Breast Lesions (breast + lesion)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Breast Lesions

  • malignant breast lesion


  • Selected Abstracts


    Benign Fibroepithelial Breast Lesion with Inflammatory Eosinophilic Infiltration

    THE BREAST JOURNAL, Issue 4 2002
    Juan B. M. Laforga MD
    No abstract is available for this article. [source]


    Radioguided Localization of Clinically Occult Breast Lesions (ROLL): A Pilot Study

    THE BREAST JOURNAL, Issue 4 2007
    Heriberto Medina-Franco MD
    Abstract:, Management of nonpalpable breast lesions requiring pathologic diagnosis has been with wire localization during the last few decades. Recently, radioguided localization (ROLL) became an alternative for this type of lesions. The objective of the present study was to evaluate the feasibility of this technique in a tertiary referral center in Mexico City. Consecutive patients requiring pathologic diagnosis from a nonpalpable breast lesion were included in the present study. On the same day of operation, all patients were injected with particles of human serum albumin. Localization of the lesion was performed in the operation theater with the aid of a hand-held gamma-probe. All lesions were identified in a control x-ray of the surgical specimen. Demographic, clinical, surgical and pathologic data were recorded. Forty patients with a mean age of 56.8 ± 7.8 years were included. In 39 of the 40 patients (97.5%) the "hot spot" was identified easily. In all patients, the area of maximum radioactivity corresponded to the site of the lesion. Imaging confirmation of the lesion in the surgical specimen was done during the first excision in 37 patients (92.5%). In the remaining cases (7.5%), a wider excision was performed during the same procedure, finding the suspected lesion in all cases. Diagnosis of cancer was made in seven patients, (17.5%). There were no significant surgical complications. Our data suggest that ROLL offer a simple and reliable method to localize occult breast lesions, allowing complete removal of the lesion in 100% of the patients. Because of the small quantity of radioactivity, the procedure is safe for both patients and the medical staff, producing less discomfort in patients than wire localization. [source]


    FNAC of a breast lesion after treatment for carcinoma

    CYTOPATHOLOGY, Issue 5 2008
    A. Mansuet-Lupo
    No abstract is available for this article. [source]


    Primary small cell carcinoma of the lung initially presenting as a breast mass: A fine-needle aspiration diagnosis

    DIAGNOSTIC CYTOPATHOLOGY, Issue 3 2009
    Wei Liu M.D.
    Abstract The incidence of metastases to the breast from extramammary sites is relatively low compared with the incidence of primary breast carcinoma. Primary sites which have a predilection for metastases to the breast include, in the order of decreasing frequency, malignant melanoma, lymphoma, lung carcinoma, ovarian carcinoma, and soft tissue sarcoma, followed by gastrointestinal and genitourinary primaries. Most lung primaries metastasizing to breast represent adenocarcinoma. Other types of lung carcinoma, including small cell carcinoma, are relatively rare. We report a case of lung small cell carcinoma metastasizing to the breast and initially presenting with a breast mass in a 50-year-old female. The tumor was first diagnosed on a fine-needle aspiration biopsy specimen (FNAB) from the breast lesion and subsequently supported by core biopsy. A discussion of the differential diagnoses to consider on FNAB follows. Because of the difference in treatment for primary small cell carcinoma of breast versus primary small cell carcinoma of the lung, as well as the difference in prognosis for both malignancies, determining the site of primary malignancy is crucial to adequate patient care. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source]


    A retrospective study of the diagnostic accuracy of fine-needle aspiration for breast lesions and implications for future use

    DIAGNOSTIC CYTOPATHOLOGY, Issue 12 2008
    Christina Day M.D.
    Abstract In recent years, the use of fine-needle aspiration (FNA) in the diagnosis of breast lesions has declined in many institutions. We sought to evaluate the role of FNA for breast lesions and the annual rate of the procedure at our institution over a 4½ year period (May 2002,October 2006). A total of 831 FNAs were performed, with 258 (31%) having histologic follow-up. The number of FNAs obtained was 159 from 5/02 to 4/03, 192 from 5/03 to 4/04, 194 from 5/04 to 4/05, 191 from 5/05 to 4/06, and 95 from 5/06 to 10/06. Each case was placed into one of four categories: nondiagnostic (9%), benign (77.5%), atypical/suspicious (5.5%), or malignant (8%). Surgical tissue was available for 37% of nondiagnostic cases, 22% of benign cases, 80% of atypical/suspicious cases, and 72% of malignant cases. The overall sensitivity and specificity for FNA was 83 and 92% respectively. The overall positive and negative predictive values were 83 and 92% respectively. There were no false-positive cases, indicating a positive predictive value of 100% for a Dx of malignancy. For cases with surgical follow-up, the false-negative rate was 5.4%. Although there is a national trend away from FNAs of breast lesion, this has not been the experience at our institution. Although FNA may not be ideal in the initial evaluation of suspicious lesions, we argue that FNA for clinically benign palpable lesions and recurrent carcinomas has significant value. Diagn. Cytopathol. 2008. © 2008 Wiley-Liss, Inc. [source]


    Radioguided Localization of Clinically Occult Breast Lesions (ROLL): A Pilot Study

    THE BREAST JOURNAL, Issue 4 2007
    Heriberto Medina-Franco MD
    Abstract:, Management of nonpalpable breast lesions requiring pathologic diagnosis has been with wire localization during the last few decades. Recently, radioguided localization (ROLL) became an alternative for this type of lesions. The objective of the present study was to evaluate the feasibility of this technique in a tertiary referral center in Mexico City. Consecutive patients requiring pathologic diagnosis from a nonpalpable breast lesion were included in the present study. On the same day of operation, all patients were injected with particles of human serum albumin. Localization of the lesion was performed in the operation theater with the aid of a hand-held gamma-probe. All lesions were identified in a control x-ray of the surgical specimen. Demographic, clinical, surgical and pathologic data were recorded. Forty patients with a mean age of 56.8 ± 7.8 years were included. In 39 of the 40 patients (97.5%) the "hot spot" was identified easily. In all patients, the area of maximum radioactivity corresponded to the site of the lesion. Imaging confirmation of the lesion in the surgical specimen was done during the first excision in 37 patients (92.5%). In the remaining cases (7.5%), a wider excision was performed during the same procedure, finding the suspected lesion in all cases. Diagnosis of cancer was made in seven patients, (17.5%). There were no significant surgical complications. Our data suggest that ROLL offer a simple and reliable method to localize occult breast lesions, allowing complete removal of the lesion in 100% of the patients. Because of the small quantity of radioactivity, the procedure is safe for both patients and the medical staff, producing less discomfort in patients than wire localization. [source]


    Fibromatosis of the Breast: Case Report and Current Concepts in the Management of an Uncommon Lesion

    THE BREAST JOURNAL, Issue 1 2006
    Graham S. Schwarz MD
    Abstract: Fibromatosis is an uncommon breast lesion that can mimic breast carcinoma in its clinical presentation. We present a case in which excisional biopsy was necessary to establish a diagnosis of fibromatosis. Clinical, diagnostic imaging, and pathologic features are discussed. Magnetic resonance imaging (MRI) has emerged as a tool for further characterization of breast lesions and as a screening modality in high-risk patient populations. Ours marks the second case in which dynamic MRI has been correlated with histologically confirmed primary mammary fibromatosis. Unlike the previous report, MRI in this case mimics breast carcinoma in its morphologic and pharmacokinetic features of enhancement. Wide local excision with clear margins remains the treatment of choice. Current data on radiotherapy and pharmacologic therapy for mammary fibromatosis are reviewed., [source]


    A deceptive breast lesion

    ANZ JOURNAL OF SURGERY, Issue 7-8 2009
    Justin James MS FRCS Ed
    No abstract is available for this article. [source]


    Bilateral breast lesions in a patient with medullary thyroid carcinoma

    CYTOPATHOLOGY, Issue 6 2009
    F. Andreiuolo
    No abstract is available for this article. [source]


    Immunohistochemical expression of E-cadherin in sclerosing adenosis, ductal carcinoma in situ and invasive ductal carcinoma of the breast

    DIAGNOSTIC CYTOPATHOLOGY, Issue 4 2010
    Gil Facina M.D., Ph.D.
    Abstract E-cadherin (EC) is an important glycoprotein cell-adhesion molecule that appears to play a significant role in the progression of breast lesions. The objective of this study was to evaluate EC expression in sclerosing adenosis, ductal carcinoma in situ and invasive ductal carcinoma. Samples of breast lesions from 44 women were used in this study, comprising cases of sclerosing adenosis (n = 11), ductal carcinoma in situ (DCIS) (n = 10) and invasive ductal carcinoma (n = 23). Immunohistochemical evaluation of EC expression was assessed semiquantitatively and considered negative (<10% of cells with stained cytoplasmic membranes), positive+ (10,50% of cells stained) or positive++ (> 50% of cells stained). Fisher's exact test was used to compare the distribution of staining intensity in the lesions (P< 0.05). There was a progressive loss of EC expression from benign to malignant lesions. This difference was statistically significant when sclerosing adenosis was compared with DCIS (P < 0.0002), when sclerosing adenosis was compared with invasive ductal carcinoma (P < 0.008) and when DCIS was compared with invasive ductal carcinoma (P < 0.007). The present findings point to a significant association between reduced EC expression and the progression and aggressivity of breast lesions. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]


    Efficacy of fine-needle aspiration biopsy in diagnosis of breast cancer: A retrospective study of 303 cases in Bahrain

    DIAGNOSTIC CYTOPATHOLOGY, Issue 9 2009
    F.R.C.Path, Khalid Al-Sindi M.D.
    Abstract Breast cancer is a leading cause of death in many countries worldwide and breast lesions remain a common diagnostic dilemma. Fine-needle aspiration biopsy (FNAB) has been suggested as the most important, first line, minimally invasive measure in the management of patients with breast lesions. The aim of this study is to evaluate the efficacy of FNAB in patients with breast lesions by comparing the diagnostic accuracy of cytology results with that of the definitive histological examination outcome and also to investigate the added value of a single aspirator experience to the overall diagnostic precision and compared with the internationally published results. A retrospective study of 303 breast FNAB samples were carried out by a single experienced cytopathologist with complete comparison records. The prevalence of positive cytologic diagnosis for the breast cancer was determined to be 20.4%. The overall diagnostic accuracy of FNAB was 97.9%, with a specificity and sensitivity of 98.3 and 96.5%, respectively. The overall positive and negative predictive values were determined to be 93.2 and 99.2%, respectively. In addition, the sensitivity was comparable in cases that have been attempted by palpation-guided sampling compared with those aspirations that were carried out under US guidance. Results from this study confirm that FNAB biopsies performed and reported by a dedicated, single, skilled cytopathologist are highly effective in diagnosis of breast lesions and reliable in differentiating benign and malignant breast lesions with an overall high efficacy in a specialized laboratory-based FNAB clinic. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source]


    A retrospective study of the diagnostic accuracy of fine-needle aspiration for breast lesions and implications for future use

    DIAGNOSTIC CYTOPATHOLOGY, Issue 12 2008
    Christina Day M.D.
    Abstract In recent years, the use of fine-needle aspiration (FNA) in the diagnosis of breast lesions has declined in many institutions. We sought to evaluate the role of FNA for breast lesions and the annual rate of the procedure at our institution over a 4½ year period (May 2002,October 2006). A total of 831 FNAs were performed, with 258 (31%) having histologic follow-up. The number of FNAs obtained was 159 from 5/02 to 4/03, 192 from 5/03 to 4/04, 194 from 5/04 to 4/05, 191 from 5/05 to 4/06, and 95 from 5/06 to 10/06. Each case was placed into one of four categories: nondiagnostic (9%), benign (77.5%), atypical/suspicious (5.5%), or malignant (8%). Surgical tissue was available for 37% of nondiagnostic cases, 22% of benign cases, 80% of atypical/suspicious cases, and 72% of malignant cases. The overall sensitivity and specificity for FNA was 83 and 92% respectively. The overall positive and negative predictive values were 83 and 92% respectively. There were no false-positive cases, indicating a positive predictive value of 100% for a Dx of malignancy. For cases with surgical follow-up, the false-negative rate was 5.4%. Although there is a national trend away from FNAs of breast lesion, this has not been the experience at our institution. Although FNA may not be ideal in the initial evaluation of suspicious lesions, we argue that FNA for clinically benign palpable lesions and recurrent carcinomas has significant value. Diagn. Cytopathol. 2008. © 2008 Wiley-Liss, Inc. [source]


    Liesegang rings in fine needle aspirate of breast cysts with predominance of apocrine cells: A study of 14 cases

    DIAGNOSTIC CYTOPATHOLOGY, Issue 10 2008
    F.I.A.C., Raj K. Gupta M.D.
    Abstract Fine needle aspirate (FNA) from 14 cases (age range 17,84 years), with Liesegang rings (LR's) in breast cysts seen over a period of 26 years comprised the material of this study from more than 38,000 FNA's of the breast which had been done for a variety of breast lesions. In six of the 14 cases, the aspirate was obtained under ultrasound guidance whereas in the remaining cases it was collected from a palpable lesion. The aspiration was performed using a 22 gauge needle and the syringe and needle contents were washed in a cytology container with 30% ethyl alcohol in physiologic saline. The cytologic preparations from half of the sample were made on a 5 micron Schleicher and Schuell filter and stained by Papanicolaou method whereas from the remainder of the sample a cell block was made and sections cut, stained with hematoxylin-eosin (H&E) and used for immunohistochemical study. Filter preparations and cell blocks revealed cyanophilic, spherical, ring-like structures of various sizes and shape mostly with double walls, and striations with amorphous material in the lumen and under polarized light were nonrefractile. Seen also were several apocrine cells and some macrophages and the LR's were found to be negative on immunostains for EMA and CK, and a panel of other special stains (Table I). Since LR's can be mistaken for ova, larvae, or parasites, it is important to be aware of their potential presence in aspirate samples of breast cysts to avoid a misdiagnosis. The exact mechanism of formation of LR's is not fully understood and certain views as proposed are discussed in this presentation. Diagn. Cytopathol. 2008;36:701,704. © 2008 Wiley-Liss, Inc. [source]


    A comparative analysis of core needle biopsy and fine-needle aspiration cytology in the evaluation of palpable and mammographically detected suspicious breast lesions

    DIAGNOSTIC CYTOPATHOLOGY, Issue 11 2007
    Shailja Garg M.B.B.S.
    Abstract The present study was undertaken to compare the efficacy of needle core biopsy (NCB) of the breast with fine-needle aspiration cytology (FNAC) in breast lesions (palpable and non-palpable) in the Indian set-up, along with the assessment of tumor grading with both the techniques. Fifty patients with suspicious breast lesions were subjected to simultaneous FNAC and ultrasound-guided NCB following an initial mammographic evaluation. Cases were categorized into benign, benign with atypia, suspicious and malignant groups. In cases of infiltrating duct carcinomas, grading was performed on cytological smears as well as on NCB specimens. Both the techniques were compared, and findings were correlated with radiological and excision findings. Out of 50 cases, 18 were found to be benign and 32 malignant on final pathological diagnosis. Maximum number of patients with benign diagnosis was in the fourth decade (42.11%) and malignant diagnosis in the fourth as well as fifth decade (35.48% each). Sensitivity and specificity of mammography for the diagnosis of malignancy was 84.37% and 83.33%, respectively. Sensitivity and specificity of FNAC for malignant diagnosis was 78.15% and 94.44%, respectively, and of NCB was 96.5% and 100%, respectively. But NCB had a slightly higher specimen inadequacy rate (8%). NCB improved diagnostic categorization over FNAC by 18%. Tumor grading in cases of IDC showed high concordance rate between NCB and subsequent excision biopsy (94.44%) but low concordance rate between NCB and FNAC (59.1%). NCB is superior to FNAC in the diagnosis of breast lesions in terms of sensitivity, specificity, correct histological categorization of the lesions as well as tumor grading. Diagn. Cytopathol. 2007;35:681,689. © 2007 Wiley-Liss, Inc. [source]


    The fine needle aspiration biopsy diagnostic criteria of proliferative breast lesions: A retrospective statistical analysis of criteria for papillomas and radial scar lesions

    DIAGNOSTIC CYTOPATHOLOGY, Issue 7 2007
    Andrew Field F.R.C.P.A.
    Abstract This study aimed to analyze statistically the accuracy of fine needle aspiration biopsy cytological criteria in diagnosing epithelial hyperplasia with atypia (EHA), papillary lesions (PAP), and radial scar/complex sclerosing lesions (RS/CSL). The 42 criteria studied were extracted from a literature review and those developed and used in our department. Cytological cases with diagnoses of EHA, PAP, and RS/CSL for the period of 1997,2001 were correlated with relevant histological follow-up and the positive predictive power of these diagnoses have been presented in an earlier publication. Some 77 cases with definite, specific histological diagnoses of atypia or a more severe lesion, PAP and RS/CSL, were reviewed and scored using 55 cytological criteria. As the group of EHA and RS/CSL yielded a smaller number of cases, these were grouped together in the statistical analysis and compared to PAP. The cytological features, which were most diagnostic for PAP, were stellate (Odds ratio 1.75) and meshwork (Odds ratio 3.29) tissue fragments, while the presence of tubular structures was inversely proportional to the histological outcome of PAP. True papillary fragments were uncommon and not statistically significant in diagnosing PAP of the breast. Diagn. Cytopathol. 2007;35:386,397. © 2007 Wiley-Liss, Inc. [source]


    Infarcted intraductal papilloma of the breast: Cytologic features with stage of infarction

    DIAGNOSTIC CYTOPATHOLOGY, Issue 5 2006
    Akinori Ishihara M.D., F.I.A.C., Ph.D.
    Abstract Fine-needle aspiration cytology (FNAC) is being employed with increasing frequency for the pre-operative diagnostic workup of breast lesions. Although most cases show morphologic features very characteristic of specific entities, rare lesions with infarcted breast can cause problems in interpretation. We present cytologic findings in seven cases of an infarcted intraductal papilloma of the breast (IDPB) that was diagnosed by FNAC, and we also report the correlation of cytological features and stages of infarcted IDPB. In the early stage of infarction, numerous degenerative cells and necrotic debris were demonstrated. Isolated degenerative cells showed columnar, spindle, polygonal and fiber-like cells, with coagulated and smudged nuclei. Ghost cells were also seen. Extensive necrosis was demonstrated with a few sheets of ductal cells in the mid-stage of infarction. In the late stage of infarction, clusters of fibroblasts, ductal cells and necrotic debris were found. Knowledge of the characteristic cytologic pattern in different stages of infarcted IDPB may be helpful to suggest the probable pre-operative diagnosis of those lesions. Familiarity with this entity is important in preventing misdiagnosis of malignancy. Diagn. Cytopathol. 2006;34:373,376. © 2006 Wiley-Liss, Inc. [source]


    p27Kip1 Expression and grading of breast cancer diagnosed on cytological samples

    DIAGNOSTIC CYTOPATHOLOGY, Issue 6 2004
    Giancarlo Troncone M.D.
    Abstract The progressive reduction in p27Kip1 (p27) protein immunohistochemical staining with increasing histological grading is a well-established finding occurring in breast cancer, and its role as diagnostic complement and prognostic marker has been thoroughly evaluated. To clarify whether this test may be applied to breast cytopathology, we performed p27 immunostaining on fresh fine-needle cytology (FNC) samples from 10 benign and 40 malignant breast lesions. On average, p27 immunostaining was significantly lower in carcinomas than in benign lesions (P < 0.005). In particular, among carcinomas, p27 immunostaining progressively reduced from well-to poorly differentiated lesions (G1 vs. G2, P < 0.05; G1 vs. G3, P < 0.001; G2 vs. G3; P < 0.001). A similar trend was noted in a subgroup of 20 matched FNCs and histological samples of breast carcinomas, when p27 immunostaining on FNCs was stratified according to the histological grading (G1 vs. G2, P = 0.18; G1 vs. G3, P < 0.05; G2 vs. G3, P < 0.05). In addition, p27 immunostaining on FNCs showed a good positive correlation with that on histology (Spearman R = 0.58; P < 0.01), with a diagnostic concordance between samples of 85%, by using the standard 50% positive cell cutoff. Taken in concert, our data suggest that p27 immunostaining is a reliable marker of tumor cell differentiation in breast cytopathology as well as in histopathology. Accordingly, staining FNCs for p27 may be an useful complement in addition to cytological grading in the preoperative assessment of breast cancer. Diagn. Cytopathol. 2004;30:375,380. © 2004 Wiley-Liss, Inc. [source]


    Adenoid cystic carcinoma of the breast diagnosed by fine-needle aspiration

    DIAGNOSTIC CYTOPATHOLOGY, Issue 4 2004
    Anjali Saqi M.D.
    Abstract Fine-needle aspiration cytology remains a useful tool for preoperative diagnosis of breast lesions. We describe a case of adenoid cystic carcinoma (ACC) of the breast detected by ultrasound-guided fine-needle aspiration (FNA). Subsequent histopathology corroborated the diagnosis. ACC is a rare but distinctive neoplasm of the breast that can be accurately diagnosed by FNA. Its infrequent presentation, favorable prognosis, and relatively conservative management in the breast prompt us to reinforce its features. Diagn. Cytopathol. 2004;30:271,274. © 2004 Wiley-Liss, Inc. [source]


    Adenomyoepithelioma of the breast: A cytologic dilemma.

    DIAGNOSTIC CYTOPATHOLOGY, Issue 3 2002
    Report of a case, review of the literature
    Abstract Adenomyoepithelioma of the breast is a rare benign tumor made up of epithelial and myoepithelial cells. The cytologic features of this lesion are not well defined. This report describes the cytologic features of a case of adenomyoepthelioma characterized by hypercellularity and the presence of many atypical epithelial cells, leading to the erroneous diagnosis of adenocarcinoma. Review of the cytology literature shows that this condition frequently mimics the cytologic features of a number of benign and malignant breast lesions, thus representing not only an important potential pitfall in the diagnosis of carcinoma but also a differential diagnosis to consider in a variety of breast lesions. Diagn. Cytopathol. 2002;26:191,196; DOI 10.1002/dc.10073 © 2002 Wiley-Liss, Inc. [source]


    Breast masses in males: Multi-institutional experience on fine-needle aspiration

    DIAGNOSTIC CYTOPATHOLOGY, Issue 2 2002
    Momin T. Siddiqui M.D.
    Abstract Male breast masses are uncommon pathologic findings. They are rarely aspirated, resulting in limited cytopathologic experience. The following study describes the cytopathology of male breast lesions from data collected for a period of 10 yr from three large institutions. A total of 14,026 breast aspirations were performed of which 614 were from male patients. All cases were reviewed and correlated with the appropriate clinicopathologic follow-up. The FNA diagnoses were as follows: benign, 427 cases (gynecomastia 353, fat necrosis 21, miscellaneous 53); malignant, 32 cases (ductal carcinoma nos 15, metastatic tumors 17); and atypical/suspicious, 61 cases. Ninety-four cases were nondiagnostic due to scant cellularity. Male breast aspirates accounted for 4.3% of the total breast FNAs performed. The clinicopathologic follow-up in both the benign and malignant categories showed 100% correlation. The overall sensitivity was 95.3%, specificity was 100%, and diagnostic accuracy was 98%. A relatively high specimen unsatisfactory rate was seen (>15%). The commonest cytopathologic diagnosis was gynecomastia, followed by ductal carcinoma. Florid duct atypia in gynecomastia may mimic adenocarcinoma, necessitating a higher threshold for cytopathologic interpretation for malignancy in males. Diagn. Cytopathol. 2002;26:87,91; DOI 10.1002/dc.10066 © 2002 Wiley-Liss, Inc. [source]


    The use of specimen ultrasound in the identification of screen-detected breast lesions

    HISTOPATHOLOGY, Issue 7 2008
    T Kendall
    No abstract is available for this article. [source]


    Pharmacokinetic mapping for lesion classification in dynamic breast MRI

    JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2010
    Matthias C. Schabel PhD
    Abstract Purpose: To prospectively investigate whether a rapid dynamic MRI protocol, in conjunction with pharmacokinetic modeling, could provide diagnostically useful information for discriminating biopsy-proven benign lesions from malignancies. Materials and Methods: Patients referred to breast biopsy based on suspicious screening findings were eligible. After anatomic imaging, patients were scanned using a dynamic protocol with complete bilateral breast coverage. Maps of pharmacokinetic parameters representing transfer constant (Ktrans), efflux rate constant (kep), blood plasma volume fraction (vp), and extracellular extravascular volume fraction (ve) were averaged over lesions and used, with biopsy results, to generate receiver operating characteristic curves for linear classifiers using one, two, or three parameters. Results: Biopsy and imaging results were obtained from 93 lesions in 74 of 78 study patients. Classification based on Ktrans and kep gave the greatest accuracy, with an area under the receiver operating characteristic curve of 0.915, sensitivity of 91%, and specificity of 85%, compared with values of 88% and 68%, respectively, obtained in a recent study of clinical breast MRI in a similar patient population. Conclusion: Pharmacokinetic classification of breast lesions is practical on modern MRI hardware and provides significant accuracy for identification of malignancies. Sensitivity of a two-parameter linear classifier is comparable to that reported in a recent multicenter study of clinical breast MRI, while specificity is significantly higher. J. Magn. Reson. Imaging 2010;31:1371,1378. © 2010 Wiley-Liss, Inc. [source]


    Detection of choline signal in human breast lesions with chemical-shift imaging

    JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 5 2008
    Hyeon-Man Baek PhD
    Abstract Purpose To investigate the application of MR spectroscopy using chemical-shift imaging (CSI) for characterizing human breast lesions at 1.5T, and to evaluate the diagnostic performance using ROC (receiver operating characteristics) analysis. Materials and Methods Thirty-six patients (35,73 years old, mean 52), with 27 malignant and 9 benign lesions, underwent anatomical imaging, dynamic contrast-enhanced MR imaging, and CSI. The ROC analysis was performed and the cutoff point yielding the highest accuracy was found to be a choline (Cho) signal-to-noise ratio (SNR) >3.2. Results The mean Cho SNR was 2.8 ± 0.8 (range, 1.8,4.3) for the benign group and 5.9 ± 3.4 (2.1,17.5) for the malignant group (P = 0.01). Based on the criterion of Cho SNR >3.2 as malignant, CSI correctly diagnosed 22 of 27 malignant lesions and 7 of 9 benign lesions, resulting in a sensitivity of 81%, specificity of 78%, and overall accuracy of 81%. If the criterion was set higher at Cho SNR >4.0 the specificity improved to 89% but sensitivity was lowered to 67%. Conclusion The ROC analysis presented in this work could be used to set an objective diagnostic criterion depending on preferred emphasis on sensitivity or specificity. J. Magn. Reson. Imaging 2008;27:1114,1121. © 2008 Wiley-Liss, Inc. [source]


    MR-guided percutaneous core biopsy of small breast lesions: First experience with a vertically open 0.5T scanner

    JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2002
    Jens P. Schneider MD
    Abstract Purpose The growing use of highly sensitive but only moderate specific breast MRI requires the development of both minimal-invasive as well as precise biopsy systems. The aim of the study was to prove the accuracy and feasibility of a biopsy procedure carried out in prone position in a vertically opened MR imager. Materials and Methods The biopsies were carried out in 21 women with lesions visible on MRI alone using an open breast coil with an integrated biopsy device. A 14 G coaxial needle was placed under near real-time MRI-guidance. After the tip of this needle was verified in contact with the lesion, we used a non MR-compatible, but MR-safe biopsy gun with a 16 G canula to take four to eight cores. Results We found eight malignant and 12 benign lesions. In one patient the procedure was not successful. In case of malignancy, the operation confirmed the diagnosis in all cases. The 12/21 patients with benign lesions have been followed without evidence of lesions growth over eight to 28 months. Conclusion The described procedure allows MRI-guided minimal invasive core biopsy of small breast lesions (five to 17 mm) with a high degree of accuracy. J. Magn. Reson. Imaging 2002;15:374-385. © 2002 Wiley-Liss, Inc. [source]


    Freehand iMRI-guided large-gauge core needle biopsy: A new minimally invasive technique for diagnosis of enhancing breast lesions

    JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2001
    Bruce L. Daniel MD
    Abstract The lack of reliable methods for minimally invasive biopsy of suspicious enhancing breast lesions has hindered the utilization of contrast-enhanced magnetic resonance imaging (MRI) for the detection and diagnosis of breast cancer. In this study, a freehand method was developed for large-gauge core needle biopsy (LCNB) guided by intraprocedural MRI (iMRI). Twenty-seven lesions in nineteen patients were biopsied using iMRI-guided LCNB without significant complications. Diagnostic tissue was obtained in all cases. Nineteen of the 27 lesions were subsequently surgically excised. Histopathologic analysis confirmed that iMRI-guided LCNB correctly distinguished benign lesions from malignancy in 18 of the 19 lesions. The histology revealed by core biopsy was partially discrepant with surgical biopsy in 2 of the other 19 lesions. Freehand iMRI-guided LCNB of enhancing breast lesions is promising. Larger studies are needed to determine the smallest lesion that can be sampled reliably and to precisely measure the accuracy of iMRI-guided LCNB as a minimally invasive tool to diagnose suspicious lesions found by breast MRI. J. Magn. Reson. Imaging 2001;13:896,902. © 2001 Wiley-Liss, Inc. [source]


    Multidetector row computed tomography for diagnosing intraductal extension of breast carcinoma

    JOURNAL OF SURGICAL ONCOLOGY, Issue 1 2005
    Takeo Fujita
    Abstract Objectives Several reports supported the association of higher ipsilateral breast tumor recurrence rates with positive or intermediate margins compared with negative pathologic margins. Precise evaluation of intraductal component and adequate surgical margin are important factors affecting the tumor recurrence after breast conserving surgery. Numerous studies have reported the utility of magnetic resonance imaging for diagnosing developing intraductal extension of breast cancer, but few have investigated multidetector-row computed tomography (MD-CT). The present study evaluated the clinical utility of MD-CT for detecting intraductal extension of breast carcinoma, and analyzed clinical parameters affecting the detection of intraductal extension under MD-CT. Methods Subjects comprised 44 patients grouped into three categories according to degree of intraductal extension of the main tumor under MD-CT (Intraductal spread grade 1,3: IDS 1,3). Tumors were also categorized histopathologically (p-IDS 0,3), and CT-pathological correlations were examined retrospectively. Clinical parameters were evaluated to determine the affect on detection of intraductal components. Results MD-CT detected 44 breast lesions (100%). Sensitivity for detection of intraductal component was 81.2%, specificity was 67.8%, and accuracy was 72.7%. Regarding extent of intraductal components, significant correlations were found between histopathological and MD-CT findings. A strong correlation was found in postmenopausal women between T2 tumor and high histological grade. Conclusions MD-CT findings of intraductal extension from breast carcinoma correlate with histological degree of intraductal extension, and MD-CT may be useful for preoperative assessment of breast-conserving surgery, particularly for postmenopausal women with histological high nuclear grade and T2 tumor. J. Surg. Oncol. 2005;91:10,16. © 2005 Wiley-Liss, Inc. [source]


    Magnetization transfer ratio as a predictor of malignancy in breast lesions: Preliminary results

    MAGNETIC RESONANCE IN MEDICINE, Issue 5 2008
    Ruth Helena Morais Bonini
    Abstract MRI is an important tool for investigating breast cancer. Although recognized as the method of choice for screening high-risk patients, and for other indications the role of MRI for lesion characterization remains controversial. Recently some authors have advocated the use of morphologic and postcontrast features for this purpose. Quantitative breast MRI techniques have not been applied extensively in breast diseases. Magnetization transfer (MT) is a quantitative MR technique commonly used to investigate neurological diseases. In breast diseases the use of MT has been limited to improving visualization of areas of enhancement in postcontrast images. The purpose of this study was to evaluate the feasibility and utility of MT in discriminating benign from malignant breast lesions. Fifty-two lesions, BIRADS 4 and 5, from 49 patients, were prospectively evaluated using the MT ratio (MTR). Patients were divided into two groups: benign and malignant lesions. The MTR of fat, pectoralis major muscle, fibroglandular tissue, and breast lesions were calculated. A statistically significant difference was found between MTR from benign and malignant lesions (P < 0.001). Preliminary results suggest that MT can be used to evaluate breast lesions. Further studies are necessary to better define the utility and applicability of this technique. Magn Reson Med 59:1030,1034, 2008. © 2008 Wiley-Liss, Inc. [source]


    Eliminating spurious lipid sidebands in 1H MRS of breast lesions

    MAGNETIC RESONANCE IN MEDICINE, Issue 2 2002
    Patrick J. Bolan
    Abstract Detecting metabolites in breast lesions by in vivo 1H MR spectroscopy can be difficult due to the abundance of mobile lipids in the breast which can produce spurious sidebands that interfere with the metabolite signals. Two-dimensional J -resolved spectroscopy has been demonstrated in the brain as a means to eliminate these artifacts from a large water signal; coherent sidebands are resolved at their natural frequencies, leaving the noncoupled metabolite resonances in the zero-frequency trace of the 2D spectrum. This work demonstrates that using the zero-frequency trace,or equivalently the average of spectra acquired with different echo times,can be used to separate noncoupled metabolite signals from the lipid-induced sidebands. This technique is demonstrated with simulations, phantom studies, and in several breast lesions. Compared to the conventional approach using a single echo time, echo time averaging provides increased sensitivity for the study of small and irregularly shaped lesions. Magn Reson Med 48:215,222, 2002. © 2002 Wiley-Liss, Inc. [source]


    Recent advances in breast MRI and MRS

    NMR IN BIOMEDICINE, Issue 1 2009
    S. Sinha
    Abstract Breast MRI is an area of intense research and is fast becoming an important tool for the diagnosis of breast cancer. This review covers recent advances in breast MRI, MRS, and image post-processing and analysis. Several studies have explored a multi-parametric approach to breast imaging that combines analysis of traditional contrast enhancement patterns and lesion architecture with novel methods such as diffusion, perfusion, and spectroscopy to increase the specificity of breast MRI studies. Diffusion-weighted MRI shows some potential for increasing the specificity of breast lesion diagnosis and is even more promise for monitoring early response to therapy. MRS also has great potential for increasing specificity and for therapeutic monitoring. A limited number of studies have evaluated perfusion imaging based on first-pass contrast bolus tracking, and these clearly identify that vascular indices have great potential to increase specificity. The review also covers the relatively new acquisition technique of MR elastography for breast lesion characterization. A brief survey of image processing algorithms tailored for breast MR, including registration of serial dynamic images, segmentation and extraction of morphological features of breast lesions, and contrast uptake modeling, is also included. Recent advances in MRI, MRS, and automated image analysis have increased the utility of breast MR in diagnosis, screening, management, and therapy monitoring of breast cancer. Copyright © 2008 John Wiley & Sons, Ltd. [source]


    Double immunostaining with p63 and high-molecular-weight cytokeratins distinguishes borderline papillary lesions of the breast

    PATHOLOGY INTERNATIONAL, Issue 3 2007
    Shu Ichihara
    Papillary breast lesions remain a source of diagnostic confusion because the full range of epithelial proliferations may arise within, or secondarily involve, papilloma. The expression of p63 and high-molecular-weight cytokeratins (HMWCK) was studied simultaneously in 33 papillary lesions including intraductal papilloma (IP, n = 10), atypical papilloma (AP, n = 8) and intraductal papillary carcinoma (IPC, n = 15) by double immunostaining. The myoepithelial cell nuclei were stained dark brown whereas the cytoplasms of usual ductal hyperplasia (UDH) and myoepithelium were stained purple. The myoepithelial layer was recognized as a dark brown dotted line at the epithelial stromal junction in all IP (10/10), most AP (7/8) and some IPC (7/15), suggesting that the retained myoepithelial layer in the papillary processes does not necessarily guarantee benignity. However, the malignant epithelial cells in AP and IPC were typically recognized as monotonous populations unstained with either chromogen. These monotonous cells contrasted with the proliferating cells of UDH in papilloma, which had intense purple cytoplasm in a mosaic-like fashion. The present data suggest that the double immunostaining with the two popular antibodies p63 and HMWCK is a useful tool for reproducible classification of papillary breast lesions. [source]