“The unusual suspects”—Mammographic, sonographic, and histopathologic appearance of atypical breast masses

Naeem, Muhammad; Zulfiqar, Maria; Ballard, David H.; Billadello, Laura; Cao, Guihua; Winter, Andrea M.; Lowdermilk, Mary Catherine

doi:10.1016/j.clinimag.2020.04.039

Cited by 3 publications

(3 citation statements)

References 57 publications

(72 reference statements)

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“…Patient 5, who had dermal sclerosis, did have a mammogram demonstrating an interval worsening of skin thickening, which prompted workup that led to her RAAS diagnosis. Our findings are concordant with prior literature and highlight that mammography often demonstrates normal findings or only nonspecific findings, such as skin thickening, and is unreliable for surveillance/detection of RAAS [8,25,[38][39][40][41]. We found PET/CT particularly useful; extensive skin thickening (.5 cm) with mild to moderate uptake was evident in all cases (median standard uptake value, 2.8; range, 1.9-12.5); coregistration of PET/CT images with CT simulation images facilitated target delineation in conjunction with clinical findings.…”

Section: Imagingsupporting

confidence: 91%

Hyperfractionated-Accelerated Reirradiation with Proton Therapy for Radiation-Associated Breast Angiosarcoma

Looi

Bradley

Liang

et al. 2022

International Journal of Particle Therapy

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Purpose Radiation-associated angiosarcoma (RAAS) is a rare complication among patients treated with radiation therapy for breast cancer. Hyperfractionated-accelerated reirradiation (HART) improves local control after surgery. Proton therapy may further improve the therapeutic ratio by mitigating potential toxicity. Materials and Methods Six patients enrolled in a prospective registry with localized RAAS received HART with proton therapy between 2015 and 2021. HART was delivered twice or thrice daily in fraction sizes of 1.5 or 1.0 Gy, respectively. All patients received 45 Gy to a large elective volume followed by boosts to a median dose of 65 (range, 60-75) Gy. Toxicity was recorded prospectively by using the Common Terminology Criteria for Adverse Events, version 4.0. Results The median follow-up duration was 1.5 (range, 0.25-2.9) years. The median age at RAAS diagnosis was 73 (range, 60-83) years with a median latency of 8.9 (range, 5-14) years between radiation therapy completion and RAAS diagnosis. The median mean heart dose was 2.2 (range, 0.1-4.96) Gy. HART was delivered postoperatively (n = 1), preoperatively (n = 3), preoperatively for local recurrence after initial management with mastectomy (n = 1), and as definitive treatment (n = 1). All patients had local control of disease throughout follow-up. Three of 4 patients treated preoperatively had a pathologic complete response. The patient treated definitively had a complete metabolic response on her posttreatment PET/CT (positron emission tomography–computed tomography) scan. Two patients developed distant metastatic disease despite local control and died of their disease. Acute grade 3 toxicity occurred in 3 patients: 2 patients undergoing preoperative HART experienced wound dehiscence and 1 postoperatively developed grade 3 wound infection, which resolved. Conclusion HART with proton therapy appears effective for local control of RAAS with a high rate of pathologic complete response and no local recurrences to date. However, vigilant surveillance for distant metastasis should occur. Toxicity is comparable to that in photon/electron series. Proton therapy for RAAS may maximize normal tissue sparing in this large-volume reirradiation setting.

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Section: Imagingsupporting

confidence: 91%

Hyperfractionated-Accelerated Reirradiation with Proton Therapy for Radiation-Associated Breast Angiosarcoma

Looi

Bradley

Liang

et al. 2022

International Journal of Particle Therapy

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“…Sarcoidosis of the Breast DOI: http://dx.doi.org/10.5772/intechopen.1003708 architectural distortion which has been described as a high density mass with spiculated margins [2,21]. Calcifications were relatively uncommon, observed in only 17% of the patients, and when present, they tended to be fine and punctate.…”

Section: Breast Sarcoidosis Involving the Right Upper-inner Quadrant ...mentioning

confidence: 99%

“…Furthermore, posterior acoustic shadowing, suggesting a dense or solid nature of the masses, was observed in 79% of patients. Sarcoidosis can be seen as a solitary irregular mass, but can also be seen as multiple masses [21,22]. In some cases, diffuse hypoechoic parenchymal changes without distinct masses have been documented.…”

Section: Breast Sarcoidosis Involving the Right Upper-inner Quadrant ...mentioning

confidence: 99%

Sarcoidosis of the Breast

Pluguez-Turull,

Del Toro,

Tjendra

2024

Sarcoidosis - Diagnosis, Research, and Therapy of a Granulomatous Disease

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The clinical manifestation of breast sarcoidosis accounts for <1% of cases of sarcoidosis and typically presents in the setting of already documented systemic involvement. Within the breast, sarcoidosis can often present as a firm palpable mass in young or middle-aged women. On mammography, imaging findings range from small, well-defined round masses to irregular, spiculated masses. Ultrasound most commonly demonstrates an ill-defined hypoechoic mass. As a result, breast sarcoidosis can mimic benign and malignant pathologies such as fat necrosis, fibroadenoma or breast cancer. This variability in imaging appearance represents a diagnostic challenge often culminating in image-guided or surgical biopsy and histological analysis to establish a definitive diagnosis. Ultimately, while breast involvement is uncommon, it accentuates the diverse clinical manifestations of sarcoidosis, which may be clinically suspected and must be adequately evaluated to exclude more significant pathologies.

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Meme Lezyonlarının Tanısında Ultrasonografi Eşliğinde İnce İğne Aspirasyon Sitolojisi Uygulamasının Etkinliği

Şener

Demircioglu

Öztürk³

2020

City Med J

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Bu çalışmada, özellikle malign potansiyeli olan meme lezyonlarında ultrason eşliğinde uygulanan ince iğne aspirasyonunun güvenilirliği değerlendirildi. İnce iğne aspirasyon siyolojisi ile olguların eksizyonel biyopsilerini karşılaştırarak ince iğne aspirasyonunun kesin tanıya ulaştırabilirliği araştırıldı. Hastanemiz Radyoloji Kliniği meme ünitesinde 2005-2009 tarihleri arasında memedeki kitlesine US eşliğinde ince iğne aspirasyon sitolojisi (İİAS) yapılan olgular dahil edildi. 163 olguda saptanan ve İİAS uygulanan 163 solid kitle retrospektif olarak tarandı. İİAS’nin lezyon gruplarına göre özgüllük oranı, duyarlılık oranı, negatif öngörü oranı ve yanlış negatiflik oranı hesaplandı. Sonografik olarak BIRADS 3 olarak değerlendirilen 124 kitlenin 116 tanesinin aspirasyon sonucu benign, 7 tanesinin sonucu tanısal olmayan sitoloji ve 1 tanesinin sonucu maligndi. İİAS’nin BIRADS 3 lezyonlar için yanlış negatiflik oranı %0,8, negatif öngörü oranı %99.1 olarak hesaplandı. BIRADS 4 olgularda IIAS sonuçları ile eksizyonel biyopsilerin sonuçları karşılaştırıldığında, sitolojisi adenozis olarak raporlanan bir olgunun biyopsi sonucunun da adenozis olduğu (%100), benign sitoloji olarak raporlanan 11 olgunun 1’i lobüler karsinoma insitu (%9), 3’ü(%27) fibroadenom, 7’si(%64) ise fibrokistik hastalık olarak raporlandı. Sitoloji sonucu malign bildirilen 5 olgunun doku tanıları ise 3 infiltratif duktal karsinom (%60), 1 infiltratif lobüler karsinom (%20) ve 1 insitu karsinom (%20) olarak raporlandı. Sitoloji sonucu duktal karsinom bildirilen 1 olgunun doku tanısı da duktal karsinom olarak raporlandı. Sonografik olarak BIRADS 5 kriterdeki 7 kitlenin boyutları 13-24 mm arasında (ort 19 mm) idi. Bu lezyonların İİAS sonuçları 3 malign sitoloji(%43), 4 duktal karsinom idi (%57). Duktal karsinom olarak sitolojisi raporlanan olguların tamamının doku tanısı da duktal karsinom, malign sitoloji olarak raporlanan olguların 2’si lobüler karsinom(%67), 1’i ise duktal karsinom olarak raporlandı (%33). Sonuç olarak İİAS iyi bir sitolog varlığında, radyoloji ve klinik ile beraber değerlendirildiğinde güvenilir sonuçlar vermekle beraber şüpheli ve uyumsuz sonuçlarda doku tanısı ile desteklenmesi gerekmektedir.

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“The unusual suspects”—Mammographic, sonographic, and histopathologic appearance of atypical breast masses

Cited by 3 publications

References 57 publications

Hyperfractionated-Accelerated Reirradiation with Proton Therapy for Radiation-Associated Breast Angiosarcoma

Hyperfractionated-Accelerated Reirradiation with Proton Therapy for Radiation-Associated Breast Angiosarcoma

Sarcoidosis of the Breast

Meme Lezyonlarının Tanısında Ultrasonografi Eşliğinde İnce İğne Aspirasyon Sitolojisi Uygulamasının Etkinliği

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