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PURPOSE To analyze the malignancy rate of ultrasound-guided core needle biopsy (US-CNB) for screen-detected breast lesions and to evaluate the results according to the mode of detection of the target lesions. METHODS This is a retrospective review of 703 consecutive women who underwent US-CNB for screen-detected breast lesions at a single tertiary hospital. Breast Imaging Reporting and Data System (BI-RADS) categories and histopathological results of the target lesions were assessed. The cases were divided into two groups: the mammography-based detected lesions (M-group) and the US-based detected lesions (U-group). The biopsy performances of the two groups were compared using the χ2 test. RESULTS The malignancy rate in the entire population was 22.0%: 0.8%, 12.3%, 65.2%, 89.3%, and 94.6% in BI-RADS categories 3, 4A, 4B, 4C, and 5, respectively. The malignancy rate was significantly higher in the M-group (54.1% [79/146]) than in the U-group (13.6% [76/557]) (p < 0.001). BI-RADS category 3 was the most common assessment overall that led to a US-CNB (362/703, 51.5%) and the rate of BI-RADS category 3 diagnoses that led to US-CNB was significantly higher in the U-group (p < 0.001). CONCLUSIONS The malignancy rate associated with US-CNB for screen-detected breast lesions was 22.0%. The breast lesions detected by mammography have a higher malignancy rate than those detected by US. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:261-266, 2017.

Background This study investigated which zonal tissue would be more secure from the risk of fat necrosis between Holm zones II and III and examined the risk factors of fat necrosis in a clinical series of medial row perforator-based deep inferior epigastric artery perforator (DIEP) flaps. Patients and Methods A retrospective chart review was performed for patients undergoing unilateral breast reconstructions with medial row perforator DIEP flaps. Data regarding patients, operation-related characteristics, and complications including fat necrosis were collected. Fat necrosis was mainly diagnosed by ultrasound examination, and its location was also assessed. Results A total of 103 cases were analyzed. Fat necrosis was diagnosed in 13.6% of patients and developed more frequently in zone III (7.8%) than in zone II (4.9%). In risk factor analysis, the inset rate, the weight ratio of the inset flap to harvested flap, was significantly associated with the development of fat necrosis. The flaps with inset rates more than 79% showed 16 times higher risk of fat necrosis than those below 79% in multivariate analysis. The incidence of fat necrosis in zone III was significantly increased in the high inset rate group when compared with the low inset rate group, whereas the incidence in zone II did not change. Conclusions In unilateral breast reconstruction using medial row perforator DIEP flaps, fat necrosis developed more frequently in zone III than in zone II, and this tendency was more prominent in high inset rate group. Not transferring excessive contralateral tissue including lateral zone III tissue might be helpful for reducing the risk of fat necrosis. © 2014 Wiley Periodicals, Inc. Microsurgery 35:272–278, 2015.

Purpose To investigate the characteristic sonographic (US) findings of pure ductal carcinoma in situ (DCIS) in a large series. Methods We retrospectively reviewed the US findings of 126 cases of pure DCIS in 123 consecutive patients who underwent surgery for breast cancer in our hospital. We analyzed the US findings of the lesions according to mass or nonmass abnormality, shape, margin, orientation, echogenicity, echotexture, boundary echo, posterior acoustic features, presence of associated ductal dilatation, presence of intralesional cystic focus, and presence of microcalcifications on US. We compared the US characteristics of pure DCIS with and without mammographic microcalcifications. Results Seventy-eight cases of pure DCIS had microcalcifications and 48 had no microcalcifications on mammography (MG). Overall, 109 cases (86.5%) of pure DCIS were demonstrated on US. DCIS with microcalcifications on MG showed positive US findings in 79.5% of cases. The most common US finding was heterogeneous hyper- or isoechoic parenchyma with intralesional microcalcifications and without posterior acoustic features. DCIS without microcalcifications on MG showed positive US findings in 97.9% of cases. The most common US findings were masses with round or oval shape, microlobulated margin, parallel orientation, heterogeneous mild hypoechogenicity, and without boundary echo or posterior acoustic features. Ductal dilatations and intralesional cystic foci were present in 17.5% (22/126) and 23.8% (30/126) of pure DCIS, respectively. Conclusions Overall, US could demonstrate 85.7% of pure DCIS cases, including 16 (12.7%) cases of clinically and mammographically occult pure DCIS. DCIS with and without microcalcifications on MG showed different US characteristics. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound, 41:465–471, 2013

Purpose To evaluate the menstrual cycle and breast composition influence on background parenchymal enhancement of breast magnetic resonance imaging (MRI) and to investigate the optimal time for breast MR examinations. Materials and Methods We evaluated the dynamic contrast-enhanced breast MR images of 238 women who had completed a questionnaire survey about menstrual status. On MRI, the degree of enhancement (DE) of normal parenchyma was measured in the images 2 minutes and 6 minutes after contrast injection. A comparison between premenopausal and postmenopausal women and a separate comparison between dense breasts and fatty breasts were analyzed according to the premenopausal women's menstrual cycle. Results Premenopausal women showed significantly higher DE than the postmenopausal women (P

Background It remains uncertain whether MRI identification of additional foci of disease leads to improved outcome. We undertook a study to evaluate the influence of breast MRI on early and long-term outcome. Methods Among 1,271 patients undergone breast cancer surgery between January 2005 and December 2006, 785 patients were attempted for BCS. Operative approach and radiologic findings were compared according to MRI use. We reselected 615 patients with unilateral early-stage breast cancer treated with BCS including RT. We compared the histopathologic characteristics and outcomes according to MRI use. Results In patients attempted for BCS (n = 785), re-excision rates were not significantly different according to MRI use (P = 1.000). Conversion to mastectomy or bilateral cancer surgery were higher in MRI group (P = 0.002). The IBTR rate was higher in the non-MRI group (P = 0.020). Difference in contralateral cancer rate and total recurrence rates failed to reach statistical significance (P = 0.168, 0.383, respectively). Multivariate study after adjustment showed no difference in recurrence rates and IBTR rates between the two groups (hazard ratios 1.34, 6.37 Ps = 0.385, 0.076). Conclusion Use of MRI in patients with early-stage breast cancer did not result in improvement of a patient's outcome. J. Surg. Oncol. 2013;107:815–821. © 2013 Wiley Periodicals, Inc.

Objectives The purpose of this study was to investigate the frequency and appearance of changes in the breast on sonography in patients after breast cancer surgery including sentinel lymph node localization using methylene blue dye. Methods Three hundred thirty-seven consecutive patients who underwent breast-conserving surgery in 2006 underwent breast sonography during 2 years after surgery. Sentinel lymph node localization using methylene blue dye was selectively performed. We retrospectively analyzed the unexplained focal lesions not at the lumpectomy site on sonography and investigated whether these findings were associated with sentinel lymph node localization. Results Unexplained focal lesions were identified in 36 (14.1%) of 256 patients who had undergone sentinel lymph node localization. The lesions were in the periareolar region (n = 26; outer in 16, upper in 6, inner in 2, and lower in 2) or the retroareolar region (n = 10). The lesion appeared with a fat necrosis-like pattern in the subcutaneous fat layer in 24 (66.7%) or as an irregular mass in the glandular layer in 12 (33.3%). The unexplained focal lesions were pathologically proven benign (n = 10) or were improved or stable during 2 years of imaging follow-up after surgery (n = 26). The unexplained focal lesions in 2 (2.5%) of 81 patients without sentinel lymph node localization were in the nonareolar region, and 1 of these was a recurrence. Conclusions After sentinel lymph node localization using methylene blue dye, breast sonography can show unexplained focal lesions in the periareolar and retroareolar regions. Although most of the changes suggest fat necrosis, an irregular parenchymal mass can develop and mimic a recurrence.

Myofibroblastoma (MFB) of the breast was coined by Wargotz et al 1 in 1987 to describe benign spindle cell tumors of the breast with myofibroblastic features. There has been only 1 report about mammographic and sonographic findings of MFB of the female breast. 2 We report a case of a pathologically diagnosed breast MFB in a female patient and describe the imaging characteristics, including mammography, sonography, and magnetic resonance imaging (MRI). We also discuss other breast diseases that can be included in the differential diagnosis with MFB from a radiologic point of view.

The purpose of our study was to provide sonographic findings of cystic nodules, which can mimic malignancies, after fine-needle aspiration (FNA) and to determine the differential points from malignancies.We retrospectively reviewed the sonographic findings of 33 lesions in 32 patients who had FNA for predominantly cystic nodules or cysts and showed suspicious findings during sonographic follow-up, as well as findings of 47 surgically confirmed papillary thyroid carcinomas (PTCs) in 45 consecutive patients. We evaluated the size, shape, presence of shadowing and a halo, margin, echogenicity, and presence of echogenic dots for each nodule. The final diagnosis of cystic nodules was confirmed by FNA, surgery, or follow-up sonography.Of the 33 cystic lesions, 31 (94%) were adequate with benign results, and 2 (6%) were inadequate specimens at the initial FNA. There were no malignancies in the cystic nodules at follow-up. The average interval between the initial FNA and suspicious sonographic findings was 26 months (range, 1-92 months). The average size of the suspicious nodules was 0.8 cm (range, 0.3-1.8 cm). Cystic nodules after aspiration were similar to PTCs in their sonographic findings, but the former frequently showed shadowing and a halo (85% versus 21%; P.0001). With further follow-up, 29 lesions (88%) showed additional decreases in size.Benign cystic nodules after aspiration can have suspicious malignant features. However, shadowing and a halo associated with malignant features are characteristic findings of cystic nodule shrinkage. Awareness of these findings and correlation with the FNA history can aid in preventing unnecessary FNA.

Background Recently PET is emerged as a method to estimate the response of neoadjuvant chemotherapy (NAC) in advanced breast cancer. This study is aimed to estimate the predictive role of PET CT and other imaging modalities (ultrasound, MRI) through NAC. Methods PET CT was acquired before and after NAC from 41 patients. Pathologic results were classified as pathological complete response (pCR) and non-pCR. The results of clinical responses were assessed with imaging indexes (postTx, postchemotherapy size or peak standardized uptake values (pSUV); delta, the size difference between treatment; RR, reduction rate of tumor size or pSUV), and they were compared with pathologic results. Results Seven patients (17.1%) showed pCR. As a result of comparison of the image index, all image indexes of MRI were predictive for pCR (P

This study was designed to assess the role of sonography (US) in the differentiation of benign from malignant thyroid nodules with peripheral calcifications.Sixty-four thyroid nodules with peripheral calcifications that were detected on US were included in the study. Nineteen nodules (30%) were benign, and 45 nodules (70%) were malignant. We retrospectively compared the US findings of the benign and malignant nodules, including interruption, thickening (or=0.5 mm and over more than 50% of the circumference) of calcifications, internal echogenicity, margin, and presence of cystic change, size, and shape. Univariate and multivariate logistic regression analyses were performed.Interruption of peripheral calcifications was more common in malignant nodules (84%) than in benign nodules (53%) (OR, 7.9; 95% CI, 1.3-48.4; p0.05). Thickening of the peripheral calcification was seen more frequently in malignant nodules (64%) than in benign nodules (11%) (OR, 14.7; 95% CI, 1.8-117.5; p0.05). For internal echogenicity, malignant nodules (58%) were more often hypoechoic than benign nodules (OR, 23.6; 95% CI, 2.2-256.3; p0.01). The mean tumor size was 1.1 cm for malignant nodules and 1.2 cm for benign nodules (p0.05). There were no significant differences for the presence or absence of cystic change, size, shape, and margin between malignant and benign nodules.Interruption and thickening of peripheral calcifications and decreased internal echogenicity of a thyroid nodule with peripheral calcifications are in favor of malignancy.

Objective. The purpose of this series was to evaluate the sonographic features of secretory carcinoma of the breast. Methods. Between 1994 and 2006, 9 patients had histologically confirmed secretory carcinoma of the breast in our institution, and 6 of them underwent breast sonography. We retrospectively evaluated the sonographic findings of the patients in correlation with other available images and reviewed the clinical records. Results. Clinical manifestations were a palpable mass (n = 3), a bloody nipple discharge (n = 1), and screening-detected abnormalities (n = 2). Breast sonograms showed masses with a round or oval (n = 5) or tubular (n = 1) shape, with relatively well-circumscribed (n = 2) or partially microlobulated (n = 4) margins, and with a hypoechoic (n = 4) or an isoechoic (n = 2) internal echo texture. Most lesions were single nodules (n = 3) or groups of nodules (n = 2) measuring 1 cm or smaller, except 1 mass measuring 3.5 cm with axillary lymph node metastasis. Two cases had associated ductectasia. Sonographic assessments were classified as Breast Imaging Reporting and Data System category 3 in 2 cases, category 4A in 3 cases, and category 4B in 1 case. Conclusions. Secretory carcinoma of the breast is frequently shown as a small benign-looking nodule or group of nodules or sometimes as an intraductal lesion with a low clinical stage on sonography. Although secretory carcinoma is a rare breast malignancy, awareness of its sonographic features will be helpful for the differential diagnosis.

p21Waf1 (p21), p27Kip1 (p27) and cyclin D1 have recently been reported as useful prognostic markers for patients with breast carcinoma. However, studies on these cell cycle regulators in ductal carcinoma in situ (DCIS) have been extremely limited. Therefore, we studied the immunohistochemical expression of p21, p27 and cyclin D1 proteins in 49 DCIS cases and compared the findings with the clinicopathologic parameters (age, tumor size, gross type, histologic type, histologic grade, necrosis and mitotic index), p53 and estrogen receptor (ER) status. A significant correlation was found between positive p21 immunoreactivity (67.3% of the cases) and well-differentiated histologic grade, non-comedo type, ER-positive and p53-negative (p53-) status. DCIS with p21+/p53- is likely to be the non-comedo type. The overexpression of cyclin D1 (59.2% of the cases) correlated positively with the ER expression (P = 0.001). The p27 protein expression (46.9% of the cases) correlated with the cyclin D1 immunopositivity (P = 0.0003) and ER expression (P = 0.005). No significant associations were seen in the p27 or cyclin D1 expression and other clinicopathologic parameters. Our results suggest that p21 might be more related to the useful biologic markers in DCIS than p27 or cyclin D1. The significant positive association between p21, p27 or cyclin D1 and ER status, and close association of p27 and cyclin D1 expression might be implicated in the tumor biology of DCIS.

Purpose We investigated the mammographic, sonographic, and pathologic findings in metaplastic carcinoma of the breast. Methods The mammographic (n = 16) and sonographic (n = 11) findings in 16 patients with metaplastic carcinoma of the breast were analyzed retrospectively along with pathologic findings. Whenever possible, results of preoperative fine-needle aspiration biopsy and immunohistochemical studies were obtained. Results All patients presented with a palpable breast mass. The mean size of the lesions at pathologic examination was 4.2 cm. On mammography, 15 patients had a mass (1 patient had 2 masses), and 1 patient had only clustered microcalcifications without an associated mass. The mean longest diameter of the 16 masses on mammography was 4.6 cm. Eleven lesions (69%) were round to ovoid in shape, 13 lesions (81%) showed ill-defined or obscured margins, and 10 lesions (63%) showed associated architectural distortion. On sonography, 6 (55%) of 11 lesions were round to ovoid, 9 lesions (82%) had well-defined margins, and 6 lesions (55%) showed complex echogenicity with solid and cystic components. At pathologic examination, 4 of these 6 lesions showed hemorrhagic or cystic necrosis. Axillary lymph nodes were positive in 6 (40%) of 15 patients in whom axillary node dissection was performed. Conclusions Metaplastic carcinoma of the breast manifests as a rapidly growing, mammographically ill-defined round mass with associated architectural distortion on mammograms. Complex echogenicity with solid and cystic components may be seen sonographically and is related to hemorrhagic or cystic necrosis seen pathologically. © 2000 John Wiley & Sons, Inc. J Clin Ultrasound 28:179–186, 2000.

We evaluated the mammographic (n = 16) and ultrasonographic (n = 15) findings of 18 patients with metastatic breast carcinoma. Fifteen patients showed multiple or diffuse lesions and three patients showed single lesions. Ten patients (55.6%) had bilateral lesions. Mammography revealed high density (15 cases, 93.8%), round to oval (11 cases, 68.8%) lesions with poorly defined or obscured margins (12 cases, 75.0%). No associated calcification was found in any lesion. Ultrasonographically, poorly defined (8 cases, 53.3%), irregularly shaped (8 cases, 53.3%), hypoechoic (14 cases, 93.3%), heterogeneous (8 cases, 53.3%) lesions were predominantly distributed superficially (11 cases, 73.3%). Axillary lymphadenopathy was detected in six patients (33.3%). The longest diameter of most of the lesions was less than 2.0 cm (13 cases, 81.3%). We conclude that metastatic tumors to the breast appear as relatively small, superficially located, poorly defined, irregular nodules without calcification on mammography and ultrasonography. However, when the metastatic lesion is diffuse, the appearance is indistinguishable from that of inflammatory breast carcinoma.

We reviewed the sonographic findings of 42 benign papillary lesions of the breast and correlated them with pathologic findings. Sonography detected 95% of papillomas (22 intraluminal masses, four extraductal masses, nine purely solid masses, and five mixed type masses). The sonographic margins of the mass were well defined in 20 lesions and poorly defined in 14 lesions. Poorly defined margins on sonography were frequent in papillomas with pathologic pseudoinvasion and in juvenile papillomatosis. Most benign papillary lesions of the breast have the sonographic findings suggestive of intraductal origin. The sonographic findings of papillary lesions correlated well with pathologic findings.