Author:
Wang Hongli,Hu Yue,Tan Cui,Gu Ran,Li Yudong,Jin Liang,Jiang Xiaofang,Mei Jingsi,Liu Qiang,Gong Chang
Abstract
Abstract
Background
Approximately 50% of breast mucinous carcinomas (MCs) are oval and have the possibility of being misdiagnosed as fibroadenomas (FAs). We aimed to identify the key features that can help differentiate breast MC with an oval shape from FA on ultrasonography (US).
Methods
Seventy-six MCs from 71 consecutive patients and 50 FAs with an oval shape from 50 consecutive patients were included in our study. All lesions pathologically diagnosed. According to the Breast Imaging Reporting and Data System (BI-RADS), first, the ultrasonographic features of the MCs and FAs were recorded and a final category was assessed. Then, the differences in ultrasonographic characteristics between category 4 A (low-risk group) and category 4B-5 (medium-high- risk group) MCs were identified. Finally, other ultrasonographic features of MC and FA both with an oval shape were compared to determine the key factors for differential diagnosis. The Mann-Whitney test, χ2 test or Fisher’s exact test was used to compare data between groups.
Results
MCs with an oval shape (81.2%) and a circumscribed margin (25%) on US were more commonly assessed in the low-risk group (BI-RADS 4 A) than in the medium-high-risk group (BI-RADS 4B-5) (20%, p < 0.001 and 0%, p = 0.001, respectively). Compared with those with FA, patients with MC were older, and tended to have masses with non-hypoechoic patterns, not circumscribed margins, and a posterior echo enhancement on US (p < 0.001, p < 0.001, and p = 0.003, respectively).
Conclusion
The oval shape was the main reason for the underestimation of MCs. On US, an oval mass found in the breast of women of older age with non-hypoechoic patterns, not circumscribed margins, and a posterior echo enhancement was associated with an increased risk of being an MC, and should be subjected to active biopsy.
Funder
Natural Science Foundation of China
Project of The Beijing Xisike Clinical Oncology Research Foundation
Science and Technology Planning Project of Guangdong Province
Fundamental Research Funds for the Central Universities, Sun Yat-sen University
High-tech, Major and Characteristic Technology Projects in Guangzhou Area
National Key R&D Program of China
Publisher
Springer Science and Business Media LLC
Subject
Obstetrics and Gynecology,Reproductive Medicine,General Medicine
Reference26 articles.
1. Toikkanen S, Kujari H. Pure and mixed mucinous carcinomas of the breast: a clinicopathologic analysis of 61 cases with long-term follow-up. Hum Pathol. 1989;20:758–64.
2. Bae SY, Choi MY, Cho DH, Lee JE, Nam SJ, Yang JH. Mucinous carcinoma of the breast in comparison with invasive ductal carcinoma: clinicopathologic characteristics and prognosis. J Breast Cancer. 2011;14:308–13.
3. Cao AY, He M, Liu ZB, Di GH, Wu J, Lu JS, et al. Outcome of pure mucinous breast carcinoma compared to infiltrating ductal carcinoma: a population-based study from China. Ann Surg Oncol. 2012;19:3019–27.
4. Berg WA. Current status of Supplemental Screening in dense breasts. J Clin Oncol. 2016;34:1840–3.
5. Mendelson EB, Böhm-Vélez M, Berg WA, Whitman GJ, Feldman MI, Madjar H. et al. ACR BI-RADS ultrasound. In: ACR BI-RADS Atlas, Breast Imaging Reporting and Data System edn. Edited by D’ Orsi CJ, Sickles EA, Mendelson EB, Morris EA. Reston: American College of Radiology; 2013: 1–173.