Asymmetric Breast Tissue Research Articles

Sonographic Evaluation of Mammographically Asymmetric Breast Tissue

Sonographic Evaluation of Mammographically Asymmetric Breast Tissue

Fine needle aspiration cytology of solid neuroendocrine carcinoma of the breast: A case report

We report a case of neuroendcrine (NE) carcinoma in the right breast of a 67-year-old female, ultrasonography revealed a lesion composed of irregular hypoechoic masses and mammography showed asymmetric breast tissue. Histopathologic examination of the surgical sample showed a solid to nested proliferation of plasmacytoid cells that showed immunocytochemical positivity for chromogranin A, synaptophysin, CD56, and estrogen receptor. Our case was diagnosed as solid NE carcinoma. Though the findings of fine needle aspiration cytology reflected the histological features, we were not able to cytopathologic grounds only to predict the NE nature of this tumor. We performed immunocytochemistry using Chromogranin A, Synaptophysin, and CD56 on our cytologic smear retrospectively with positive results for all of the markers. When the cytopathologic examination of a given breast neoplasm is suggestive of NE differentiation, immunocytochemical staining for NE markers is generally useful for a correct preoperative diagnosis. An acurate preoperative diagnosis of NE carcinoma on FNAC can be achieved based on its distinctive cytomorphologic and immunocytochemical features.

Asymmetric Mammographic Findings Based on the Fourth Edition of BI-RADS: Types, Evaluation, and Management

Asymmetric breast findings are frequently encountered at screening and diagnostic mammography. However, there has been some confusion about the applicable terminology for describing asymmetric breast findings. The fourth edition of the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) has incorporated changes in the lexicon for asymmetric breast findings to address such problems and improve the clinical utility of reporting. The fourth edition has replaced "asymmetric breast tissue" with "global asymmetry," "density seen in only a single projection" with "asymmetry," and "focal asymmetric density" with "focal asymmetry." Once an asymmetric finding is perceived, it should be determined whether it is due to a definite lesion. To interpret and manage asymmetric breast findings, additional imaging studies such as straight lateral views, rolled views, and spot compression views at mammography and ultrasonography or magnetic resonance imaging should be applied appropriately in a logical work flow, and the radiologist should be aware of the pitfalls and pearls of each technique and modality.

Ductal Dilatation as the Manifesting Sign of Invasive Ductal Carcinoma

Several established mammographic criteria of malignancy are known, including the presence of a mass lesion with spiculated or irregular margins, architectural distortions, suggestive microcalcifications, and asymmetric density or breast tissue. A pattern of unilaterally dilated ducts has previously been shown to have a very low positive predictive value for cancer. 1 - 5 The few reports of studies that have investigated the possible relationship of ductal dilatation and . malignancy concluded that ductal dilatation alone cannot be an indicator of malignancy and can be deemed suggestive only when it is associated with one of the more widely accepted findings of malignancy. 6 , 7 These include worrisome calcifications or a mass noted on mammography and clinical symptoms such as nipple discharge and a palpable abnormality. Sonography is an important tool that can be used as an adjunct to mammography for detection and staging of breast cancer, although sonographic evaluation of suggestive dilated ducts is not routine in clinical practice. In this report, we describe the mammographic and sonographic findings in a patient with multifocal invasive ductal carcinoma that manifested as unilateral dilated ducts involving a single segment, the diagnosis of which was prompted primarily by sonographic findings. A previous patient is described within the context of this report to enable comparison of these features with those of a benign breast lesion manifesting as a solitary dilated duct that proved to be a benign papilloma. To our knowledge, descriptive sonographic findings of a breast lesion suggestive of malignancy in the setting of mammographic findings of dilated ducts have not been reported.

Imagerie du sein opéré et traité

Breast imaging plays a major role during and after treatment of a breast cancer. Immediate postoperative mammography is required to confirm the complete excision of cancers that contained calcifications. Ultrasound is the best examination for the detection of immediate postsurgical complications such as hematoma, abcess or lymphocele. Post-therapeutic benign changes (surgery, radiotherapy) have to be known for avoiding unusefull invasive explorations. Breast scars, irradiated breast and fat necrosis will be described over time at mammography, ultrasound and MRI. Local treatment failure that occurs within the first 5 to 7 years after treatment is most likely to be located at or near the site of original cancer ; in approximatively 50 % of cases, the local relapse will be detected by suspicious microcalcifications on mammmograms. Local failure after ten years is commonly caused by carcinomas growing elsewhere in the breast. Ultrasound is useful for analyzing architectural distorsion, focal asymmetric breast tissue, post-therapeutic dense breasts or abnormal clinical findings. Magnetic resonance imaging has a high specificity and negative predictive value in this population allowing the elimination of an infiltrating relapse in difficult cases. In these treated patients, quality control of mammograms and comparison with previous imaging data are mandatory at each annual imaging follow-up.

When the mammogram is negative: the role of ultrasound in breast cancer diagnosis

Objective: The timely and accurate diagnosis of breast cancer has become an increasingly important medicolegal issue leaving little room for error. Breast self-examination and periodic mammograms have been the cornerstone of standards of care. However, increasingly troublesome cases of failure to diagnose or of significant delay in diagnosis have been noted with sole reliance on these techniques. Ultrasound is emerging as an inexpensive, easy, and readily available technique that is complementary for the detection of breast cancer. Methods: We examined the features of 40 non-palpable breast cancers that were diagnosed by ultrasound-guided biopsy after a negative screening mammogram. Characteristics on mammogram included: benign stable mass (14), dense breast (2), asymmetric tissue (9). Results: On ultrasound, 7 of the benign masses were suspicious for malignancy and 7 had a benign appearance. The 9 patients with asymmetric breast tissue had cancer in a different location by ultrasound. Completely normal mammograms were noted in 15 patients with malignant appearing masses on ultrasound who had been referred for clinical reasons including: strong family or personal history of breast cancer (6), rule out abscess (2), palpable mass (4) (that turned out to not be cancerous), positive lymph node for cancer (1), unknown (2). While 33 patients had suspicious findings on ultrasound, none of these cancers would have been detected if bilateral screening ultrasound had not been performed. An additional 7 appeared normal and were only detected by biopsy of benign appearing masses. Conclusions: Our results demonstrate that mammography and ultrasound are complementary techniques that can increase the sensitivity for early, accurate detection of breast cancer. It is apparent that mammography used alone has limited sensitivity for detecting cancers. It is also clear that a high index of suspicion is indicated to avoid inadvertently missing breast cancers not detectable by standard criteria using either technique.

Focal asymmetric densities seen at mammography: US and pathologic correlation.

The American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) defines four different types of asymmetric breast findings: asymmetric breast tissue, densities seen in one projection, architectural distortion, and focal asymmetric densities. These lesions are frequently encountered at screening and diagnostic mammography and are significant because they may indicate a neoplasm, especially if an associated palpable mass is present. Once these lesions are detected at standard mammography, supplementary breast imaging with additional mammographic views and ultrasonography (US) can be a key aspect of work-up. The role of US in this setting has not been clearly defined. However, a positive US finding such as a solid mass or an area of focal shadowing increases the level of suspicion for malignancy. A thorough knowledge of the patient's clinical history, along with a fundamental understanding of the ACR BI-RADS lexicon and the role and limitations of supplementary breast imaging, will allow more accurate interpretation of these potentially perplexing soft-tissue findings.

Developing asymmetric breast tissue.

To show that benign asymmetric breast tissue detected mammographically may increase over time. Serial mammograms obtained in 21 women with negative physical examination results and mammographically detected developing asymmetric breast tissue were reviewed, and findings were correlated with results of biopsy (n = 16), ultrasonography (US) (n = 8), and contrast material-enhanced magnetic resonance (MR) imaging (n = 3). Five patients who did not undergo biopsy were followed up for 13-84 months. Thirteen of 16 biopsy specimens were reviewed. At the time of mammographic change, 12 patients without baseline asymmetric tissue had a mean age of 41.7 years and a mean size of asymmetric tissue of 2.4 cm. The mean age of nine patients with baseline asymmetric tissue was 46.9 years. In eight patients, the mean size increase was 2.5 cm. One patient showed increased tissue density but stable size. All US and MR images were negative. Pseudoangiomatous stromal hyperplasia was present in all 13 biopsy specimens reviewed and extensive in 12. No malignancies have been reported in five of the followed-up patients, and two have had continued enlargement of asymmetric tissue. Pseudoangiomatous stromal hyperplasia is a common histopathologic finding in developing asymmetric breast tissue. Follow-up, rather than biopsy, is a management option if benign imaging and clinical criteria are met.

Short-term recall for ‘probably benign’ mammographic lesions detected in a three yearly screening programme

The outcome of short-term recall for the follow-up of 131 screen detected 'probably benign' non-palpable mammographic lesions is presented. Patients were selected for short-term recall after attending a dedicated assessment clinic and underwent repeat ipsilateral mammography 1 year later. Interval progression in the mammographic appearance prompted excision biopsy, whereas no change led to discharge back to the normal screening protocol. Of 35,671 asymptomatic women screened between 1988 and 1992, 1762 (5%) attended an assessment clinic. Subsequently, 131 women (7% assessed, 0.4% screened) were placed on short-term recall and were reviewed between 1989 and 1993 (age range 50-67 years). The 'probably benign' lesions were: calcifications (91 cases, 69%); circumscribed density (18 cases, 14%); parenchymal deformity/stellate density (13 cases, 10%); and asymmetric breast tissue (9 cases, 7%). 128/131 women attended for short-term recall (compliance 98%). Five from 128 were subject to excision biopsy with a yield of three invasive carcinomas and two ductal carcinomas in-situ. The positive predictive values for malignancy were: overall 'probably benign' lesions (PPV 3.9%); calcifications (PPV 3.3%); circumscribed density (PPV 0%); parenchymal deformity/stellate density (PPV 15.4%); and asymmetric breast tissue (PPV 0%). The largest carcinoma measured 15 mm and none of the tumours demonstrated vascular invasion or axillary metastases placing them in a favourable prognostic group. The results suggest that short-term recall is a reasonable management option for a small number of women with 'probably benign' calcifications. Parenchymal deformity and stellate densities should probably not be managed by this approach and require excision after initial assessment. Circumscribed densities and asymmetric breast tissue can be safely discharged following assessment.

Likelihood of Malignant Disease for Various Categories of Mammographically Detected, Nonpalpable Breast Lesions

To determine the likelihood of malignant disease for mammographically detected, nonpalpable breast lesions, we defined 11 morphologic categories and retrospectively reviewed the mammograms in 859 cases in which biopsy was performed after a wire localization procedure at our institution during 1989 and 1990. Within each category, the total number of lesions and the percentage of cases with a surgical pathologic diagnosis of malignant involvement were as follows: benign calcification, 25 (0% malignant); indeterminate calcification, 200 (22%); malignant calcification, 39 (92%); smooth mass, 84 (1%); irregular mass, 337 (40%); architectural distortion, 45 (47%); asymmetric breast tissue, 37 (3%, or 1 case of asymmetrically prominent ducts); smooth mass with calcification, 3 (0%); irregular mass with calcification, 68 (66%); architectural distortion with calcification, 14 (57%); and asymmetric breast tissue with calcification, 7 (29%). The overall rate of malignant involvement for the 859 cases was 34%. If follow-up examinations rather than biopsies had been done for the lesions categorized as benign calcification, smooth mass, smooth mass with calcification, and asymmetric breast tissue (excluding asymmetrically prominent ducts), the overall positive predictive value would have increased from 34 to 41%, and 148 biopsies would have been deferred (17% of all biopsies). If morphologic criteria are applied to the evaluation of mammographically detected, nonpalpable lesions, the rate of malignant disease at biopsy may reach 40%. This rate correlates with that in recent large series.

BREAST MASSES: Mammographic and Sonographic Evaluation

Asymmetric breast tissue can nearly always be distinguished from a true mass by means of mammographic evaluation. Stellate masses from early invasive breast cancer are often extremely subtle so that optimal technique and meticulous interpretation are essential. Benign stellate masses such as post-biopsy scarring and fat necrosis frequently have a characteristic appearance. A radial scar is usually indistinguishable from malignancy on the mammogram. Nearly all circumscribed masses are benign and are usually cysts, fibroadenomas, or intramammary lymph nodes. A few circumscribed masses represent in situ or invasive carcinoma or both. Characteristics that may allow a definitively benign diagnosis for a circumscribed mass include the presence of fat and certain calcification patterns on the mammogram and features of a simple cyst on the sonogram. Management decisions for other circumscribed masses will depend on characteristics such as shape, margins, calcification, multiplicity, size, stability, and sonographic features as well as patient age and risk factors. Most nonspecific circumscribed masses should be followed rather than biopsied as they are commonly present on mammograms and have a change of malignancy of less than 5%. Even when biopsied on the basis of interval change, most small circumscribed cancers will not have metastasized to the regional nodes. For palpable breast masses, selection of mammography or ultrasonography as the primary imaging modality will depend on patient's age and risk factors.

Asymmetric Breast Tissue

HomeRadiologyVol. 173, No. 2 PreviousNext LettersAsymmetric Breast TissueMarc J. Homer, Thomas J. SmithMarc J. Homer, Thomas J. SmithAuthor AffiliationsDepartment of Radiology, New England Medical Center, 750 Washington Street, Boston, MA 02111Department of Surgery, New England Medical Center, 750 Washington Street, Boston, MA 02111Marc J. HomerThomas J. SmithPublished Online:Nov 1 1989https://doi.org/10.1148/radiology.173.2.577-aMoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: Nov 1989 FiguresReferencesRelatedDetailsCited ByBreast Imaging2011Breast Imaging2011Mammographic feature analysisCarl J.D'Orsi, Daniel B.Kopans1993 | Seminars in Roentgenology, Vol. 28, No. 3Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 173, No. 2 Metrics Altmetric Score PDF download

Asymmetric breast tissue.

HomeRadiologyVol. 173, No. 2 PreviousNext LettersAsymmetric Breast TissueMarc J. Homer, Thomas J. SmithMarc J. Homer, Thomas J. SmithAuthor AffiliationsDepartment of Radiology, New England Medical Center, 750 Washington Street, Boston, MA 02111Department of Surgery, New England Medical Center, 750 Washington Street, Boston, MA 02111Marc J. HomerThomas J. SmithPublished Online:Nov 1 1989https://doi.org/10.1148/radiology.173.2.577-aMoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: Nov 1989 FiguresReferencesRelatedDetailsCited BySeminars in Roentgenology, Vol. 28, No. 3Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 173, No. 2 Metrics Downloaded 15 times Altmetric Score PDF download

Asymmetric breast tissue.

A prospective study was undertaken to evaluate the significance of asymmetric breast tissue (asymmetric volume of breast tissue, asymmetrically dense breast tissue with preserved architecture, or asymmetrically prominent ducts) on mammograms. Of 8,408 mammograms obtained in 1985, 221 (3%) demonstrated asymmetric breast tissue. Follow-up was 36-42 months after the initial mammographic study. During this time none of the patients underwent biopsy on the basis of mammographic findings, although 20 underwent excisional biopsy because of clinical findings. Breast cancer was diagnosed in two patients and breast lymphoma in one patient. Biopsy specimens from the remaining 17 patients were benign. At mammography, all three malignant lesions had a palpable abnormality associated with the asymmetric tissue. Breast cancer was not found in any of the remaining 201 patients. Therefore, an asymmetric volume of breast tissue, asymmetrically dense breast tissue, or asymmetrically prominent ducts that do not form a mass, do not contain microcalcifications, or do not produce architectural distortion should be viewed with concern only when associated with a palpable asymmetry and are otherwise normal variations.