Evaluation of Precancerous Breast Lesion Upgrade Rate

Background: Breast imaging guided core-needle biopsy enable the assessment of suspected precancerous lesions. In some precancerous lesion there is a risk of upgrading to cancer after surgical removal. This study was conducted to determine the upgrading rate of CNB-diagnosed precancerous breast lesions. Methods: A retrospective study was conducted to examine the data of patients who had undergone core needle biopsy from April 2016 to March 2019 at the Radiology Department of the Breast Clinic of Motamed Cancer Institute and whose pathological reports were indicative of a precancerous lesion such as atypical ductal hyperplasia, sclerosing adenosis, flat epithelial atypia or papillary lesion and had undergone surgery for this lesion. The upgrading rate and its related factors such as the size of the lesion, patient’s age, family history of breast cancer and method of core-needle biopsy were analyzed in SPSS software. Results: A total of 241 patients were recruited with a pathological report of pre-cancerous predisposing lesions. The mean age of the patients was 42.14 years and the highest upgrading rates in the analysis were observed for papillary lesion (19.3%) and atypical ductal hyperplasia, (21.4%), while the upgrading rates were (1.2% ) for sclerosing adenosis and (0%) for flat epithelial atypia. Data analysis showed that the lesions’ upgrading rate correlated with the lesion’s size (P=0.005).Conclusion: The findings of this study showed that size of the lesions increase the risk of upgrading to cancer, which is much higher in papillary lesion and atypical ductal hyperplasia compared to sclerosing adenosis and flat epithelial atypia. It seems that surgical excision of the entire lesion in patients with larger mass size may decrease the upgrading rate of cancer. Conducting specific studies on each distinct lesion can help yield more conclusive results.

Complex fibroadenoma with focal ossification- an enigmatic finding in a less common tumor

Breast lumps have diverse causes including benign as well as malignant lesions. Fibroadenoma (FA) is a common cause of breast lump. Complex fibroadenomas, a particular subtype, pose diagnostic dilemmas due to confusing the radiological findings and hold higher incidence of transformation to malignancy. A 49 year old female presented with a painless lump in right breast for 2 years which appeared calcified on radiology. Excision biopsy was performed which grossly revealed an encapsulated grey-white firm to hard with cystic areas. Microscopically the sections showed a well encapsulated fibroepithelial tumor showing areas of sclerosing adenosis, hyalinization, cysts lined by cuboidal cells with eosinophilic secretions, areas of calcification and ossification. No evidence of lobular hyperplasia or in-situ carcinoma was seen. Patient was advised follow up. This case represents the unusual occurrence of complex fibroadenoma in a middle-aged female showing with ossification.

DIGITAL BREAST TOMOSYNTHESIS AND FULL-FIELD DIGITAL MAMMOGRAPHY IN BREAST CANCER DETECTION ASSOCIATED WITH FOUR ASYMMETRY TYPES

The aim: Comparing sensitivity and specificity of digital breast tomosynthesis and full-field digital mammography in breast cancer detection associated with four different types of asymmetries according to BI-RADS Atlas. Materials and methods: Study included 201 patients with four types of asymmetries according BI-RADS atlas (asymmetry – 81 (40,3%), focal asymmetry – 82 (40,8%), global asymmetry – 36 (17,9%) and developing asymmetry – 2 (1,0%)) who underwent full-field digital mammography, digital breast tomosynthesis and hand-held full breast ultrasound from January 2017 to June 2018. The general rate of breast cancer for the 201 patients with asymmetries was 8 cases (4,0%) (IBC, n=6 (3,0%); DCIS, n=2 (1,0%) other findings associated with asymmetries were non-malignant, n=10 (5,0%) (sclerosing adenosis, n=5 (2,5%); fibroadenomatosis, n=3 (1,5%); simple cyst, n=1 (0,5%); radial scar associated with papilloma, typical ductal hyperplasia and sclerosing adenosis, n=1 (0,5%). Results: Analysis of the results showed that sensitivity of digital breast tomosynthesis was 75.0% [95% CI, 34.91% to 96.81%] and specificity was 94.8% [95% CI, 90.68% to 97.49%] which was superior to full-field digital mammography sensitivity 50.0% [95% CI, 15.70% to 84.30%] and specificity 91.19% [95% CI, 86.27% to 94.78%] for breast cancer detection associated with different types of asymmetries. Conclusions: Using of digital breast tomosynthesis in assessment of breast asymmetries can improve sensitivity and specificity in breast cancer detection and reduce number of unnecessary biopsies and short-interval follow-up examinations.

Conventional and contrast-enhanced ultrasound features in sclerosing adenosis and correlation with pathology

OBJECTIVES: To evaluate the efficacy of conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) in differential diagnosis of sclerosing adenosis (SA) from malignance and investigate the correlated features with pathology. METHODS: We retrospectively enrolled 103 pathologically confirmed SA. All lesions were evaluated with conventional US while 31 lesions with CEUS. Lesions were divided into SA with or without benign lesions (Group 1, n = 81) and SA with malignancy (Group 2, n = 22). Performance of two methods were analyzed. The ultrasonographic characteristics were compared between two groups with Student’s t-test for measurement and chi-squared or Fisher’s exact test for count data. RESULTS: There were 22 lesions complicated with malignancy, and the mean age of Group 2 was higher than Group 1 (55.27 vs. 41.57, p < 0.001). The sensitivity, specificity and accuracy of conventional US and CEUS were 95.45%, 46.91%, 57.28% and 100%, 62.5%, 70.97%. Angularity (p < 0.001), spicules (p = 0.023), calcification (p = 0.026) and enlarged scope (p = 0.012) or crab claw-like enhancement (p = 0.008) in CEUS were more frequent detected in SA with malignancy. CONCLUSIONS: Though CEUS showed an improved accuracy, the performance of ultrasound in the diagnosis of SA was limited. Awareness and careful review of the histopathologically related imaging features can be helpful in the diagnosis of SA.