Differential Diagnosis Of Breast Masses Research Articles

Mammary myofibroblastoma of the male breast: a case report and literature review.

Mammary myofibroblastoma (MFB) is a rare benign spindle cell tumour predominantly affecting males, but also observed in postmenopausal females. Its diagnosis remains challenging owing to overlapping histological features with malignant lesions and limited tissue sampling in core biopsies. We present a case of incidentally discovered mammary MFB in a 63-year-old man and review its clinical, radiological and histopathological characteristics. The patient, who had a history of distal pancreatectomy and splenectomy, presented with an incidental left anterior chest wall nodule discovered on computed tomography scan. Clinical examination revealed a benign left retroareolar lump, confirmed by breast ultrasound and mammography. Ultrasound-guided core biopsy demonstrated characteristic spindle cells, prompting immunohistochemical staining confirming the diagnosis of MFB. The lesion was surgically excised with clear margins. Mammary MFB is commonly seen in postmenopausal women and older men, presenting as painless, mobile breast lumps. Imaging findings are nonspecific, resembling fibroadenomas or fat necrosis. Histologically, MFB lacks mammary ducts or lobules and displays characteristic spindle cells with collagenous stroma. Immunohistochemistry aids in differentiating it from other spindle cell tumours. Surgical excision is curative, with no reported cases with recurrence. Mammary MFB should be considered in the differential diagnosis of breast masses in males and postmenopausal women. Despite the challenges in diagnosis, its benign nature and favourable prognosis warrant timely recognition and appropriate management through surgical excision. Further research is needed to establish clear management guidelines and explore its underlying pathogenesis.

Breast Pilomatrixoma in a 47-year-old Woman: Pathological and Radiological Diagnosis

Background: Pilomatrixoma is a benign adnexal tumor with differentiation towards the matrix of the hair follicle and occurs mostly in the head, neck, and upper extremities of the child. Pilomatrixoma of the breast is considered a very rare tumor. Case presentation: Herein, we present a 47-year-old woman who was referred to the surgery ward for a palpable right breast mass. Imaging studies revealed a well-circumscribed lesion categorized as BIRADs3. Because clinically the lesion was large and had a stony hard consistency so patient underwent surgery and intraoperative consultation was negative and revealed a well-defined lesion composed of basaloid cells, multinucleated giant cells admixed with bone trabeculae, and nests of ghost cells. Immunohistochemical (IHC) studies were done and the cells were positive for AE1/AE3, Beta-catenin, and BCL2 and negative for Mart1 and CD117. Based on H&E and IHC studies, pilomatrixoma of the breast tissue was confirmed. Conclusion: Breast pilomatrixoma is a very rare benign neoplasm that could clinically mimic malignant neoplasm and should be considered in the differential diagnosis of breast masses

SPINAL TUMORS-03 MALIGNANT PHYLLODES TUMOR OF THE BREAST WITH METASTASIS TO THE THORACIC SPINE: A CASE REPORT

Abstract Malignant phyllodes tumors (MPT) of the breast are rare, and spinal metastasis from these tumors is even rarer. We present a case report of a 37-year-old female with a breast mass, who was diagnosed with malignant MPT after incisional biopsy. The patient underwent a right partial mastectomy, and negative margins were reported. However, two weeks later, the patient presented to the emergency department with severe back pain, paresthesia, and lower limb weakness. Neurosurgery consultation led to a diagnosis of T4 pathological fracture, spinal tumor and spinal cord compression, likely due to metastasis from the breast mass. Chest abdomen and pelvis CT revealed no other lesion except the T4 compression fracture. The patient underwent cord decompression tumor resection, and transpedicular fixation of T3-T5 with T4 vertebroplasty. Histopathological analysis confirmed that it was a metastasis from phyllodes tumor. Our case report highlights the importance of early detection and management of MPT, as well as the need for close follow-up and monitoring of patients with a history of breast masses it also highlights the importance of considering malignant phyllodes tumors as a differential diagnosis for breast masses and the potential for metastasis to the spine.

S-DETECT FUNCTION AS THE LATEST METHOD OF ULTRASOUND EXAMINATION
 OF MAMMARY GLAND FORMATIONS:
 COMPARATIVE CHARACTERISTICS

Relevance: Breast masses remain a public health dilemma worldwide. Breast cancer (BC) is one of the leading causes of cancer mortality. So,
 in Kazakhstan in 2018-2019. Breast cancer ranked 3rd in the structure of mortality from malignant diseases, with a share of 8.7-8.1%.
 Breast cancer is the most common cancer among women. According to the WHO, over 2.2 million breast cancer cases were registered in 2020.
 In the world, breast cancer ranks fifth among the causes of death (685,000 deaths per year).
 On average, about 3000 breast cancer cases are detected in the Republic of Kazakhstan annually, and more than 1380 women die from this
 disease. The high rate of increase in morbidity and mortality, which is ahead of most other tumors, puts the problem of breast cancer in the lead.
 The rapid progress of technological developments in medicine has positively influenced the diagnosis of breast formations. Samsung Medison
 introduced the S-Detect function for the breast, which allows you to highlight the formation and characterize the affected area. Previously, reliable
 assessments were made using sonoelastography methods.
 The study aimed to determine the role of the S-Detect function in the differential diagnosis of breast masses.
 Methods: A comparative analysis of images taken with the S-Detect function and the sonoelastography method was carried out in 50 patients.
 Results: The S-Detect program made it possible to make a correct diagnosis in 87-93% (46 out of 50) of cases, confirmed by the results of
 morphological verification (histology, cytology). The sonoelastography method showed correct results in 75-80% (40 out of 50) cases.
 Conclusion: The use of S-Detect technology in analyzing the nature of formations in the mammary glands showed good agreement with
 B-mode, color (CFM) and power Doppler. S-Detect technology can be effectively used by novice radiologists when writing conclusions.

Ultrasound super-resolution imaging for differential diagnosis of breast masses.

Ultrasound imaging has been widely used in breast cancer screening. Recently, ultrasound super-resolution imaging (SRI) has shown the capability to break the diffraction limit to display microvasculature. However, the application of SRI on differential diagnosis of breast masses remains unknown. Therefore, this study aims to evaluate the feasibility and clinical value of SRI for visualizing microvasculature and differential diagnosis of breast masses. B mode, color-Doppler flow imaging (CDFI) and contrast-enhanced ultrasound (CEUS) images of 46 patients were collected respectively. SRI were generated by localizations of each possible contrast signals. Micro-vessel density (MVD) and microvascular flow rate (MFR) were calculated from SRI and time to peak (TTP), peak intensity (PI) and area under the curve (AUC) were obtained by quantitative analysis of CEUS images respectively. Pathological results were considered as the gold standard. Independent chi-square test and multivariate logistic regression analysis were performed using these parameters to examine the correlation. The results showed that SRI technique could be successfully applied on breast masses and display microvasculature at a significantly higher resolution than the conventional CDFI and CEUS images. The results showed that the PI, AUC, MVD and MFR of malignant breast masses were significantly higher than those of benign breast masses, while TTP was significantly lower than that of benign breast masses. Among all five parameters, MVD showed the highest positive correlation with the malignancy of breast masses. SRI is able to successfully display the microvasculature of breast masses. Compared with CDFI and CEUS, SRI can provide additional morphological and functional information for breast masses. MVD has a great potential in assisting the differential diagnosis of breast masses as an important imaging marker.

Diagnostic accuracy of S-Detect to breast cancer on ultrasonography: A meta-analysis (PRISMA).

Background:Computer-aided diagnosis (CAD) systems have shown great potential as an effective auxiliary diagnostic tool in breast imaging. Previous studies have shown that S-Detect technology has a high accuracy in the differential diagnosis of breast masses. However, the application of S-Detect in clinical practice remains controversial, and the results vary among different clinical trials. This meta-analysis aimed to determine the diagnostic accuracy of S-Detect for distinguishing between benign and malignant breast masses.Methods:We searched PubMed, Cochrane Library, and CBM databases from inception to April 1, 2021. Meta-analysis was conducted using STATA version 14.0 and Meta-Disc version 1.4 softwares. We calculated the summary statistics for sensitivity (Sen), specificity (Spe), positive, and negative likelihood ratio (LR+/LR−), diagnostic odds ratio(DOR), and summary receiver operating characteristic (SROC) curves. Cochran Q-statistic and I2 test were used to evaluate the potential heterogeneity between studies. Sensitivity analysis was performed to evaluate the influence of single studies on the overall estimate. We also performed meta-regression analyses to investigate potential sources of heterogeneity.Results:Eleven studies that met all the inclusion criteria were included in the meta-analysis. A total of 951 malignant and 1866 benign breast masses were assessed. All breast masses were histologically confirmed using S-Detect. The pooled Sen was 0.82 (95% confidence interval(CI) = 0.74–0.88); the pooled Spe was 0.83 (95%CI = 0.78–0.88). The pooled LR + was 4.91 (95%CI = 3.75–6.41); the pooled negative LR − was 0.21 (95%CI = 0.15–0.31). The pooled DOR of S-Detect in the diagnosis of breast nodules was 23.12 (95% CI = 14.53–36.77). The area under the SROC curve was 0.90 (SE = 0.0166). No evidence of publication bias was found (t = 0.54, P = .61).Conclusions:Our meta-analysis indicates that S-Detect may have high diagnostic accuracy in distinguishing benign and malignant breast masses.

Qualitative Diagnosis of Solid Breast Mass by Blood Flow in Solid Breast Mass Based on Color Doppler Ultrasound

The incidence of breast cancer ranks first among female malignant tumor. With the increase of the sensitivity of color Doppler ultrasound blood flow, the blood flow distribution in and around the tumor can be clearly displayed, and the analysis of hemodynamic parameters is provided, which provides convenience for the study of tumor blood flow characteristics. Studies have shown that tumor cells can secrete a substance called angiogenesis factor, which makes the tumor site form a rich vascular network to promote tumor growth and metastasis. The tumor has many new blood vessels, abnormal structure, thin wall, lack of muscle layer, and is prone to form arteriovenous rash. These characteristics provide a pathological basis for color Doppler flow imaging (CDFI) for the diagnosis of breast cancer. This article discusses the role of two-dimensional sonographic features in the differential diagnosis of benign and malignant breast masses, CDFI was used to study the blood flow distribution and hemodynamic characteristics in benign and malignant breast masses; explore the value of blood flow characteristics and blood flow parameters in the differential diagnosis of breast masses. The experimental results show that the detection rate of blood flow signals and the classification of blood flow signals in the malignant group are higher than those in the benign group, mainly level II and III blood flow, and the irregular branched blood flow is more common, especially when the tumor appears penetrating blood flow supports the diagnosis of malignancy. PSV, RI and PI have a certain differential meaning in the diagnosis of benign and malignant breast masses. PSV, RI and PI of malignant masses are higher than benign masses. For tumors without obvious necrosis, the larger the tumor diameter, the richer the blood flow and the higher the blood flow grade is. The malignant tumors have more blood flow than the benign ones.

Software implementation for diagnostic decision-making based on multiparametric ultrasonography parameters of breast masses

Purpose. To build a system for making diagnostic decisions based on multiparametric ultrasound examination of the mammary gland.Material and Methods. A total of 277 women with various complaints of breast diseases were examined using a wide range of ultrasound technologies, including elastography and contrast enhancement. To verify the lesions, the patients underwent histological or cytological examination. The results of ultrasound examination, histological and cytological conclusions were entered into the database. The system was trained with 219 patient samples selected from the database. The patient’s samples were grouped according to the visual ultrasound characteristics. The data groups’ analysis allowed the compilation of a table with relative frequencies (probability) of symptoms for this diagnosis. Based on the convolution and the Bayesian method, the system for support of the medical decision by age, clinical picture, and ultrasound diagnostics results were built. Sensitivity and specificity were determined for software implementation in the initial database.Conclusion. The proposed decision support system allows us to determine the probability of malignancy and standardize decision-making in the differential diagnosis of breast masses.

Primary Leiomyosarcoma of the Breast Papilla: A Case Report

Background: Breast leiomyosarcoma is a rare subtype of breast sarcoma, constituting 5–10% of the cases. Less than one-third of reported cases are located in the nipple papillary region, making it an extraordinarily rare malignancy, responsible for less than 0.1% of all malignant breast tumors. As no radiological criteria allow definitive diagnosis of papillary leiomyosarcoma, histopathological and immunohistochemical examination of suspicious lesions is required. The prognosis is generally optimistic compared with those for other breast sarcomas.Case presentation: A 54-year-old previously healthy woman reported the appearance of a nodule in her right nipple in the preceding 9 months, associated with pruritus. Physical examination revealed that the lesion had a cystic consistency and measured approximately 3.0 cm. Imaging examinations showed no involvement of the adjacent breast parenchyma or axillary region and the lesion was classified as Breast Imaging-Reporting and Data System (BI-RADS) category IV. The lesion was excised, and the histopathological diagnosis was well-differentiated leiomyosarcoma of the mammary papilla, with immunohistochemical examination showing positivity for smooth-muscle tissue antigens. A staging CT examination was performed, showing no evidence of distant metastasis. After 2 years of follow-up, the patient shows no sign of tumor recurrence.Conclusion: Although rare, leiomyosarcoma must be included in differential diagnosis of breast masses, especially those involving the periareolar region. Due to its good prognosis, reporting on this type of tumor is important to guide therapeutic planning, and to identify and track possible complications of its underdiagnosis.

The value of S-Detect for the differential diagnosis of breast masses on ultrasound: a systematic review and pooled meta-analysis.

To evaluate the value of S-Detect (a computer aided diagnosis system using deep learning) in breast ultrasound (US) for discriminating benign and malignant breast masses. A literature search was performed and relevant studies using S-Detect for the differential diagnosis of breast masses were selected. The quality of included studies was assessed using a Quality Assessment of Diagnostic Accuracy Studies (QUADAS) questionnaire. Two review authors independently searched the articles and assessed the eligibility of the reports. A total of ten studies were included in the meta-analysis. The pooled estimates of sensitivity and specificity were 0.82 (95%CI: 0.77-0.87) and 0.86 (95%CI: 0.76-0.92), respectively. In addition, the diagnostic odds ratios, positive likelihood ratio and negative likelihood ratio were 28 (95%CI: 16- 49), 5.7 (95%CI: 3.4-9.5), and 0.21 (95%CI: 0.16-0.27), respectively. Area under the curve was 0.89 (95%CI: 0.86-0.92). No significant publication bias was observed. S-Detect exhibited a favourable diagnostic value in assisting physicians discriminating benign and malignant breast masses and it can be considered as a useful complement for conventional US.

Application of Point Shearwave Elastography to Breast Ultrasonography: Initial Experience Using "S-Shearwave" in Differential Diagnosis.

PurposeTo evaluate the optimal measurement location, cut-off value, and diagnostic performance of S-Shearwave in differential diagnosis of breast masses seen on ultrasonography (US).Materials and MethodsDuring the study period, 225 breast masses in 197 women were included. S-Shearwave measurements were made by applying a square region-of-interest automatically generated by the US machine. Shearwave elasticity was measured three times at four different locations of the mass, and the highest shearwave elasticity was used for calculating the optimal cut-off value. Diagnostic performance was evaluated by using the area under the receiving operator characteristic curve (AUC).ResultsOf the 225 breast masses, 156 (69.3%) were benign and 69 (30.7%) were malignant. Mean S-Shearwave values were significantly higher for malignant masses (108.0 ± 70.0 kPa vs. 43.4 ± 38.3 kPa; p < 0.001). No significant differences were seen among AUC values at different measurement locations. With a cut-off value of 41.9 kPa, S-Shearwave showed 85.7% sensitivity, 63.9% specificity, 70.7% accuracy, and positive and negative predictive values of 51.7% and 90.8%, respectively. The AUCs for US and S-Shearwave did not show significant differences (p = 0.179).ConclusionS-Shearwave shows comparable diagnostic performance to that of grayscale US that can be applied for differential diagnosis of breast masses seen on US.

Comparison of One- and Two-Region of Interest Strain Elastography Measurements in the Differential Diagnosis of Breast Masses.

To compare the diagnostic performance and interobserver variability of strain ratio obtained from one or two regions of interest (ROI) on breast elastography. From April to May 2016, 140 breast masses in 140 patients who underwent conventional ultrasonography (US) with strain elastography followed by US-guided biopsy were evaluated. Three experienced breast radiologists reviewed recorded US and elastography images, measured strain ratios, and categorized them according to the American College of Radiology breast imaging reporting and data system lexicon. Strain ratio was obtained using the 1-ROI method (one ROI drawn on the target mass), and the 2-ROI method (one ROI in the target mass and another in reference fat tissue). The diagnostic performance of the three radiologists among datasets and optimal cut-off values for strain ratios were evaluated. Interobserver variability of strain ratio for each ROI method was assessed using intraclass correlation coefficient values, Bland-Altman plots, and coefficients of variation. Compared to US alone, US combined with the strain ratio measured using either ROI method significantly improved specificity, positive predictive value, accuracy, and area under the receiver operating characteristic curve (AUC) (all p values < 0.05). Strain ratio obtained using the 1-ROI method showed higher interobserver agreement between the three radiologists without a significant difference in AUC for differentiating breast cancer when the optimal strain ratio cut-off value was used, compared with the 2-ROI method (AUC: 0.788 vs. 0.783, 0.693 vs. 0.715, and 0.691 vs. 0.686, respectively, all p values > 0.05). Strain ratios obtained using the 1-ROI method showed higher interobserver agreement without a significant difference in AUC, compared to those obtained using the 2-ROI method. Considering that the 1-ROI method can reduce performers' efforts, it could have an important role in improving the diagnostic performance of breast US by enabling consistent management of breast lesions.

Strain histograms used for differential diagnosis of breast masses according to hardness percentage.

To evaluate the diagnostic performance of percentage of hard component (PHC) versus strain ratio (SR) in focal breast lesion diagnosis.Ultrasonography and elastography images of 245 malignant and 255 benign breast lesions were obtained and analyzed according to the Breast Imaging-Reporting and Data System of the American College of Radiology. PHC and SR were measured for each lesion and receiver operating characteristic (ROC) curve analysis was performed to evaluate and compare the diagnostic performance of conventional ultrasound (CU) only, PHC with CU, and SR with CU.Mean PHC differed significantly between malignant (90.46 ± 13.29) and benign (62.03 ± 25.61) lesions. Mean SR differed significantly between malignant (4.61 ± 1.75) and benign (2.34 ± 1.80) lesions. ROC curve threshold values were 82.45 for PHC and 2.69 for SR. The area under the curve values for CU, SR with CU, and PHC with CU were 0.956, 0.960, and 0.956, respectively, with no significant differences among them (P < .05).PHC was comparable to SR for differentiating malignant from benign breast masses and may be an auxiliary tool for breast lesion stiffness evaluation. ROC data for CU, SR with CU, and PHC with CU were statistically similar.

Evaluation of the Usefulness of Differential Diagnosis of Breast Mass using Elasticity Score and Elasticity Ratio in Elastography

This study evaluated the usefulness of the elasticity score and elasticity ratio in the differential diagnosis of benign and malignant lesion in breast elastography. We performed a retrospective analysis based on the results of core needle biopsy histology. The Mann-Whitney U test was used to confirm the difference between the 5-degree elasticity score and the Fisher's Exact test. ROC curve analysis was used to determine the elasticity score and the best cut-off value of the elasticity ratio for the prediction of malignant lesions. There was a statistically significant difference (p= .000) between the homogeneity of the elasticity score and the difference of the elasticity ratio between the benign and malignant lesion groups. On the ROC curve analysis, the elasticity score and the elasticity ratio for predicting benign and malignant lesion were determined as AUC 0.806, 0.824, cut-off value 3, 4.4 (p= .001). Therefore, the elasticity score and elasticity ratio may be useful in the differential diagnosis of breast mass.

Application of S-Detect classification system in diagnosis of breast benign and malignant mass by ultrasound

Objective To investigate the value of S-Detect classification in differential diagnosis of breast mass. Methods The data of forty-seven patients with breast mass lesions (n=61) from our hospital during January to December in 2016 were retrospectively analyzed. Both the man-made BI-RADS classification (identified by three different specialist physicians with 2, 5 and 7 years of experience, respectively) and computer S-Detect classification were performed. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the man-made BI-RADS classification and S-Detect classification of the benign or malignant diagnosis of breast lumps were calculated. The ROC curve was further plotted, and the area under the curve (AUC) of each group was compared, respectively. Results Sixty-one breast mass lesions were confirmed 36 benign lesions and 25 malignant lesions by pathological biopsy. The sensitivity, specificity and accuracy of man-made BI-RADS classification were as follows: 2-year experience physicians 69.4%, 72.0% and 70.5%; 5-year experience physicians: 64.0%, 92.0% and 75.4%; 7-year experience physicians: 69.4%, 92.0% and 78.7%. The diagnostic sensitivity, specificity, and accuracy of S-Detect classification were 80.6%, 96.0% and 86.9%. The specificity, accuracy and positive predictive value of S-Detect classification were significantly higher than those of 2-year experience physicians by BI-RADS classification (P<0.05). The area under the ROC curve of each group was 0.729, 0.786 and 0.801 for 2, 5 and 7-year experience physicians, respectively, and 0.917 for S-Detect classification. Conclusions Compared with the man-made BI-RADS classification, S-Detect classification has advantages in diagnosis of the benign or malignant of breast mass and is helpful to improve the accuracy of diagnosis, especially for junior physicians. Key words: Ultrasonography, mammary; S-Detect classification; Breast diseases; Man-made BI-RADS classification

Differential diagnosis of breast masses in South Korean premenopausal women using diffuse optical spectroscopic imaging.

Young patients with dense breasts have a relatively low-positive biopsy rate for breast cancer (∼1 in 7). South Korean women have higher breast density than Westerners. We investigated the benefit of using a functional and metabolic imaging technique, diffuse optical spectroscopic imaging (DOSI), to help the standard of care imaging tools to distinguish benign from malignant lesions in premenopausal Korean women. DOSI uses near-infrared light to measure breast tissue composition by quantifying tissue concentrations of water (ctH2O), bulk lipid (ctLipid), deoxygenated (ctHHb), and oxygenated (ctHbO2) hemoglobin. DOSI spectral signatures specific to abnormal tissue and absent in healthy tissue were also used to form a malignancy index. This study included 19 premenopausal subjects (average age 41±9), corresponding to 11 benign and 10 malignant lesions. Elevated lesion to normal ratio of ctH2O, ctHHb, ctHbO2, total hemoglobin (THb=ctHHb+ctHbO2), and tissue optical index (ctHHb×ctH2O/ctLipid) were observed in the malignant lesions compared to the benign lesions (p<0.02). THb and malignancy index were the two best single predictors of malignancy, with >90% sensitivity and specificity. Malignant lesions showed significantly higher metabolism and perfusion than benign lesions. DOSI spectral features showed high discriminatory power for distinguishing malignant and benign lesions in dense breasts of the Korean population.

Semi-Quantitative Strain Ratio in the Differential Diagnosis of Breast Masses: Measurements Using One Region-of-Interest

The purpose of this study was to evaluate the diagnostic performances of semi-quantitative strain ratio measured by using one region-of-interest (ROI) on breast US elastography images. Two hundred one breast masses of 165 women (mean age: 47.2 y) were included. Ultrasonography (US) and elastography images of the masses were obtained and prospectively analyzed according to elasticity pattern, strain ratio, and final Breast Imaging-Reporting and Data System (BI-RADS) assessments. Of the 201 breast masses, 127 (63.2%) were benign and 74 (36.8%) were malignant. Elastography pattern and strain ratio (cut-off of 1.44) had significantly higher specificity than gray-scale US, 39.4% and 61.4% versus 29.1%, respectively (all p < 0.05). Area under the receiver operating characteristics curve (Az) was highest for gray-scale US (0.646), without statistical significances, than for elastography pattern (0.596, p = 0.159) or strain ratio (0.625, p = 0.610). Semi-quantitative strain ratio measured from one ROI has comparable diagnostic performances to gray-scale US, which may contribute to more accurate differential diagnosis of breast masses seen on US.

Pre-B acute lymphoblastic leukemia masquerading as breast carcinoma: A rare case report

Leukemic involvement of the breast is very rare and more commonly seen in acute myeloid leukemia. Involvement of the breast in acute lymphoblastic leukemia (ALL) at diagnosis is very rarely reported and is often confused with primary breast tumors. We present a case of young female presenting with breast mass and axillary lymphadenopathy, thus masquerading as breast carcinoma. Breast biopsy and bone marrow examination revealed leukemic infiltration of pre-B cell ALL. Cerebrospinal fluid showed involvement with leukemic cells. The patient was treated with MCP-841 protocol and therapeutic cranial irradiation, followed by maintenance oral chemotherapy leading to complete resolution of breast mass. Thus, ALL should be considered in the list of differential diagnosis of breast masses, especially in young females.

Myofibroblastoma of the Breast

This study aimed presenting a case of a 64-year-old woman with a rare diagnosis of myofibroblastoma (MFB). MFB is one of the rare, benign, spindle-like stromal tumors arising from the connective tissue of the breast. MFBs are often confused with fibroadenomas and hamartomas because of their benign characteristic appearance on breast imaging and are diagnosed after excisional biopsies. Their differential diagnosis with malignant neoplasia of the breast is important because of their wide morphological spectrum. Our case also demonstrated a breast mass with benign imaging characteristics and a needle core biopsy revealing a benign, spindle-like stromal tumor. The pathological examination performed after the excision of the lump demonstrated a collagenous-/fibrous-type MFB. This case report emphasizes the rare but important place of MFB variants of the breast in the differential diagnosis of breast mass.

Single bolus split dynamic MRI: Is the combination of high spatial and dual-echo high temporal resolution interleaved sequences useful in the differential diagnosis of breast masses?

To test the split dynamic magnetic resonance imaging (MRI) technique in the assessment of breast masses in which high spatial resolution and dual-echo high temporal resolution data are acquired during a single bolus injection. Forty-four women with breast masses were examined using split dynamic MRI. Quantitative analysis was performed with pharmacokinetic modeling on T1 -weighted images and estimation of maximum peak change in R2 * images (R2 *-peakenh ). High spatial resolution data were interpreted by two radiologists using the Breast Imaging Reporting and Data System (BI-RADS). Mann-Whitney tests were used to determine the parameters ability for establishing or excluding malignancy. For both readers, diagnostic accuracy, with and without information from the quantitative analysis, was determined using receiver operating characteristic (ROC) analysis, and evaluated using pairwise comparison of the areas under the ROC curve (Az ) and McNemar tests. Significant parameters for establishing or excluding malignancy were R2 *-peakenh (P < 0.001), plasma volume (P = 0.006), and time-to-peak enhancement (P = 0.003) showing an Az of 0.928 combined. For one out of the two readers, diagnostic accuracy was significantly improved when adding quantitative kinetic analysis to the BI-RADS score (P = 0.017). High temporal resolution T1 -weighted and R2 * dynamic information combined with BI-RADS interpretations improved the diagnostic performance in differentiating malignant from benign breast masses compared to BI-RADS interpretations alone.