乳腺浸润性导管癌的MRI诊断

目的：探讨乳腺浸润性导管癌的MRI诊断价值。方法：对60例经手术病理证实的乳腺浸润性导管癌患者行MRI平扫及动态增强检查,从病灶形态学及时间-信号曲线、早期强化率等方面进行诊断。结果：60例浸润性导管癌中,12例T1WI等信号,48例低信号;15例T2WI等信号,45例高信号;57例病灶内部信号不均匀。增强扫描30例呈边缘环状强化,15例呈分支状强化,9例呈均匀强化,6例轻度强化。时间-信号强度曲线：Ⅰ型6例,Ⅱ型33例,Ⅲ型21例。54例早期增强率〉80％,6例〈80％但〉60％。结论：依据MR形态学特征、时间-信号强度曲线和早期增强率可以对乳腺浸润性导管癌作出准确的诊断。     

3.0T磁共振动态增强在乳腺浸润性导管癌诊断中的应用价值

目的 探讨MR动态增强在乳腺浸润性导管癌诊断与鉴别诊断中的应用价值.方法 17例乳腺浸润性导管癌,均采用3.0T MR扫描仪及乳腺专用线圈行常规MR平扫和动态增强检查.所有病例均经手术病理证实,分析比较病灶的MRI信号强度、形态学以及血流动力学特点.结果 17例17个乳腺浸润性导管癌均表现为肿块型,T_1WI呈低信号影(8/17)或等信号影(9/17),T_2WI呈高信号影(14/17)或等信号影(3/17).形态学表现:病灶不规则形及分叶状占82.4%(14/17);病灶边界不清楚(12/17)、边缘不光滑(15/17),其中毛刺征或星芒征7例.病灶增强后多表现为不均匀性显著强化(10/17)或环形强化(5/17);在最大信号强度投影(MIP)图上有82.4%(14/17)的病灶周围可见血管纠集征.血流动力学表现为所有病例早期强化率均＞90%;88.2%(15/17)的病灶强化峰值＜3 min;时间-信号强度曲线以Ⅱ、Ⅲ型为主,Ⅱ型35.3%(6/17),Ⅲ型58.8%(10/17).结论乳腺浸润性导管癌MR动态增强影像学表现具有一定的特征性,有助于本疾病的诊断与鉴别诊断.     

乳腺癌的动态增强MRI及DWI鉴别诊断

目的:探讨动态增强及弥散加权成像在不同病理类型中的乳腺癌鉴别诊断价值.方法:回顾分析49例经病理证实(34例浸润性导管癌,7例黏液腺癌,4例乳头状癌,4例浸润性筛状癌)的乳腺癌MRI资料,病例均行MRI动态增强检查及DWI成像,绘制时间一信号强度曲线,计算早期强化率及峰值强化率,测量病灶ADC值,并进行单因素方差分析及正常对照组ADC值配对配对t检验.结果:动态增强MRI显示时间-信号强度曲线Ⅲ型34例(69.3%),Ⅱ型10例(20.4%),Ⅰ型5例(10.2%).浸润性导管癌、黏液腺癌、筛状癌及乳头状癌之间的早期强化率有明显差异(F=3.399,P=0.027<0.05),峰值强化率无明显差异(F=2.241,P=0.099>0.05),ADC值有显著性差异(F值为37.954,P=0.000<0.05).黏液腺癌与浸润性导管癌的早期强化率及ADC值均有明显差异(P=0.042,0.000<0.05).结论:乳腺癌因其病理基础不同,表现出不同的MRI特征,动态增强MRI及ADC值测量对部分病理类型的鉴别可提供一些参考,其中对黏液腺癌与浸润性导管癌的鉴别诊断具有重要参考价值.     

MRI动态增强扫描在乳腺良恶性病变中的诊断价值

目的:评价MRI动态增强扫描在乳腺良恶性病变中的诊断价值。方法:回顾性分析58例经病理证实的乳腺病变的MRI动态增强扫描强化形态及时间-信号强度曲线图表现。结果:良性病变共22例(纤维腺瘤8例,导管内乳头状瘤5例,乳腺囊肿5例,导管囊状扩张伴慢性炎症1例,囊性乳腺病3例);恶性病变共36例(浸润性导管癌28例,浸润性小叶癌3例,导管原位癌2例,浸润性乳头状癌2例,髓样癌1例)。恶性病变多表现为边缘毛刺、分叶征或边缘模糊,环状强化或不规则强化。良性病变多表现为边缘光滑整齐的均匀强化,其中5例囊肿无强化。其中形态学阳性预测值为89.47%,阴性预测值为90.00%,准确率为89.66%。强化表现阳性预测值为89.74%,阴性预测值为94.74%,准确率为91.38%。时间-信号强度曲线图:22例良性病变,13例(59.09%)表现为Ⅰ型,8例(36.36%)表现为Ⅱ型,1例(4.55%)表现为Ⅲ型;36例恶性病变,1例(2.78%)表现为Ⅰ型,9例(25.00%)表现为Ⅱ型,26例(72.22%)表现为Ⅲ型,阳性预测值为79.55%,阴性预测值为92.86%,准确率为82.76%。结论:乳腺MRI动态增强的形态学表现与时间-信号强度曲线图相结合,在良恶性病变的诊断与鉴别诊断中具有较高的价值。     

乳腺原位癌MRI表现和诊断价值

目的：探讨MRI对乳腺原位癌的诊断价值。方法：回顾性分析9例经病理学证实的乳腺原住癌的MRI表现,所有患者均行MRI平扫及灌注成像。结果：所有病变于T1WI呈低信号,7例T2WI呈混杂稍高信号或高信号、2例呈等信号。增强扫描示6例呈非肿块样强化,其中2例呈线样／导管样强化,3例呈斑片状强化,1例为弥漫性强化;3例呈肿块样强化。时间-信号强度曲线：平台型7例,上升型1例,廓清型1例。灌注成像测量的灌注参数包括洗进（Washin）、洗出（Washout）、达峰时间（TTP）、最大信号强度值（MIPt）及阳性强化积分（PEI）,其均值依次为756．84±48．70、-0．0856±8．99、248．51±22．52、464．51±28．43、1282．11±96．86,与正常乳腺组织各参数值比较差异均有统计学意义（P〈0．05）。结论：乳腺原位癌以局灶性强化最常见,时间-信号强度曲线以平台型为主,MRI在乳腺原位癌诊断中具有一定的价值,MR灌注成像也为原位癌的诊断提供一种新的方法。     

乳腺导管造影在溢液性乳腺癌诊断中的应用

目的：探讨不同病理类型的溢液性乳腺癌在乳腺导管造影中的X线征象,提高对本病的诊断水平。方法：搜集经手术病理证实并行乳腺X线片及腺导管造影检查的乳腺癌108例,溢液性质为血性62例,浆液46例,临床因溢液而疑及乳腺癌。分析不同病理类型乳腺癌（浸润性导管癌64例,浸润性小叶癌23例,其他21例包括髓样癌7例,化生性癌1例,富于脂质癌2例,导管原位癌7例,粘液癌1例,浸润性乳头状癌3例）在乳腺导管造影中的X线征象。结果：乳腺癌导管造影主要征象：鼠尾征13例,导管走行僵直16例,充盈缺损（杯口征）7例,导管扩张99例,截断征（刀切征）24例,导管结构紊乱60例,断续征37例,虫蚀样改变30例,潭湖征32例。108例乳腺癌中有106例合并两种以上征象。浸润性导管癌最多见,64例,占50%;其次为浸润性小叶癌,23例,占21.3%。结论：充分认识溢液性乳腺癌的乳腺导管造影征象,对进一步明确乳腺癌的诊断具有重要价值,合并征象越多,对乳腺癌的诊断价值越高。     

ADC值测量对不同病理类型乳腺癌的诊断价值

目的 探讨MR扩散加权成像(DWI)及表观扩散系数(ADC)值对不同病理类型乳腺癌的诊断价值.资料与方法 50例经组织病理学证实的乳腺癌患者,其中浸润性导管癌35例,导管原位癌8例,小管癌5例,导管乳头状癌1例,黏液癌1例.使用 GE 3.0 T磁共振仪,扫描序列包括T1WI、T2WI平扫、DWI及动态增强.所有病例采用单次激发自旋回波平面成像(SE-EPI)序列行DWI扫描,扩散敏感系数(b值)取0、800 s/mm2,在ADW 4.2工作站对DWI图像进行后处理,测量感兴趣区的ADC值,对不同病理类型乳腺癌病灶的平均ADC值进行统计学分析,评价ADC值在乳腺癌不同病理类型鉴别诊断中是否具有临床价值.结果 浸润性导管癌平均ADC值为0.961×10-3 mm2/s,导管原位癌平均ADC值为1.203×10-3mm-2/s,浸润性小管癌平均ADC值为1.125×10-3mm2/s,浸润性导管癌与导管原位癌及小管癌的ADC值差异具有统计学意义(P<0.05).结论 DWI在乳腺癌病理分型上可提供一些其他MRI序列无法获得的有价值的信息,ADC值测量对浸润性导管癌及导管原位癌的鉴别诊断具有一定的临床价值.     

全数字化乳腺摄影与MRI对乳腺恶性病变诊断的对比分析

目的 探讨乳腺癌全数字化乳腺摄影(full-field digital mammography,FFDM)与乳腺MRI的影像学表现,评价其对乳腺癌的诊断价值.方法 收集68例经穿刺或手术病理证实的乳腺癌病例,对比分析其X线摄影及MRI表现.全数字化乳腺摄影采用常规方法摄片,MRI采用自旋回波T1WI,T2WI序列及动态增强扫描等.结果 68例乳腺恶性肿瘤中,浸润性导管癌57例,浸润性小叶癌3例,叶状囊肉瘤1例,血管肉瘤1例,导管内癌2例,炎性乳癌2例,印戒细胞癌1例,Paget's病1例.乳腺X线摄影诊断正确61例,诊断准确率89.7％.MRI诊断正确66例,诊断准确率97.1％.结论 乳腺X线摄影是乳腺恶性病变的首选检查方法,MRI能更多的显示乳腺病灶的内部特征,二者联合应用对乳腺癌的临床诊断具有重要意义.     

溢液性乳腺癌的乳腺导管造影表现及病理基础

目的:分析溢液性乳腺癌的乳腺导管造影表现及其病理基础,为临床提供可靠的诊断依据,以提高早期乳腺癌的诊治水平。方法:临床表现为乳头溢液并经手术、病理证实的乳腺癌患者26例,回顾性观察其乳腺导管造影表现,并与病理结果对比分析。结果:26例中,导管原位癌8例;浸润性导管癌5例;导管原位癌伴早期浸润7例;复合型癌3例,其中导管原位癌合并浸润性小叶癌2例,浸润性导管癌合并浸润性小叶癌1例;导管内乳头状瘤病癌变3例,其中乳腺X线平片未发现异常5例,毛刺或分叶状肿块2例,肿块伴钙化9例,多形性钙化灶10例。乳腺导管造影主要表现:导管内充盈缺损伴有不同程度导管扩张;导管管壁浸润破坏对比剂渗漏,形成"潭湖征";导管管壁不规则,呈"虫蚀样"改变或"断续征"。本组乳腺导管造影诊断乳腺癌的符合率为88.4%。结论:乳腺导管造影是溢液性乳腺癌诊断的安全而有效的检查方法,具有很高的定性、定位诊断价值,尤其对临床触诊阴性的早期乳腺癌能作出较准确的诊断,提高了早期乳腺癌的检出率。     

乳腺癌的MRI成像技术及其诊断价值

目的:探讨乳腺癌的MRI特征表现,分析各种MR成像技术的临床应用价值和存在的不足.方法:38例乳腺癌患者术前均经MRI平扫、DWI、动态增强及1H-MRS检查,回顾性分析乳腺癌的MRI表现,并分析各种乳腺MR成像技术的应用价值及存在的不足.结果:在平扫T1WI、压脂T2WI乳腺癌多表现为等或低信号;DWI中b=0时病灶呈明显高信号,随b值增加病灶信号强度依次降低;以形状不规则、毛刺征、环形强化、早期增强率≥70%和Ⅱ型或Ⅲ型曲线作为诊断乳腺癌标准,其敏感度分别为65%、67.5%、80%、95%和95%;1H-MRS显示乳腺癌出现明显升高的Cho峰,Cho/Cr升高,基于Cho峰的出现诊断乳腺癌的敏感度为77.5%.结论:乳腺癌MRI病灶形态学、动态增强特点具有特征性,DW和1H-MRS检查具有重要的辅助诊断价值,但是部分良、恶性病灶的表现存在部分重叠,对乳腺导管原位癌的诊断MRI无明显优势.     

Evaluation of enhancement patterns using three-dimensional dynamic contrast-enhanced MR imaging in 209 cases of breast cancer

PURPOSE: To evaluate contrast-enhanced patterns using three-dimensional (3D) dynamic MR imaging in 209 cases of breast cancer. MATERIALS AND METHODS: Three-dimensional dynamic imaging of the breast (1.5-T scanner) was performed in 755 cases. Of 227 breast carcinomas, 209 cases that were histologically confirmed were enrolled in this study. The histological diagnoses included ductal carcinoma in situ (DCIS) (n=12), invasive ductal carcinoma (n=176), mucinous carcinoma (n=10), medullary carcinoma (n=4), invasive lobular carcinoma (n=6), and other (n=1). Tumor size was a mean 24.6 mm in diameter (range, 7-110 mm), including 110 cases of small breast carcinomas (< or = 2 cm). The contrast-enhancement pattern was analyzed from the early phase of 3D-MRI and the post-contrast T1-weighted SE image acquired before the delayed phase of 3D-MRI. The type of peripheral enhancement (PE) was evaluated on the early and delayed phases of 3D-MRI. These enhancement patterns were also compared with the histological findings of small breast carcinomas. RESULTS: The sensitivity of the 209 cases of breast carcinoma was 99% (207/209) on 3D dynamic MRI. Two hundred six cases (98.6%), including all DCIS, showed strong enhancement on the early phase of 3D MRI. An increased washout pattern showing signal intensity lower than that of fat on post-contrast T1-weighted imaging was noted in 201 cases (96.1%), of which 179 cases (85.6%) showed washout patterns. PE was identified in 63 cases (30.4%) and in 35 of 110 cases of small breast carcinoma (31.8%). Delayed PE following central washout was noted in 65% of 63 cases and 71.4% of 35 cases of small breast carcinoma. Delayed PE was well correlated with marginal fibrosis. CONCLUSION: Three-dimensional dynamic MRI of the breast was highly sensitive for breast carcinoma. Delayed PE following central washout was considered a specific finding of breast carcinoma. It is important to understand the enhancement patterns of 3D dynamic MRI for excellent specificity of breast carcinomas.     

Multicentric and multifocal cancer: whole-breast US in preoperative evaluation

PURPOSE: To evaluate preoperative whole-breast ultrasonography (US) in the management of breast cancer. MATERIALS AND METHODS: The ipsilateral breast in 40 patients with known breast cancer or in whom there was high suspicion of breast cancer was evaluated with whole-breast US. Biopsy was performed on all discrete solid lesions. RESULTS: US depicted 45 (94%) of 48 invasive tumor foci and seven (44%) of 16 foci of ductal carcinoma in situ (DCIS). Mammography depicted 39 (81%) of 48 invasive tumor foci and 14 (88%) of 16 foci of DCIS. The nine (14%) of 64 malignant foci seen only at US included three infiltrating ductal carcinomas, two mixed infiltrating and intraductal carcinomas, two infiltrating lobular carcinomas, and two foci of DCIS. Two (18%) of 11 foci of infiltrating lobular carcinoma were missed at both US and mammography. Of 20 patients mammographically suspected of having unifocal disease, three (15%) required wider excision on the basis of US findings. Two additional foci were depicted only at US in one of 16 patients mammographically suspected of having multicentric or multifocal disease. Of four patients with mammographically occult disease, US correctly depicted the diffuse (n = 2) or unifocal (n = 2) extent of the cancer. CONCLUSION: Whole-breast US complements mammography in the preoperative evaluation of patients with breast cancer, particularly when breast conservation is contemplated.     

早期乳腺癌的CR表现及病理基础

目的评价早期乳腺癌的CR表现及其病理基础。方法回顾性分析经病理证实的43例早期乳腺癌的CR片,包括导管原位癌及导管原位癌伴微浸润30例、浸润性导管癌12例和浸润性小叶癌1例,观察早期乳腺癌的CR表现,并与病理对照。结果(1)43例早期乳腺癌中,CR表现钙化21例(49%),结节15例(35%),非对称性局限性密度增高影伴结构紊乱7例(16%)。(2)乳腺数字化图像可以显示早期乳腺癌病变的细微结构。结论乳腺CR成像对早期乳腺癌的诊断具有重要意义。     

MR imaging screening of the contralateral breast in patients with newly diagnosed breast cancer: preliminary results

PURPOSE: To investigate the role of screening magnetic resonance (MR) imaging in the detection of synchronous contralateral breast cancer in patients with newly diagnosed breast cancer. MATERIALS AND METHODS: Between January 1999 and July 2001, 182 patients with newly diagnosed breast cancer (after either core or excisional biopsy with positive or close margins of resection) underwent bilateral contrast material-enhanced MR imaging at 1.5 T with a dedicated bilateral breast multicoil array. The contralateral breast was imaged for cancer screening. Family history of breast cancer, index cancer histology, breast density, and age at diagnosis of first breast cancer were assessed as potential risk factors for synchronous contralateral breast cancer. RESULTS: Fifteen patients (8.2%) had a suspicious enhancing lesion depicted in the contralateral breast. Seven patients (3.8%) had malignant results: ductal carcinoma in situ (DCIS) in four, invasive ductal carcinoma with DCIS in two, and invasive ductal carcinoma in one. Eight patients (4.4%) had benign results: fibrocystic changes in four, atypical ductal hyperplasia in two, atypical lobular hyperplasia and focal lobular carcinoma in situ in one, and ductal hyperplasia in one. Six patients with negative MR findings underwent prophylactic mastectomy; no malignancy was found. No significant differences were noted among patients with true-positive (n = 7), false-positive (n = 8), or negative (n = 167) MR findings with regard to family history of breast cancer (P <.27), index cancer histology (P <.19), breast density (P <.34), or age at diagnosis of first breast cancer (P <.10). CONCLUSION: The preliminary results demonstrate the feasibility of using MR imaging of the breast in a screening role, specifically to evaluate the contralateral breast in patients with newly diagnosed breast cancer to detect mammographically and clinically occult synchronous breast cancer.     

MR imaging-guided 9-gauge vacuum-assisted core-needle breast biopsy: initial experience

PURPOSE: To perform magnetic resonance (MR) imaging-compatible vacuum-assisted 9-gauge core-needle biopsy of suspicious enhancing breast lesions identified at MR imaging. MATERIALS AND METHODS: The institutional review board granted exempt status for this HIPAA-compliant study and waived the requirement for informed consent. The MR imaging-guided 9-gauge vacuum-assisted core-needle biopsy findings of 85 lesions in 75 patients aged 31-89 years were retrospectively reviewed. The biopsies were performed as part of the patients' clinical care with a Food and Drug Administration-approved biopsy system and not within a research protocol. All included patients had received a diagnosis of malignant, benign, or high-risk (for cancer) breast tissue at core-needle biopsy and had undergone subsequent surgery or follow-up imaging. MR imaging-guided biopsy results were compared with final histopathologic or follow-up imaging findings. RESULTS: At MR imaging-guided core-needle biopsy, malignancy was identified in 52 (61%) lesions: 35 invasive cancers and 17 ductal carcinoma in situ (DCIS) lesions. Four (24%) of the 17 DCIS lesions were upgraded to invasive cancer at excisional biopsy or mastectomy. A high-risk lesion (ie, atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, or radial scar) was identified in 18 (21%) cases. Two (25%) of eight atypical ductal hyperplasia lesions were upgraded to DCIS at excision. No malignancy was found in the atypical lobular hyperplasia (n = 2), lobular carcinoma in situ (n = 5), or radial scar (n = 3) lesions. Fifteen (18%) lesions were found to be benign lesions of unknown type at excision or mastectomy. For 13 of these 15 lesions, the benign results were concordant with the imaging findings. Both (two of 86, 2%) discordant cases represented false-negative lesions. The remaining 13 benign lesions were validated at excisional biopsy (n = 9) or follow-up imaging (n = 4). CONCLUSION: Initial experience revealed MR imaging-guided 9-gauge vacuum-assisted core-needle breast biopsy to be a reasonable alternative to MR imaging-guided wire localization of suspicious lesions identified at MR imaging only, on the basis of published information regarding the latter.     

Biopsy of amorphous breast calcifications: pathologic outcome and yield at stereotactic biopsy.

PURPOSE: To assess the pathologic outcome of amorphous breast calcifications and the success of stereotactic biopsy for such lesions. MATERIALS AND METHODS: From July 1995 through February 2000, biopsy of all clustered amorphous calcifications not clearly stable for at least 5 years or in a diffuse scattered distribution was recommended. Logistic regression analysis was used to stratify the risk of malignancy by patient risk factors, calcification distribution, and stability. RESULTS: Calcifications were retrieved from 150 biopsies; 30 (20%) proved malignant and included 27 ductal carcinomas in situ and three low-grade invasive and intraductal carcinomas (2-5 mm). Another 30 (20%) yielded high-risk lesions, including 21 atypical ductal hyperplasia, eight atypical lobular hyperplasia, and one lobular carcinoma in situ. In 150 lesions, stereotactic biopsy was performed on 113 and aborted in 10. Calcifications were retrieved from all 113 stereotactic biopsies. Of those with calcification retrieval, there were three histologic underestimates (accuracy, 97%). Stereotactic biopsy spared a surgical procedure in 57 (46%) of 123 patients. Needle localization was required for 23 (15%) of 150 patients due to poor conspicuity. Five (45%) of 11 biopsies performed in women with ipsilateral breast cancer showed malignancy (P = .025). When multiple lesions of amorphous calcifications were present in one breast, sampling of one reliably predicted the outcome of others. CONCLUSION: We found a substantial rate of ductal carcinoma in situ and high-risk lesions associated with amorphous calcifications. Stereotactic biopsy can be successfully performed for the majority of subtle amorphous calcifications; however, only a minority were spared a surgical procedure.     

MRI of occult breast carcinoma in a high-risk population

OBJECTIVE: The purpose of this study was to determine the frequency of cancer and the positive predictive value of biopsy in the first screening round of breast MRI in women at high risk of developing breast cancer. MATERIALS AND METHODS: Retrospective review was performed of the records of 367 consecutive women at high risk of developing breast cancer who had normal findings on mammography and their first breast MRI screening examination during a 2-year period. The frequency of recommending biopsy at the first screening MRI study and the biopsy results were reviewed. RESULTS: Biopsy was recommended in 64 women (17%). Biopsy revealed cancer that was occult on mammography and physical examination in 14 (24%) of 59 women who had biopsy and in 14 (4%) of 367 women who underwent breast MRI screening. Histologic findings in 14 women with cancer were ductal carcinoma in situ in eight (57%) and infiltrating carcinoma in six (43%). The median size of infiltrating carcinoma was 0.4 cm (range, 0.1-1.2 cm). Two patients had nodes that were positive for cancer. Biopsy revealed high-risk lesions (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, or radial scar) in 13 (4%) of 367 women and other benign findings in 32 (9%) of 367 women who had MRI screening. CONCLUSION: Among women at high risk of developing breast cancer, breast MRI led to a recommendation of biopsy in 17%. Cancer was found in 24% of women who underwent biopsy and in 4% of women who had breast MRI screening. More than half the MRI-detected cancers were ductal carcinoma in situ.     

Lobular carcinoma in situ at percutaneous breast biopsy: surgical biopsy findings.

OBJECTIVE: The purpose of this study was to review surgical histologic findings in women with lobular carcinoma in situ (LCIS) at percutaneous breast biopsy. MATERIALS AND METHODS: Retrospective review was performed of 1315 consecutive lesions that underwent percutaneous breast biopsy. Percutaneous biopsy yielded LCIS in 16 (1.2%) lesions. Subsequent surgical biopsy was performed in 14 lesions in 13 women. Histologic findings were reviewed. RESULTS: In five of the 14 lesions, percutaneous biopsy yielded LCIS and a high-risk lesion (radial scar in three and atypical ductal hyperplasia in two); in one (20%) of these five lesions, surgery revealed ductal carcinoma in situ (DCIS). In four of the 14 lesions, the LCIS in the percutaneous biopsy had features that overlapped with those of DCIS; in two (50%) of these four lesions, surgery revealed DCIS (n = 1) or infiltrating lobular carcinoma (n = 1). In the remaining five of the 14 lesions, surgery revealed no DCIS or infiltrating carcinoma. Five (38%) of 13 women with LCIS lesions had synchronous or metachronous infiltrating carcinoma (three ductal, one lobular, one mixed) in the ipsilateral (n = 1) or contralateral (n = 4) breast. CONCLUSION: Surgical excision was warranted in lesions in which LCIS was found at percutaneous breast biopsy when the percutaneous biopsy histologic features overlapped with those of DCIS, when a high-risk lesion was present, or when there was imaging-histologic discordance. LCIS without these factors was not shown to require surgical excision in our small series, but a larger study is needed. Diagnosis of LCIS at percutaneous biopsy is a marker for women who are at increased risk of ductal or lobular carcinoma in either breast.     

Efficacy of helical CT in evaluating local tumor extent of breast cancer

PURPOSE: To clarify the diagnostic accuracy of helical CT (HCT) in the determination of local tumor extent of breast cancer. MATERIALS AND METHODS: One hundred forty consecutive patients with breast cancer, including 87 invasive ductal carcinomas without extensive intraductal components (EIC), 44 invasive ductal carcinomas with EIC, 2 non-invasive ductal carcinomas, and 7 invasive lobular carcinomas, were included in the study. Three-dimensional tumor diameter including whole extent was measured on HCT, and the amount of invasion to fat tissue, skin, pectoral muscle, and chest wall was estimated using a three-step scale. These results were then compared with the pathological findings. RESULTS: Breast cancers appeared as areas of high attenuation compared with the surrounding breast tissue in all patients. Tumor extent was correctly diagnosed by HCT to within a maximum difference of 1 cm in 88 patients (63%) and within 2 cm in 122 patients (87%). Sensitivity, specificity, and accuracy in diagnosing muscular invasion of breast cancer using HCT were 100%, 99%, and 99%, respectively. Sensitivity, specificity, and accuracy in diagnosing skin invasion of breast cancer using HCT were 84%, 93%, and 91%, respectively. CONCLUSION: HCT was able to visualize all of the tumors and detect the correct tumor extent in most patients.     

Nonpalpable breast cancer: mammographic appearance as predictor of histologic type.

PURPOSE: To investigate the association between mammographic appearance and histologic diagnosis of nonpalpable breast cancers. MATERIALS AND METHODS: Mammographic characteristics of 317 consecutive clinically nonpalpable breast cancers in patients treated with breast-conserving surgery were reviewed. Malignant lesions were categorized as spiculated masses, other lesions, calcifications, and combined findings. Calcifications were characterized as amorphous, pleomorphic, or fine linear and branching. Logistic regression was used for the evaluation. Odds ratios (ORs) represent the magnitude of the association between a histologic diagnosis and a mammographic finding. RESULTS: Spiculated mass without calcifications (n = 150) and calcifications alone (n = 79) accounted for three of four cancers. A spiculated mass without calcifications was strongly associated with invasive cancers (OR = 12). Calcifications alone were strongly associated with ductal carcinoma in situ (DCIS) (OR = 19). In a decreasing order, the following invasive cancers were each associated with spiculated lesions without calcifications: ductal carcinoma grade 1 (OR = 28), ductal carcinoma grade 2 (OR = 17), lobular carcinoma (OR = 11), and ductal carcinoma grade 3 (OR = 4.6). Fine linear and branching calcifications alone were associated with not only DCIS nuclear grades 3 (OR = 17) and 2 (OR = 9.7) but also with invasive ductal carcinoma grade 3 (OR = 13). CONCLUSION: Mammographic appearance can be a predictor of histologic diagnosis in three of four nonpalpable breast cancers.