Ultrasonographic features of traumatic neuromas in breast cancer patients after mastectomy

Abstract

PurposeThe purpose of this study was to evaluate the ultrasonographic (US) features of traumatic neuromas in breast cancer patients after mastectomy.MethodsThis study was performed with approval from our Institutional Review Board, and the requirement for informed consent was waived. Six traumatic neuromas in five patients were included in this study. The US findings of traumatic neuromas were evaluated retrospectively by two radiologists according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The final assessment was also recorded.ResultsOn US, all six lesions presented as a mass within the pectoralis muscle layer (mean size, 4.8 mm; range, 3.9 to 5.5 mm). Of the six masses, four had an oval shape with a circumscribed margin, and two had an irregular shape and an indistinct margin. They were all hypoechoic. Two lesions showed a non-parallel orientation. On color Doppler examinations, two lesions showed internal vascularity. Strain elastography was performed for four neuromas, resulting in scores of 1 (n=1), 4 (n=2), and 5 (n=1). The final assessment categories were BI-RADS 3 (n=2), 4A (n=2), and 4B (n=2).ConclusionOn US, an oval shape, circumscribed margin, parallel orientation, and hypoechogenicity were the most frequent features of traumatic neuromas in breast cancer patients after mastectomy. Neuromas may show increased vascularity on color Doppler imaging and present as a hard mass on elastography.

Traumatic neuroma as a rare cause of intractable neuropathic breast pain following cancer surgery: Management and review of the literature

“…Although in some cases the mass is painless (18,21), however, persistent chronic pain has been reported (19,24). In all six cases presented by Sung et al (10), the TBN was located within the pectoralis major muscle near the mastectomy scar. TBN may be occult on mammogram (6,18).…”

“…On ultrasonography, TBN may appear as a homogenous well circumscribed hypoechoic mass with no internal vascular flow on color Doppler imaging (6,18,20,21). In some cases, however, TBN may appear as an irregularly shaped mass with indistinct margins and nonparallel orientation (10,23). A tail sign on ultrasonography has been reported in 50% of the cases reported by Al Sharif et al (6).…”

“…Clinically TBN may present as a palpable mass or may be identified incidentally (1,6,10). It is most commonly encountered in the upper outer quadrant of the breast (6,10).…”

“…Clinically TBN may present as a palpable mass or may be identified incidentally (1,6,10). It is most commonly encountered in the upper outer quadrant of the breast (6,10). Although in some cases the mass is painless (18,21), however, persistent chronic pain has been reported (19,24).…”

“…The most common MRI finding in the remaining cases was an isointense foci on T1 weighted images with a benign type I enhancement curve (2). On positron emission tomography (PET) computed tomography (CT) scan no fluorodeoxyglucose (FDG) focal uptake of TBN has been reported (10,20).…”