OBJECTIVE: To compare the diagnostic performance of digital breast tomosynthesis (DBT) and conventional breast ultrasound (US) to characterize breast lesions as benign or malignant. MATERIALS AND METHODS: A total of 332 women, presenting for screening examinations or for breast biopsy between March and June 2012 were recruited to undergo digital mammography (DM), DBT, and breast US examination. Among them, 113 patients with 119 breast lesions depicted on DM were finally included. Three blinded radiologists performed an enriched reader study and reviewed the DBT and US images. Each reader analyzed the lesions in random order, assigned Breast Imaging Reporting and Data System (BI-RADS) descriptors, rated the images for the likelihood of malignancy (%) and made a BI-RADS final assessment. Diagnostic accuracy, as assessed by the area under the receiver operating characteristic curve, sensitivity, and specificity of DBT and US were compared. RESULTS: Among the 119 breast lesions depicted on DM, 75 were malignant and the remaining 44 were benign. The average diagnostic performance for characterizing breast lesions as benign or malignant in terms of area under the curve was 0.899 for DBT and 0.914 for US (p = 0.394). Mean sensitivity (97.3% vs. 98.7%, p = 0.508) and specificity (44.7% vs. 39.4%, p = 0.360) were also not significantly different. CONCLUSION: Digital breast tomosynthesis may provide similar reader lesion characterization performance to that of US for breast lesions depicted on DM.
Adult ; Aged ; Biopsy ; Breast/*pathology ; Breast Neoplasms/*diagnosis/radiography/ultrasonography ; Female ; Humans ; Mammography/*methods ; Middle Aged ; ROC Curve ; Radiographic Image Enhancement/*methods ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography, Mammary/*methods

PURPOSE: To show the results of an audit of screening breast ultrasound (US) in women with negative mammography in a single institution and to analyze US-detected cancers within a year and interval cancers. MATERIALS AND METHODS: During the year of 2006, 1974 women with negative mammography were screened with US in our screening center, and 1727 among them had pathologic results or any follow up breast examinations more than a year. We analyzed the distribution of Breast Imaging Reporting and Data System (BI-RADS) category and the performance outcome through follow up. RESULTS: Among 1727 women (age, 30-76 years, median 49.5 years), 1349 women (78.1%) showed dense breasts on mammography, 762 (44.1%) had previous breast US, and 25 women (1.4%) had a personal history of breast cancers. Test negatives were 94.2% (1.627/1727) [BI-RADS category 1 in 885 (51.2%), 2 in 742 (43.0%)]. The recall rate (=BI-RADS category 3, 4, 5) was 5.8%. Eight cancers were additionally detected with US (yield, 4.6 per 1000). The sensitivity, specificity, and positive predictive value (PPV1, PPV2) were 88.9%, 94.6%, 8.0%, and 28.0%, respectively. Eight of nine true positive cancers were stage I or in-situ cancers. One interval cancer was stage I cancer from BI-RADS category 2. CONCLUSION: Screening US detected 4.6 additional cancers among 1000. The recall rate was 5.8%, which is in lower bound of acceptable range of mammography (5-12%), according to American College of Radiology standard.
Adult ; Aged ; Breast/pathology ; Breast Neoplasms/*diagnosis/*radiography/*ultrasonography ; Female ; Humans ; Mammography/*methods ; Mass Screening/*methods ; Middle Aged ; Sensitivity and Specificity ; Ultrasonography/methods ; *Ultrasonography, Mammary

OBJECTIVE: To evaluate the retrieval rate and accuracy of ultrasound (US)-guided 14-G semi-automated core needle biopsy (CNB) for microcalcifications in the breast. MATERIALS AND METHODS: US-guided 14-G semi-automated CNB procedures and specimen radiography were performed for 33 cases of suspicious microcalcifications apparent on sonography. The accuracy of 14-G semi-automated CNB and radiology-pathology concordance were analyzed and the microcalcification characteristics between groups with successful and failed retrieval were compared. RESULTS: Thirty lesions were successfully retrieved and the microcalcification retrieval rate was 90.9% (30/33). Thirty lesions were successfully retrieved. Twenty five were finally diagnosed as malignant (10 invasive ductal carcinoma, 15 ductal carcinoma in situ [DCIS]) and five as benign. After surgery and mammographic follow-up, the 25 malignant lesions comprised 12 invasive ductal carcinoma and 13 DCIS. Three lesions in the failed retrieval group (one DCIS and two benign) were finally diagnosed as two DCIS and one benign after surgery. The accuracy of 14-G semi-automated CNB was 90.9% (30/33) because of two DCIS underestimates and one false-negative diagnosis. The discordance rate was significantly higher in the failed retrieval group than in the successful retrieval group (66.7% vs. 6.7%; p < 0.05). Punctate calcifications were significantly more common in the failed retrieval group than in the successful retrieval group (66.7% vs. 3.7%; p < 0.05). CONCLUSION: US-guided 14-G semi-automated CNB could be a useful procedure for suspicious microcalcifications in the breast those are apparent on sonography.
Adult ; Aged ; Biopsy, Large-Core Needle/*methods/standards ; Breast/*pathology ; Breast Diseases/pathology/radiography ; Breast Neoplasms/*pathology/surgery/ultrasonography ; Calcinosis/*pathology/ultrasonography ; Carcinoma, Ductal, Breast/*pathology/ultrasonography ; Carcinoma, Intraductal, Noninfiltrating/*pathology/radiography ; Female ; Humans ; Middle Aged ; *Ultrasonography, Interventional/standards ; Young Adult

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare subtype of cutaneous lymphoma. There have been a few case reports describing the radiologic imaging findings of SPTCL. We report a case of SPTCL, rarely presented with a breast mass. Here, we review her clinical history and radiologic (mammography and ultrasound) findings.
Adult ; Breast Neoplasms/*pathology/radiography/ultrasonography ; Female ; Humans ; Lymphoma, T-Cell/*pathology/radiography/ultrasonography ; Mammography ; Panniculitis/*pathology/radiography/ultrasonography ; Rare Diseases/*pathology/radiography/ultrasonography ; Skin Neoplasms/*pathology/radiography/ultrastructure

Sonography is an attractive supplement to mammography in breast cancer screening because it is relatively inexpensive, requires no contrast-medium injection, is well tolerated by patients, and is widely available for equipment as compared with MRI. Sonography has been especially valuable for women with mammographically dense breast because it has consistently been able to detect a substantial number of cancers at an early stage. Despite these findings, breast sonography has known limitations as a screening tool; operator-dependence, the shortage of skilled operators, the inability to detect microcalcifications, and substantially higher false-positive rates than mammography. Further study of screening sonography is still ongoing and is expected to help establish the role of screening sonography.
Biopsy ; Breast Neoplasms/pathology/radiography/*ultrasonography ; Diagnosis, Differential ; Female ; Humans ; Mammography ; Mass Screening ; Observer Variation ; Predictive Value of Tests ; *Ultrasonography, Mammary

Breast metastases in cases leukemia are very rare and occur primarily in patients with acute myeloid leukemia. We report the involvement of breast metastases in a 30-year-old woman with acute T cell lymphoblastic leukemia. The patient's mammograms revealed an extremely dense pattern with ill-defined, denser mass-like lesions in both breasts. A bilateral breast ultrasonographic evaluation revealed lobular-shaped and partly ill-defined hypoechoic masses with a multi-septated nodular (mottled) appearance.
Adult ; Breast Neoplasms/drug therapy/radiography/*secondary/ultrasonography ; Diagnosis, Differential ; Female ; Humans ; Mammography ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/*pathology ; Ultrasonography, Mammary

PURPOSE: To evaluate radiological findings of non-calcified ductal carcinoma in situ (DCIS) and to correlate those with histological features. MATERIALS AND METHODS: From July 2002 to March 2006, 22 patients with histologically-proven non-calcified DCIS were included. Mammography was obtained in 19 patients, ultrasound in 18 patients, and both examinations in 15 patients. Radiological findings were evaluated according to the Breast Imaging Reporting and Data System by American College of Radiology. Histological tumor subtype and Van Nuys classification of DCIS were assessed. RESULTS: Histological subtypes consisted of mixed type in 11 patients (50%), comedo in 4 (18%), cribriform in 4 (18%), papillary type in 2 (9%), and solid in one (5%). According to Van Nuys classification, group 3 DCIS was observed in 13 (59%) patients. In the 19 patients who underwent mammography, 13 patients presented with abnormal findings: focal asymmetry in 7 patients (37%), masses in 4 (21%), skin thickening in one (5%), and architectural distortion in one (5%). In the 18 patients who had received breast ultrasound, a mass was present in 15 (83%) patients and ductal changes in 3 patients (17%). Sixty percent of patients with masses on ultrasound had group 3 DCIS and 100% of patients with ductal change had group 1 DCIS (p=0.017). CONCLUSION: Diagnosis of non-calcified DCIS by mammography is not an easy task due to the lack of typical malignant calcifications or masses. High resolution ultrasound can be useful for detecting non-calcified DCIS, and ultrasound findings are correlated with histological features.
Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms/metabolism/pathology/*radiography/*ultrasonography ; Calcinosis/metabolism/pathology ; Carcinoma, Intraductal, ; Female ; Humans ; Mammography ; Middle Aged

Some breast neoplasms are classified as primary neuroendocrine carcinomas because they are positive for neuroendocrine markers. Although neuroendocrine carcinomas can originate from various organs of the body, primary neuroendocrine carcinomas of the breast are extremely rare. The diagnosis of primary neuroendocrine carcinoma of the breast can only be made if nonmammary sites are confidently excluded or if an in situ component can be found. Here we report a primary large-cell neuroendocrine carcinoma (LCNL) involving the left breast. Breast ultrasonography revealed a lobulated, heterogeneous, low-echoic mass in the left breast, and the lesion ap-peared as a well-defined, highly-enhancing mass on a chest computed tomography scan. Ultrasound-guided core needle biopsy was performed on the mass, and primary LCNC was confirmed by histopathologic examination.
Adult ; Breast Neoplasms/*diagnosis/pathology/ultrasonography ; Carcinoma, Large Cell/*diagnosis/pathology/radiography ; Carcinoma, Neuroendocrine/*diagnosis/pathology/radiography ; Diagnosis, Differential ; Female ; Humans ; Tomography, X-Ray Computed

OBJECTIVE: To evaluate the diagnostic accuracy of the use of an ultrasonography (US)-guided vacuum-assisted biopsy for microcalcifications of breast lesions and to evaluate the efficacy of the use of US-guided vacuum-assisted biopsy with long-term follow-up results. MATERIALS AND METHODS: US-guided vacuum-assisted biopsy cases of breast lesions that were performed between 2002 and 2006 for microcalcifications were retrospectively reviewed. A total of 62 breast lesions were identified where further pathological confirmation was obtained or where at least two years of mammography follow-up was obtained. These lesions were divided into the benign and malignant lesions (benign and malignant group) and were divided into underestimated group and not-underestimated lesions (underestimated and not-underestimated group) according to the diagnosis after a vacuum-assisted biopsy. The total number of specimens that contained microcalcifications was analyzed and the total number of microcalcification flecks as depicted on specimen mammography was analyzed to determine if there was any statistical difference between the groups. RESULTS: There were no false negative cases after more than two years of follow-up. Twenty-nine lesions were diagnosed as malignant (two invasive carcinomas and 27 carcinoma in situ lesions). Two of the 27 carcinoma in situ lesions were upgraded to invasive cancers after surgery. Among three patients diagnosed with atypical ductal hyperplasia, the diagnosis was upgraded to a ductal carcinoma in situ after surgery in one patient. There was no statistically significant difference in the number of specimens with microcalcifications and the total number of microcalcification flecks between the benign group and malignant group of patients and between the underestimated group and not-underestimated group of patients. CONCLUSION: US-guided vacuum-assisted biopsy can be an effective alternative to stereotactic-guided vacuum-assisted biopsy in cases where microcalcifications are visible with the use of high-resolution US.
Adult ; Aged ; *Biopsy/methods ; Breast/*pathology ; Breast Neoplasms/*diagnosis/pathology/radiography ; Calcinosis/*pathology ; Female ; Humans ; Mammography ; Middle Aged ; *Ultrasonography, Interventional ; Ultrasonography, Mammary ; Vacuum

OBJECTIVE: We wanted to evaluate the mammographic and sonographic differential features between pure (PT) and mixed tubular carcinoma (MT) of the breast. MATERIALS AND METHODS: Between January 1998 and May 2004, 17 PTs and 14 MTs were pathologically confirmed at our institution. The preoperative mammography (n = 26) and sonography (n = 28) were analyzed by three radiologists according to BI-RADS. RESULTS: On mammography, a mass was not detected in eight patients with PT and in one patient with MT (57% vs. 8%, respectively, p = 0.021), which was statistically different. The other findings on mammography and sonography showed no statistical differences between the PT and MT, although the numerical values were different. When the lesions were detected mammographically, an irregularly shaped mass with a spiculated margin was more frequently found in the MT than in the PT (100% vs. 83%, respectively, p = 0.353). On sonography, all 28 patients presented with a mass and most lesions showed as not being circumscribed, hypoechoic masses with an echogenic halo. Surrounding tissue changes and posterior shadowing were more frequently found in the MT than in the PT (75% vs. 50%, respectively, p = 0.253, 58% vs. 19%, respectively, p = 1.000). An oval shaped mass was more frequently found in the PT than in the MT (44% vs. 25%, respectively; p = 0.434). CONCLUSION: PT and MT cannot be precisely differentiated on mammography and sonography. However, the absence of a mass on mammography or the presence of an oval shaped mass would favor the diagnosis of PT. An irregularly shaped mass with surrounding tissue change and posterior shadowing on sonography would favor the diagnosis of MT and also a less favorable prognosis.
Adenocarcinoma/pathology/*radiography/*ultrasonography ; Adult ; Aged ; Breast Neoplasms/pathology/*radiography/*ultrasonography ; Diagnosis, Differential ; Female ; Humans ; Mammography ; Middle Aged ; Ultrasonography, Mammary