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Vascular tumors of the breast are uncommon, and most are angiosarcomas. 1-3 Benign hemangiomas of the breast are rare, and there are few reports. We report a case of a breast subcutaneous hemangioma in which skin redness had recently developed and high vascularity was shown on power Doppler sonography.

The objective was to evaluate the sonographic findings of sclerosing lobular hyperplasia (SLH) of the breast and to correlate the sonographic findings and the pathologic features. This study consisted of 9 patients with pathologically proven sclerosing lobular hyperplasia who had undergone a preoperative imaging study. We retrospectively reviewed 9 ultrasonograms and 6 mammograms. In each patient mammographic findings including, shape and margin, and ultrasonographic findings including the size, length-to-anteroposterior ratio, shape, margin, internal echo pattern, and the presence and location of internal echogenic septum, were evaluated. Histopathologic correlations focused on characteristic imaging findings. Of the 6 mammograms, 4 cases showed a lobular (3 of 6) or an oval shaped mass (1 of 6) with a partly obscured margin (4 of 6). The remaining 2 cases showed heterogeneously dense breast without visible mass. Ultrasonograms showed a lobular (5 of 9) or an oval (4 of 9) shaped mass with a circumscribed margin (9 of 9). The mean length/anteroposterior ratio was 1.98. Intratumoral echogenic septum was present in 8 cases. Six cases had a peripherally arising septum. Histopathologic review revealed that this septum was correlated to interlobular sclerosis. A peripherally arising intratumoral echogenic septum on ultrasonography seen in SLH might be explained by the interlobular sclerosis.

We report a case of tuberculous thyroiditis in a woman with Behçet's syndrome. The initial physical examination in May 1998 revealed multiple soft, nontender, mobile lymph nodes, each measuring less than 1 cm, in the left lower internal jugular chain. Sonography performed in February 2000 showed multiple small (1 cm), oval lymph nodes, each with an intact fatty hilum, in the left lower internal jugular chain; the thyroid gland appeared normal. Follow-up sonography 6 months later showed multifocal, heterogeneous, hypoechoic lesions with ill-defined margins in both lobes of the thyroid and several small, oval lymph nodes, each with an intact fatty hilum, in the left lower internal jugular chain. Fine-needle aspiration was performed on the largest thyroid lesion, and cytologic analysis of the aspirate revealed a small number of epithelioid histiocytes in a necrotic background, which was suggestive of tuberculosis. Follow-up sonography after 3 months of antituberculosis chemotherapy showed that the thyroid lesions had resolved.

The initial presentation of breast malignancy as noninvasive carcinoma in an area of sclerosing adenosis is unusual. Especially, lobular carcinoma in situ in sclerosing adenosis sometimes can be a potential source of confusion with invasive lobular carcinoma. We report a case of lobular carcinoma in situ presenting in adenosis exhibiting patterns akin to invasive lobular carcinoma, thus leading to potential misdiagnosis. Overall architecture of the lesion as seen at lower power and immunohistochemistry can be useful to distinguish between sclerosing adenosis with lobular carcinoma in situ and infiltrating lobular carcinoma.

We evaluated mammographic changes to assess the effect of tamoxifen in breast cancer patients who had undergone surgery.We reviewed the mammograms of 102 breast cancer patients treated with tamoxifen (20 mg per day); these patients were subgrouped into tamoxifen-only patients and patients treated with tamoxifen in combination with another therapy (chemotherapy, radiotherapy, or both). The control group was made up of 50 breast cancer patients who did not undergo tamoxifen therapy and 20 healthy women who had an age distribution and menstruation status similar to those of the breast cancer patients. Two radiologists evaluated parenchymal patterns on mammograms of the contralateral breast in the breast cancer patients and of the left breast in the healthy women. Parenchymal changes before and after surgery were also analyzed.Follow-up mammography showed decreased breast parenchyma in 59.8% of the tamoxifen group, 87.0% of the premenopausal tamoxifen-treated women, 36.0% of the nontamoxifen patients, and 10.0% of the healthy women.On follow-up mammography of breast cancer patients, breast parenchyma was shown to be decreased after tamoxifen therapy. Mammography can be a useful method for evaluating breast parenchymal changes after tamoxifen treatment.

Purpose Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of unknown etiology. The diagnosis of IGM requires that other granulomatous lesions in the breast be excluded. Tuberculous mastitis (TM) is also an uncommon disease that is often difficult to differentiate from IGM. The purpose of this study is to develop a new algorithm for the differential diagnosis and treatment of IGM and TM. Methods Medical records of 68 patients (58 with IGM and 10 with TM) between July 1999 and February 2009 were retrospectively reviewed. Results The mean age of the patients was 33.5 (IGM) and 40 (TM) years (p=0.018). The median follow-up was 84 months. Of the total 10 patients with TM, 5 patients had a history of pulmonary tuberculosis. The most common symptoms of the diseases were breast lump and pain. However, axillary lymphadenopathy was more seen in TM (50%) compared to IGM (20.6%) (p=0.048). TM showed more cancer-mimicking findings on radiologic study (p=0.028). In IGM, 48 patients (82.7%) underwent surgical wide excision and 21 patients (36.2%) were managed with corticosteroid therapy and antibiotics. All of the TM patients received anti-tuberculosis medications and 9 patients (90%) underwent wide excision. The mean treatment duration was 2.8 months in IGM and 8.4 months in TM. Recurrence developed in 5 patients (8.6%) in IGM and 1 patient (10%) in TM. Conclusion This study shows different characteristics between IGM and TM. The IGM patients were younger and had more mastalgia symptoms than the TM patients. Axillary lymphadenopathy was seen more often in TM patients. Half of the TM patients had pulmonary tuberculosis or tuberculosis lymphadenitis. Surgical wide excision might be both therapeutic and useful for providing an exact diagnosis.

The purpose of our study was to analyze the incidence of incidental thyroid cancers which were detected by simultaneous sonographic examination of breast and thyroid glands. Between January 2001 and March 2004, 518 patients were diagnosed with breast cancer after modified radical mastectomy (n = 369) or breast conserving surgery (n = 149). We screened thyroid glands when we examined breast for diagnosis and follow-up after surgery. If we found the sonographic finding of suspicious for malignancy in thyroid, we immediately performed ultrasound-guided fine needle aspiration biopsy (FNAB). Forty-two cases showed suspicious sonographic findings and of those, 18 cases (42.9%) were determined to have suspicious malignant cytology by ultrasound guided FNAB. Among 518 breast cancers, total 13 cases (2.5%) were diagnosed with papillary carcinoma after thyroidectomy. The mean longest diameter of the thyroid masses was 9.9mm (range 1 - 30mm). Six cases (6/13, 46.2%) were diagnosed as simultaneous breast and thyroid cancers, and the rest of the thyroid cancers were detected after 6 to 33 months (mean 16.5 months) after surgery. In conclusion, the patients with breast cancer had a high incidence (2.5%) of thyroid cancer. Sonographic screening is useful for the early detection of thyroid cancer.

Primary breast lymphoma (PBL) is a rare clinical presentation of localized non-Hodgkin's lymphoma (NHL), and it makes up 0.04~1.1% of all breast tumors and it is 0.38~0.7% of all NHLs. The prognosis and patterns of relapse of PBL are still not clearly defined. The clinical features of PBL are different from those of breast carcinoma and the usual form of lymphoma. These features are a rapidly enlarging breast mass, multiple lesions, the absence of nipple discharge and retraction, and softer axillary lymph nodes as compared to the metastatic lymph nodes from breast carcinoma. B symptoms are unusual in PBL. A 30-year-old pregnant woman was admitted due to dysarthria and right side weakness that she had experienced for 7 days. She had several medical problems: intrauterine pregnancy at 34 weeks, some neurologic deficits and enlargement of both breasts. A biopsy from the breast and a brain magnetic reson- ance image (MRI) revealed diffuse large B cell lymphoma and multiple brain metastases, respectively. After delivery of a healthy, premature infant by Cesarean section, whole brain radiation therapy and combination chemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine and prednisone) were started. She showed good response to therapy. We report here on this unusual case and we review the

Foreign bodies, such as surgical sponges or drains, are sometimes retained after surgical procedures.1 Retention of a drain in the breast tissue postoperatively is an unusual complication. This report describes two cases of characteristic sonographic findings related to retained silastic drains following breast surgery.

In this paper, we evaluate the radiological features of pregnancy-associated breast lesions and discuss the difficulties in diagnosis by imaging. We selected patients who were diagnosed with pregnancy-associated breast lesions during the previous 5 years. All patients complained of palpable lesions in the breast and underwent ultrasonographic (US) examination, the first choice for examination of pregnancy-related breast lesions. Any suspicious lesions found by the US were recommended for a US-guided core biopsy, US-guided fine needle aspiration (FNA), or surgery. Various breast lesions were detected during pregnancy and lactation, including breast cancer, mastitis and abscesses, lactating adenoma, galactoceles, lobular hyperplasia, and fibroadenomas. The imaging features of pregnancy-associated breast lesions did not differ from the features of non-pregnancy-associated breast lesions; however, some pregnancy-associated benign lesions had suspicious sonographic features. A US-guided core biopsy was necessary for differentiating benign from malignant. In patients with breast cancer, the cancer was often advanced at the time of diagnosis. In conclusion, various pregnancy-related breast lesions were detected and the imaging of these lesions had variable findings. Breast ultrasound could be an excellent imaging modality for diagnosis and differentiation between benign and malignant lesions. However, when the imaging results are suspicious, a biopsy should be performed to obtain a pathologic diagnosis.

Pharyngoesophageal or Killian-Jamieson diverticulum is due to herniation of the mucosa and submucosa of the pharynx through a potentially weak area of the pharyngeal wall. It originates on the anterolateral wall just below the cricopharyngeous. It can be detected incidentally during thyroid ultrasonography (US). We present here a case report of pharyngoesophageal (Killian-Jamieson) diverticulum mimicking a thyroid nodule on US. We discuss the image findings that might be useful for the differential diagnose and to prevent invasive procedures such as needle aspiration biopsy.

Purpose: The purpose of this study was to establish a quality standard for mammographic equipment in Korea and to eventually improve mammographic quality in clinics and hospitals throughout Korea by educating technicians and clinic personnel. Materials and Methods: For the phantom test and on site assessment, we visited 37 sites and examined 43 sets of mammographic equipment. Items that were examined include phantom test, radiation dose measurement, developer assessment, etc. The phantom images were assessed visually and by optical density measurements. For the clinical image assessment, clinical images from 371 sites were examined following the new Korean standard for clinical image evaluation. The items examined include labeling, positioning, contrast, exposure, artifacts, collimation among others. Results: Quality standard of mammographic equipment was satisfied in all equipment during on site visits. Average mean glandular dose was 114.9 mRad. All phantom image test scores were over 10 points (average, 10.8 points). However, optical density measurements were below 1.2 in 9 sets of equipment (20.9%). Clinical image evaluation revealed appropriate image quality in 83.5%, while images from non-radiologist clinics were adequate in 74.6% (91/122), which was the lowest score of any group. Images were satisfactory in 59.0% (219/371) based on evaluation by specialists following the new Korean standard for clinical image evaluation. Satisfactory images had a mean score of 81.7 (1 S.D.=8.9) and unsatisfactory images had a mean score of 61.9 (1 S.D=11). The correlation coefficient between the two observers was 0.93 (p

Purpose: The need for completion axillary lymph node dissection, even in early breast cancer patients with a positive sentinel lymph node, has been questioned. The purpose of this study was to determine the factors that predict the presence of metastasis in non-sentinel lymph nodes (NSLNs) when the sentinel lymph node (SLN) was positive. Methods: Between December 1998 and June 2004, the records of 104 early breast cancer patients with a positive SLN and who underwent completion axillary lymph node dissection were reviewed. The clinicopathological features in SLN-positive patients were evaluated as possible predictors of metastatic NSLN. Results: Forty four (42.3%) of the 104 patients with positive SLN had metastatic NSLNs. In a univariate analysis, unicentric multifocality (P=0.016), lymphovascular invasion (P=0.006) and SLN metastasis larger than 2 mm (P= 0.003) were associated with positive NSLN findings. The number of SLNs removed was significantly associated as a negative predictor (P=0.043). A multivariate analysis revealed that SLN metastasis >2 mm (P=0.021) and lymphovascular invasion (P=0.040) were independent predictors of metastatic NSLN. Conclusion: The likelihood of metastatic NSLNs correlates with the size of the largest SLN metastasis and the presence of lymphovascular invasion of the primary tumor. Even though in early breast cancer with positive SLNs, incorporating these factors may help determining which patients would benefit from additional axillary lymph node dissection. (Journal of Korean Breast Cancer Society 2004;7:268-274)

Purpose: Sentinel lymph node (SLN) biopsy has become a new standard procedure in the treatment of patients with early breast cancer. Furthermore, many institutions have begun offering the sentinel lymph node biopsy without simultaneous axillary dissection as a possible standard procedure when the SLN was free from tumors. For appropriate intraoperative decision making on the presence of cancer cells in axillary lymph nodes, a fast and accurate method to assess the SLN is required. The authors performed a prospective investigation of the relative merits of rapid cytokeratin immunohistochemical (IHC) staining of the SLN removed during the operations of breast cancer patients. Methods: Between December 2002 and August 2003, 38 patients with T1and T2 breast cancer were enrolled after undergoing successful sentinel lymph node biopsy. A total of 60 sentinel lymph nodes (mean number, 1.58) were biopsied and first examined by hematoxylin-eosin (HE7:154-160)

Purpose: To compare the galactographic findings of malignant and benign disease in patients with pathologic nipple discharge and to analyze the features suggesting malignancy. Materials and Methods: In 24 patients in whom pathologic nipple discharge had occurred, the findings of preoperative galactography were correlated with those of pathology. Results: Nine of the 24 cases were malignant and the other 15 were benign. Intraductal calcification occurred in five malignant cases (56%) and two (13%) which were benign. Seven malignant cases (78%) involved the segmental ducts, and in eight (89%), the peripheral ducts below the subsegmental duct were involved. Five benign cases (33%) involved the lactiferous sinus, seven (47%) the segmental duct, and two (13%) the subsegmental duct. Distal duct dilatation occurred in four benign cases (27%), while ductal stenosis was noted in six cases (67%) and ductal distortion in seven (78%). A malignant tumor appeared as a multiple (n=5, 56%) or irregular (n=5, 56%) filling defect, and a benign tumor as a single (n=12, 80%), oval (n=6, 40%) or lobular (n=4, 27%) filling defect. Conclusion: At galactography, a malignant tumor frequently appeared as an irregular multiple intraductal filling defect in a peripheral duct. A benign tumor, on the other hand, appeared as an oval or lobular single lesion. The presence of ductal stenosis, distortion and intraductal microcalcifications not opacified by contrast material suggest possible malignancy.

The purpose of this study was to evaluate the usefulness of an ultrasound-guided fine-needle aspiration biopsy (US-FNAB) for the evaluation and treatment planning of nonpalpable thyroid lesions, including infracentimetric nodules. One hundred and twenty one patients underwent US-FNAB for 149 non-palpable solid nodules. Sixty-five patients underwent surgery, and 84 were followed up for at least 36 months. The results of the US-FNAB correlated with the pathological findings and clinical follow-up results. The nodules ranged from 0.3 to 2 cm in diameter, with a mean of 0.8 cm. Among the 149 nodules, 115 were infracentimetric and 34 were centimetric or supracentimetric in size. Of the 149 thyroid nodules, US-FNAB was true positive in 43, true negative in 90, false positive in 7 and false negative in 1. In 8 cases, the lesion was inadequately sampled. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the US-FNAB for the infracentimetric nodules were 96.9, 93.4, 86.1, 98.6 and 94.4%, and for the centimetric or supracentimetric nodules, were 100, 90.5, 85.7, 100 and 93.9%, respectively. There were no significant differences in the results between the infracentimetric and centimetric or supracentimetric nodules. In conclusion, an US-FNAB is a useful tool for determining the treatment plan of non-palpable solid thyroid nodules, even when less than 1 cm in diameter, and shows high sensitivity, specificity and accuracy.

Purpose: This study was performed to evaluate the efficacy and safety of sentinel lymph node biopsy alone (SLNB) without axillary lymph node dissection. Methods: Between Jun. 1999 and Dec. 2002, we carried out SLNB in 85 consecutive patients with T1 breast cancer whose sentinel lymph node(s) were tumor-free on intraoperative frozen section. Even when sentinel lymph node(s) turned out to be positive by permanent pathology, additional axillary lymph node dissection was not performed. Patients underwent total mastectomy or partial mastectomy and received an appropriate adjuvant therapy according to the characteristics of the primary tumor. All patients who had breast conserving surgery received postoperative radiotherapy to the remaining breast, but not to the axilla. Results: SLNB only took 14 minutes and yielded no postoperative complications. Among the 85 patients whose sentinel lymph nodes were tumor-free on frozen section, 11 patients were diagnosed as metastatic in the permanent pathology. One of them had a macro-metastasized (2.5 cm) sentinel lymph node, and the rest had micro-metastasized sentinel lymph nodes. For 23.1 months of mean follow-up period, all the patients including a patient who died of liver metastases at 17 months showed no evidence of axillary recurrence. Conclusion: No axillary recurrence following SLNB suggests that SLNB may be a good alternative to routine axillary lymph node dissection while providing less surgical morbidity in women with a small breast cancer. However, more patients accumulation and follow-up period will be needed for the final conclusion. (Journal of Korean Breast Cancer Society 2003;6:263-270) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Purpose: To evaluate the actual state of quality control in Korea through an analysis of mammographic phantom images obtained from a multicenter, and to determine the proper exposure conditions required in order to obtain satisfactory phantom images. Materials and Methods: Between April and June, 2002, 193 phantom images were referred to the Korea Food and Drug Administration for evaluation. Two radiologists recorded the number of fibers, specks and masses they contained, and the "pass" criteria were as follows: checked number of fibers: four or more; specks, three or more; masses, three or more (a total of ten or more features). Images in which optical density was over 1.2 were classified as satisfactory. In addition, changes in the success ratio, and difference between the two groups (i.e. "pass" and "fail", with regard to exposure conditions and optical density) were evaluated. Results: Among the 193 images, 116 (60.1%) passed and 77 (39.9%) failed. Among those which passed, 73 /100 (73%) involved the use of a grid, 80/117 (68.3%) were obtained within the optimal kVp range, 50/111 (45.0%) involved the use of optimal mAs, and 79/112 (70.5%) were obtained within the optimal range of optical density. Among those which failed, the corresponding figures were 17/52 (32.6%), 33/66 (50.0%), 31/69 (44.9%), and 35/65 (53.8%). There were statistically significant differences between the pass and fail rates, and with regard to kVp, optical density, and the use of a grid, but with regard to mAs, statistical differences were not significant. If only phantom images with an optical density of over 1.2 [as per the rule of the Mammographic Quality Standard Act (MQSA)] was included, the success rate would fall from 60.1% to 43.0%. Conclusion: The pass rate for mammographic phantom images was 60.1%. If such images are to be satisfactory, they should be obtained within the optimal range of optical density, using optimal kVp and a grid.

The characteristic features of hamartoma in terms of discrepancies in mammographic and sonographic shapes of the mass were evaluated. We reviewed 16 pathologically proven breast hamartomas, which had undergone preoperative mammography and ultrasonography. All masses were analyzed according to ACR-BIRADS on mammography. On sonography, each mass was analyzed for size, shape, margin, internal echogenicity, and posterior acoustic enhancement. We also analyzed the echogenicity of halo, and compared the characteristic changes in the shape of hamartomas attributable to compression in mammograms and sonograms. The most common sites were at 12 o'clock in the right breast and 2 o'clock in the left. The most common mammographic findings of the hamartomas were a round shape (11/16), a circumscribed margin (13/16), internal fat densities (D4)(16/16) and radiolucent halos (14/16). The most common sonographic findings of the hamartomas were an oval shape (16/16), circumscribed margins (10/16), heterogeneous internal echogenicity (14/16), echogenic (7/16) or echolucent halos (5/16), and posterior enhancements (12/16). The characteristic feature of hamartomas was a change of the mammographic round shape mass into an elongated oval shape mass by sonography (11/11), suggesting the compressibility of hamartomas. Three of the hamartomas contained a pathologically proven internal calcification. The presence of a hamartoma was suggested by a change in a mammographic round mass with a radiolucent halo into an oval heterogeneous mass surrounded by an echogenic or echolucent halo on the sonogram. This characteristic difference between the mammographic and sonographic findings was attributed to the hamartoma compressibility, and was associated with the over-proliferation of fat containing mature normal breast tissue.

The purpose of this study was to evaluate the thickness of the compressed breast in mediolateral oblique (MLO) and craniocaudal (CC) mammograms, to relate these thickness and breast patterns to mean glandular dose (MGD) in Korean women, and to evaluate the suitability of using the American College of Radiology's Recommendations for Korean women from a quality assurance standpoint. The study population consisted of 92 paired MLO and CC mammograms obtained on one mammographic unit. The digital readouts of compressed breast thickness, applied compression force and tube voltage were recorded. Entrance skin exposure was measured by dosimetry. MGD was calculated by multiplying entrance skin exposure by the exposure-to-absorbed dose conversion factor. The range of breast thickness was 1.3-6.2 cm in CC mammograms with a mean breast thickness of 3.6 cm, and 1.6-6.5 cm in MLO mammograms with a mean breast thickness of 3.9 cm. MGDs in CC and MLO mammograms were 1.77 mSv and 1.88 mSv per view, respectively. Breast composition patterns were divided into 4 groups according to ACR BI-RADS; P1 (n=20), P2 (n=16), P3 (n=48) and P4 (n=8). The MGDs for these groups were: 1.82, 1.84, 1.84, and 1.91 mSv, respectively. When subjects were subdivided by breast thickness into three groups, namely, below 3 cm, 3 cm to 4.2 cm, aaa and above 4.2 cm, the corresponding MGDs were 1.83, 1.86, and 1.91 mSv. According to our initial trial, the mean breast thickness and the MGDs of Korean women are lower than recommended by the American College of Radiology, which are commonly used for quality assurance purposes.

Purpose: To describe the changes in diagnostic methods and reassess the role of core biopsy compared with needle localization biopsy (NLB) in the evaluation of non-palpable breast lesions. Materials and Methods: We retrospectively analyzed 930 non-palpable breast lesions which underwent either core biopsy or NLB between January 1996 and December 2000. NLB involved 511 lesions in 482 patients, and core biopsy, 419 lesions in 365 patients. For a given lesion, NLB was guided by either mammography (n=213) or ultrasonography (US) (n=298), but only US was used to guide a core biopsy. Over the five-year period, we calculated the total number of biopsies per year relating to non-palpable breast lesions, also determining the mammographic findings in cases involving NLB and the percentage of malignancies seen at histopathology. Results: The total number of biopsies increased with time: 1996: n=91, 1997: n=118, 1998: n=144, 1999: n=245, 2000: n=332. The implementation of core biopsy, however, led to a decrease in the proportion of NLB (1996: 97.8%, 1997: 84.7%, 1998: 75.7%, 1999: 47.8%, 2000: 28.9%). Among nonpalpable lesions which underwent mammography-guided NLB, 46.5% (20/43) were a mass or density in 1996, while in 2000 the proportion was 5.7% (2/35). During this period, however, the finding of calcification without a mass increased from 48.8% in 1996 to 94.3% in 2000. The proportion of cases in which NLB demonstrated malignancy increased from 13.5% in 1996 to 49% in 2000; where US-guided NLB was used, the increase was remarkable: from 15.2% in 1996 to 65.6% in 2000. Conclusion: In the evaluation of non-palpable breast lesions, the appropriate use of core biopsy can decrease the need for a more invasive method such as NLB. Furthermore, because most benign lesions diagnosed by core biopsy do not also undergo NLB, the use of the latter increases the yield of malignancies.

Purpose: To evaluate the clinical and imaging findings of tubular carcinoma of the breast. Materials and Methods: We retrospectively assessed the clinical and imaging findings of ten lesions of pathologically proven tubular carcinoma in nine patients, also evaluating the mammographic findings and categorizing the mass according to the ACR BI-RADS classification. The ultrasonographic findings were assessed in terms of shape, echogenicity, margin and posterior shadowing, and in four cases the size of nodules at physical examination was compared with the mammographic, ultrasonographic and pathologic findings. Results: Nine lesions were palpable at physical examination. Bilateral tubular carcinoma of the breast was found in one patient, and unilateral single lesions in the others. There was no metastasis and no death within an average of 666 (range, 163) days of surgery. At mammography, masses were detected in six cases; the features, observed were a lobular or irregular shape (6/6), a spiculated margin (3/6) and high density (5/6). Ultrasonography showed that all unilateral lesions were hypoechoic (8/8), with a lesion height-to-width ratio of greater than 1.0 in seven of these, an ill-defined margin in sis, and posterior acoustic shadowing in seven. Mean nodule diameter was 1.17 cm at physical examination, 1.09 cm at mammography, 0.86 cm at ultrasonography and 0.80 cm at pathological evaluation. Conclusion: Most tubular carcinomas were palpable in spite of their small size, and their postoperative prognosis was good. Ultrasonography is useful in the detection of mammographically occult tubular carcinoma and for measuring the size of lesions.

Purpose: The status of the axillary nodes in breast carcinoma patients is one of the most significant prognostic factors. Although many trials in order to gain information concerning axillary status, to date there is no satisfactory procedures other than axillary lymph node dissection (ALND) which has many complications. Recently sentinel lymphadenectomy has become accepted as an alternative to ALND. Methods: Sentinel lymphadenectomy followed by ALND was performed in 157 patients with invasive breast carcinoma between Nov. 1998 and Dec. 2000. The period from Nov. 1998 to May. 1999, which included the first 54 patients was set as a learning period. 99m Tc antimony trisulfide colloid was used in the detection of the sentinel node, with a gamma camera preoperatively and then a gamma probe in the operating room. The dissected sentinel nodes were examined by both frozen section and serial section (SS) with immunohistochemical stains (IHC). Results: The detection rate was 96.8%. The false negative rate was 22.6% for the frozen sections and 4.8% for the permanent sections. The detection rate and the false negative rate had improved after the learning period with statistic significance (P-value

Purpose: To determine the usefulness of ultrasound-guided core biopsy for the diagnosis of non-palpable beast lesions. Materials and Methods: Between April 1996 and December 2000, 932 lesions in 901 patients were the object of ultrasound-guided core biopsy. Of these, 440 non-palpable lesions ranging in size from 0.3 to 3.0 (average, 0.9)cm, and found in 428 patients (all women aged, on average, 43.9 years), were included in this study. The pathologic results of core biopsy were compared with the available surgical data, and clinical and radiologic follow-up data were also reviewed. A 16-gauge needle was used in 197 lesions, and a 14-gauge neadle in the other 243. Results: At core biopsy, 53 lesions were diagnosed as invasive carcinoma, and 45 of these were excised. Forthfour were confirmed as invasive carcinoma, and in one case there was no residual tumor. Seven lesions, diagnosed as ductal carcinoma in situ at core biopsy, were surgically removed, and the final diagnosis was ductal carcinoma in four cases and invasive carcinoma in two. Two of four cases initially diagnosed as atypical ductal hyperplasia were finally diagnosed as invasive carcinoma after surgery. Six lesions diagnosed at core biopsy as benign were later found to be malignant (false-negative rate, 8.3%). Radiologic imaging suggested that all six lesions- for two of which, a 14-gauge needle was used, and for four, a 16-gauge needle-were malignant. The false -negative rate was 5.1% and 12%, respectively, whithout statistical significance (p=0.26). Conclusion: Ultrasound-guided core needle biopsy for non-palpable breast lesions is useful and can replace surgical excision. To avoid false-negative assessment, however, strict radiologic-histopathologic correlation is required.

Periductal mastitis arises from major ducts. Radiographic reports describing the phases of duct ectasia and secretory calcifications, have been published, but descriptions of the phases of periductal mastitis are rare. We report the mammographic and ultrasonographic findings of periductal mastitis in a 30-year-old woman who presented with a breast lump.

The goal of this study was to evaluate the sonographic findings of thyroid metastases arising from non-thyroid primaries. The study over a 5-year period comprised nine patients who had histopathologically proven metastatic disease to the thyroid. Ultrasonography was available in all cases. Ultrasound-guided needle aspiration was performed on 10 suspected nodules as determined by ultrasound. The Ultrasonographic findings were analyzed in two different ways. The first analysis included only those nodules biopsed, and the second analysis included all the nodules, biopsed and non-biopsed. The primary neoplasms were breast carcinoma (n=6), uterine leiomyosarcoma (n=1), cervical carcinoma (n=1), and nasopharyngeal carcinoma (n=1). Excluding 2 nodules, the 8 remaining metastatic nodules exhibited ill-defined hypoechoic character with heterogeneous texture. The other two nodules showed relatively circumscribed iso- or hypo-echoic character with cystic portion. From the analysis of ultrasonographic findings including all thyroid nodules irrespective of pathologic proof, 7 cases - excluding the 2 cases from the 9 cases - showed unilateral or bilateral multiple nodules suspected of metastasis. There was no evidence of microcalcification in any thyroid nodules. In conclusion, the sonographic findings of the thyroid metastatic nodules were not specific, but unilateral or bilateral multiple suspected thyroid nodules without evidence of microcalcification may be suggestive of metastatic nodules among patients with a known primary non-thyroidal tumor.

Purpose: To compare changes in breast parenchymal density among diverse age groups in asymptomatic Korean women with those of Western women, and to evaluate the effect of different patterns of breast parenchymal density on the sensitivity of screening mammography in Korean women. Materials and Methods: We analyzed the distribution of breast parenchymal density among diverse age groups in 823 asymptomatic Korean women aged 30-64 who underwent screening mammography between January and December 1998. On the basis of ACR BI-RADS breast composition, four density patterns were designated: patterns l and 2 related to fatty mammograms, and patterns 3 and 4 to dense mammograms. We compared the results with those for western women. Results: In Korean women, the frequency of dense mammogram was 88.1 % (30-34 years old), 91.1 % (35-39), 78.3 % (40-44), 61.1 % (45-49), 30.1 % (50-54), 21.1 % (55-59), and 7.0 % (60-64). Korean women in their 40s thus showed a higher frequency of dense mammograms, but this frequency decreased abruptly between the ages of 40 and 54. In Western women, however, there was little difference between 40 and 54-year-olds: the figures were 47.2 % (40-44 years), 44.8 %(45-49), and 44.4 %(50-54). Conclusion:Because the frequency of their dense mammograms shows little change between Western women in their forties and in their fifties, it is clear that between these two age groups, mammographic sensitivity is only slightly different. Because the frequency of dense mammograms is much greater among Korean women in their forties than among Western women og the same age, and among Korean women this frequency decreases abruptly, it appears, however, that the mammographic sensitivity of Korean women is less among those in their forties than among those in their fifties. It is therefore thought that mammography combined with ultrasonography may increase screening sensitivity among Korean women under 50, who have a relatively higher incidence of breast cancer in the younger age groups than do Western women.

Purpose: To evaluate the clinical and imaging findings of signet ring cell carcinoma of the breast. Materials and Methods: We retrospectively evaluated the clinical, mammographic and ultrasonographic (US)findings of five patients aged 23 -49 (mean 37) years with signet ring cell carcinoma of the breast. Diagnosis involved US-guided core-needle biopsy. In all patients the stomach was evaluated endoscopically after confirmation of the breast lesion. Metastatic breast cancer was confirmed in four patients and primary breast cancer in one. Results: Three of the four patients with metastatic signet ring cell carcinoma complained of breast pain and swelling or enlargement. Mammography indicated the presence showed of diffuse increased density and skin thickening, without calcifications, while US demonstrated diffuse marked skin thickening, lymphatic dilatation, and axillary lymph node enlargement. Neither modality revealed the presence of mass, however. In the remaining patient, an enlarged breast mass was observed; mammography showed no abnormality, but US re-vealed an illdefined hypoechoic mass. Mammographic and US findings in the patient with primary signet ring cell carcinoma of the breast indicated an ill-defined spiculated mass, resembling other breast carcinomas. Conclusion: Metastatic signet ring cell carcinoma of the breast showed clinical symptoms similar to these seen in inflammatory breast cancer, though the former condition occurred in younger women. Radiographs demonstrated diffuse increased density and skin thickening without associated microcalcifications or mass.

We report a case of granular cell tumor of the breast presenting as a spiculated lesion mimicking carcinoma on mammography and ultrasonography (US).

Two Korean women (41 and 23-years of age) presented with painful breast enlargement and redness. The involved breast was confirmed as metastatic signet ring cell carcinoma. Although metastatic signet ring cell carcinoma of the breast shows similar clinical symptoms to inflammatory breast cancer, the difference between the two is that this malignancy showed no microcalcifications or mass on radiographic findings (mammograms and US). Therefore, after the confirmation of signet ring cell carcinoma of the breast has been made, metastatic signet ring cell carcinoma should be considered if there are no microcalcifications or masses evident on radiographic findings.

Purpose : To analyze the mammographic findings of extensive intraductal compenent (EIC)-positive early invasive breast carcinoma and to determine the mammographic features which predict an EIC positivity in aninvasive carcinoma. Materials and Methods : The mammographic and pathologic findings in 71 patients aged 34-79 (mean 50) years in whom stage I or II invasive breast carcinoma had been diagnosed were etrospectively analysed. The m a mmographic findings were assigned to one of three groups: mass, mass with microcalcification, or microcalcification only. The shape and distribution of a calcification were classified according to the lexicon, and its extent was classified as either more or less than 3cm. To detect the presence or absence of EIC and the type of ductal carcinoma in situ (DCIS), the findings were reexamined by means of slide mappings. Results : Twenty-eight of 71 patients (39%) showed EIC positivity. The mammographic findings of EIC-positive invasive cancer (n=28) were mass with microcalcification (n=14), microcalcification only (n=7) and mass only (n=7). The mammographic finding which predicted EIC positivity was mass with microcalcification (PPV: 0.67, NPV: 0.33, p=0.02). A mammographic of mass only (n=39) showed a significantly high negative predictive value for EIC positivity. (PPV 0.18, NPV 0.82, P lexicon.

Purpose: The purpose of this study was to perform a medical audit of the screening of mammographic results according to ACR BI-RADS Follow-Up and Outcome Monitoring and to evaluate the efficacy of screening mammography in the early detection of breast cancer. Materials and Methods: We reviewed the results of 15,300 mammographic examinations of 13,889 women aged 30-75 years who underwent mammography at least once at the Severance Health Promotion Center between 1994 and 1998. Women with abnormal mammographic findings were recalled for additional study and those with dense breast composition (3, 4) underwent additional ultrasound. All results were categorized on the basis of the ACR BI-RADS final assessment scale, 1-5. We reviewed the pathologic or follow-up results of all women in categories 4 and 5, and/or those in any category who took the films out of the health center. Results: The recall rate was 13%. Biopsy or surgical Consultation was recommended for 92 women and biopsy was performed in 52. Pathology revealed 17 cancers and 35 benign lesions. Positive predictive value 2 was found in 18.5% of cases, and positive predictive value 3 in 33%. The cancer detection rate was 1.2/1,000, and sensitivity was 89.5%. Invasive cancers smaller than 1cm or in situ ductal cancers were found in eight of 17 cases (47%), while node-positive invasive cancers were found in nine of 14 cases (64%). Four of 17 mammo-graphically detected cancers were palpated by a surgeon. Conclusion: In asymptomatic women, screening mammography is an effective method for the detection of early breast cance.

Purpose : The purpose of this study was to assess the mammographic features and pathologic outcome of category 4 lesions using the Breast Imaging Reporting and Data System(BI-RADS), and to evaluate the significance of final assessment categories. Materials and Methods : Using BI-RADS, the interpretations of 8,134 mammograms acquired between January 1997 and May 1998 were categorized. From among 161 lesions categorized as “4 ”(“suspicious abnormality ”) and pathologically confirmed by surgery or biopsy, we analysed 113, found in 66 patients. Results : The pathologic outcome of these 113 lesions was as follows: infiltrating ductal carcinoma, 17.7%(20/113); DCIS(ductal carcinoma in sitv), 8.0 %(9/113); ADH(atypical ductal hyperplasia), 5.3 % (6/113); DEH(ductal epithelial hyperplasia), 1.8 %(2/113); ductectasia, 0.9 %(1/113), FCD(fibrocystic change), 27 .4 %(31/113); fibroadenoma, 7.1 %(8/113); stromal fibrosis, 9.7%(11/113); normal parenchyma, 7.1 % (8/113); other pathology, 15.0 %(17/113). The most frequent mammographic features of BI-RADS category 4 lesions were irregular mass shape(41.2 %), spiculated mass margin(52.3%), amorphous calcification(47.3%) and clustered calcification distribution(37.1% ). Conclusion : Because category 4 lesions account for about 25.7 % of all breast malignancies, mammographic lesions in this category (“suspicious abnormality ”)should be considered for supplementary study and breast biopsy rather than short-term follow-up. Initial pathologic findings can thus be confirmed.

Mammography is an invaluable method for the in detection of breast cancer, especially in asymptomaticpa-tients. Occasionally, however, mammography fails to detect cancer, resulting in false reassurance and delayeddi-agnosis. In this paper we describe various causes and the mammographic findings of false-negative mammo-grams.

Purpose : To analyze the differences in mammographic and pathologic findings between palpable and non-palpable breast carcinoma. Materials and Methods : Among 362 patients with surgically proven breast carcinoma, 317, whose chief com-plaint during preoperative evaluation was a palpable mass, Comprised group I, and 45 with no masses com-prised group II. We compared mammographic and pathologic findings between the two groups. Results : As regards the pattern of mammographic presentation, mass alone accounted for 51.4 % of group I and 33.3 % of group II, while calcification alone was seen in 7.6 % of group I and 24.4 % of group II(p