Posterior breast cancer – mammographic and ultrasonographic features

Ana Janković; Mirjan Nadrljanski; Vesna Plešinac Karapandžić; Nebojša Ivanović; Zoran Radojičić; Zorica Milošević

doi:10.2298/2316

Ana Janković Institute of Oncology and Radiology of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Mirjan Nadrljanski Institute of Oncology and Radiology of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Vesna Plešinac Karapandžić Institute of Oncology and Radiology of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Nebojša Ivanović Institute of Oncology and Radiology of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Zoran Radojičić Faculty of Organizational Sciences, University of Belgrade
Zorica Milošević Institute of Oncology and Radiology of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

DOI: https://doi.org/10.2298/2316

Keywords: breast neoplasma, mammography, ultrasonography, sensitivity and specificity,

Abstract

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. Methods. 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. Results. 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 microcalcifications (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). Conclusion. 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.

References

Vrdoljak E, Wojtukiewicz MZ, Pienkowski T, Bodoky G, Berzinec P, Finek J, et al. Cancer epidemiology in Central, South and Eastern European countries. Croat Med J 2011; 52(4): 478−87.

Morris EA, Schwartz LH, Drotman MB, Kim SJ, Tan LK, Liberman L, et al. Evaluation of pectoralis major muscle in patients with posterior breast tumors on breast MR images: Early experience. Radiology 2000; 214(1): 67−72.

American College of Radiology (ACR). ACR Breast imaging reporting and data system: Breast Imaging Atlas. ACR breast imaging reporting and data system, breast imaging atlas. . Reston, VA: American College of Radi-ology; 2003.

Kopans DB. Breast imaging. Philadelphia: Lippincott; Philadelphia, PA: Lippincott-Raven; 1998.

Brown M, Eccles C, Wallis MG. Geographical distribution of breast cancers on the mammogram: An interval cancer database. Br J Radiol 2001; 74(880): 317−22.

Tabár L, Tot T, Dean PB. Breast Cancer : The Art and Science of Early Detection with Mammography: Perception, Interpretation, Histopathologic Correlation. 2nd ed. New York: Georg Thieme Verlag; 2005.

Liberman L, Abramson AF, Squires FB, Glassman JR, Morris EA, Dershaw DD. The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories. AJR 1998; 171(1):35−40.

Jankovic A. Mammographic and ultrasonographic features of prepectoral carcinomas [thesis]. Belgrade: School of Medicine; 2012. (Serbian)

Tucker AK. Textbook of mammography. Edinburgh, London, Madrid, Melbourne, New York, Tokyo: Churchill Livingstone; 1993.

Majid AS, de Paredes ES , Doherty RD, Sharma NR, Salvador X. Missed breast carcinoma: Pitfalls and pearls. Radiographics 2003; 23(4): 881−95.

Fu KL, Fu YS, Lopez JK, Cardall SY, Bassett LW. The normal breast. Diagnosis of diseases of the breast. In: Bassett LW, Jackson VP, Fu SK, Fu YS, editors. Philadelphia: Saunders; 2005. p. 396.

Bane AL, Tjan S, Parkes RK, Andrulis I, Frances OP. Invasive lobular carcinoma: to grade or not to grade. Mod Pathol 2005;18(5):621-8.

Mann RM, Hoogeveen YL, Blickman JG, Boetes C. MRI compared to conventional diagnostic work-up in the detection and evaluation of invasive lobular carcinoma of the breast: A review of existing literature. Breast Cancer Res Treat 2008; 107(1): 1−14.

Albayrak ZK, Onay HK, Karatag GY, Karatag O. Invasive lobular carcinoma of the breast: mammographic and sonographic evaluation. Diagn Interv Radiol 2011; 17(3): 232−8.

Kaiser WA. Signs in MR-Mammography. Berlin, Heidelberg, New York: Springer-Verlag; 2008.