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Kulali F, Guner G. Outcomes in Sonographically Categorized Complex Cystic Breast Lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2071-2077. [PMID: 34825721 DOI: 10.1002/jum.15891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/23/2021] [Accepted: 11/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To investigate outcomes of patients with complex cystic breast lesions and to determine malignancy rates for each sonographic category. MATERIAL AND METHODS A total of 124 women with a mean age of 45 were enrolled in this retrospective study. Complex cysts were classified into four categories according to sonographic findings (thick septa/wall, intramural nodule, solid/cystic ratio) by two radiologists. Size, margin, short-to-long axis ratio, and vascularity were also noted. The relationship between sonographic features and histopathological/follow-up results was evaluated. RESULTS Of 124 complex cysts, 11 were malignant and 113 were benign. There were 31 with thick septa/wall (category 1), 14 with intramural nodule (category 2), 60 with solid/cystic ratio < 1 (category 3), and 19 with solid/cystic ratio > 1 (category 4). Among 11 malignant tumors, six intraductal papillary carcinomas and three invasive ductal carcinomas were in category 3, whereas one invasive ductal carcinoma was in category 1 and one was in category 4. Most of malignant lesions (9/11, 82%) were in category 3. Most of benign lesions (96/113, 85%) were fibroadenomatoid/fibrocystic changes. The presence of vascularity (96%), irregular margin (94%), and short-to-long axis ratio ≥ 1 (94%) had higher accuracy rates for diagnosis of malignancy. CONCLUSION The malignancy rate was 8.8% in our study. Besides internal morphological features, other sonographic features should be considered in the evaluation of complex cystic breast lesions. Due to substantial risk of malignancy and the overlapping sonographic features of benign and malignant lesions, tissue sampling of all complex cysts should be performed.
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Affiliation(s)
- Fatma Kulali
- Department of Radiology, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Gulbanu Guner
- Department of Radiology, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
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Evaluation of Breast Problems. Clin Obstet Gynecol 2022; 65:430-447. [PMID: 35708978 DOI: 10.1097/grf.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Breast disorders arise from a myriad of etiologies. They are frequent reasons for patient encounters in primary care and obstetric and gynecologic practices. The most common complaints include breast pain, nipple discharge and breast lumps or masses. Given widespread and well-known screening recommendations, breast cancers are regularly diagnosed during routine screening. Regardless of the presenting complaint, a patient's presentation, physical examination, and diagnostic imaging may require a unique framework for adequate and timely diagnosis for appropriate intervention and treatment. This manuscript aims to discuss and guide assessment to manage breast disorders.
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Gerets JCWL, Kool M, Simons PCG, Aarts F, Vogelaar FJ. Prevalence of underlying malignancies in complex cysts of the breast. Breast Dis 2022; 41:89-95. [PMID: 34542054 DOI: 10.3233/bd-201057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The management of complex cysts of the breast is an ongoing topic of discussion. The aim of this study was to determine the prevalence of underlying malignancy in radiologically diagnosed complex cysts, and to assess whether watchful waiting could be the preferred method to safely manage complex cysts of the breast. SUBJECTS AND METHODS A single-center retrospective study was performed between May 2003 and November 2019 in the VieCuri Medical Centre. Women with a radiologically diagnosed complex cyst of the breast were included. Prevalence of underlying malignancy was calculated, as were absolute risk reduction and number needed to treat in order to diagnose malignancy. In addition, patient characteristics were compared to determine characteristics associated with malignancy. RESULTS Of 78 radiologically diagnosed complex cysts of the breast, five (6,4%) were found to be malignant. The number needed to treat was calculated at 12,8 (absolute riks reduction 0,078). Age (P = 0,003) was associated with malignancy. CONCLUSION Complex cysts of the breast could be managed more conservatively. Patient characteristics can be used to assess the eligibility for radiological follow-up. This, in turn, would lead to a lower NNT and possibly a decrease in disease burden and healthcare costs.
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Affiliation(s)
- J C W L Gerets
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - M Kool
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - P C G Simons
- Department of Radiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - F Aarts
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - F J Vogelaar
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
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Multiple Bilateral Circumscribed Breast Masses Detected at Imaging: Review of Evidence for Management Recommendations. AJR Am J Roentgenol 2019; 214:276-281. [PMID: 31825259 DOI: 10.2214/ajr.19.22061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Historically, management recommendations for multiple bilateral circumscribed breast masses encountered with breast imaging have varied. This article reviews the evidence and provides best-practice recommendations for managing these masses. CONCLUSION. Meticulous imaging technique and interpretation are required to correctly diagnose multiple bilateral circumscribed breast masses. Radiologists should classify such masses identified at mammography, digital breast tomosynthesis, or bilateral whole-breast sonography as benign and recommend annual follow-up. Elucidating the significance of these masses on MRI, contrast-enhanced mammography, or nuclear breast imaging requires further study.
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Berg WA, Vourtsis A. Screening Breast Ultrasound Using Handheld or Automated Technique in Women with Dense Breasts. JOURNAL OF BREAST IMAGING 2019; 1:283-296. [PMID: 38424808 DOI: 10.1093/jbi/wbz055] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/01/2019] [Indexed: 03/02/2024]
Abstract
In women with dense breasts (heterogeneously or extremely dense), adding screening ultrasound to mammography increases detection of node-negative invasive breast cancer. Similar incremental cancer detection rates averaging 2.1-2.7 per 1000 have been observed for physician- and technologist-performed handheld ultrasound (HHUS) and automated ultrasound (AUS). Adding screening ultrasound (US) for women with dense breasts significantly reduces interval cancer rates. Training is critical before interpreting examinations for both modalities, and a learning curve to achieve optimal performance has been observed. On average, about 3% of women will be recommended for biopsy on the prevalence round because of screening US, with a wide range of 2%-30% malignancy rates for suspicious findings seen only on US. Breast Imaging Reporting and Data System 3 lesions identified only on screening HHUS can be safely followed at 1 year rather than 6 months. Computer-aided detection and diagnosis software can augment performance of AUS and HHUS; ongoing research on machine learning and deep learning algorithms will likely improve outcomes and workflow with screening US.
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Affiliation(s)
- Wendie A Berg
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of the University of Pittsburgh School of Medicine, Department of Radiology, Pittsburgh, PA
| | - Athina Vourtsis
- Diagnostic Mammography Medical Diagnostic Imaging Unit, Athens, Greece
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Mizushima Y, Morita M, Yamaguchi R. Ultrasound Findings in Three Complex Cystic Breast Carcinomas: Correlation with Intrinsic Tumor Subtype. Kurume Med J 2019; 65:99-104. [PMID: 31406039 DOI: 10.2739/kurumemedj.ms653002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In ultrasound examinations, mixed mammary gland masses are divided into either intracystic masses that contain a solid component in the cyst or solid masses that contain a fluid component in the mass. The histological types and subtypes of three complex cystic masses that showed different internal compositions in ultrasound were determined using the ultrasound findings of three patients. Case 1: The mass showed a large cystic component (bleeding) inside and a broad-based solid lesion at the margin in the ultrasound finding. The histological type was encapsulated papillary carcinoma and the subtype was luminal A. Case 2: The mass was lobulated with a small cystic component at the margin. The histological type was solid papillary carcinoma and the subtype was luminal A. Case 3: The mass was lobulated with a circumscribed margin. Cystic components suspected of being hemorrhagic necrosis were observed at the margin and within the solid component. The histological type was squamous cell carcinoma and the subtype was triple negative. Case 2 was a solid mass in appearance, but a cystic component noted at the margin was possibly an intracystic mass. For Case 3, findings suggestive of necrosis were observed both at the margin and in the solid component and this suggested a mass with fluid degeneration. Complex cystic masses are usually examined with a focus on the solid component seen on ultrasound images; however, it is also important to observe the cystic composition. This can help determine the subtypes in addition to the histological types.
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Affiliation(s)
- Yasuko Mizushima
- Department of Laboratory Medicine, Kurume University Medical Center
| | - Michi Morita
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Rin Yamaguchi
- Department of Laboratory Medicine, Kurume University Medical Center.,Department of Pathology, Kurume University Medical Center
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Asymptomatic Complicated Cysts in Postmenopausal Women: Is Tissue Sampling Unnecessarily High? Acad Radiol 2019; 26:900-906. [PMID: 30268721 DOI: 10.1016/j.acra.2018.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/10/2018] [Accepted: 08/12/2018] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES To determine the malignancy rate of complicated cysts in postmenopausal women and to discuss appropriate (Breast Imaging Reporting and Data System assessment and recommendation. MATERIALS AND METHODS This study was approved by our institutional review board and informed consent was waived. One hundred fourteen postmenopausal patients with 183 complicated cysts as defined by the newest Breast Imaging Reporting and Data System edition were identified retrospectively between January 2013 and December 2015 (to allow for 2 years follow-up period). One hundred eight complicated cysts were assessed as probably benign and 75 as suspicious. Prospective review of all images and pathology was performed and patient's age, breast density, risk factors, use of hormone replacement therapy, and family history of breast cancer were recorded. A total of 30 symptomatic patients and lesions not meeting criteria for complicated cysts were excluded from our cohort. Benignity was determined by aspiration, biopsy, resolution, recategorization to a simple cyst, or adequate follow-up. RESULTS None of our complicated cysts proved malignant. Fifteen of 108 probably benign complicated cysts were aspirated yielding benign fluid in 10 and 5 were biopsied yielding benign pathology (only 2 with atypical cells). Twenty-nine of 75 complicated cysts categorized as suspicious were aspirated and fluid was discarded in 25 and 4 sent for cytology yielding benign pathology. The other 41 complicated cysts thought to be suspicious were biopsied with benign pathology (only 1 atypical). CONCLUSION This study supports the use of a probably benign assessment of asymptomatic complicated cysts irrespective of age. The sensitivity for malignancy was 100% in our cohort.
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Ataya D, Niell BL. Complicated Cysts: Should Management Depend Upon Age? Acad Radiol 2019; 26:907-908. [PMID: 30987873 DOI: 10.1016/j.acra.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/16/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Dana Ataya
- H. Lee Moffitt Cancer Center and Research Institute, Section of Breast Imaging, Department of Radiology, 129092 Magnolia Drive, Tampa, FL 33612.
| | - Bethany L Niell
- H. Lee Moffitt Cancer Center and Research Institute, Section of Breast Imaging, Department of Radiology, 129092 Magnolia Drive, Tampa, FL 33612
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Li Y, Peng Y, He X. A highly aggressive invasive ductal carcinoma from a complex cystic breast mass and BI-RADS assessment: A case report. Medicine (Baltimore) 2018; 97:e13740. [PMID: 30558095 PMCID: PMC6320051 DOI: 10.1097/md.0000000000013740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE The term cystic breast lesions is a sonographic diagnosis, which can be categorized as simple, complicated or complex. The complex cysts are deemed as having a low risk of breast cancer. The highly aggressive invasive ductal carcinomas among complex cysts, in particular, are infrequent reported. PATIENT CONCERNS A 56-year-old female with a breast complex cyst who, after fine-needle aspiration, complained about oozing with fluid as well as skin ulceration that did not heal. DIAGNOSES An advanced HER-2-enriched invasive ductal carcinoma was diagnosed. INTERVENTIONS The patient received neoadjuvant chemotherapy of anti-HER-2 target drug, palliative surgery and following postoperative chemotherapy. OUTCOMES The patient was in good general condition at 6 months follow-up after surgery. LESSONS Meticulous ultrasound evaluation of Breast Imaging Reporting and Data System (BI-RADS) category is crucial and indispensable when a complex cyst is found. The radiologist and clinician should be fully awake to its possibility of malignancy, especially fast-growing one in post-menopausal women. Excision biopsy may be preferred for diagnosis.
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MESH Headings
- Biopsy, Fine-Needle/adverse effects
- Biopsy, Fine-Needle/methods
- Breast/pathology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Female
- Fibrocystic Breast Disease/pathology
- Humans
- Middle Aged
- Neoadjuvant Therapy/methods
- Treatment Outcome
- Ultrasonography, Mammary/methods
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Affiliation(s)
| | | | - Xin He
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Abstract
Benign breast disease is a spectrum of common disorders. The majority of patients with a clinical breast lesion will have benign process. Management involves symptom control when present, pathologic-based and imaging-based evaluation to distinguish from a malignant process, and counseling for patients that have an increased breast cancer risk due to the benign disorder.
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Evaluation of Adipokines, Inflammatory Markers, and Sex Hormones in Simple and Complex Breast Cysts' Fluid. DISEASE MARKERS 2016; 2016:5174929. [PMID: 27293305 PMCID: PMC4880712 DOI: 10.1155/2016/5174929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/02/2016] [Accepted: 04/13/2016] [Indexed: 11/18/2022]
Abstract
Objective. The aim of the study was to analyze the association between levels of adipokines in the breast cyst fluid and in the circulation in relation to the type of cysts. Material and Measurements. A cross-sectional study involved 86 women with breast cysts (42 with simple cysts and 44 with complex cysts). Plasma and breast cyst fluid leptin, adiponectin, visfatin/NAMPT, resistin, TNF-α, and IL-6 levels, in addition to serum levels of estradiol, progesterone and prolactin, and anthropometric parameters and body composition (by bioimpedance method), were measured. Results. The levels of leptin, adiponectin, and resistin were significantly lower in breast cyst fluid than in plasma regardless of the cyst type. Contrarily, the levels of visfatin/NAMPT and TNF-α were significantly increased, and IL-6 levels were similar in the breast cyst fluid and plasma in both study groups. There was no correlation between corresponding levels of leptin, adiponectin, resistin, visfatin/NAMPT, TNF-α, and IL-6 in breast cyst fluid and plasma. Conclusions. Higher levels of visfatin/NAMPT and TNF-α in the fluid from simple and complex breast cysts than in plasma suggest that their local production is related to inflammation.
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Wang HY, Jiang YX, Zhu QL, Zhang J, Xiao MS, Liu H, Dai Q, Li JC, Sun Q. Automated Breast Volume Scanning: Identifying 3-D Coronal Plane Imaging Features May Help Categorize Complex Cysts. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:689-698. [PMID: 26742895 DOI: 10.1016/j.ultrasmedbio.2015.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 09/22/2015] [Accepted: 11/23/2015] [Indexed: 06/05/2023]
Abstract
The study described here sought to identify specific ultrasound (US) automated breast volume scanning (ABVS) features that distinguish benign from malignant lesions. Medical records of 750 patients with 792 breast lesions were retrospectively reviewed. Of the 750 patients, 101 with 122 cystic lesions were included in this study, and the results ABVS results were compared with biopsy pathology results. These lesions were classified into six categories based on ABVS sonographic features: type I = simple cyst; type II = clustered cyst; type III = cystic masses with thin septa; type IV = complex cyst; type V = predominantly cystic masses; and type VI = predominantly solid masses. Comparisons were conducted between the ABVS coronal plane features of the lesions and histopathology results, and the positive predictive value (PPV) was calculated for each feature. Of the 122 lesions, 90 (73.8%) were classified as benign, and 32 (26.2%) were classified as malignant. The sensitivity, specificity and accuracy associated with ABVS features for cystic lesions were 78.1%, 74.4% and 75.4%, respectively. The 11 cases (8.9%) of type I-IV cysts were all benign. Of the 22 (18.0%) type V cysts, 16 (13.1%) were benign and 6 (4.9%) were malignant. Of the 89 (72.9%) type VI cysts, 63 (51.7%) were benign and 26 (21.3%) were malignant. The typical symptoms of malignancy on ABVS include retraction (PPV = 100%, p < 0.05), hyper-echoic halos (PPV = 85.7%, p < 0.05), microcalcification (PPV = 66.7%, p < 0.05), thick walls or thick septa (PPV = 62.5%, p < 0.05), irregular shape (PPV: 51.2%, p < 0.05), indistinct margin (PPV: 48.6%, p < 0.05) and predominantly solid masses with eccentric cystic foci (PPV = 46.8%, p < 0.05). ABVS can reveal sonographic features of the lesions along the coronal plane, which may be of benefit in the detection of malignant, predominantly cystic masses and provide high clinical values.
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Affiliation(s)
- Hong-Yan Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yu-Xin Jiang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | - Qing-Li Zhu
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Zhang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Meng-Su Xiao
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - He Liu
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qing Dai
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jian-Chu Li
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Exploration d’un syndrome kystique mammaire : recommandations. ACTA ACUST UNITED AC 2015; 44:970-9. [DOI: 10.1016/j.jgyn.2015.09.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 11/21/2022]
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Which patients require or can skip biopsy for breast clustered microcysts? Predictive findings of breast cancer and mucocele-like tumor. Breast Cancer 2015; 23:590-6. [DOI: 10.1007/s12282-015-0607-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/21/2015] [Indexed: 11/26/2022]
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Berg WA, Mendelson EB. Technologist-performed handheld screening breast US imaging: how is it performed and what are the outcomes to date? Radiology 2014; 272:12-27. [PMID: 24956046 DOI: 10.1148/radiol.14132628] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Breast density-inform legislation is increasing the need for data on outcomes of tailored screening. Dense parenchyma can mask cancers, and denser tissue is also more likely to develop breast cancer than fatty tissue. Digital mammography is standard for women with dense breasts. Supplemental screening magnetic resonance imaging should be offered to women who meet high-risk criteria. Supplemental screening ultrasonographic (US) imaging may be appropriate in the much larger group of women with dense breasts. Both physician- and technologist-performed screening US imaging increases detection of node-negative invasive breast cancer. To meet anticipated demand in the United States, screening US images will most likely be acquired by trained technologists rather than physicians. While automated US offers standard documentation, there are few data on outcomes. US has been used diagnostically for decades to characterize masses seen by using mammography, but training specific to screening has been lacking. Standard approaches to training and documentation of technologist-performed handheld screening US imaging are needed. This article reviews the current status of technologist-performed handheld screening breast US imaging.
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Affiliation(s)
- Wendie A Berg
- From the Department of Radiology, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, 300 Halket St, Pittsburgh, PA 15213 (W.A.B.); and Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill (E.B.M.)
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Abstract
Ultrasonography (US) is an indispensable tool in breast imaging and is complementary to both mammography and magnetic resonance (MR) imaging of the breast. Advances in US technology allow confident characterization of not only benign cysts but also benign and malignant solid masses. Knowledge and understanding of current and emerging US technology, along with the application of meticulous scanning technique, is imperative for image optimization and diagnosis. The ability to synthesize breast US findings with multiple imaging modalities and clinical information is also necessary to ensure the best patient care. US is routinely used to guide breast biopsies and is also emerging as a supplemental screening tool in women with dense breasts and a negative mammogram. This review provides a summary of current state-of-the-art US technology, including elastography, and applications of US in clinical practice as an adjuvant technique to mammography, MR imaging, and the clinical breast examination. The use of breast US for screening, preoperative staging for breast cancer, and breast intervention will also be discussed.
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Affiliation(s)
- Regina J Hooley
- Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, New Haven, CT 06520-8042, USA.
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Gallo Vallejo J, Mas Masats M, Vico Zúñiga I, Aibar Villán L. Mastopatía fibroquística. Aspectos controvertidos. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2013. [DOI: 10.1016/j.gine.2013.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Barr RG, Zhang Z, Cormack JB, Mendelson EB, Berg WA. Probably benign lesions at screening breast US in a population with elevated risk: prevalence and rate of malignancy in the ACRIN 6666 trial. Radiology 2013; 269:701-12. [PMID: 23962417 DOI: 10.1148/radiol.13122829] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively validate predefined breast ultrasonographic (US) Breast Imaging Reporting and Data System (BI-RADS) category 3 criteria in a multicenter setting in an elevated-risk population. MATERIALS AND METHODS The American College of Radiology Imaging Network 6666 database was reviewed for prospectively defined BI-RADS category 3 lesions. Patient characteristics, lesion US features at initial detection, and work-up recommendations were analyzed with descriptive statistics. Exact 95% confidence intervals (CIs) were given, where appropriate. Lesion reference standard was biopsy or a minimum of 1-year follow-up. In addition, malignancy rate for lesions that had at least 2 years of follow-up data or that had biopsy data was calculated. RESULTS Of 2662 participants, 519 (19.5%) had 745 BI-RADS category 3 lesions (25.5% of 2916 US lesions other than simple cysts), with a median size of 7 mm (range, 2-135 mm). The number of new BI-RADS category 3 lesions decreased with year 2-3 screening, but the percentage of new BI-RADS category 3 lesions was stable at 26.4% (506 of 1920 lesions), 23.6% (142 of 601 lesions), and 24.6% (97 of 395 lesions), respectively. Of 745 BI-RADS category 3 lesions, 124 (16.6%) were ultimately sampled for biopsy. Six malignancies (0.8% of BI-RADS category 3 lesions; 95% confidence interval [CI]: 0.3%, 1.7%) occurred in five (1.0%) of 519 participants: Five malignancies were invasive (median size, 10 mm; size range, 2-18 mm), and one was node positive. When the analysis is limited to lesions with at least 2-year follow-up or biopsy, the malignancy rate among BI-RADS category 3 lesions is 0.9% (95% CI: 0.3%, 2.0%). Three malignant BI-RADS category 3 lesions were sampled for biopsy because of a suspicious change at follow-up (two N0 lesions, one each at 6- and 12-month follow-up; one N1 lesion at 24-month follow-up), one was sampled for biopsy because of an upgrade after additional mammography (NX), one was found at mastectomy for another cancer (N0), and one was found at prophylactic contralateral mastectomy in the same patient (NX). CONCLUSION As BI-RADS category 3 lesions have a low malignancy rate (0.8%; 95% CI: 0.3%, 1.7%) and only 0.1% of the cancers had suspicious changes at 6-month follow-up and only one (17%; 95% CI: 0.4%, 64%) of six malignancies were node positive at detection (24-month follow-up), a recommendation of 1-year diagnostic follow-up may be appropriate for BI-RADS category 3 lesions detected at screening US. Online supplemental material is available for this article.
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Affiliation(s)
- Richard G Barr
- From Radiology Consultants, 250 DeBartolo Pl, Bldg B, Youngstown, OH 44512 (R.G.B.); Center for Statistical Sciences, Brown University, Providence, RI (Z.Z., J.B.C.); Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill (E.B.M.); and Department of Radiology, Magee-Women's Hospital of the University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pa (W.A.B.)
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Conde DM, de Sousa EP, de Sousa JA, Ferreira RB. Doctor, I am 81 years old and have been diagnosed with various breast cysts. Should I be concerned? Breast J 2013; 19:558-9. [PMID: 23902452 DOI: 10.1111/tbj.12169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Berg WA, Zhang Z, Cormack JB, Mendelson EB. Multiple bilateral circumscribed masses at screening breast US: consider annual follow-up. Radiology 2013; 268:673-83. [PMID: 23616634 DOI: 10.1148/radiol.13122251] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine prospectively the prevalence and rate of malignancy of multiple bilateral (MB) circumscribed breast masses detected at screening ultrasonography (US) compared with those of other US-depicted masses. MATERIALS AND METHODS This institutional review board-approved, HIPAA-compliant prospective trial included women at elevated risk for breast cancer, who gave written informed consent to participate in a study evaluating cancer detection rates for three rounds of annual supplemental screening US at 21 international sites. After exclusions, 2662 participants and 7473 screening studies were included. Physician-performed US studies were interpreted, with blinding to mammography results. Simple cysts were noted. Breast Imaging Reporting and Data System features of all other findings were recorded, with addition of the descriptor MB similar-appearing circumscribed masses (minimum of three total and at least one in each breast), with details of the largest such mass recorded. Rates of malignancy were determined after biopsy or mammographic and US follow-up at a minimum of 11 months. For this analysis, 490 women (1370 screenings) with prior mastectomy were excluded. Descriptive statistics and exact 95% confidence intervals (CIs) were generated. RESULTS Of 2172 evaluable participants (6103 screening studies; median age at study entry, 54.0 years; range, 25-91 years), 1454 had unique findings at US. One hundred thirty-five (6.2%) participants had 153 unique MB circumscribed masses, with no malignancies (0% [95% CI: 0%, 2.4%]; 95% CI: 0%, 2.9% for the 127 masses with at least 2 years of follow-up). There were 1319 (60.7%) participants with 2464 non-MB lesions, including 1038 solitary circumscribed masses with a malignancy rate of 0.8% (eight of 1038). Of 836 solitary circumscribed masses with at least 2 years of follow-up, the malignancy rate was 0.4% (three of 836; 95% CI: 0.1%, 1.0%). Of the 135 women with MB circumscribed masses, 82 (60.7%) also had a solitary lesion. Two of these 82 women (2.4%) had cancer. CONCLUSION MB similar-appearing circumscribed masses seen at screening US are almost always benign, with no malignancies found among such lesions in this prospective, multicenter experience. These lesions are suitable for diagnostic follow-up in 1 year, with resumption of screening thereafter if they are stable.
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Affiliation(s)
- Wendie A Berg
- American College of Radiology Imaging Network, Philadelphia, Pa, USA.
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Pongrattanaman S, Prueksadee J. Sonographic-pathologic correlation of complex cystic breast lesions. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2013. [DOI: 10.1016/s2222-1808(13)60011-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Cote ML, Ruterbusch JJ, Alosh B, Bandyopadhyay S, Kim E, Albashiti B, Sharaf Aldeen B, Radisky DC, Frost MH, Visscher DW, Hartmann LC, Nassar WH, Ali-Femhi R. Benign breast disease and the risk of subsequent breast cancer in African American women. Cancer Prev Res (Phila) 2012; 5:1375-80. [PMID: 23087047 DOI: 10.1158/1940-6207.capr-12-0175] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Benign breast disease (BBD) is an established risk factor for breast cancer among Caucasian women but less is known about BBD in African American women. As African American women suffer from disproportionate mortality due to breast cancer, special focus on pathologic characteristics that may influence disease risk is warranted. Benign breast biopsies from African American women were identified by the University Pathology Group (Detroit, MI). African American women of ages 20 to 84 years, who underwent a breast biopsy from 1997 to 2000, were eligible for the study. Subsequent breast cancers were identified through a linkage with the Detroit Surveillance Epidemiology and End Results (SEER) program. The first biopsy was reviewed by the pathologist, and lesions were classified following Dupont and Page criteria along with involution and other histologic features. Logistic regression was used to estimate the risk of developing a subsequent breast cancer with the histologic characteristics of BBD. A total of 1,406 BBD biopsies from African American women were included in this study with a median follow-up of 10.1 years. The majority (68%) showed nonproliferative disease, 29% had proliferative disease without atypia, and 3% had proliferative disease with atypia. Subsequent incident breast cancers occurred in 55 women (3.9%). Women whose biopsies showed proliferative disease with atypia were more than three-fold more likely to develop breast cancer as compared with women who had nonproliferative disease [relative risk (RR) 3.29, 95% confidence interval (CI) 1.21-8.93]. Better characterization of the risk of breast cancer among women with BBD, considering both ethnicity and detailed molecular findings, can lead to better surveillance, earlier diagnosis, and potentially improved survival.
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Affiliation(s)
- Michele L Cote
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA.
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Sanders LM, Lacz NL, Lara J. 16 year experience with aspiration of noncomplex breast cysts: cytology results with focus on positive cases. Breast J 2012; 18:443-52. [PMID: 22845618 DOI: 10.1111/j.1524-4741.2012.01277.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We performed a retrospective review of 5375 aspirations performed during the last 16 years of noncomplex cysts. Cytology results and outcomes following aspirations of simple and complicated cysts performed by the senior author at our institution were reviewed. Complex cysts with associated solid components which were core biopsied are excluded from this review. We present our data as the largest series to date performed by one breast radiologist at a single institution. Our data separate cysts with atypia or malignant cytology into those sampled concurrently with solid neoplasms and those which were isolated lesions. Various technical issues which have not been previously addressed in the literature are discussed. Noncomplex cysts are benign 99% of the time. Cysts with papillary cytology require no further workup. Margin-negative seromas do not require cytologic analysis of fluid. Sixteen malignancies were revealed (0.3%), eight of which were solitary cysts (0.1%). Atypical cytology predicted malignancy in 21%; therefore, atypical cytology requires further workup. Malignant cytology was associated with breast cancer in 90.9% of patients; therefore, all patients with malignant cytology require biopsy.
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Affiliation(s)
- Linda M Sanders
- Medical Director, Breast Center at the Ambulatory Care Center of Barnabas Health, Livingston, New Jersey 07039, USA.
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Hooley RJ, Greenberg KL, Stackhouse RM, Geisel JL, Butler RS, Philpotts LE. Screening US in patients with mammographically dense breasts: initial experience with Connecticut Public Act 09-41. Radiology 2012; 265:59-69. [PMID: 22723501 DOI: 10.1148/radiol.12120621] [Citation(s) in RCA: 315] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To determine performance and utilization of screening breast ultrasonography (US) in women with dense breast tissue who underwent additional screening breast US in the 1st year since implementation of Connecticut Public Act 09-41 requiring radiologists to inform patients with heterogeneous or extremely dense breasts at mammography that they may benefit from such examination. MATERIALS AND METHODS Informed consent was waived for this institutional review board-approved, HIPAA-compliant retrospective review of 935 women with dense breasts at mammography who subsequently underwent handheld screening and whole-breast US from October 1, 2009, through September 30, 2010. RESULTS Of 935 women, 614 (65.7%) were at low risk, 149 (15.9%) were at intermediate risk, and 87 (9.3%) were at high risk for breast cancer. Of the screening breast US examinations, in 701 (75.0%), results were classified as Breast Imaging Reporting and Data System (BI-RADS) category 1 or 2; in 187 (20.0%), results were classified as BI-RADS category 3; and in 47 (5.0%), results were classified as BI-RADS category 4. Of 63 aspirations or biopsies recommended and performed in 53 patients, in nine, lesions were BI-RADS category 3, and in 54, lesions were BI-RADS category 4. Among 63 biopsies and aspirations, three lesions were malignant (all BI-RADS category 4, diagnosed with biopsy). All three cancers were smaller than 1 cm, were found in postmenopausal patients, and were solid masses. One cancer was found in each risk group. In 44 of 935 (4.7%) patients, examination results were false-positive. Overall positive predictive value (PPV) for biopsy or aspirations performed in patients with BI-RADS category 4 masses was 6.5% (three of 46; 95% confidence interval [CI]: 1.7%, 19%). Overall cancer detection rate was 3.2 cancers per 1000 women screened (three of 935; 95% CI: 0.8 cancers per 1000 women screened, 10 cancers per 1000 women screened). CONCLUSION Technologist-performed handheld screening breast US offered to women in the general population with dense breasts can aid detection of small mammographically occult breast cancers (cancer detection rate, 0.8-10 cancers per 1000 women screened), although the overall PPV is low.
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Affiliation(s)
- Regina J Hooley
- Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, New Haven, CT 06520-8042, USA.
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Sedgwick E. The breast ultrasound lexicon: breast imaging reporting and data system (BI-RADS). Semin Roentgenol 2012; 46:245-51. [PMID: 22035666 DOI: 10.1053/j.ro.2011.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Emily Sedgwick
- Department of Radiology, Baylor College of Medicine, Lester and Sue Smith Breast Center, Houston, TX 77030, USA.
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Berg WA, Cosgrove DO, Doré CJ, Schäfer FKW, Svensson WE, Hooley RJ, Ohlinger R, Mendelson EB, Balu-Maestro C, Locatelli M, Tourasse C, Cavanaugh BC, Juhan V, Stavros AT, Tardivon A, Gay J, Henry JP, Cohen-Bacrie C. Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology 2012; 262:435-49. [PMID: 22282182 DOI: 10.1148/radiol.11110640] [Citation(s) in RCA: 549] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To determine whether adding shear-wave (SW) elastographic features could improve accuracy of ultrasonographic (US) assessment of breast masses. MATERIALS AND METHODS From September 2008 to September 2010, 958 women consented to repeat standard breast US supplemented by quantitative SW elastographic examination in this prospective multicenter institutional review board-approved, HIPAA-compliant protocol. B-mode Breast Imaging Reporting and Data System (BI-RADS) features and assessments were recorded. SW elastographic evaluation (mean, maximum, and minimum elasticity of stiffest portion of mass and surrounding tissue; lesion-to-fat elasticity ratio; ratio of SW elastographic-to-B-mode lesion diameter or area; SW elastographic lesion shape and homogeneity) was performed. Qualitative color SW elastographic stiffness was assessed independently. Nine hundred thirty-nine masses were analyzable; 102 BI-RADS category 2 masses were assumed to be benign; reference standard was available for 837 category 3 or higher lesions. Considering BI-RADS category 4a or higher as test positive for malignancy, effect of SW elastographic features on area under the receiver operating characteristic curve (AUC), sensitivity, and specificity after reclassifying category 3 and 4a masses was determined. RESULTS Median participant age was 50 years; 289 of 939 (30.8%) masses were malignant (median mass size, 12 mm). B-mode BI-RADS AUC was 0.950; eight of 303 (2.6%) BI-RADS category 3 masses, 18 of 193 (9.3%) category 4a lesions, 41 of 97 (42%) category 4b lesions, 42 of 57 (74%) category 4c lesions, and 180 of 187 (96.3%) category 5 lesions were malignant. By using visual color stiffness to selectively upgrade category 3 and lack of stiffness to downgrade category 4a masses, specificity improved from 61.1% (397 of 650) to 78.5% (510 of 650) (P<.001); AUC increased to 0.962 (P=.005). Oval shape on SW elastographic images and quantitative maximum elasticity of 80 kPa (5.2 m/sec) or less improved specificity (69.4% [451 of 650] and 77.4% [503 of 650], P<.001 for both), without significant improvement in sensitivity or AUC. CONCLUSION Adding SW elastographic features to BI-RADS feature analysis improved specificity of breast US mass assessment without loss of sensitivity.
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Affiliation(s)
- Wendie A Berg
- Magee-Womens Hospital, University of Pittsburgh School of Medicine, 300 Halket St, Pittsburgh, PA 15213, USA.
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Khaled W, Mathieu MC, Canale S, Ferchiou M, Vilcot L, Balleyguier C. Un sein inquiétant ? ! IMAGERIE DE LA FEMME 2012. [DOI: 10.1016/j.femme.2012.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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29
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Complex cystic lesions of the breast on ultrasonography: Feature analysis and BI-RADS assessment. Eur J Radiol 2011; 79:73-9. [DOI: 10.1016/j.ejrad.2009.12.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 12/30/2009] [Indexed: 11/23/2022]
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Tea MKM, Grimm C, Heinz-Peer G, Delancey J, Singer C. The predictive value of suspicious sonographic characteristics in atypical cyst-like breast lesions. Breast 2011; 20:165-9. [DOI: 10.1016/j.breast.2010.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 09/14/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022] Open
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Cho N, Moon WK, Chang JM, Kim SJ, Lyou CY, Choi HY. Aliasing artifact depicted on ultrasound (US)-elastography for breast cystic lesions mimicking solid masses. Acta Radiol 2011; 52:3-7. [PMID: 21498318 DOI: 10.1258/ar.2010.100116] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND It has been reported that ultrasound (US)-elastography is helpful in differentiation of benign and malignant solid masses and in reducing benign biopsy procedures for the supplemental breast US in addition to screening mammography. Furthermore, potential application of US-elastography in distinguishing cystic lesions which is known to be a major source of benign biopsy results has been suggested. PURPOSE To describe the aliasing artifact on US-elastography for breast cystic lesions that mimic solid masses. MATERIAL AND METHODS We retrospectively reviewed 13 lesions which showed a blue-green-red pattern artifact on US-elastography in 13 women (mean age 50 years; age range 3-66 years). They disappeared immediately after a needle biopsy. Breast composition, mammography and US findings, histology and follow-up imaging findings were analyzed. RESULTS All 13 patients showed heterogeneously dense (n=5) or extremely dense breast parenchyma (n=8). The most common US findings were an irregular shape (n=7, 54%) and a circumscribed margin (n=7, 54%). All 13 lesions had internal echogenicity and were initially considered as solid masses; 62% (n=8) showed hypoechogenicity and 38% (n=5) had echogenic and anechoic components. Posterior shadowing was seen in 31% (n=4) of the lesions. All 13 lesions have been proven to be fibrocystic changes on biopsy histology. Follow-up US performed for 10 of 13 lesions showed no residual lesion (n=9) or decreased its size (n=1). CONCLUSION An aliasing artifact that appears as a blue-green-red pattern in a breast mass as depicted on US-elastography is suggestive of a possible cystic breast lesion.
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Affiliation(s)
- Nariya Cho
- Department of Radiology and Clinical Research Institute, Seoul National University Hospital and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Woo Kyung Moon
- Department of Radiology and Clinical Research Institute, Seoul National University Hospital and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Jung Min Chang
- Department of Radiology and Clinical Research Institute, Seoul National University Hospital and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Seung Ja Kim
- Department of Radiology and Clinical Research Institute, Seoul National University Hospital and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Chae Yeon Lyou
- Department of Radiology and Clinical Research Institute, Seoul National University Hospital and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Hye Young Choi
- Department of Radiology and Clinical Research Institute, Seoul National University Hospital and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Current Status of Breast Ultrasound. Can Assoc Radiol J 2011; 62:31-40. [DOI: 10.1016/j.carj.2010.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 06/28/2010] [Accepted: 07/24/2010] [Indexed: 12/21/2022] Open
Abstract
Ultrasound (US) has a significant role in diagnostic breast imaging. It is most commonly used as an adjunctive test in characterizing lesions detected by other imaging modalities or by clinical examination. US is recognized as the modality of choice in the evaluation of women who are symptomatic and younger than 30 years of age, pregnant, or lactating. Combined mammography and US appear to have a role in screening high-risk populations. The use of standard Breast Imaging Reporting and Data System US lexicon is helpful in guiding the differentiation between benign and malignant sonographic signs. Biopsy is warranted when benign features are absent or for any feature consistent with malignancy, despite other benign findings. Whole breast and axillary US are useful in assessing tumour extension, multifocality, and the status of axillary lymph nodes. US is the modality of choice for guiding interventional breast procedures. The role of US as a guidance tool for nonoperative breast treatment is being investigated.
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Rinaldi P, Ierardi C, Costantini M, Magno S, Giuliani M, Belli P, Bonomo L. Cystic breast lesions: sonographic findings and clinical management. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1617-1626. [PMID: 20966473 DOI: 10.7863/jum.2010.29.11.1617] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE This article reviews basic sonographic findings for distinguishing cystic lesions of the breast. METHODS We describe sonographic features of simple and complicated cysts in comparison with complex masses and intracystic carcinomas. RESULTS We correlate cystic lesion appearances with histologic patterns and illustrate the diagnostic and therapeutic management of cystic breast lesions. CONCLUSIONS Sonography is a useful tool in distinguishing simple cysts from complicated cysts and complex masses of the breast.
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Affiliation(s)
- Pierluigi Rinaldi
- Department of Bioimaging and Radiological Sciences, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, Rome, Italy
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Abstract
Masses due to cystic lesions of the breast are extremely common findings on mammography, ultrasonography, and magnetic resonance imaging. Although many of these lesions can be dismissed as benign simple cysts, requiring intervention only for symptomatic relief, complex cystic and solid masses require biopsy. Perhaps, the most challenging are complicated cysts, that is, cysts with internal debris. When the debris is mobile or a fluid-debris level is seen, complicated cysts can be dismissed as benign findings. As an isolated finding, homogeneous complicated cysts can be classified as probably benign, with intervention only considered with interval development or enlargement, abscess is suspected, or if suspicious features develop. When multiple and bilateral complicated and simple cysts are present (ie, at least three, with at least one in each breast), a benign, BI-RADS 2, assessment is usually appropriate. Clustered microcysts are common benign findings in pre- and perimenopausal women, though short-interval surveillance may be appropriate for many such lesions in post-menopausal women, particularly if the lesion is new or rather small or deep (ie, diagnostic uncertainty).
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Affiliation(s)
- Wendie A Berg
- American Radiology Services Inc, Johns Hopkins Green Spring, 10755 Falls Road, Suite 440, Lutherville, MD 21093, USA.
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35
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Role of Ultrasonography in Breast Cancer Imaging. PET Clin 2009; 4:227-40. [DOI: 10.1016/j.cpet.2009.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lévy L. Comment décrire et classer une lésion en échographie du sein en 2009 ? IMAGERIE DE LA FEMME 2009. [DOI: 10.1016/j.femme.2009.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Catalano O, Raso MM, D’Aiuto M, Illiano LA, Saturnino PP, Siani A. Additional role of colour Doppler ultrasound imaging in intracystic breast tumours. Radiol Med 2008; 114:253-66. [DOI: 10.1007/s11547-008-0346-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Accepted: 03/06/2008] [Indexed: 11/29/2022]
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Tea MKM, Grimm C, Fink-Retter A, Bikas D, Kroiss R, Kubista E, Wagner T. The validity of complex breast cysts after surgery. Am J Surg 2008; 197:199-202. [PMID: 18649871 DOI: 10.1016/j.amjsurg.2007.11.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Revised: 11/15/2007] [Accepted: 11/18/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Breast cysts are the most common cause of benign breast masses. Simple breast cysts do not need further evaluation, but complex breast cysts require additional assessment due to the potential presence of malignancy. However, these complex cysts have rarely been examined and quantified according to the associated cancer detection rate. Our study is the first investigation to evaluate the malignancy rate of complex breast cysts identified by histopathological results. METHODS Imaging findings of complex cysts were correlated retrospectively with clinical and pathologic outcomes. We detected a malignancy rate of 14%. Sonographic criteria of a complex cyst such as thick cyst wall (P = .0006), lobulation (P = .01), and hyperechogenicity (P = .04) were predictive of neoplasm. Two or more criteria combined were associated with a 13.6-fold higher risk of malignancy (P <.0001). CONCLUSION Based on our results we reinforce the importance of adequate assessment of complex breast cysts to prevent a missed or delayed diagnosis of malignancy.
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Affiliation(s)
- Muy-Kheng M Tea
- Department of Obstetrics and Gynecology, Division of Senology, Medical University of Vienna, Vienna, Austria.
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Daly CP, Bailey JE, Klein KA, Helvie MA. Complicated breast cysts on sonography: is aspiration necessary to exclude malignancy? Acad Radiol 2008; 15:610-7. [PMID: 18423318 DOI: 10.1016/j.acra.2007.12.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 12/22/2007] [Accepted: 12/22/2007] [Indexed: 10/22/2022]
Abstract
RATIONALE AND OBJECTIVES To determine the incidence of breast cancer in women presenting for fine needle aspiration of sonographically diagnosed complicated breast cysts. MATERIALS AND METHODS Institutional review board approval was obtained. A retrospective study was performed of 186 consecutive women who presented for fine needle aspiration of 243 sonographic complicated cysts detected by clinical examination or imaging between January 2002 and August 2003. Sonographic complicated cysts were defined as those meeting most but not all criteria for simple cysts similar to current Breast Imaging Reporting and Data System classification. We excluded solid masses, cysts with solid components, intracystic masses, and simple cysts. Prospective mammography, ultrasound, and procedure reports were reviewed. A case was considered positive if cytology, core needle biopsy, or surgical excision was positive for cancer. Final diagnosis was established by biopsy, cytology, clinical resolution, or stability over time. RESULTS One of 243 (0.4%) lesions proved malignant (95% confidence interval 0-1.94%); 210/243 (86.4%) of cases yielded fluid on aspiration. Of 141 samples submitted to cytology, 138 (97.9%) were benign and 3 (2.1%) atypical. All cases of atypia were benign at surgical excision. Ninety five of 243 (39.1%) aspiration samples with typical cyst fluid were discarded. A total of 33/243 (13.6%) cases did not yield fluid, 1 of which was positive for cancer. Thirty cases underwent core needle or excisional biopsy for imaging discordance with benign results. CONCLUSIONS Breast cancer presenting as a complicated cyst by ultrasound was rare (0.4%, 95% confidence interval 0-1.94%). These results provide support for classification of complicated cysts as probably benign.
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Booi RC, Carson PL, O'Donnell M, Roubidoux MA, Hall AL, Rubin JM. Characterization of cysts using differential correlation coefficient values from two dimensional breast elastography: preliminary study. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:12-21. [PMID: 17900795 PMCID: PMC2330278 DOI: 10.1016/j.ultrasmedbio.2007.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 06/22/2007] [Accepted: 07/09/2007] [Indexed: 05/17/2023]
Abstract
Although simple cysts are easily identified using sonography, description and management of nonsimple cysts remains uncertain. This study evaluated whether the correlation coefficient differences between breast tissue and lesions, obtained from 2D breast elastography, could potentially distinguish nonsimple cysts from cancers and fibroadenomas. We hypothesized that correlation coefficients in cysts would be dramatically lower than surrounding tissue because noise, imaging artifacts, and particulate matter move randomly and decorrelate quickly under compression, compared with solid tissue. For this preliminary study, 18 breast lesions (7 nonsimple cysts, 4 cancers, and 7 fibroadenomas) underwent imaging with 2D elastography at 7.5 MHz through a TPX (a polymethyl pentene copolymer) 2.5 mm mammographic paddle. Breasts were compressed similar to mammographic positioning and then further compressed for elastography by 1 to 7%. Images were correlated using 2D phase-sensitive speckle tracking algorithms and displacement estimates were accumulated. Correlation coefficient means and standard deviations were measured in the lesion and adjacent tissue, and the differential correlation coefficient (DCC) was introduced as the difference between these values normalized to the correlation coefficient of adjacent tissue. Mean DCC values in nonsimple cysts were 24.2 +/- 11.6%, 5.7 +/- 6.3% for fibroadenomas, and 3.8 +/- 2.9 % for cancers (p < 0.05). Some of the cysts appeared smaller in DCC images than gray-scale images. These encouraging results demonstrate that characterization of nonsimple breast cysts may be improved by using DCC values from 2D elastography, which could potentially change management options of these cysts from intervention to imaging follow-up. A dedicated clinical trial to fully assess the efficacy of this technique is recommended.
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Affiliation(s)
- Rebecca C Booi
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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41
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Doshi DJ, March DE, Crisi GM, Coughlin BF. Complex Cystic Breast Masses: Diagnostic Approach and Imaging-Pathologic Correlation. Radiographics 2007; 27 Suppl 1:S53-64. [DOI: 10.1148/rg.27si075508] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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42
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Booi RC, Carson PL, O'Donnell M, Richards MS, Rubin JM. Diagnosing cysts with correlation coefficient images from 2-dimensional freehand elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1201-7. [PMID: 17715314 DOI: 10.7863/jum.2007.26.9.1201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE We compared the diagnostic potential of using correlation coefficient images versus elastograms from 2-dimensional (2D) freehand elastography to characterize breast cysts. METHODS In this preliminary study, which was approved by the Institutional Review Board and compliant with the Health Insurance Portability and Accountability Act, we imaged 4 consecutive human subjects (4 cysts, 1 biopsy-verified benign breast parenchyma) with freehand 2D elastography. Data were processed offline with conventional 2D phase-sensitive speckle-tracking algorithms. The correlation coefficient in the cyst and surrounding tissue was calculated, and appearances of the cysts in the correlation coefficient images and elastograms were compared. RESULTS The correlation coefficient in the cysts was considerably lower (14%-37%) than in the surrounding tissue because of the lack of sufficient speckle in the cysts, as well as the prominence of random noise, reverberations, and clutter, which decorrelated quickly. Thus, the cysts were visible in all correlation coefficient images. In contrast, the elastograms associated with these cysts each had different elastographic patterns. The solid mass in this study did not have the same high decorrelation rate as the cysts, having a correlation coefficient only 2.1% lower than that of surrounding tissue. CONCLUSIONS Correlation coefficient images may produce a more direct, reliable, and consistent method for characterizing cysts than elastograms.
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Affiliation(s)
- Rebecca C Booi
- Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0553 USA
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Levy L, Suissa M, Chiche JF, Teman G, Martin B. BIRADS ultrasonography. Eur J Radiol 2007; 61:202-11. [PMID: 17215097 DOI: 10.1016/j.ejrad.2006.08.035] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Revised: 08/21/2006] [Accepted: 08/24/2006] [Indexed: 11/20/2022]
Abstract
The fourth edition of the BIRADS mammography appeared in 2003 and is now associated with the first editions of the BIRADS ultrasound and MRI. BIRADS is a system of assistance to the drafting of the reports more and more used in the world and soon directly implemented on mammography and ultrasound units. The categories of evaluation of the BIRADS allow a clear synthesis of the descriptive data resulting from the use of the lexicon and invite the radiologist to a reasoned, objective and less intuitive step. They give an action to be taken and responsibility to the radiologist and the referring physicians in the assumption of the patients.
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Affiliation(s)
- L Levy
- Institut de Radiologie, 31 Avenue Hoche, 75008 Paris, France.
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Chang YW, Kwon KH, Goo DE, Choi DL, Lee HK, Yang SB. Sonographic differentiation of benign and malignant cystic lesions of the breast. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:47-53. [PMID: 17182708 DOI: 10.7863/jum.2007.26.1.47] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The purpose of this study was to subdivide the types of sonographic findings of benign versus malignant cystic masses and to determine appropriate patient care according to the sonographic findings with pathologic correlation. METHODS The sonographic findings of 175 symptomatic cystic breast lesions were pathologically proven and reviewed retrospectively. Cystic lesions were classified as 6 types: simple cysts (type I), clustered cysts (type II), cysts with thin septa (type III), complicated cysts (type IV), cystic masses with a thick wall/septa or nodules (type V), and complex solid and cystic masses (type VI). Sonographic findings were compared with the pathologic results and were evaluated according to the incidence of benign and malignant masses. RESULTS All 23 type I, 15 type II, 22 type III, and 35 type IV cases were pathologically proven to be benign. Seven (25.9%) of the 27 type V cases and 33 (62.3%) of the 53 type VI cases were proven to be malignant. We analyzed the shapes and margins of 80 cases of cystic masses with a solid component (types V and VI); 16 (44%) of 36 sonographically circumscribed masses were malignant. CONCLUSIONS Because the sonographically detected simple cysts (type I), clustered cysts (type II), and cysts with thin septa (type III) were all benign, annual routine follow-up appears reasonable. Symptomatic complicated cysts (type IV) should be aspirated and appropriately treated according to clinical symptoms. Cystic masses with a solid component (types V and VI) should be examined by biopsy with pathologic confirmation.
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Affiliation(s)
- Yun-Woo Chang
- Department of Radiology, College of Medicine, Soonchunhyang University Hospital, Seoul, Korea.
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Abstract
Benign breast diseases constitute a heterogeneous group of lesions including developmental abnormalities, inflammatory lesions, epithelial and stromal proliferations, and neoplasms. In this review, common benign lesions are summarized and their relationship to the development of subsequent breast cancer is emphasized.
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Affiliation(s)
- Merih Guray
- University of Texas M. D. Anderson Cancer Center, Unit 85, 1515 Holcombe Boulevard, Houston, Texas 77030, USA
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Abstract
Ultrasound use should be considered in most instances of a palpable breast finding, particularly in young women. A primary advantage is the ability to directly correlate the physical exam finding with imaging. Ultrasound is useful in characterizing palpable masses as well as detecting cancer in women with negative mammograms. The negative-predictive value of imaging for cancer in the evaluation of a palpable lump is very high, which may reassure women with low-suspicion palpable findings. Short-term follow-up of a palpable mass with benign features may be feasible, though further study is needed to establish criteria. A suspicious dominant palpable finding should be further evaluated even if imaging is negative.
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Shulman SG, March DE. Ultrasound-Guided Breast Interventions: Accuracy of Biopsy Techniques and Applications in Patient Management. Semin Ultrasound CT MR 2006; 27:298-307. [PMID: 16915998 DOI: 10.1053/j.sult.2006.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ultrasound (US) provides a versatile approach for guiding biopsies and other breast interventions. The wide availability, real-time capability, technical improvements, and increasing user experience have greatly expanded the role of US-guided interventions in the diagnosis and management of breast disease. This article reviews the accuracy of US-guided fine-needle aspiration biopsy, automated core biopsy, and vacuum-assisted biopsy. Some of the more specialized procedures that reflect the growing role of US-guided interventions in patient management will also be discussed.
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Affiliation(s)
- Suzanne G Shulman
- Department of Radiology, Baystate Medical Center, Springfield, Massachusetts 01199, USA
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Soo MS, Ghate SV, Baker JA, Rosen EL, Walsh R, Warwick BN, Ramachandran AR, Nightingale KR. Streaming detection for evaluation of indeterminate sonographic breast masses: a pilot study. AJR Am J Roentgenol 2006; 186:1335-41. [PMID: 16632728 DOI: 10.2214/ajr.05.0005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Streaming detection is a novel sonography technique that uses ultrasonic energy to induce movement in cyst fluid that is detected on Doppler sonography. This pilot study evaluates the utility of streaming detection for differentiating cysts from solid masses in breast lesions that are indeterminate on sonography. SUBJECTS AND METHODS Thirty-nine lesions-11 simple cysts and seven solid masses (control group) and 21 masses with indeterminate findings for the diagnosis of a cyst versus a solid lesion (study group)-in 34 patients were evaluated using streaming detection. All lesions underwent cyst aspiration or biopsy (n = 35) or were diagnosed simple cysts (n = 4) on sonography. Lesion size and depth were recorded. Streaming detection software was placed on conventional sonography units. Acoustic pulses were focused on the lesion, and if fluid movement was generated, it was seen on the spectral Doppler display as velocity away from the transducer. Lesions were then aspirated or underwent biopsy, and the viscosity of the aspirated fluid was recorded. The sensitivity and specificity of the technique and the effect of cyst size, cyst depth, and fluid viscosity in diagnosing fluid-filled cysts were assessed. RESULTS Overall, 31 cysts and eight solid masses (seven benign, one carcinoma) were diagnosed in the study and control groups. Aspiration of indeterminate lesions resulted in 20 cysts and one solid mass. Lesions ranged in size from 4 to 47 mm and in depth from 4 to 29 mm. In the control group, streaming detection correctly showed nine of the 11 simple cysts (sensitivity, 82%; positive predictive value, 100%), and acoustic streaming was absent in all seven solid masses (specificity, 100%; negative predictive value, 78%). Of the indeterminate lesions, streaming detection allowed correct identification of 10 of 20 cysts (sensitivity, 50%; positive predictive value, 100%). Acoustic streaming was not detected in the one solid study group lesion. Neither cyst size or depth nor fluid viscosity had a significant effect on the ability to detect fluid. CONCLUSION The streaming detection technique improved differentiation of cysts from solid masses in indeterminate lesions and has potential for reducing the number of recommended cyst aspirations for the diagnosis of indeterminate breast masses.
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Affiliation(s)
- Mary Scott Soo
- Department of Radiology, Breast Imaging Division, Duke University Medical Center, Box 3808, 2nd Fl., Red Zone, South Hospital, Durham, NC 27710, USA.
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Houssami N, Irwig L, Ung O. Review of complex breast cysts: implications for cancer detection and clinical practice. ANZ J Surg 2005; 75:1080-5. [PMID: 16398815 DOI: 10.1111/j.1445-2197.2005.03608.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The use of ultrasound in breast diagnosis has resulted in the increasing identification of incidental benign-appearing lesions, of which complex (or atypical) breast cysts are frequently reported. Complex breast cysts were estimated to be reported in approximately 5% of breast ultrasound examinations. A systematic review of the literature on sonographically detected complex breast cysts was carried out. The quality of primary studies and extracted data on cancer detection was assessed. Very few studies have examined complex breast cysts and quantified the associated cancer detection rate. In most of these studies, subjects have been selected on the basis of progress to intervention, which would overestimate the likelihood of malignancy. The only study to examine complex cysts from all consecutive ultrasounds reported one case of non-invasive cancer from 308 lesions--0.3% (95% confidence interval, 0.01-1.84). Ultrasound features associated with a higher risk of the lesion being a cancer are: thickened walls, thick internal septations, a mix of cystic and solid components, and an imaging classification of indeterminate. Using the information from the present review, complex breast cysts were categorized on the basis of associated risk of malignancy, and an approach to the management of these lesions to assist clinical decision-making was suggested. Provided adequate information is given to the patient, complex breast cysts with a very low risk of malignancy do not always require image-guided biopsy.
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Affiliation(s)
- Nehmat Houssami
- New South Wales Breast Cancer Institute, Westmead Hospital, New South Wales, Australia.
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Berg WA. Sonographically Depicted Breast Clustered Microcysts: Is Follow-Up Appropriate? AJR Am J Roentgenol 2005; 185:952-9. [PMID: 16177414 DOI: 10.2214/ajr.04.0929] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate outcomes of lesions prospectively classified on breast sonography as clustered microcysts without a discrete solid component. SUBJECTS AND METHODS Over a 4-year interval during which 1,900 consecutive breast sonography examinations were obtained at the University of Maryland, 110 examinations (5.8%) yielded 123 lesions so classified. Sonography was performed by a physician using a linear-array broadband transducer (L7.5-12 or L7-13 MHz). Follow-up of at least 24 months was available for 66 lesions, and 14-gauge core biopsy was performed on another 13 lesions. The median patient age was 48 years (range, 32-71 years), and the median lesion size was 8 mm (range, 5-30 mm). RESULTS Of the 79 lesions with acceptable follow-up, all were depicted sonographically, 57 (72%) were seen mammographically, and four (5%) were palpable. Of the 13 lesions biopsied, five (38%) showed apocrine metaplasia; five (38%), fibrocystic changes; two (15%), cysts; and one (8%), a microscopic fibroadenoma and cysts. Of the 66 lesions with 2-year follow-up, 35 (53%) were stable, 15 (23%) had resolved, 12 (18%) decreased, and four (6%) minimally increased at 1 year and were then stable (n = 2) or decreased (n = 2) after 2 subsequent years. Fusion of several small cystic spaces was seen in one (2%) of the lesions followed. CONCLUSION Breast clustered microcysts are relatively common, seen in 5.8% of breast sonograms. In our series of 79 lesions with follow-up, none proved malignant: Follow-up on an annual basis appears reasonable for most such lesions. Validation of this approach across multiple centers is needed.
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Affiliation(s)
- Wendie A Berg
- Johns Hopkins Greenspring, 10755 Falls Rd., Suite 440, Lutherville, MD 21093, USA.
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