Benign Imaging Features Research Articles

Short-Term Follow-Up of Palpable Breast Lesions With Benign Imaging Features: Evaluation of 375 Lesions in 320 Women

Short-Term Follow-Up of Palpable Breast Lesions With Benign Imaging Features: Evaluation of 375 Lesions in 320 Women

Short-Term Follow-Up of Palpable Breast Lesions With Benign Imaging Features: Evaluation of 375 Lesions in 320 Women

The purpose of this study was to evaluate the feasibility of short-term follow-up of palpable masses that have benign imaging features. The cases of all women with round, oval, or lobular palpable masses with circumscribed margins and homogeneous ultrasound echotexture for which short-term follow-up was recommended from July 1997 through December 2003 were retrospectively identified. Evaluation was by ultrasound and/or mammography and focused clinical examination. Outcome was assessed with imaging or clinical follow-up lasting at least 12 months. The cancer incidence for palpable lesions was compared with that for nonpalpable lesions recommended for short-term follow-up. In 379 women, 443 palpable masses with benign features for which short-term follow-up was recommended were identified. Outcome data were available on 375 masses in 320 women. Lesions were evaluated with mammography and ultrasound (n = 186) or ultrasound alone (n = 189). Masses were typically identified only with ultrasound (n = 258, 68.8%); were oval (n = 275, 73.3%), of equal density to normal breast tissue on mammograms (n = 95 on 117 mammograms, 81.2%), and hypoechoic (n = 336 in 372 ultrasound examinations, 90.3%); and were prospectively believed to be fibroadenoma (n = 304, 81.1%). Eighty-five lesions (22.7%) were biopsied soon after evaluation, and one 1.5-mm ductal carcinoma in situ was diagnosed. At follow-up (mean, 2.7 years), 26 lesions (6.9%) had grown. Twenty-four of the 26 lesions were biopsied, and no cancer was diagnosed. The overall cancer prevalence was similar for palpable (0.3%) and nonpalpable (1.6%) masses. The cost of short-term follow-up was less than that of biopsy. Short-term follow-up is a reasonable alternative to biopsy of palpable breast lesions with benign imaging features, particularly for young women with probable fibroadenoma.

Ossifying fibromyxoid tumour, an unusual cause of rim ossification: Imaging features and correlation with histopathology

With the presentation of a soft tissue mass, some imaging features, such as a rim of mature ossification, are considered to relate to a more benign range of differential diagnoses, such as myositis ossificans. In this case report, we present the imaging features of an ossifying fibromyxoid tumour, which is a less frequently reported lesion in the radiographic literature. So demonstrating that some benign imaging features may relate to a lesion with histology that has a less predictable clinical outcome, dependant on correct initial management.

Analysis of the Mammographic and Sonographic Features of Pseudoangiomatous Stromal Hyperplasia

The purpose of this study was to describe the imaging findings in 149 patients with pseudoangiomatous stromal hyperplasia (PASH) who had undergone at least 4 years of clinical follow-up for detection of subsequent malignancy. PASH is a common entity that presents with benign imaging features without evidence of subsequent malignant potential. At our institution, in the absence of suspicious features a diagnosis of PASH at core biopsy is considered sufficient, and surgical excision has been obviated.

Imaging Differences in Metaplastic and Invasive Ductal Carcinomas of the Breast

The purpose of this study was to compare the imaging features of metaplastic breast carcinoma with those of invasive ductal carcinoma. Women diagnosed on preoperative mammography or sonography with metaplastic breast carcinoma and T-stage matched invasive ductal carcinoma of the breast from a single pathology database were included in the study. Clinical and pathologic information on all metaplastic cancers was documented. Mammography and sonography variables were recorded using the BI-RADS lexicon. Groups were compared using Fisher's exact test, the chi-square test, or Wilcoxon's rank sum test, as appropriate. Forty-three patients diagnosed with metaplastic carcinoma were matched to 43 patients with ductal carcinoma by tumor T stage. Patients with metaplastic carcinoma were younger (median, 46 vs 53 years, p = 0.048) than those with ductal carcinoma. Mammographically, metaplastic carcinomas were less frequently irregular in shape (16% vs 74%, p < 0.0001) and less frequently showed microlobulated or spiculated margins (19% vs 56%, p = 0.0008) and calcifications (25% vs 51%, p = 0.02) when compared with ductal carcinomas. Sonographically, metaplastic carcinomas were less frequently irregular in shape (27% vs 69%, p = 0.001) and less frequently showed angular margins (9% vs 49%) and posterior acoustic shadowing (9% vs 49%, p < 0.0001). Characteristic malignant imaging features, including irregular shape, spiculated margins, segmentally distributed pleomorphic calcifications, and posterior acoustic shadowing, are uncommon in metaplastic carcinomas. These carcinomas tend to show more benign imaging features, such as round or oval shape with circumscribed margins, when compared with ductal carcinomas.

Mucinous Carcinoma of the Breast: Diagnostic Criteria Based on Ultrasonography

In previous studies, the benign imaging features of mucinous carcinoma (MCA) of the breast that may result in missing the diagnosis have been reported. The aim of this study was to evaluate the diagnostic criteria from ultrasonography of MCA of the breast, and to investigate the general applicability of ultrasonographic features in diagnosing this tumor. We retrospectively reviewed the ultrasonographic findings of 41 (34 pure MCA and 7 mixed MCA) pathologically-confirmed cases of MCA of the breast. We analyzed the size, shape, margin, internal echogenicity, echotexture, intratumoral calcification, posterior acoustic enhancement, and surrounding desmoplastic reaction. The original sonogram report of each case was categorized based on the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) for ultrasound assessment categories. The median age of the patients was 52 years (range, 34—96 years). The median tumor size was 2.6 cm (range, 0.8—15 cm). Tumor size was found to significantly correlate with the duration of lesion palpability. Lobular shape (53.7%), microlobulated margin (65.9%) and mildly hypoechoic echogenicity (53.7%) were the most frequent sonographic findings. Multiple linear regression showed that tumor type was the only predictor of the presence and sonogram appearances of lymph nodes. In all cases, when the width-to-anteroposterior dimension ratio, either being less than or greater than 1.4, was taken into consideration, no significant correlation with any of the variables stated above was found. Posterior enhancement was detected in most cases, accounting for about 19.5% of the characteristics of larger tumor size, heterogeneous echotexture or evidence of mixed MCA. Most sonogram reports disclosed a suspicion of or definite malignancy in 38 cases (92.7%). The sensitivity of malignant sonographic features with traditional lexicons was poor for MCA of the breast, which supports the assumption of the less invasive nature of this tumor. The deformed ovoid shape is useful for suspecting a nontypical benign lesion, and we noted a high positive reporting rate of suspicion of malignancy. Posterior enhancement occurs quite often in MCA due to its tissue characteristics.

The value of ultrasound-guided fine needle aspiration in the assessment of solid breast lumps.

To assess the value of routine ultrasound-guided fine needle aspiration (US-FNA) of solid mass lesions of the breast, all such patients presenting to the breast clinic over a 5 month period were offered US-FNA in addition to standard imaging. One thousand, three hundred and eight-six consecutive patients were assessed and 77 solid mass lesions identified. US-FNA was performed in 49 of these. Sixteen demonstrated cytological features of malignancy that was confirmed at surgery. US-FNA did not diagnose malignancy in cases with typical benign imaging features. It did alter diagnosis from an equivocal suspicious mass lesion to a definite diagnosis of malignancy in four cases (25%). It also altered diagnosis from an equivocal, probably benign, diagnosis to a more confident diagnosis of benign disease in 18 (58%) of benign cases. US-FNA confirmed the diagnosis of malignancy in four cases where a suspicious mass could only be imaged by ultrasound. US-FNA is simple, rapid and, unlike large Tru-Cut biopsies, is not associated with complications. It causes only minimal discomfort to both patient and operator. We recommend that US-FNA becomes a routine component of the imaging workup of breast mass lesions both to exclude malignancy in equivocal cases and to confirm malignancy when this is expected.

Critical Commentary

With the presentation of a soft tissue mass, some imaging features, such as a rim of mature ossification, are considered to relate to a more benign range of differential diagnoses, such as myositis ossificans. In this case report, we present the imaging features of an ossifying fibromyxoid tumour, which is a less frequently reported lesion in the radiographic literature. So demonstrating that some benign imaging features may relate to a lesion with histology that has a less predictable clinical outcome, dependant on correct initial management.