Mammary nodules as incidental findings on chest computed tomography: a retrospective analysis on their frequency and predictive value (original) (raw)
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Current Problems in Diagnostic Radiology, 2014
This pictorial review demonstrates computed tomography (CT) features with mammogram and, in some instances, ultrasound and positron emission tomography scan correlation of a wide spectrum of both malignant and benign findings on breast evaluation. Characterization of the margins, shape, pattern of enhancement, density, and associated findings is essential for accurate assessment of breast lesions during CT examination. Spiculated margins, irregular shape, and the presence of enhancement have a high predictive pattern for malignancy. The associated findings that could be seen include skin thickening, lymphadenopathy, architectural distortion, or chest wall or skin invasion. Nearly all detected breast calcifications on chest CT scans are benign. However, any breast masses and calcifications seen need further evaluation by other modalities, such as mammography or ultrasound or both. Malignant Entities The most highly predictive pattern for malignancy includes spiculated margins and irregular shape
4–11 Risk of Malignancy in Solid Breast Nodules According to Their Sonographic Features
Breast Diseases: A Year Book Quarterly, 2006
Objective. The purpose of this study was to assess the risk of malignancy for each type of sonographic feature in solid breast nodules. Methods. The study included 304 patients from the Department of Gynecology and Obstetrics of the Federal University of Goiás who had solid breast nodules. A medical trainee, working under the supervision of a preceptor, obtained the sonographic images of the breast, and the features were recorded in a questionnaire. Each sonographic feature was analyzed and compared with the anatomic and pathologic findings after the lesion was excised. Results. Of the 304 patients included in the study, 292 (96%) had a conclusive diagnosis. Among these women, 216 (74%) had benign tumors and 76 (26%) had malignant tumors. The odds ratio of malignancy in breast nodules, as calculated by multivariate analysis, was as follows: lesions without circumscribed margins, 17.02 (95% confidence interval, 5.28-54.90); lesions with heterogeneous echo texture, 7.70 (2.99-19.84); lesions with thickened Cooper ligaments, 15.61 (1.08-225.10); nodules whose anteroposterior dimension was larger than their width, 3.29 (1.09-9.96); those with an anterior echogenic rim, 2.59 (0.80-8.40); and those with posterior shadowing, 1.57 (0.62-4.01). Among the 133 cases that had all the sonographic features of a benign lesion, 3 nodules (2.3%) had a histologic diagnosis of malignant. Conclusion. Sonography is a diagnostic method that can help establish the differentiation between benign and malignant solid tumors. A lack of circumscribed margins, heterogeneous echo patterns, thickened Cooper ligaments, and an increased anteroposterior dimension can indicate a higher probability of malignancy in solid breast nodules.
INCIDENTAL BREAST PATHOLOGY DETECTED IN CHEST COMPUTER TOMOGRAPHY (CT)
Objective To emphasize the importance of requested chest CT scan for cardiothoracic conditions for radiologist to evaluate the breast area this may impact patient’s management. Material and method A total number of 130 female patients whom underwent chest CT for cardiothoracic reasons, were retrospectively reviewed their images to evaluate and characterize breast lesions in a period between June 2016 –December 2017 at King Hussein Medical Center. The age of the patient’s ranges from (20-70 years) with the mean age 45 years. All scans were performed with Siemens definition dual source 64 slice CT scan, chest CT scan protocol with intravenous (IV) contrast media. The results will be analyzed by simple statistical method.
Incidental breast lesions detected on CT: what is their significance?
British Journal of Radiology, 2010
An increasing number of breast lesions are being detected incidentally on CT. The aim of this study was to investigate the rate of referrals to the breast unit for assessment of lesions identified on CT and the resulting yield of previously undiagnosed breast malignancies from this pathway. A retrospective review was undertaken of CT examinations conducted over a period of 14 years. All patients (with no previous history of breast cancer) whose report contained the keyword ''breast'' and who were referred to a specialist breast unit for assessment were reviewed. CT lesion morphology and enhancement pattern were identified and compared with the final diagnostic outcome. 70 patients were identified by retrospective analysis, yielding 78 incidental breast lesions, of which 22 (28.2%) were malignant (category B5). This gave a positive predictive value (PPV) for malignancy of 28.2%. The best morphological predictor of malignancy was spiculation (PPV, 76%) and irregularity (PPV, 58%), whereas calcification patterns (PPV, 36%) were diagnostically unhelpful. Malignant lesions were likely to be larger (mean, 28.5 mm) than benign lesions (mean, 20.2 mm; p,0.05). In conclusion, 30% of incidental breast lesions in this large series of patients proved to be unsuspected breast cancers, particularly irregular spiculated masses. Referral for formal triple assessment of CT-diagnosed breast lesions is worthwhile, and careful examination of the breast should be a routine part of CT examinations.
Focal Breast Lesions in Clinical CT Examinations of the Chest: A Retrospective Analysis
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren
Purpose Based on radiological reports, the percentage of breast cancers visualized as incidental findings in routine CT examinations is estimated at ≤ 2 %. In view of the rising number of CT examinations and the high prevalence of breast cancer, it was the goal of the present study to verify the frequency and image morphology of false-negative senological CT findings. Materials and Methods All first contrast-enhanced CT examinations of the chest in adult female patients carried out in 2012 were retrospectively included. A senior radiologist systematically assessed the presence of breast lesions on all CT images using the BI-RADS system. All BI-RADS ≥ 3 notations were evaluated by a second senior radiologist. A consensus was obtained in case of differing BI-RADS assessments. Reference diagnoses were elaborated based on all available clinical, radiological and pathological data. The findings of the CT reports were classified according to the BI-RADS system and were compared with the r...
Atypical ultrasound appearance of benign breast nodules
medultrason.ro
Circumscribed breast masses prezent, frequently a typical ultrasound appearance, with no diffi culties in establishing the correct diagnosis. Sometimes, these lesions may have a complex appearance and an ultrasound atypical image, which may lead to diffi culties in differentiating them from other benign or malignant breast disorders. This is why, in any case of circumscribed mass discovered on ultrasound, all features should be carrefully analysed, in order to avoid unneccesary interventional procedures and, on the other hand, to avoid the missdiagnosis with important therapeutical consequences.
Agreement of breast nodularity on clinical examination and mammographic density
Nursing and Midwifery Studies, 2018
Background: Breast density is routinely reported on mammograms, while breast nodularity is seldom reported on clinical examination, and there is no standard system for its classification. Objectives: The aim of this study was to evaluate the agreement of mammographic density with nodularity on clinical breast examination (CBE). In addition, the relationship of mammographic density with age, menopausal status, and number of parities were assessed. Methods: This cross-sectional study was conducted from September 2013 to February 2014, on 30-70-year-old women who referred for screening or diagnostic mammography to Shahid Beheshti Hospital, Kashan, Iran. Nodule size, nodule consistency, and mammographic density were assessed, and Cohen's kappa coefficient was calculated. The Chi-square test was also used to assess the relationship of mammographic density with age, menopausal status, and a number of parities. Results: In this study, 320 women with an age mean value of 46.01 ± 7.73 underwent mammography and CBE. Mammographic density showed a statistically significant weak agreement with nodule size (Kappa coefficient = 0.275; P < 0.001) and nodule consistency (Kappa coefficient = 0.256; P < 0.001). Moreover, mammographic density was inversely related to age, menopausal status, and number of parities (P < 0.001). Conclusions: Breast nodularity on clinical examination has only a weak agreement with mammographic density. Further studies are needed to develop more comprehensive instruments for assessing not only nodule size and consistency but also nodules distribution in all breast quadrants.
Atypical ultrasound appearance of malignant breast nodules
medultrason.ro
Breast cancer represents the most frequent malignancy in women, with more than a million cases of breast cancer diagnosed worldwide each year. Despite the increasing incidence, mortality from breast cancer continues to fall mainly due to earlier detection via mammographic screening but also due to the complementary diagnostic imaging methods. Among these, ultrasound is most frequently used to reach a correct diagnosis. Despite the fact that ultrasound is able to differentiate between benign and malignant breast masses, in practice, there are many situations in which the atypical appearance of a mass leads to misdiagnosis. This is why, in the case of a breast nodule, all the sonographic features should be carefully analysed in order to reach the correct diagnosis and to reduce the rate of false negative results.
Reproducibility of histological diagnosis of breast lesions: Results of a panel in Italy
European Journal of Cancer, 1996
Sixteen pathologists independently examined and classified a series of 81 breast lesions selected from the files of several Italian Pathology Departments in the context of a national task force on breast cancer (FONCAM). A four category classification system was used for analysis; according to the majority diagnosis (MD), simply defined as the most frequently reported in the panel, the series included 37 benign lesions without atypia (45.7%), nine atypical hyperplasias (1 l.l%), 18 in situ (22.2%) and 17 invasive carcinomas (21.00/o. Concordance, estimated for all possible pair-wise comparisons between pathologists, was good (mean kappa value: 0.59). A comparison between the diagnoses of each pathologist and the panel majority diagnosis was also made. Overall, a global kappa value of 0.72 was found (range 0.57-0.85), with category-specific values being excellent for invasive carcinoma (0.89) and benign lesions without atypia (0.77), relatively good for in situ carcinoma (0.69) but poor for atypical hyperplasia (0.38). These results confirm that quality assurance procedures are particularly indicated for large screening programmes for breast cancer, and suggest that for atypical lesions strict diagnostic criteria should be adopted.