Image Guided Core Needle Biopsy (CNB) of the Breast—Part 1: Ductal Carcinoma In Situ (DCIS) and Invasive Ductal Carcinoma (IDC)

Abstract

There are varied mammographic and ultrasonographic manifestations of breast carcinomas that begin in the milk ducts and are confined to the ducts and lobules or penetrated through the duct wall into the stroma. The mammographic findings include focal masses with or without spiculated hyperdense lesion, oval or lobulated shape, various patterns of microcalcifications, asymmetric density, architectural distortion, and associated features such as skin thickening and retraction, nipple retraction, and axillary lymphadenopathy. The ultrasonographic abnormalities include masses (solid or cystic) and their shapes, margins, echo patterns, posterior acoustic features, calcifications, vascularity determined by color Doppler imaging, and effects on surrounding tissue. Radiologists play no role in giving direct pathological reports. Our role is to describe the findings and give an impression of what they look like in terms of Breast Imaging Report and Data System (BIRADS). For any suspected lesion with a chance of malignancy of 2% and above (BIRADS 4 and 5), a pathological study is recommended. For any lesions seen by ultrasonography (US), a US-guided core needle biopsy (CNB) is recommended. For lesions seen only by mammography, stereotactic guidance is appropriate. The image-guided intervention provides the pathological result that is essential for the clinician to plan treatment with the patient. Part 1 of this case report includes DCIS and IDC. The interesting cases are the varieties of presentation, different patterns of imaging findings, CNB results, and finally the surgical pathological results.