Value of ultrasonography in differential diagnosis of granulomatous lobular mastitis and breast cancer

Objective To investigate the value of color Doppler ultrasonography in diagnosis and differential diagnosis of breast sclerosing adenosis (SA).Methods Preoperative sonography in 32 SA,99 invasive ductal carcinoma(IDC),51 ductal carcinoma in situ(DCIS) and 64 fibroadenoma(FA) confirmed by pathology were retrospectively analyzed.Results The average age of SA group was younger than IDC and DCIS groups',but older than FA group's (P ＜0.05).The focal maximum diameter of SA group was the smallest among all(P ＜0.05).All the SA sonograms showed solid hypoechoic lesions,with spiculate margin was less than IDC group and larger than DCIS and FA groups (P ＜0.05).Similar ultrasonic characteristics,such as irregular shape,unclear border,acoustic halos were seen in SA and DCIS groups (P ＞0.05),while IDC group showed the highest rate and FA group had the least(P ＜0.05).SA masses' uneven internal echo,calcification,posterior acoustic attenuation was higher than FA group(P ＜0.05),but less than IDC and DCIS groups(P ＞0.05).Meanwhile,A/T ratios(≥0.7) were higher than DCIS and FA groups,but less than IDC group(P ＞0.05).In addition,SA group had a similar detection rate of the internal blood flow with FA group(P ＞0.05),but less than the IDC and DCIS groups(P ＜0.05).Conelusions Ultrasonography has a significant clinical value in diagnosis and differential breast sclerosing adenosis. Key words: Ultrasonography, Doppler, color; Breast neoplasms; Fibrocystic breast disease

Objective To investigate the value of color Doppler ultrasonography in mammary ductal ectasia(MDE). Methods Preoperative sonograms of 54 MDE, 135 invasive ductal carcinoma(IDC) and 68 ductal carcinoma in situ (DCIS) patients were retrospectively analyzed and further confirmed by histopathology. Results MDE showed 88.9% (48/54)mass type and 11.1% (6/54) ductal type.The average age of patients in MDE was younger than that in IDC(P<0.05). The number of MDE located around the areola was more than that of IDC(P<0.05). Mean maximum diameter of MDE was smaller than that of DCIS (P<0.05). Compared to DCIS and IDC, MDE in mass type showed higher detection rate of liquidity area and mammary ductal ectasia(all P<0.05), while lower detection rate of hyperecho, peripheral hyperechoic zone, posterior echo attenuation or blood flow richness(all P<0.001). Compared to IDC, MDE in mass type showed higher detection rate of inside ductal echolocation, while showed lower detection rate of irregular shape, spiculate margin or axillary lymph node enlargement. Compared to DCIS, MDE showed higher detection rate of large aspect ratios(≥0.7). Less MDE in ductal type with hyperecho were found than DCIS in ductal type(P<0.001). The coincidence rate of ultrasonic diagnosis and postoperative histopathhology results in 54 MDE patientis was 13.0%(7/54). Conclusions The sonographic findings of MDE has diverse manifestations. It shows important value of ultrasonography for MDE in its diagnosis and differential diagnosis with breast cancer. Key words: Ultrasonography; Mammary ductal ectasia; Breast neoplasms; Diagnosis, differential

Does the Presence of Ductal Carcinoma in situ Affect Prognostic Outcomes After Neoadjuvant Therapy in Invasive Ductal Carcinoma of the Breast?

Background: It has been well investigated with regards to reproductive risk factors of invasive ductal carcinoma (IDC), yet it is still controversial if these factors could be applicable for either ductal carcinoma in situ (DCIS) patients or invasive ductal carcinoma with ductal carcinoma (DCIS-IDC) patients. We aimed to investigate effects of reproductive risk factors on clinical outcomes of IDC, DCIS, and DCIS-IDCpatients who received proper treatments.Method: A total of 37,049 patients of IDC, and DCIS who were registered in the web-based breast cancer registration program of the Korean Breast Cancer Society (KBCS), was assessed with a retrospective design. All patients were classified into three categories: 1) patients with pure DCIS, 2) patients with IDC with DCIS(DCIS-IDC), and 3) patients with pure IDC that is less than 1 cm without lymph node metastasis; overall survival (OS) and breast cancer specific survival (BCSS) of each group in response to parity, age at first birth (AFB), breast feeding, time interval between AFB and diagnosis of breast cancer, time interval between menarche and AFB were analyzed via the multivariate Cox regression analysis was performed.Results:The high parity (≥4) considerably elevated the hazard ratio (HR) of OS in three groups (DCIS; [HR], 1.52; 95% confidence interval [CI], 0.615-3.778; P&amp;lt;.0001,IDC; HR, 1.43; 95% CI, 0.885-2.314 ; P&amp;lt;.0001, and DCIS-IDC; [HR], 1.44; 95% confidence interval [CI], 0.452-4.594; P&amp;lt;.005) yet the parity influenced on the BCSS differently in the IDC group and the DCIS-IDCgroup. Meanwhile, in the DCIS-IDCgroup, the HR was elevated in which patients gave birth to 4 children whilst the HR of BCSS was lowered if they gave birth to either 1-2 children or more than 5 children. The AFB significantly reduced the HR of OS in the DCIS group and IDC group compared to nulliparous patients. In patients who breast-feed, the HRs of OS and BCSS were shown to be significantly elevated in the IDC group and DCIS group (HR of OS in IDC, 1.486;95% CI, 1.212-1.821; P=.0001 and HR of OS in DCIS, 2.036; 95% CI, 1.267-2.271 ; P=.0033; and HR of BSCC in IDC, 1.474; 95% CI, 1.111-1.957 ; P=.0072, HR of BCSS in DCIS,3.362; 95%CI, 1.18-9.56;P=0.023)(Table 3). Considering the time interval between AFB and age at diagnosis, the HR of OS was considerably elevated in all three groups (HR of DCIS, 1.067;95% CI, 1.050-1.085 ; P&amp;lt;.0001, HR of IDC, 1.041; 95% CI, 1.034-1.049 ; P&amp;lt;.0001, HR of DCIS-IDC, 1.031; 95% CI, 1.008-1.054 ; P=0.008) yet the HR of BCSS was only influenced in the IDC group (HR, 1.027;95% CI, 1.016-1.037 ; P&amp;lt;.0001). When it comes to the time interval between menarche and AFB, the HR of OS was significantly elevated in the group of DCIS (HR, 1.053; 95% CI, 1.007-1.100 ; P&amp;lt;.0219).Conclusion: The breast feeding history and age gap between AFB and diagnosis were found to be breast cancer risk factors that might be different from generally accepted trends, reducing occurrence of breast cancers. Taken altogether, we were able to demonstrate that known reproductive risk factors, such as AFB and parity, influence on clinical outcomes differently amongst the IDC group, the DCIS group, and the DCIS-IDC group. Citation Format: Lee J, Lee J, Oh M. Effects of reproductive risk factors for ductal carcinoma in situ, invasive ductal carcinoma, and invasive ductal carcinoma with ductal carcinoma in situ on clinical outcomes. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-09-06.

14-3-3ζ promoted invasion and lymph node metastasis of breast invasive ductal carcinoma with HER2 overexpression

Objective This study aim to investigate the oncological safety of neoadjuvant therapy (NAT) followed by breast-conserving surgery (BCS) for invasive ductal carcinoma (IDC) patients with the presence of ductal carcinoma in situ (DCIS) on pre-NAT biopsy. Methods The data of women with IDC who underwent radical surgery between January 2013 and December 2021 were retrospectively reviewed from two institutions. The study endpoints were 5-year disease-free survival (DFS) and local recurrence-fee survival (LRFS). Results Overall, 994 eligible patients were enrolled. Patients with IDC with DCIS (n = 277) and patients undergoing BCS (n = 285) were selected separately for prognostic analysis. For patients with IDC with DCIS, the 5-year DFS (p = 0.517) and 5-year LRFS (p = 0.397) rates of the patients undergoing BCS were similar to those of patients undergoing mastectomy after propensity score matching. In addition, the 285 patients who underwent BCS were divided into the IDC + DCIS and IDC groups. The 5-year DFS (p = 0.394) and 5-year LRFS (p = 0.341) rates were similar between the IDC and IDC + DCIS groups. Conclusion NAT followed by BCS combined with adjuvant radiotherapy is a safe and feasible treatment option in patients with IDC with DCIS under the premise of strict adherence to the surgical indications and adequate incision margins.

The objective of this study was to investigate the clinical significance and roles of tumor progression locus 2 (TPL2) and peptidyl-prolyl cis–trans isomerase 1 (Pin1) in the occurrence and development of breast invasive ductal carcinoma (IDC). Immunohistochemistry was used to detect the expression of TPL2 and Pin1 in human breast tissues, which included normal breast tissues (Normal), tissues with fibrocystic changes (FCC), ductal carcinoma in situ (DCIS), and IDC. The roles of TPL2 and Pin1 in the occurrence and development of IDC, as well as the correlation between their expression levels and clinicopathological parameters, were analyzed. Compared with Normal and FCC groups, the overexpression of TPL2 and Pin1 was significantly increased in DCIS and IDC groups (DCIS vs Normal: P = 0.002/P < 0.001; IDC vs Normal: P = 0.007/P = 0.003; DCIS vs. FCC: P = 0.008/P = 0.004; IDC vs. FCC: P = 0.04/P = 0.043). The expression levels of TPL2 and Pin1 were positively correlated in DCIS and IDC groups (P = 0.001, P = 0.011). In the IDC group, the Ki67 level in the TPL2 overexpression group was significantly lower than that in the TPL2 low expression group (P = 0.02). The TPL2 overexpression rate was significantly higher in IDC with histological grades 1–2 than that in IDC with histological grade 3 (P = 0.029). The TPL2 overexpression rate in IDC with tumor-node-metastasis (TNM) stage I was significantly higher than that in IDC with TNM stages II–III (P = 0.035). We conclude that TPL2 and Pin1 may synergistically promote the occurrence and development of IDC, but TPL2 overexpression may be an early molecular event in IDC development. TPL2 overexpression is significantly related with IDC with lower malignancy or earlier TNM stage, suggesting that the prognosis of IDC patients with TPL2 overexpression may be better and TPL2 overexpression may be a predictor of good prognosis in IDC.

Background: Ductal carcinoma in situ (DCIS) is considered to be a precancerous lesion that shares many genetic similarities with invasive ductal carcinoma (IDC). However, it remains unclear how DCIS might develop into IDC and whether the coexistence of DCIS has any clinical significance.There is limited data on whether coexisting DCIS in patients with IDC (IDC-DCIS) has any impact on patients' clinical presentation, tumor characteristics, prognosis and treatment selection. We aim to investigate differences in patients with pure IDC versus patients with IDC-DCIS. Methods: We reviewed clinicopathologic data from the Breast Molecular Epidemiological Resource (BMER) database, which is a prospectively maintained breast cancer database from the University of Iowa. Missing information was supplemented by Iowa Cancer Registry database. Patients with a diagnosis of pure IDC and IDC-DCIS from 2009 to 2014 who underwent surgical resection of their breast cancer were included. We excluded patients with stage IV disease at diagnosis and those who underwent neoadjuvant therapy. Patients who had more than one tumor were only analyzed once using parameters of the largest tumor. Patient and tumor characteristics and treatment selection were compared between the IDC and IDC-DCIS groups. Student's t test was used for continuous variables and chi squared test for categorical variables. Results: We observed that women with IDC-DCIS (n=226) had higher incidence of Her-2 positive cancers than those with pure IDC (n=95) (p=0.04). The IDC-DCIS group was more likely to be ER + and PR +, though these differences were not statistically significant. Another distinguishing characteristic between the two groups was that the IDC group contained more current smokers than the IDC-DCIS group (18.9% vs 10.6%, p&amp;lt;0.01). Patients with IDC-DCIS were more likely, than patients with pure IDC, to be under-staged based on clinical information. Clinical stage distribution in IDC-DCIS group was: 4% stage 0, 61.9% stage I, 28.3% stage II and 5.8% stage III. In contrast, the percentages of pathologic stage I, II and III were 54.5%, 35.4% and 10.2%, respectively (p=0.002). Similar analysis for patients with pure IDC showed no significant overall change from clinical to pathologic stage. Patients with IDC-DCIS tended to have higher total mastectomy rates than patients with IDC (37.2% vs 31.6%, p=0.34). Management of patients in either group were not significantly different in terms of radiation, chemotherapy, or hormonal therapy. There were 4 deaths (4.2%) in the IDC group and 12 deaths (5.3%) in the IDC-DCIS group (p=0.68). Conclusions: Our study showed that active smoking may be a risk factor for the development of IDC without pre-existing DCIS. Patients with IDC-DCIS had higher rates of Her-2 positivity and significant differences between clinical and pathologic stages. Management and survival of both groups were similar. Citation Format: Xu L, Monga V, Thomas A, Leone JP. The impact of the presence of ductal carcinoma in situ in patients with invasive ductal carcinoma [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-17-10.

To study the clinicopathologic features of granulomatous lobular mastitis and mammary duct ectasia. The clinicopathologic data from August 2005 to May 2013 of 32 cases of granulomatous lobular mastitis and mammary duct ectasia were retrospectively reviewed. The age of patients ranged from 26 to 45 years. Two patients had no history of delivery. Fourteen patients had no history of lactation or lactational disorder in the lesional side. Most of the remaining patients had history of breast feeding. Gross examination showed that the lesions were poorly circumscribed and varied from 3 to 12 cm in greatest dimension. Tiny abscess cavities, ranging from 0.1 to 0.5 cm in diameter and containing light yellowish to greyish secretion, were demonstrated. Histologic examination showed granuloma formation and ductal dilatation. Eleven patients had received antibiotic treatment. Twelve cases were complicated by sinus formation related to skin incision and drainage. The duration of follow-up ranged from 5 to 90 months. Three cases showed ipsilateral recurrence and 3 cases had similar pathology in the contralateral breast. Four patients defaulted follow-up. Granulomatous lobular mastitis is associated with mammary duct ectasia. Accurate pathologic diagnosis is prudent for clinical management and control of local recurrence.

Background: High breast density is an independent risk factor for breast cancer as well as benign breast diseases. However there are few studies about breast density of ductal carcinoma in situ (DCIS) and benign breast disease(BBD). In this study, we investigated patterns of breast density of DCIS and BBD, and comparatively analyzed breast densities of DCIS and BBD. Material and Methods From 2008 to 2009, 345 patients underwent surgery for DCIS at Asan Medical Center, and 295 patients for BBD at 2010. We retrospectively reviewed each groups and estimated cranio-caudal view of digital mammogram of unaffected breast by computer-assisted thresholding methods, using Cumulus 4, version 4.0. For BBD we included atypical ductal hyperplasia, fibroadenoma, papilloma(atypical/intraductal), phyllodes tumor(benign/borderline), and excluded unavailable mammogram(mostly, because of scanned films from outside hospitals and previously diagnosed breast cancer). Results Mean ages of each group were 46.51 year old in DCIS group and 41.43 year old in BBD group, and the mean percentage density(PD) were 44.89% and 45.27%, respectively. There was no significant difference between two groups in total population(p=0.79). We categorized into two groups according to the age, ≥50 and &amp;lt;50, for each DCIS and BBD group. Mean percentage density of below 50 year old was 52.92% in DCIS gruop and 49.58% in BBD group(p=0.031). Mean percentage density above 50 year old was 33.67% in DCIS group and 33.29% In BBD group(p=0.867). Conclusion The mean values and distribution patterns of PD were similar between BBD group and DCIS group. However, in the subgroup aged under 50, the DCIS group has significantly higher breast density than the BBD group. Although the causal association of breast density with breast cancer has been relatively well documented, this kind of cross-sectional study has an inherent limitation. The absolute difference between the DCIS group and the BBD group under age 50 (3.34% in table2) needs more investigation for its clinical implications. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-08-06.

Granulomatous lobular mastitis (GLM) and mammary duct ectasia (MDE) are inflammatory diseases. However, only a limited number of studies have focused on characterizing their clinicopathological features. The aim of the present study was to investigate the etiology, clinicopathological characteristics and diagnosis of GLM and MDE. The clinical information and treatment of 118 female patients with pathologically-proven GLM or MDE were retrospectively analyzed in the present study. A total of 29 cases had GLM, 77 had MDE and 12 had GLM accompanied by MDE. GLM tends to occur in patients who have had their last birth within 5 years and are usually <40 years of age. GLM masses were usually larger than MDE masses and suppurated or ulcerated more easily. Histopathologically, GLM was characterized by a significant granulomatous inflammatory reaction centered on lobules. Compared with MDE, GLM had a higher incidence of granuloma and microabscess formation within the lobules and surrounding tissue. More multinucleated giant cells within granuloma were observed in patients with GLM than in those with MDE, while MDE was characterized by significant dilatation of the duct terminals and inflammatory changes in the duct wall and periductal tissues. When compared with patients with GLM, foam cells within the duct epithelium or surrounding stroma were more common in patients with MDE. The present study demonstrated that GLM and MDE had distinct clinicopathological characteristics. Further research is required in order to identify more appropriate treatment strategies for these specific types of breast inflammation.

Granulomatous lobular mastitis is a rare chronic breast disease, firstly described by Kessler and Wolloch in 1972. In this article we present a 35-year-old patient with granulomatous lobular mastitis and in situ ductal carcinoma and discuss clinicopathological characteristics of the disease with literature data. A 35-year-old female patient admitted to the outpatient clinic with a complaint of swelling in right breast ongoing since March 2017. On the basis of physical examination and radiological examinations, antibiotic therapy was initiated considering the inflammatory breast disease and the patient was referred to our general surgery clinic because she did not benefit from treatment. On the recommendation of histopathological correlation, trucut biopsy was performed and reported as granulomatous mastitis. In the histopathological examination of the prepared sections, we found lobule-restricted, non-caseous granulomas and neoplastic epithelial cell proliferation in 4 different foci, the largest being 0.7×0.4 cm in diameter, limited to the ductal lobular system. The case was diagnosed as granulomatous lobular mastitis and in situ ductal carcinoma. This lesion, which clinically and radiologically can be confused with carcinoma, rarely coexists with breast carcinoma. Our case demonstrates the coexistence of granulomatous lobular mastitis and in situ ductal carcinoma.

Objective To investigate the effect of the ultrasonography-guided abscess puncture aspiration or drainage combined with local application of triamcinolone acetonide in the treatment of granulomatous lobular mastitis (GLM) . Methods The clinical data of forty-six severe GLM patients from February 2015 to February 2017 were analyzed. Twenty-three patients were treated with the ultrasonography-guided abscess puncture aspiration and irrigation (control group), and the other 23 patients were treated with triamcinolone acetonide injection 40 mg from the pinpoint or a drainage tube into the abscess cavity, pressure dressing, 2 times a week after the routine abscess puncture aspiration and irrigation treatment (observation group). The recovery rate, onset time, hospitalization days and patient satisfaction were compared between two groups, and hormone related adverse reaction of observation group was observed. Results There were 17 cases with effective treatment and 1 cured case in the observation group, while 10 cases with effective treatment, no cured case and 1 case lost in control group, with statistical difference (χ2=5.15, P=0.023). Compared with the control group, the observation group had faster onset time, fewer days of hospitalization, and higher satisfaction of the patients (t=5.81, 5.80, χ2=8.09, P<0.01, <0.01, 0.004). The observation group had no obvious hormone-related adverse reactions, whereas 6 patients in the control group had side effects, which gradually disappeared after the cessation of treatment. Conclusion The ultrasonography-guided percutaneous aspiration and drainage combined with local application of triamcinolone acetonide is a choice for clinical treatment of severe GLM. Key words: Granulomatous mastitis; Carcinoma, lobular; Paracentesis; Triamcinolone acetonide

Objective To investigate the ultrasound characteristics of microinvasive breast carcinoma(MBC), and to improve its detection rate. Methods Sixty-five MBC, 85 breast ductal carcinoma in situ(DCIS) and 99 breast invasive ductal carcinoma(IDC) confirmed by pathology were divided into mass type and ductal type according to ultrasonic manifestaions, and the ultrasound characteristics were retrospectively analyzed. Results MBC showed 89.23%(58/65) mass type with 64 lesions and 10.77%(7/65) ductal type.DCIS showed 88.24%(75/85) mass type with 78 lesions and 11.76%(10/85) ductal type. IDC group showed all mass type with 102 lesions. In MBC, most mass type lesions were solid and hypoechoic with a mean maximum diameter, which was larger than DCIS, but similar with IDC(P>0.05). More mass type lesions with irregular shape and calcification were found in MBC than in DCIS(P 0.05). The detection rate of spiculate margin in mass type lesions of MBC was higher than DCIS(P 0.05). More ductal type lesions displayed indistinct duct wall in MBC than DCIS(P<0.05). Meanwhile, MBC had a higher detection rate of internal blood flow(grade 2-3) than DCIS. Conclusions There are more lesions with large diameter, irregular shape, short spiculate margin and calcification in MBC than DCIS. Compared with IDC, MBC lesions are atypical in spiculate margin, and less lesions show hyperechoic halos and high A/T ratio. To be familiar with ultrasound characteristics of MBC is significant for improving its ultrasound detection rate. Key words: Ultrasonography; Breast neoplasms; Microinvasive breast carcinoma

The findings of preoperative ultrasonography in patients with granulomatous lobular mastitis treated in Xintai People′s Hospital from December 2013 to December 2016 were retrospectively analyzed. Among 15 cases of granulomatous lobular mastitis confirmed by pathology, there were 6 cases of mass type, 5 cases of tubular type and 4 cases of mixed type diagnosed by ultrasound before operation, which were consistent to pathological diagnosis in 3, 4, 3, respectively. On the ultrasound images, the blood flow signals are more rich, the tubular and mixed type have certain specificity, and color Doppler flow imaging (CDFI) usualy can make correct diagnosis. For the atypical mass lesions, the final diagnosis can be made by ultrasound-guided needle aspiration biopsy. Key words: Granulomatous mastitis; Ultrasonography