Breast Masses Research Articles

Primary breast angiosarcoma: A case report.

Primary breast angiosarcoma is a rare tumor, accounting for only 0.05% of all malignant breast tumors. The primary breast angiosarcoma typically presents with nonspecific clinical manifestations, which can easily lead to misdiagnosis. Potential factors contributing to misdiagnosis include skin changes that may be erroneously attributed to breast trauma-induced bruising and breast swelling that may be mistaken for inflammatory diseases or other benign tumors. A 19-year-old female was admitted to the hospital due to repeated lump formation in the left breast for 9 months after left breast trauma. The diagnosis of primary breast angiosarcoma was confirmed on hematoma biopsy. Due to the patient's condition, no special treatment was given postoperatively. After then, there was a recurrence in the chest wall, and the patient received 2 cycles of chemotherapy, resulting in a reduction in the size and lightening of the recurrent chest wall mass. When chemotherapy intolerance happened, the patient chose to discontinue treatment. After an 18-month follow-up, the recurrent chest wall mass increased and the patient died from bleeding. Primary breast angiosarcoma has a low incidence but high malignancy, with a high recurrence and metastasis rate, leading to a poor prognosis. The adjuvant chemotherapy, radiotherapy, targeted therapy, and other treatments should be considered to reduce the local recurrence rate and prolong patient survival.

Comparison of Full-Field Digital Mammography with Synthesized Mammography from Tomosynthesis in a Diagnostic population: Prospective Study

Abstract Background Synthesized mammography (SM) refers to two-dimensional (2D) images derived from the digital breast tomosynthesis (DBT) data. It can reduce the radiation dose and scan duration when compared with conventional full-field digital mammography (FFDM) plus tomosynthesis. Purpose To compare the diagnostic performance of 2D FFDM with synthetic mammograms obtained from DBT in a diagnostic population. Materials and Methods A total of 1,468 mammograms with both FFDM and SM + DBT images were obtained and analyzed over 2 years, after obtaining approval from the institute ethics committee. The images were reported and compared as per the 2013 American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon in terms of breast density, morphological features of mass, calcifications, and presence of asymmetry or architectural distortion followed by the BI-RADS category. The agreement between the two modalities was studied using the Kappa value, and the radiation exposure dose was recorded in both groups. Results FFDM and SM + DBT showed strong agreement for breast density, mass characteristics, and detection of calcifications (kappa > 0.8). Downstaging of breast density and mass density were seen by SM + DBT without any statistically significant difference. The nipple–areola complex visualization was poor in SM (50.34 vs. 76.29% in FFDM), and there were SM-specific artifacts mainly related to the reconstruction algorithm. The radiation dose was higher with SM. Conclusion FFDM has comparable performance to SM + DBT in diagnostic setup. The latter may be particularly helpful in patients with dense breasts.

Hongjin Xiaojie Capsule, a Chinese patent medicine, for treating moderate to severe cyclical breast pain: A single-blind randomized controlled trial

BackgroundModerate to severe breast pain has major effects on the quality of life for patients. Patent Chinese medicines are widely used in the treatment of breast pain due to their stable dosage form and good efficacy. ObjectiveTo evaluate the beneficial effects and safety of Hongjin Xiaojie Capsule (HJXJC), a Chinese patent medicine, for the treatment of cyclical breast pain. Design, setting, participants and interventionThis is a multicenter, single-blind randomized controlled trial conducted in 3 medical centers in China from 2019 to 2021. Patients with moderate to severe cyclic breast pain were randomly divided into the intervention group (who took HJXJC, four capsules per dose, three times a day for 12 weeks) and the control group (waiting for the treatment) in a 1:1 ratio. Main outcome measuresThe primary outcome was pain duration, and the patients recorded measurements at baseline and at the end of weeks 4, 8, 12 and 16 on a patient log card. ResultsThe full analysis set (FAS) population included 298 participants (intervention group, n = 150; control group, n = 148), while the per-protocol analysis set (PPS) included 274 participants. After 12 weeks, the duration of breast pain was significantly shorter in the intervention group (FAS: mean difference, –6.69; 95% CI, –7.58 to –5.80; P < 0.01, vs control. PPS: mean difference, –7.09; 95% CI, –8.01 to –6.16; P < 0.01, vs control). The Short-form McGill Pain Questionnaire (SF-MPQ) scores were significantly lower in the intervention group (FAS: mean difference, –12.55; 95% CI, –13.90 to –11.21; P < 0.01, vs control. PPS: mean difference, –13.07; 95% CI, –14.48 to –11.66; P < 0.01, vs control). The above indicators continued to be significantly different through week 16. Moreover, in the intervention group, breast lumps shrank after 12 weeks and the size of breast lumps was statistically smaller than that in the control group (P < 0.05), whereas the sizes of breast nodules and uterine fibroid showed no statistically significant difference compared with the control group (P > 0.05). At weeks 8 and 12, the dysmenorrhea scores in the intervention group were lower than those in the control group (P < 0.05). No obvious adverse reactions were observed in any group. ConclusionHJXJC can significantly shorten the duration of breast pain, reduce breast pain, reduce the size of breast lumps, and relieve dysmenorrhea. However, it has no significant effect on the size of breast nodules or uterine fibroid. Trial registrationThis trial has been registered at the ISRCTN Registry. Number: ISRCTN44184398. Please cite this article asZhang Q, Fan YY, Wu XQ, Huo YD, Wang CH, Liang SB, Wang T, Zhong R, Wang X, Lai BY, Pei XH, Liu JP. Hongjin Xiaojie Capsule, a Chinese patent medicine, for treating moderate to severe cyclical breast pain: A single-blind randomized controlled trial. J Integr Med. 2024; 22(5): 552–560.

The Pathological Pattern of Breast Cancer in the Najran Region of Saudi Arabia: A Retrospective Study.

Background Breast cancer (BC) is the most widespread cancer on a global scale, and its prevalence is likewise significant in the Kingdom of Saudi Arabia. Nevertheless, the data accessible regarding the epidemiology and histopathological characteristics of BC in clinical practice is restricted and primarily confined to research endeavors. Aim This study aims to investigate the histopathological profile of women diagnosed with BC seeking treatment at King Khalid Hospital in the Najran region of the Kingdom of Saudi Arabia. Methods In this retrospective study, BC biopsies performed on Saudi patients at King Khalid Hospital between January 2018 and December 2022 were examined. All records of breast biopsies from this timeframe were extracted from the hospital's histopathology laboratory computer database after written permission from the head of the laboratory department. For all neoplastic lesions, the World Health Organization's 2012 categorization of breast tumors was applied. Results A total of 61 women with BC were included. Women's age ranged from 30 to 89 years, with a mean age of 49.6 ± 12.3 years. The most reported BC was invasive ductal carcinoma (IDC; 70.5%). Other types reported included invasive papillary carcinoma (8.2%), ductal carcinoma in situ (4.9%), and invasive lobular carcinoma (3.3%). A total of 14 (23%) of the study women had multifocal cancer. Ki-67 was high in 19 cases (31.1%); six (9.8%) had BRCA1 mutations, and six (9.8%) had BRCA2 mutations. Conclusion The current study revealed that BC was frequent among young females, mainly IDC, which was reported on both sides at different sizes and grades. Breast lump was the most commonly presented symptom and had a high representation in women with hormonal receptors, mainly estrogen receptors, but positive genetic testing was infrequent.

ESR Essentials: diagnostic work-up in patients with symptomatic breast disease-practice recommendations by the European Society of Breast Imaging.

Breast complaints are frequent reasons for consultations in primary care or breast clinics. Breast pain, breast lumps, and nipple discharge are the most common complaints. Less common symptoms such as skin changes and axillary abnormalities also require specific diagnostic approaches. Imaging the symptomatic breast should be performed by appropriately trained breast radiologists following the best practice guidelines and quality standards. Full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), and breast ultrasound (US) are the main modalities used in this primary setting. The choice depends on the patient's age and symptoms. Women younger than 30-years-old are first imaged byUS, whereas women over 40-years-old usually require both FFDM or DBT and US. For women between 30-years-old and 40-years-old, the US is the modality of choice, whereas FFDM or DBT might also be performed if needed. Pregnant or lactating women with palpable lesions or nipple discharge are imaged with US as the first method; FFDM or DBT can also be performed depending on the degree of suspicion as the dose to the fetus is minimal, and shielding may even further reduce the dose. More advanced techniques such as breast magnetic resonance imaging or contrast-enhanced mammography are not indicated in this first diagnostic setting and are reserved for cases of established malignancy (local staging) or rare cases of equivocal findings not otherwise resolved or inflammatory breast cancer. Last, but not least, male breast symptoms should also be addressed with US and/or FFDM. CLINICAL RELEVANCE STATEMENT: It is equally important to correctly diagnose an underlying malignancy and to avoid false positives that would lead to unnecessary biopsies, increased costs, and anxiety for the patient. Proper use of imaging modalities ensures optimal diagnostic approach and minimizes false negatives. KEY POINTS: Ultrasound, full-field digital mammography, or digital breast tomosynthesis are the main imaging modalities in the diagnostic setting, while MRI or contrast-enhanced mammography should be reserved to selected cases. Initial imaging modality includes ultrasound combined with mammography or digital breast tomosynthesis depending on women's age and the presence (or not) of inconclusive findings. A negative imaging evaluation should not deter biopsy when a highly suspicious finding is found on physical examination.

Malignant Phyllodes Tumour with Heterologous Osteosarcomatous differentiation and Osteoclast-like giant cells: Case Report of an uncommon neoplasm

Background: Phyllodes tumour (PT), an uncommon fibroepithelial neoplasm accounts for less than 1% of all primary tumours of the breast. MPT with osseous differentiation often gets misdiagnosed on imaging as benign giant calcifications resulting in treatment delay. We describe a rare case of MPT with heterologous osteosarcomatous differentiation and osteoclast-like giant cells and review the literature to discuss clinical-radiological findings, differential diagnosis and treatment options. Case Presentation: A 34-year-old female presented with a right breast lump. Mammography showed a high-density irregular mass with amorphous dense calcification, suggesting neoplastic aetiology. Preoperative core needle biopsy raised the possibility of a phyllodes tumour versus giant cell tumour. Wide local excision was performed to confirm the diagnosis which revealed the presence of a biphasic tumour with osteoid-like matrix and numerous osteoclastic giant cells. Immunohistochemistry was used to rule out metaplastic carcinoma or carcinosarcoma. The stromal cells were negative for panCK and P63 and positive for vimentin, CD10 and BCL-2. The osseous component was positive for Osteonectin and SATB2. Thus, a final diagnosis of malignant phyllodes tumour with heterologous osteosarcomatous differentiation and osteoclast-like giant cells was made. Conclusion: MPT with osteosarcomatous differentiation is a rare and challenging entity associated with a poor clinical outcome. Accurate diagnosis requires a multidisciplinary approach involving breast surgeons, pathologists and radiologists with careful histopathological examination. Wide local excision with close surveillance is crucial for timely detection of tumour recurrence and metastasis.

RARE PRESENTATION: SYNCHRONOUS PRIMARY BREAST AND THYROID CANCER IN AN ELDERLY MALE

Synchronous primary breast and thyroid carcinomas are exceptionally rare, especially in males. This case report presents the first documented instance of synchronous primary breast and thyroid carcinoma in an 89-year-old male. The patient had a right breast mass, cervical lymph nodes and a heterogeneously enhancing lesion in right lobe of thyroid. The histopathological examination confirmed infiltrating ductal carcinoma and metastasis of papillary carcinoma thyroid in cervical lymph node. While hormonal imbalances and genetic mutations have been implicated in synchronous breast and thyroid carcinomas in females, this case underscores the complexity of cancer development and the need for additional research into the factors influencing these rare synchronous malignancies in males.

Clinical effectiveness of transaxillary single-port endoscopic surgery in the treatment of breast benign tumor.

Benign breast lumps affect 10% of women in their lifetimes. Endoscopic surgery could be an alternative surgical technique for benign breast tumors because it is performed through small wounds hidden in inconspicuous areas. The aim of this study was to explore the safety and esthetic effects of endoscopic surgery in the treatment of benign breast disease. This retrospective cohort study analyzed 363 patients with benign breast tumors from August 2021 to December 2023 in the Sixth Affiliated Hospital of Sun Yat-Sen University, of whom 118 underwent transaxillary single-port endoscopic surgery and 245 underwent traditional open surgery. Clinicopathologic characteristics, surgery type, hospital stay, and complications were analyzed to assess the effectiveness of the procedure for benign breast tumors. Breast tumor resection was successfully performed in 363 patients by endoscopic surgery or traditional open surgery. Endoscopic procedures demonstrated longer durations of surgery (98.54±35.17min vs. 70.28±26.06min, p<0.01) and postoperative drainage (64.30±34.92mL vs.18.49±19.86mL, p<0.01), but there was less blood loss. The nipple-areolar complex of the patients who underwent endoscopic resection was significantly more sensitive than the traditional open surgery group. Patients in the endoscopic group reported higher satisfaction with surgical outcome (13.10±1.97 vs. 12.63±1.90, p<0.01). And there was a significant difference in the wound scar and cosmetic outcome total score between the two groups. Transaxillary single-port endoscopic surgery is effective and safe and improves postoperative nipple-areolar sensation and cosmetic outcome, as compared to the conventional technique.

Diagnostic dilemma: axillary cysticercosis masquerading as breast mass

Cysticercosis, caused by the tapeworm Taenia solium, is a significant public health concern, particularly prevalent in developing nations. We present a case of isolated cysticercosis in the axillary region, mimicking a breast mass, in a 47-year-old woman who presented with a gradually enlarging mass in her right axilla and was initially diagnosed with fibroadenoma. However, further investigations revealed cysticercosis in the larvae, including ultrasonography and fine-needle aspiration cytology (FNAC). The patient underwent surgical excision of the cysts following a two-week course of albendazole therapy. Histopathological examination confirmed cysticercosis with a foreign body giant cell reaction. Cysticercosis typically involves muscular and subcutaneous tissues, posing diagnostic challenges due to its resemblance to other conditions. Ultrasonography, FNAC, and MRI play crucial roles in accurate diagnosis. Treatment involves a combination of surgical removal and antiparasitic medications such as albendazole. This case highlights the importance of considering cysticercosis in differential diagnosis, especially in endemic regions, and underscores the effectiveness of a comprehensive treatment approach integrating medical therapy and surgical intervention. Effective management ensures the eradication of parasitic infection and the alleviation of associated symptoms, exemplifying patient-cantered care for optimal outcomes. Increased awareness, preventive measures, and early diagnosis are essential for mitigating the burden of cysticercosis, particularly in regions with poor sanitation and high prevalence rates.

A deep learning-based method for the detection and segmentation of breast masses in ultrasound images

Objective. Automated detection and segmentation of breast masses in ultrasound images are critical for breast cancer diagnosis, but remain challenging due to limited image quality and complex breast tissues. This study aims to develop a deep learning-based method that enables accurate breast mass detection and segmentation in ultrasound images. Approach. A novel convolutional neural network-based framework that combines the You Only Look Once (YOLO) v5 network and the Global-Local (GOLO) strategy was developed. First, YOLOv5 was applied to locate the mass regions of interest (ROIs). Second, a Global Local-Connected Multi-Scale Selection (GOLO-CMSS) network was developed to segment the masses. The GOLO-CMSS operated on both the entire images globally and mass ROIs locally, and then integrated the two branches for a final segmentation output. Particularly, in global branch, CMSS applied Multi-Scale Selection (MSS) modules to automatically adjust the receptive fields, and Multi-Input (MLI) modules to enable fusion of shallow and deep features at different resolutions. The USTC dataset containing 28 477 breast ultrasound images was collected for training and test. The proposed method was also tested on three public datasets, UDIAT, BUSI and TUH. The segmentation performance of GOLO-CMSS was compared with other networks and three experienced radiologists. Main results. YOLOv5 outperformed other detection models with average precisions of 99.41%, 95.15%, 93.69% and 96.42% on the USTC, UDIAT, BUSI and TUH datasets, respectively. The proposed GOLO-CMSS showed superior segmentation performance over other state-of-the-art networks, with Dice similarity coefficients (DSCs) of 93.19%, 88.56%, 87.58% and 90.37% on the USTC, UDIAT, BUSI and TUH datasets, respectively. The mean DSC between GOLO-CMSS and each radiologist was significantly better than that between radiologists (p < 0.001). Significance. Our proposed method can accurately detect and segment breast masses with a decent performance comparable to radiologists, highlighting its great potential for clinical implementation in breast ultrasound examination.

Incidental detection of pancreatic cancer by F-18-fluorodeoxyglucose positron emission tomography/computed tomography in a patient with hereditary breast and ovarian cancer syndrome

Patients with hereditary breast and ovarian cancer syndrome (HBOC) are associated with an increased risk of developing pancreatic cancer (PC) than the general population. There is no consensus about the clinical value of F-18-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) in patients with HBOC. We report a patient with HBOC in whom PC was detected incidentally by PET/CT. A 48-year-old woman complaining of a right breast mass sought evaluation at our hospital. Her older brother died of PC at 49 years of age. Histologic analysis of the breast mass revealed breast cancer (BC). FDG-PET/CT showed unanticipated FDG accumulation in the pancreas. Magnetic resonance cholangiopancreatography (MRCP) revealed a mass in the pancreas approximately 25mm in size. Endoscopic ultrasound guided-fine needle aspiration biopsy (EUS-FNA) demonstrated PC. Genetic testing showed a BRCA2 pathologic variant [NM_000059.4(BRCA2): c.9076C > T (p.Gln3026Ter)]. She was referred to a university hospital and underwent surgery after neoadjuvant chemotherapy for PC. It is difficult to detect operable PC in most patients. The diagnostic utility of PET/CT for PC in high-risk patients, such as those with HBOC, is undetermined. Our case has demonstrated the clinical value of PET/CT in detecting incidental PC in HBOC patients.

Hormone receptor expression in low-grade adenosquamous carcinoma of the breast progressing to high-grade metaplastic carcinoma: A case report.

Breast low-grade adenosquamous carcinoma is an uncommon cancer that has been neglected in genetic and pathophysiological research. Consequently, medical practitioners face challenges in the effective diagnosis and treatment of this condition. We present the case of a 57-year-old Asian female patient who presented with bilateral breast masses on physical examination. Ultrasound and an MRI revealed a highly suspicious malignant mass in her right breast that was completely removed surgically. After pathological analysis, the diagnosis was low-grade adenosquamous carcinoma with local high-grade transformation, and some of the tumor components were estrogen receptor positive. The patient underwent appropriate postoperative chemotherapy and achieved a favorable outcome. During the follow-up period after surgical resection, the patient did not experience any local recurrence or distant metastasis. Owing to the rare combination of estrogen receptor positivity and high-grade progression, this patient also required adjuvant chemotherapy. This enhances the essential foundation for diagnosing and treating this rare disease, and facilitates the implementation of treatment plans.

Improving Lesion Location Reproducibility in Handheld Breast Ultrasound.

Interoperator variability in the reproducibility of breast lesions found by handheld ultrasound (HHUS) can significantly interfere with clinical care. This study analyzed the features associated with breast mass position differences during HHUS. The ability of operators to reproduce the position of small masses and the time required to generate annotations with and without a computer-assisted scanning device (DEVICE) were also evaluated. This prospective study included 28 patients with 34 benign or probably benign small breast masses. Two operators generated manual and automated position annotations for each mass. The probe and body positions were systematically varied during scanning with the DEVICE, and the features describing mass movement were used in three logistic regression models trained to discriminate small from large breast mass displacements (cutoff: 10 mm). All models successfully discriminated small from large breast mass displacements (areas under the curve: 0.78 to 0.82). The interoperator localization precision was 6.6 ± 2.8 mm with DEVICE guidance and 19.9 ± 16.1 mm with manual annotations. Computer-assisted scanning reduced the time to annotate and reidentify a mass by 33 and 46 s on average, respectively. The results demonstrated that breast mass location reproducibility and exam efficiency improved by controlling operator actionable features with computer-assisted HHUS.

Male breast cancer: Case report and review of literature

Introduction: Male breast cancer (MBC) is an uncommon disease that makes up less than 1% of all breast cancer diagnoses worldwide. While breast carcinomas have some similarities in both sexes, there are significant differences. Case Report: We present a case of breast cancer in a 57-year-old man who had a left breast mass of 3.5 cm classified as breast imaging reporting and data system (BIRADS 4) by the American College of Radiology (ACR). The presence of invasive breast carcinoma of grade II Scarff–Bloom–Richardson (SBR) with a negative molecular phenotype B HER2 was confirmed by a tru-cut biopsy. The axillary cytopuncture did not show any abnormalities. The patient was later treated for a left mastectomy with homolateral axillary dissection. Conclusion: Male breast cancer represents a therapeutic dilemma. A multidisciplinary approach is mandatory.

Improvement of Breast Cancer Detection Using Dual-Layer Spectral CT.

This study aimed to investigate the diagnostic performance of breast mass detection on monoenergetic image data at 40 keV (MonoE40) and on iodine maps (IM) compared with conventional image data (CI). In this prospective single-center case-control study, 50 breast cancer patients were examined using contrast-enhanced dual-layer spectral CT. For qualitative and quantitative comparison of MonoE40 and IM with CI image data, four blinded, independent readers assessed 300 randomized single slices (two slices for each imaging type per case) with or without cancerous lesions for the presence of a breast mass. Detection sensitivity and specificity were calculated and readers rated their subjective diagnostic certainty. For statistical analysis of sensitivity and specificity, a paired t-test and ANOVA were used (significance level p = 0.05). A total of 50 female patients (median age 51 years, range 28-83 years) participated. IM had the highest overall scores in sensitivity and specificity for breast cancer detection, with 0.97 ± 0.06 and 0.95 ± 0.07, respectively, compared with 0.90 ± 0.04 and 0.92 ± 0.06 in CI. MonoE40 yielded a sensitivity of 0.96 ± 0.02 and specificity of 0.94 ± 0.08. All differences in sensitivity and specificity between MonoE or IM and CI were statistically significant (p < 0.001). The superiority of IM sensitivity and specificity was most pronounced in patients with dense breasts. Spectral CT improved the detection of breast cancer with higher sensitivity and specificity compared to conventional image data in our study.

Assessing the Accuracy of Ultrasonography and Biopsy Necessity in the Management of Breast Lumps in Women Less than 40 Years

Abstract Background: Following recommended guidelines, palpable breast lumps in young women should be subjected to clinical–radiologic evaluation and tissue diagnosis where necessary. However, in our local practice, most benign breast lumps are also subjected to excision biopsy. Ultrasonography is the modality of choice in the evaluation of palpable breast lumps in young women. Aim: This study aims to determine the accuracy of ultrasonography and the necessity of tissue biopsy in the management of palpable breast lumps in women less than 40 years of age and to determine lesions that can safely be managed conservatively based on histological diagnosis. Materials and Methods: This was a prospective cross-sectional study of 87 adult females who had breast US and biopsy for palpable breast lumps in a tertiary healthcare center over a period of 10 months (July 2020–May 2021). Results: The age range of the women was 18–39 years (mean 27.9 ± 7.09 years). Benign lesions were noted in 86.2% of patients. No malignancy was detected in women &lt; 25 years. Ultrasonography had sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100%, 93.4%, 70.6%, 100%, and 94.3%, respectively, in differentiating benign from malignant breast lumps following tissue diagnosis. Conclusion: Ultrasonography and tissue biopsy are vital in the evaluation of breast lumps in women less than 40 years of age. Most (86.2%) of the lumps were benign, and no malignancy was detected in women &lt; 25 years. The high accuracy of ultrasonography in distinguishing benign from malignant lesions suggests the need for conservative management of benign lumps in young women.

Utilization of Texture Analysis in Differentiating Benign and Malignant Breast Masses: Comparison of Grayscale Ultrasound, Shear Wave Elastography, and Radiomic Features.

This study aims to determine which qualitative and quantitative US features are independently associated with malignancy, including those derived from grayscale imaging morphology, shear wave elastography (SWE), and texture analysis. This single-center retrospective study was approved by the institutional research ethics board. Consecutive breast US studies performed between January and December 2020 were included. Images were acquired using a Canon Aplio i800 US unit (Canon Medical Systems, Inc., CA) and i18LX5 wideband linear matrix transducer. Grayscale US features, SWE mean, and median elasticity were obtained. Single representative grayscale images were analyzed using dedicated software (LIFEx, version 6.30). First-order and gray-level co-occurrence matrix second-order texture features were extracted. Multivariate logistic regression was performed to assess for predictors of malignancy (STATA v16.1). One hundred forty-seven cases with complete SWE data were selected for analysis (mean age 54.3, range 21-92). The following variables were found to be independently associated with malignancy: age (P <.001), family history (P = .013), irregular mass shape (P = .024), and stiffness on SWE (mean SWE ≥40 kPa; P <.001). Remaining variables (including texture features) were not found to be independently associated with malignancy (P >.05). US texture analysis features were not associated with malignancy independent of other qualitative and quantitative US characteristics currently utilized in clinical practice. This suggests texture analysis may not be warranted when differentiating benign and malignant breast masses on US. In contrast, irregular mass shape on grayscale imaging and increased stiffness on SWE were found to be independent predictors of malignancy.

Role of contrast-enhanced mammogram as an adjunct to tomosynthesis in evaluation of circumscribed breast lesions.

We evaluated the role of contrast-enhanced mammogram (CEM) in the characterization of circumscribed lesions detected in digital breast tomosynthesis (DBT) and correlated with histopathology. A retrospective study was done on 205 circumscribed breast masses detected with DBT and for whom CEM was done before core biopsy/excision biopsy. Morphology of lesion enhancement was noted at a 2-min CEM image and depending on the enhancement pattern, they were classified as benign, malignant, and indeterminate. Indeterminate lesions were further characterized by contrast kinetics at 8 min and divided into benign and malignant lesions. The results were correlated with histopathology reports. Among the 205 lesions, 158 were benign and 47 were malignant by histopathology. All 47 malignant cases were diagnosed as malignant (sensitivity-100%) and 150 out of 158 benign lesions were diagnosed as benign by CEM (specificity-95%). Eight benign lesions were reported as malignant (false positive) by CEM. Positive predictive value was 85.4% (47/55); negative predictive value (NPV) was 100% (150/150); accuracy was 96% (197/205). The high sensitivity of CEM in our study suggests that CEM helps in the early diagnosis of benign-looking circumscribed breast malignancies. The high NPV of CEM helps to avoid unnecessary biopsies and interventions in benign lesions. This study describes the contrast enhancement pattern of benign and malignant circumscribed breast lesions and thereby helps in the diagnosis of malignancy at an early stage. CEM is a promising adjunct tool since it offers functional imaging as a supplement to anatomical imaging by DBT.

Bilateral Male Breast Cancer : A Report Case

Breast cancer occurs in men, and its rate of incidence has increased recently. The main particularity of men's breast cancer is that its prognosis is usually worse than that of women, because it is diagnosed late and hence at advanced stage. Bilateral involvement has been reported only in rare cases. We report a case of a bilateral breast cancer, in a 47 year old patient , with no family history of breast cancer , who presented with a bilateral breast mass. Histopathological biopsy showed a bilateral invasive carcinoma, Luminal B, HER 2 negative . The extension PET scan showed no distant metastases. Bilateral mastectomy and bilateral sentinel lymph node were performed. The final histopathological exam confirmed the previous biopsy diagnostic, the tumors were mutually classified T2N0M0 of the TNM breast cancer classification. The surgical treatment was followed by tamoxifen hormonotherapy and an oncological semestriel follow-up. No recurrences or relapses were reported. The aim of our current work is to draw attention to this pathology in men, in order to contribute to its early diagnosis and therefore to improve its prognosis.

A rare case of lung adenocarcinoma with metastases to the breasts bilaterally

We present a case of a 65-year-old female with a history of stage IV adenocarcinoma of the lung that metastasized to the bilateral breasts. The breasts are a rare metastatic site for lung adenocarcinoma, with metastases to the breasts bilaterally being further unique. Our patient was diagnosed with stage IV adenocarcinoma of the lung with EGFR exon 20 insertion with metastases to the bone and skin four years prior to presentation, and she underwent a left lower lobotomy and multiple failed therapies. Biopsy of her breast masses revealed TTF (lung marker) positive GATA binding protein 3, GCDFP15, and mammaglobin (breast markers) negative metastatic moderately differentiated adenocarcinoma. Next-generation sequencing studies revealed exon 20 mutation, for which there are few effective targeted therapies. She was considered for therapy with amivantamab but ultimately never received therapy due to multiple hospitalizations, and passed away due to septic shock, likely from empyema versus ESBL E. coli urinary tract infection.