The purpose of this study was to evaluate the diagnostic utility of sonoelastography in differentiating benign from malignant non-palpable breast lesions. A total of 293 BI-RADS 3-5 (Breast Imaging Reporting And Data System) impalpable breast lesions in 278 women was evaluated with B-mode ultrasound (US) and subsequently with sonoelastography (SE) before performing US-guided biopsy. Among the 293 lesions (size up to 2 cm), 110 (37.5%) were histologically malignant and 183 (62.5%) benign. Lesions that were malignant or showed atypical ductal hyperplasia were referred for surgical excision, as well as 32 benign lesions showing discordance between US/SE results and histology. All other benign lesions had US follow-up at 6/12 months, showing stability. Overall performance of SE was lower than US, with sensitivity and specificity of 80% and 80.9%, respectively, for SE as compared with 95.4% and 87.4% for US. Statistical analysis showed no improvement in the joint use of SE and US over the use of US alone, whose performance, however, was very high in our study. SE is a simple, fast and non-invasive diagnostic method that may be a useful aid to US for less experienced radiologists in the assessment of solid non-palpable breast lesions, especially BI-RADS 3, where specificity was higher (88.7%).

KEYWORDSBreast; Ultrasound; Benign breast lesions.Abstract Benign breast diseases constitute a heterogeneous group of lesions arising in the mammary epithelium or in other mammary tissues, and they may also be linked to vascular, inflammatory or traumatic pathologies. Most lesions found in women consulting a physician are benign. Ultrasound (US) diagnostic criteria indicating a benign lesion are described as well as US findings in the most frequent benign breast lesions.Sommario Le lesioni mammarie benigne costituiscono un gruppo eterogeneo di manifestazioni, sia proprie dell'epitelio mammario, sia con origine dagli altri tessuti che costituiscono l'organo, sia con altra patogenesi (vascolare, flogistica e traumatica). Esse costituiscono il reperto più frequente che si osserva nella maggior parte dei casi nei quali una donna pensa di avere un problema al seno e si rivolge al medico o al radiologo. Vengono riproposti da un punto di vista ecografico i criteri diagnostici che orientano per la benignità ed i quadri iconografici che si riscontrano nelle principali lesioni mammarie benigne ecograficamente identificabili. ª

Non-palpable breast cancers are often in situ or smaller and have less nodal and distant metastases than palpable lesions. They represent a heterogeneous group of tumours, which may have different prognostic behaviour. We analysed a retrospective series of 982 non-palpable breast cancers assessed histologically at the National Cancer Institute of Milan from 1985 to 1995, following pre-operative mammography-guided localization. The association between mammographic data (parenchymal pattern and findings), patient age and tumour histology was investigated by review of clinical records and statistical modelling. We also investigated the association between the presence or absence of microcalcification as a mammographic finding and pathological tumour characteristics (tumour size, axillary nodes status and grading) or receptor status for oestrogen (ER) and progesterone (PgR). In situ disease or invasive tumour with an intraductal component, whether extensive or not, were commoner in young women and mammography more frequently showed a dense parenchymal pattern and microcalcifications in these cases. In older women (55 years or more), a fatty breast pattern, nodular opacities with or without microcalcifications, and invasive tumours of the ductal, lobular, mixed or other types were closely related. When the relationships between mammographic findings, pathological tumour characteristics and receptor status were investigated for invasive cancers, there was an association between the presence of microcalcifications and less favourable tumour characteristics.

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KEYWORDSColor Doppler; Breast; Mammary lesions.Abstract Has color Doppler a role in the evaluation of mammary lesions? A schematic review of color Doppler diagnostic criteria, indicating a benign or malignant lesion, are described. Malignant tumors have a tendency to show increased vascularization, but avascular tumors may be found as well as hypervascular benign tumors. Number of vessels, blood-flow velocity, and intra-tumoral vessel resistance assessed by color Doppler ultrasonography don't permit clear differentiation between malignant and benign tumors, but intra-tumoral blood-flow analysis well correlates with aggressiveness and histological grade of the mass, so a preoperative assessment using Color Doppler may give preliminary prognostic informations useful for therapeutic planning. Color Doppler ultrasound may be valuable also in assessing the efficacy of neoadjuvant chemotherapy and in particular of antiangiogenesis treatments. Color Doppler ultrasound has many other useful applications in the evaluation of diseases of the female and male breast, that are reviewed in the paper. Color Doppler however is not conceived as a stand-alone examination, but associated with Bmode ultrasound that is quite effective as a diagnostic tool, often not requiring Doppler informations.Sommario Il color Doppler ha un ruolo nella valutazione delle lesioni mammarie? Viene presentata una rassegna schematica dei criteri diagnostici color Doppler, che indicano la benignità o la malignità di una lesione. I tumori maligni hanno la tendenza a mostrare vascolarizzazione aumentata, ma si possono trovare tumori maligni avascolari, così come tumori benigni ipervascolarizzati. Numero di vasi, velocità del flusso, indici di resistenza non consentono una sicura differenziazione tra tumori maligni e benigni, ma l'analisi del flusso intratumorale si correla bene con l'aggressività ed il grado istologico della neoplasia, quindi una valutazione preoperatoria, utilizzando il Color Doppler, può fornire informazioni prognostiche preliminari utili per la pianificazione terapeutica. * Corresponding author.E-mail address: giabusil@tin.it (P. Busilacchi). Può essere utile anche per valutare l'efficacia della chemioterapia neoadiuvante e, in particolare di trattamenti antiangiogenesi. Il color Doppler ha molte altre applicazioni nella valutazione delle patologie della mammella femminile e maschile, che vengono esaminati nel presente articolo. Il color Doppler, tuttavia, non è concepito come un esame autonomo, ma associata all'ecografia B-mode, che è molto efficace come strumento diagnostico delle lesioni mammarie e che, spesso, non richiede informazioni Doppler. ª