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Real-time breast sonography: application in 300 consecutive patients.

Sonography, disappointing as a primary screening method, has emerged as the single most helpful adjunct to mammography in evaluation of the clinically and/or mammographically abnormal breast. Sonography can reliably diagnose simple cysts presenting as palpable masses or as indeterminate, nonpalpable lesions on mammography. However, differentiation of benign from malignant solid masses cannot be reliably accomplished by sonography. The expense of an automated breast sonographic scanner has deterred many radiologists from the purchase of such a unit. The authors have used both an automated breast scanner and a real-time 10-MHz hand-held unit. This paper describes their experience with the real-time unit, demonstrating both normal and pathologic anatomy. Special emphasis has been placed on the sonographic diagnosis of a simple cyst because this lesion was the cause of one-quarter of all palpable masses and nonpalpable, mammographically dominant masses. Cysts are sharply marginated and anechoic. Posterior enhancement visible in 78 of 80 cysts was not demonstrable on all images in 25% of cysts.

Adenofibroma↗

Optical spectroscopy (INVOS) is unreliable in detecting breast cancer.

Recently a new nonionizing, nonimaging technique for evaluating risk of breast cancer, in vivo optical spectroscopy (INVOS), became available. The procedure evaluates the biochemical composition of the breast with spectrophotometry to provide a risk number related to the development of breast cancer. INVOS was evaluated in a prospective study of 180 women who were referred to our institution for needle localization and excisional biopsy of 181 breast lesions. All women had mammography and INVOS before surgical biopsy. The INVOS risk numbers and mammographic findings were compared with the pathologic diagnoses. Of 39 breast cancers, 19 (49%) had high-risk INVOS numbers, as did 52% of women with benign disease. INVOS had a sensitivity of 95%, specificity of 4%, and a positive predictive value of 21% for the detection of breast cancer. Mammography predicted malignancy with a sensitivity of 97%, specificity of 48%, and a positive predictive value of 34%. Receiver-operating-characteristic (ROC) curve analysis also was performed. The ROC area for mammography was 0.85 compared with 0.43 for INVOS, indicating a significantly greater (p less than .0000001) ability for mammography to detect breast cancer. We conclude that because INVOS cannot accurately predict the presence of breast cancer, it is unlikely that INVOS can be used to predict which patients are at risk for the development of breast cancer.

Adenofibroma↗

Doppler sonography of adnexal masses: the predictive value of the pulsatility index in benign and malignant disease.

OBJECTIVE: The purpose of this study was to determine whether pulsed Doppler sonography can be used to distinguish between benign and malignant adnexal masses on the basis of pulsatility index. SUBJECTS AND METHODS: In an 18-month period, all patients in whom an adnexal mass was detected at sonography had further evaluation of the mass by color and pulsed Doppler sonography. Ninety-nine patients with 102 masses that were surgically removed were included in the study. The pulsatility indexes were calculated from the reproducible spectral waveforms generated from flow centrally or peripherally within or immediately adjacent to the mass. Each lesion was categorized on the basis of its gray scale morphologic features as typically benign or indeterminate/malignant in appearance. RESULTS: Of the 102 adnexal masses, 89 were benign and 13 were malignant. In seven of the 89 benign lesions, no flow could be detected, and these were excluded from analysis. Of the remaining 82 benign lesions, 65 showed pulsatility indexes consistently equal to or greater than 1.0, and 17 showed pulsatility indexes of less than 1.0. Ten of the 13 malignant lesions had pulsatility indexes consistently less than 1.0, and three primary malignant tumors had their lowest pulsatility indexes ranging between 1.1 and 1.8. Sixty-five of the 68 masses with pulsatility indexes equal to or greater than 1.0 were benign, for a positive predictive value of 96% for benign disease. Ten of the 27 masses with pulsatility indexes of less than 1.0 were malignant, for a positive predictive value of 37% for malignant disease. Forty-five masses were detected in perimenopausal and postmenopausal patients. In this group, the pulsatility index had a positive predictive value of 88% for benign disease and 47% for malignant disease. In this study, 45 of 49 masses that had a typically benign sonographic appearance had pulsatility indexes equal to or greater than 1.0. All 49 masses had benign histology. In the remaining 46 masses with an indeterminate/malignant sonographic appearance, 20 of 23 with pulsatility indexes equal to or greater than 1.0 were benign, and 10 of 23 with pulsatility indexes of less than 1.0 were malignant. CONCLUSION: Our results show a high positive predictive value of high-impedance flow in benign adnexal disease and a predominance of low-impedance flow in malignant adnexal disease. However, the pulsatility indexes showed considerable overlap between benign and malignant lesions, indicating that Doppler sonography has severe limitations in the differentiation of benign from malignant adnexal disease on the basis of low-impedance flow (pulsatility index < 1.0).

Adenofibroma↗

Serous adenocarcinofibroma of the ovary--report of two cases and review of the literature.

We investigated the clinical and histologic characteristics of patients with ovarian serous adenocarcinofibroma. Because the tumors in both cases contained fibroma components; they were hard and clinically indistinguishable from uterine myoma, even by computed tomography. Both patients experienced relapses associated with tumors that originated outside the abdominal cavity (the subcutaneous abdominal wall in case 1, and the inguinal lymph nodes in case 2). The serum level of CA125 was normal or only moderately elevated at the first onset and relapse. The present cases suggest that the diagnostic features and clinical course differ between ovarian serous adenocarcinoma and serous adenocarcinofibroma.

Adenocarcinoma↗

Papillary cystadenofibroma of the endometrium.

Six cases of papillary cystadenofibroma of the endometrium were found in he medical literature. A seventh case of this kind of tumor is now described clinico-pathologically and the literature pertinent to this particular type of tumor reviewed.

Adenofibroma↗

Extragenital endometrioid cystadenofibroma.

We present a case of extragenital endometrioid cystadenofibroma, whose rare pelvic localization is the motive for its publication, as no similar case had been described previously. Its possible histogenesis from a pelvic mesothelium, as well as the differential diagnosis from pelvic endometriosis is discussed.

Adenofibroma↗

Glycosaminoglycans in human breast cancer.

Abnormal concentrations of glycosaminoglycans (GAG) have been reported for various types of tumors, suggesting that they may play a role in neoplasia. The correlation between the content of individual GAGs was studied in breast tumor tissues. The total content of GAG was estimated by uronic acid analysis. The relative distributions of dermatan sulphate, heparan sulphate, hyaluronic acid and chondroitin sulphate were measured after cellulose acetate electrophoresis. Mammary tissue samples were obtained at the time of surgery from 11 women, 6 with fibroadenomata and 5 with carcinoma. From each patient, biopsies were obtained centrally in the tumor and perilesional areas adjacent to the tumor, and also from clinically uninvolved tissue in the same region. In the central areas, it was found that carcinoma had a significant increase in chondroitin sulphate and uronic acid content, and a significant decrease in dermatan sulphate content, as compared with fibroadenoma. The chondroitin sulphate content in perilesional carcinomatous tissue was significantly greater than in clinically uninvolved tissue.

Adenofibroma↗

Fibroadenomatosis (fibroadenomatoid mastopathy): a benign breast lesion with composite pathologic features.

A benign breast lesion with the composite histologic features of a fibroadenoma and fibrocystic changes has been referred to previously as fibroadenomatosis or fibroadenomatoid mastopathy; this lesion is distinct from the typical well circumscribed fibroadenoma that may have fibrocystic changes. The purpose of our study was to ascertain the frequency of this change among 200 consecutive breast biopsies and excisions with a coded pathologic diagnosis of fibroadenoma and/or "fibrocystic disease"; we identified these changes in 23 (11.5%) specimens. The lesion was characterized by microscopic fibroadenomatoid foci intermingled with dilated ducts, epitheliosis, and adenosis. It is suggested that fibroadenomatosis is yet another pattern in the complex morphologic spectrum known as benign proliferative breast disease. From our experience, this particular lesion was often appreciated as a unique finding, but the appropriate diagnostic designation was in question. The natural history of fibroadenomatosis is essentially unknown. It may represent a morphologic stage in the development of fibroadenoma(s).

Adenofibroma↗

Estrogen receptor immunocytochemical assay on cytologic material from primary and metastatic breast cancer.

The determination of estrogen receptor (ER) status in primary and metastatic breast tumours has been facilitated by the recent advent of monoclonal antibodies to ER. The aim of this study was to determine the feasibility of estrogen receptor immunocytochemical assay (ER-ICA) applied to cytologic specimens from primary and metastatic breast tumours. One hundred and sixty specimens from 133 patients were evaluated by cytologic ER-ICA. Comparison with histologic ER-ICA was available for 28 of the specimens and with cytosol assay for 27 specimens. Some 101 of the 160 samples were breast lesions of which 87 had a definitive diagnosis of breast carcinoma. Of these, 68% were considered positive for ER. Metastatic breast cancers comprised 59 of the 160 specimens of which 37% were found to be positive for ER. The predominant staining intensity (SI) of the nuclei of the tumour cells added to the percentage of cells (PC) stained gave an estrogen receptor score (ERS) in both cytologic and histologic specimens. A positive threshold was determined for an ERS greater than 2, equivalent to ER levels greater than 10 fmol/mg of protein. We observed very good correlation between cytologic ERS and the corresponding cytosol assay values (r = 0.74; p less than 0.001; n = 27). The sensitivity was 95% and the specificity 88%. Correlation with histologic ER-ICA was also very high (r = 0.83; p less than 0.001; n = 28). We assessed the role of video image analysis (VIA) and did not find any additional advantages in evaluating cytologic ER-ICA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenofibroma↗

Diagnostic value of silver-stained interphasic nucleolar organizer regions in breast tumors.

Seventy-six specimens of normal breast tissue and benign and malignant breast lesions were studied to assess the mean area occupied by silver-stained proteins of the nucleolar organizer regions (MNORA) of the nucleolus. The assessment was performed with a computer-assisted image analyzer. The results indicate that only 30% of malignant lesions have a MNORA value greater than that of normal breast tissue or benign lesions. On the other hand, MNORA values of ductal carcinoma in situ were significantly greater than those of epitheliosis (papillomatosis). MNORA values were also significantly different in grade I and grade III invasive ductal carcinomas, the latter exhibiting the highest MNORA values of all the cases observed. Evaluation of MNORA values may therefore help in differentiating benign epithelial proliferations from ductal carcinomas in situ. Furthermore, because there is evidence that MNORA values are indicative of the cell duplication rate, MNORA values may ultimately be considered an objective prognostic parameter in addition to grading for invasive ductal carcinomas.

Adenofibroma↗

Medulloblastoma metastasizing to a breast fibroadenoma: a case report.

The extracranial spread of primary intercranial tumours is infrequent, occurring most commonly with medulloblastoma. The spread of one malignant tumour to a second tumour, benign or malignant, is also very rare. This case appears to be unique, in that a primary malignant cerebral tumour metastasized to a benign extracranial tumour.

Adenofibroma↗

Contrast-enhanced magnetic resonance imaging of the breast.

Contrast-enhanced magnetic resonance imaging (MRI) of 28 patients with known breast tumors was compared with clinical findings and histopathology, and for 12 of the patients also with mammography. The dynamic measurements performed in 18 patients showed that signal intensity in gradient echo (FFE) images increased rapidly in malignant tumors after contrast injection and reached a plateau level at 1-3 min postcontrast. Fibroadenomas showed slower contrast enhancement continuing throughout the whole examination period of 10 min. The most enhancing parts of the tumors were selected for intensity measurements. The differentiation between malignant and benign tumors in dynamic contrast-enhanced MRI was in accordance with the histopathological findings in all cases. The tumor diameter as measured by MRI showed very good agreement with the size of the tumor specimens. Comparison of tumor size measurements in mammography and MRI showed that MRI had the most accurate correlation to the measured size of the tumor specimens.

Adenocarcinoma, Mucinous↗

Symptoms and signs in benign and malignant tumours of the breast.

The diagnostic distribution and the relation between diagnosis and symptoms, symptom duration, tumour site, tumour size and breast size were studied in 1 244 women with breast symptoms examined at a special breast tumour clinic. 9% of the women had cancer, 62% fibroadenosis and 6% fibroadenoma. In 18% no breast disease was found. A painful tumour was experienced by 19% of all women with breast cancer, but by 54% of breast cancer patients below 50 years of age. 50% of the patients with fibroadenosis had a painful tumour. This symptom was thus not a discriminating feature between cancer and fibroadenosis in younger women. The reason that most breast tumours, both benign and malignant, are located in the upper outer quadrant is not known. It has been proposed that this might be due to the larger volume of this quadrant as compared with the others. The present results contradict this view.

Adenofibroma↗