Download pptx - BR5. A circumscribed breast mass is defined as a round or oval breast lesion well demarcated It may correspond to different diagnosis - Benign lesion

CRITERIA OF BENIGNITY AND MALIGNANCY OF CICUMSCRIBED

BREAST MASS: ABOUT A SERIE OF 55 CASES

Z.OUERGHI; N.DALI; A.MANAMANI A; A. BEN TEKAYA; I.MARZOUK; L.BEN FARHAT; L.HENDAOUI

DEPARTMENT OF DIAGNOSTIC IMAGING MONGI SLIM HOSPITAL. LA MARSA

BR5

Introduction

A circumscribed breast mass is defined as a round or oval breast lesion well demarcated

It may correspond to different diagnosis - Benign lesion dominated by cyst and

fibroadenoma - Malignant lesion such as medullary,

papillary or mucinous carcinoma or well circumscribed ductal carcinoma…

The aim of our work is to analyze the mammographic and

ultrasonographic criteria of benignity and malignancy of circumscribed breast masses

through a serie of 55 observations

Introduction

Materials and methods

This is a serie of 55 women The age is ranging from 28 to 76 old

years All patients have received a

mammogram and a breast ultasound 43 of them underwent biopsy under

ultrasound guidance, the others 12 patients were monitored ( followed up ) by breast ultrasound

On mammography : The masses density was : - high in 25 cases - low in 26 cases - Radiolucent in one case - Mixed in three cases Calcifications were present in 10 cases

which two were benign « popcorn » like in fibroadenoma and eight were malignant in invasive ductal carcinoma

Result (1)

On mammography : The halo sign was present in 19

cases The margin was: - regular in 17 cases - lobulated in 21 cases - spiculated in 17 cases

Result (1)

CYST FIBROADEMAFIBROADENOMA with « popcorn » like calcifications

WELL DEMARCATED AND SLIGHTLY DENSE MASSES

WELL DEMARCATED MASSES CONTAINING FAT DENSITY

LIPOMA HAMARTOMA HAMARTOMA with calcifications

LOBULATED AND STRONGLY DENSE MASSES

INFILTRATING DUCTAL CARCINOMA

SPICULATED MASSES WITH BRANCHED AND VERMICULAR CALCIFICATIONS


WELL DEMARCATED MASS

ILL DEMARCATED MASSES


In ultrasound : The lesions echogenecity was : - Hypoechoic in 47 cases in whoum 20 were homogenous and 27 were heteregenous - Hyperechoic in 7 cases - Anechoic in one case The long axis was : - Wider then tall in 28 cases - Taller then wide 27 cases

Result (2)

Posterior acoustic feature was : - A shadowing in 15 cases - An enhancement in 15 cases - Unaffected in 13 cases

Result (2)

WELL DEFINED HOMOGENOUS MASSES WITH POSTERIOR ACOUSTIC ENHANCEMENT AND WIDER THEN TALL LONG AXIS

FIBROADENOMA

FIBROADENOMA

CONTAINING LITTLE CYSTS

CONTAINING POP CORN LIKE CALCIFICATIONS

FIBROADENOMA

STRONGLY CALCIFICATED LOBULATED

HAMARTOMAFIBROCYSTIC MASTOPATHY

WELL DEFINED HETEROGENOUS MASS ISOECHOIC TO THE MAMMARY GLAND

LOBULATED HYOECHOIC MASS CONTAINING LITTLE CYSTS

LOBULATED HETEROGENOUS MASSES WITH TALLER THAN WIDE LONG AXIS


SPICULATED MASSES WITH POSTERIOR SHADOWING


Of the 43 patients who underwent biopsy the pathology result shows :

- Infiltrating ductal carcinoma in 24 cases - A metastasis of melanoma in one case - A fibroadenoma in 11 cases - A fibrocystic mastopathy in 8 cases - A lipoma in one case - An hamartoma in 2 cases

Result (3)

The large number of biopsies performed for benign breast abnormalities has long been recognized as a serious problem.

the mammographic and ultrasonographic

features for differentiating benign from malignant solid mass can help to decrease the number of biopsies performed for benign solid masses.

Discussion

In order to detect small cancers in breast screening, it is essential to have high quality images.

Radiologists reading mammograms shoud be trained in the recognition of the malignant and benign signs of breast masses, because breast cancer may not show typical malignant features.

Discussion

The mammograhic features of a breast mass are essentially: - the shape - the margin - the mass density - the calcifications

Skin thikening, nipple retraction and architectural distorsion associated to a breast mass can be malignant signs

Discussion

mammography DIFFERENCIATION

BENIGN MALIGNANT

Shape Round / oval with light center

stellar

Margincircumscribed Spiculated/

microlobulated/ indistinct/ obscured

Mass density Low/ fat containing High/ dense center

calcifications

annular/ regular/ clear centre as an

eggshell/lucent centred/

Coarse or popcorn like/ large rod likeSkin or dermal and

vascular one

Size : uniform Distribution : any

Density : sparse

Vermicular/ irregular/ polyhedral/

pleomorphic/Fine/ branched and

numerous

Size : heterogenous Distribution : clustered/

segmentalDensity : high

Ultrasonography does contribuate the differentiation of benign versus malignant if the mass is not visible at mammography.

In women youger than 30 years, in whom mammography is less useful, ultrasonography is often considered the modality of choice to initiate the evaluation of a breast mass.

Discussion

The ultrasonographic features of a breast mass are essentially: - the shape - the margin - the orientation or long axis - the echotexture - the posterior acoustic features - the lesion boundary

Discussion

US DIFFERENCIATI

ONBENIGN MALIGNANT

Shape Round / oval++Three or fewer lobulation

IrregularMore than three

lobulation

Margin CircumscribedWell defined

Spiculated/angular/ microlobulated

Orientation Wider than taller : long axis parallel to skin

Taller than wide : long axis perpendicular to skin

Echotexture homogenous heterogenous

Echo pattern Markedly hypoechoic Puer and intesely hyperechoic

anechoic

Posterior acoustic feature

Enhancement Shadowing ++

Lesion boundary

Thick echogenic rim Abrupt interface

Benign breast masses

mammography ultrasound

CYST Circular or oval low-density mass with smooth margins

Well defined shaped lesion without internal echoes and with posterior acoustic enhancement

SEBACEOUS CYST Cyst like mass under the skin

A mass lieing entirely within the skin surrounded by a hyperechoic band « clow sign »

FIBROADENOMA Well defined or lobulated mass wicth can contain « pop corn » like calcifications

An isoechoic mass with wider than tall orientation and distal acoustic enhancement

LIPOMA A fat density mass with a thin capsula

Isoechoic or mildly hyperechoic mass

HAMARTOMA Well defined heterogenous mass with halo sign and fat density

Well defined mass with a same echotexture than the mammary gland

INTRAMAMMARY LYMPH NODE

Well limited low density mass with fatty hilum

Hypoechoic nodule with an echogenic hilum

The radiologist must be informed about the radiological criteria of benignity and malignancy of circumscribed breast mass.

Given the frequency of breast cancer, which affects one in ten women, in any doubt a biopsy should be indicated to give the definitive diagnosis.

Conclusion

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Breast calcifications: which are malignant Muttarak M, Kongmebhol P, Sukhamwang Singapore Med J 2009; 50(9) : 907

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