and CTVgl had statistical significance (both P < 0.001). The CI between CTVan and CTVpa (0.644 ± 0.122) was significantly larger than the CI between CTVan and CTVgl (0.264 ± 0.108), and the CI between CTVpa and CTVgl (0.328 ± 0.115)(P < 0.001). The DI of CTVan to CTVpa was 0.709 ± 0.144,DI of CTVgl to CTVan was 0.994 ± 0.005 and DI of CTVgl to CTVpa was 0.989 ± 0.008. The differences of inner, outer, upper and lower boundaries of CTVpa and CTVan were (3.35 ± 7.23) mm, (5.57 ± 13.37) mm, (1.75 ± 11.62) mm, and (11.25 ± 4.07)mm, respectively. The cranial and medial boundaries had a negative correlation with CTVpa (P < 0.05 for all).

CONCLUSIONSThe differences among the three methods in the delineation of whole breast target volume are statistically significant. The target volume delineated according to the glandular mammary tissue displayed by CT scan is significantly smaller than that by the other two methods. Combination of breast palpation and anatomical marks may be helpful in delineating the whole breast target volume is relatively reasonable at present.

Breast ; pathology ; Breast Neoplasms ; diagnostic imaging ; Female ; Humans ; Imaging, Three-Dimensional ; Mastectomy, Segmental ; Palpation ; Tomography, X-Ray Computed