Janković Ana, Nadrljanski Mirjan, Karapandzić Vesna Plesinac, Ivanović Nebojsa, Radojicić Zoran, Milosević Zorica
Institute of Oncology and Radiology of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Vojnosanit Pregl. 2013 Nov;70(11):1034-8. doi: 10.2298/vsp120726032j.
BACKGROUND/AIM: Posterior breast cancers are located in the prepectoral region of the breast. Owing to this distinctive anatomical localization, physical examination and mammographic or ultrasonographic evaluation can be difficult. The purpose of the study was to assess possibilities of diagnostic mammography and breast ultrasonography in detection and differentiation of posterior breast cancers.
The study included 40 women with palpable, histopathological confirmed posterior breast cancer. Mammographic and ultrasonographic features were defined according to Breast Imaging Reporting and Data System (BI-RADS) lexicon.
Based on standard two-view mammography 87.5%, of the cases were classified as BI-RADS 4 and 5 categories, while after additional mammographic views all the cases were defined as BI-RADS 4 and 5 categories. Among 96 mammographic descriptors, the most frequent were: spiculated mass (24.0%), architectural distortion (16.7%), clustered micro-calcifications (12.6%) and focal asymmetric density (12.6%). The differentiation of the spiculated mass was significantly associated with the possibility to visualize the lesion at two-view mammography (p = 0.009), without the association with lesion diameter (p = 0.083) or histopathological type (p = 0.055). Mammographic signs of invasive lobular carcinoma were significantly different from other histopathological types (architectural distortion, p = 0.003; focal asymmetric density, p = 0.019; association of four or five subtle signs of malignancy, p = 0.006). All cancers were detectable by ultrasonography. Mass lesions were found in 82.0% of the cases. Among 153 ultrasonographic descriptors, the most frequent were: irregular mass (15.7%), lobulated mass (7.2%), abnormal color Doppler signals (20.3%), posterior acoustic attenuation (18.3%). Ultrasonographic BI-RADS 4 and 5 categories were defined in 72.5% of the cases, without a significant difference among various histopathological types (p = 0.109).
Standard two-view mammography followed by additional mammographic projections is an effective way to demonstrate the spiculated mass and to classify the prepectoral lesion as category BI-RADS 4 or 5. Additional ultrasonography can overcome the mimicry of invasive lobular breast carcinoma at mammography.
背景/目的：乳腺后部癌位于乳房胸肌前区域。由于这一独特的解剖定位，体格检查以及乳腺钼靶或超声评估可能会存在困难。本研究的目的是评估诊断性乳腺钼靶和乳腺超声在检测及鉴别乳腺后部癌方面的可能性。
本研究纳入了40例可触及、经组织病理学确诊为乳腺后部癌的女性。根据乳腺影像报告和数据系统（BI-RADS）术语定义乳腺钼靶和超声特征。
基于标准的双视图乳腺钼靶检查，87.5%的病例被分类为BI-RADS 4类和5类，而在增加乳腺钼靶视图后，所有病例均被定义为BI-RADS 4类和5类。在96个乳腺钼靶描述符中，最常见的是：毛刺状肿块（24.0%）、结构扭曲（16.7%）、簇状微钙化（12.6%）和局灶性不对称密度（12.6%）。毛刺状肿块的鉴别与在双视图乳腺钼靶检查中显示病变的可能性显著相关（p = 0.009），与病变直径（p = 0.083）或组织病理学类型（p = 0.055）无关。浸润性小叶癌的乳腺钼靶征象与其他组织病理学类型显著不同（结构扭曲，p = 0.003；局灶性不对称密度，p = 0.019；四个或五个细微恶性征象的关联，p = 0.006）。所有癌症均可通过超声检测到。82.0%的病例发现有肿块病变。在153个超声描述符中，最常见的是：不规则肿块（15.7%）、分叶状肿块（7.2%）、异常彩色多普勒信号（20.3%）、后方声衰减（18.3%）。72.5%的病例定义为超声BI-RADS 4类和5类，不同组织病理学类型之间无显著差异（p = 0.109）。
标准的双视图乳腺钼靶检查后增加乳腺钼靶投照是显示毛刺状肿块并将胸肌前病变分类为BI-RADS 4类或5类的有效方法。额外的超声检查可以克服乳腺钼靶检查中浸润性小叶癌的假象。
