Ultrasound Diagnosis of Breast Lymphoma and the Identification of Breast Infiltrating Ductal Carcinoma

Abstract

Objectives-By analyzing the B-mode ultrasound and color Doppler flow imaging characteristics of breast lymphoma (BL) and breast infiltrating ductal carcinoma (BIDC), we expected to discriminate these diseases.Methods-Thirty-two patients with BL and 30 with BIDC confirmed pathologically were selected. The BL group was divided into nodular and diffuse groups. We analyzed and compared the general and imaging characteristics of the BL subgroups and the BIDC group.Results-The mean maximum diameter of BL was 54.93 AE 43.74 cm, and that of BIDC was 23.90 AE 6.79 cm (P < .05). The differences between the nodular BL and BIDC groups in a circumscribed margin (60.00% versus 20.00%), calcification (20.00% versus 53.33%), aggregation characteristics (0.00% versus 53.33%), and density (73.33% versus 10.00%) were statistically significant (P < .05). The differences between the diffuse BL and BIDC groups in calcification (6.67% versus 53.33%), aggregation characteristics (6.67% versus 53.33%) and density (40.00% versus 10.00%) were statistically significant (P < .05). The difference in a circumscribed margin (60% versus 13.33%) between the BL subgroups was statistically significant (P < .05). The blood flow signal in BL lesions was richer than that in BIDC lesions (P < .05).Conclusions-Extrasuperior-quadrant single lesions in the BL group were larger than those in the BIDC group. The edges of the lesions in the nodular BL group were circumscribed and dense. Lesions in the diffuse BL group did not have a circumscribed margin, calcification, aggregation characteristics, or density. The blood flow signal in BL lesions was richer than that in BIDC lesions.

Multimodal Ultrasonography Features of Breast Lymphomas

“…BLs is frequently hypervascularity. 13,15,19 In this study, all three patients presented abundant blood supply, and large perforator blood flow signals even dendritic blood flow signals were seen in all cases. This is different from BCs of which usually detected some vessels, tortuous arteries, can be detected at the periphery of some malignant tumors.…”

“…Blood supply is also a parameter to distinguish benign and malignant tumors. BLs is frequently hypervascularity 13,15,19 . In this study, all three patients presented abundant blood supply, and large perforator blood flow signals even dendritic blood flow signals were seen in all cases.…”

“…Ultrasound elastography has been proven to aid in the diagnosis of breast lesions as malignant or benign, with malignancy appearing stiffer compared with normal breast tissue. Because BLs are rare, there is a relatively small number of reports focusing on elastography of BLs have been published, with a very small number of cases 9,13,15,21–23 . Although these reports used different elastic imaging techniques, however, the results show that most of BLS showed soft‐to‐intermediate elasticity and a few of them show hard 9,13,15,22,23 .…”

“…The internal echotexture of a mass is an important US feature in breast diagnostic workup. However, the US findings of BLs are heterogeneous and lack specificity, usually appear as a hypoechoic solid mass with circumscribed or indistinct margins, [10][11][12][13] or mixed echo of hyperechoic and hypoechoic, 4,6-8,14-16 or circumscribed and very low echoic, mimicking cysts, 15,16 or indistinct and irregular hyperechoic masses in the subcutis and internal tubular branching hypoechogenicity was be contained in hyperechoic areas. 17,18 In the present study, one of PBLs showed a mixed echo mass dominated by hyper echo with indistinct margin, and it was divided into small patches by some irregular hypo echo, which looks like dry earth ground.…”

“…Adrada et al 18 thought the hyperechoic nature of BLs likely reflect the high tumor cellularity. Chen et al 15 divided the BLs into nodular and diffuse types according to the boundary of the US image. The unclear margins may reflect the invasion of surrounding tissue by the abnormal cells.…”