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132
6 Ultrasound Features of Different Types of Breast Cancer
(Fig. 6.4 ) and is characterized with the following
US features:
Hypoechoic lesion •
Heterogeneous echostructure •
Irregular shape •
Lobulated, rough boundaries •
Indistinct contours •
A- or hypovascular in CDI, PDI, and 3DPD •
Intense hard staining with US elastography •
a1
It is macroscopically presented with dense
nodules without clear boundaries, often bilateral,
and exhibits scirrhous growth with intraorganic
diffusion. This type of cancer dominates in the
group of X-ray-negative tumors; therefore, US is
advantageous in its diagnosis.
According to Marquet et al. ( 1995 ) , scirrhous
breast lesion is more often imaged as a lesion
with indistinct contours. It is a consequence of
Fig. 6.1 An invasive ductal
breast carcinoma. ( a ) 1–2.
Grayscale US. ( b )
Macroscopic view. ( c )
Invasive ductal carcinoma
section stained with H&E;
original magni fi cation, ×100
a2
1336 Ultrasound Features of Different Types of Breast Cancer
Fig. 6.1 (continued)
b
c
invasive growth, and its starlike speculated shape
results from connective tissue. According to
Ueno ( 1996 ) and Mihaylov and Skrynnik ( 1997 ) ,
posterior shadowing assumes signi fi cant connective tissue component within the tumor
structure.
Breast sarcomas account for 0.2–4.0 % of all
malignant breast lesions (Rozhkova 1993 ;
Korzhenkova 2004 ) and are observed in all
ages.
Characteristic US features of breast sarcoma
(Fig. 6.5 ) are listed below:
Hypoechoic lesion •
Heterogeneous echostructure with anechoic •
incorporations
Smooth indistinct borders •
134
6 Ultrasound Features of Different Types of Breast Cancer
Fig. 6.2 Lobular breast
carcinoma in situ. ( a )
Grayscale US. ( b ) H&E-
stained image of a section of
lobular carcinoma in situ;
original magni fi cation, ×100
a
b
Large size (more often) •
Hyper- or hypovascularity with CDI, PDI, and •
3DPD
Intense, irregular (more often “mosaic”) stain-•
ing with US elastography
Rare metastasis in axillary lymph nodes •
Mucinous cancer (colloid, gelatinous, mucous
tumor) is a rare subtype of invasive ductal
carcinoma. It has a relatively good prognosis. Its
macroscopic view represents a well-circumscribed breast lesion of gray color with a wet
gelatinous surface at a cut. Microscopic view
reveals solid or mucinous complexes of monomorphic cells, which contain mucous in the
cytoplasm, located among massive clumps of
slime.
Fig. 6.3 Invasive lobular
breast carcinoma. ( a )
Grayscale US. ( b ) H&E-
stained image of a section of
invasive lobular carcinoma;
original magni fi cation, ×100
1356 Ultrasound Features of Different Types of Breast Cancer
a
b
US features of mucinous breast carcinoma
(Fig. 6.6 ) are listed below:
Hypoechoic lesion •
Heterogeneous echostructure •
Polycyclic rough borders •
Accurate or indistinct contours •
Sometimes posterior enhancement, more •
rarely acoustic shadow
A- or hypovascular in CDI, PDI, and 3DPD •
Intense, irregular “mosaic” staining with US •
elastography
Rare metastasis in axillary lymph nodes •
136
Fig. 6.4 Scirrhous breast
carcinoma. ( a ) Grayscale
US. ( b ) H&E-stained image
of a section; original
magni fi cation, ×100
6 Ultrasound Features of Different Types of Breast Cancer
a
b
Medullary breast carcinoma is most often rep-
resented as an accurately circumscribed nodule
of grayish color, soft consistence, and impure
structure, which exhibits the following US features (Fig.
6.7 ):
Roundish shape •
Decreased echodensity •
Heterogeneous echostructure, often with ane-•
choic incorporations
Accurate contours •
Irregular borders •
A- or hypovascular pattern in CDI, PDI, and •
3DPD
Decreased, irregular “mosaic” staining with •
US elastography
Tubular breast carcinoma is a rare type of
cancer. It was sorted out of the group of in fi ltrative
ductal cancer due to its more favorable clinical
fl ow and forecast. It is most often met in the
senior age. Microscopic view reveals unilaminate
tubules of slightly angular, extended shape.
Stroma is characterized with expressed fi brosis
Fig. 6.5 Breast sarcoma. ( a )
Grayscale US. ( b )
Pappenheim-stained image
of a section; original
magni fi cation, ×1,000
1376 Ultrasound Features of Different Types of Breast Cancer
a
b
and hyalinosis. The foci of periductal and perivascular elastosis are often observed.
Tubular breast carcinoma sonographically is
usually de fi ned through the following ways
(Fig.
6.8 ):
Lesion of mixed echodensity •
Irregular structure •
Even or rough borders •
Indistinct contours •
Often with posterior acoustic shadowing •
A- or hypovascular pattern in CDI, PDI, and •
3DPD
Intense hard irregular staining with US •
elastography
According to Tro fi mova ( 2002 ) and
Zabolotskaya ( 2006 ) , none of the US features
authentically characterizes breast carcinoma.
The majority of features may be considered
only in a complex with other criteria and the
data of different methods (Sencha et al. 2009 ) .
138
Fig. 6.6 Mucinous breast
carcinoma. ( a ) Grayscale
US. ( b ) H&E-stained image
of a section; original
magni fi cation, ×400
6 Ultrasound Features of Different Types of Breast Cancer
a
b
Routine and new US technologies permit to sort
out the features of lesions, which are characteristic for malignancies, to facilitate differential
diagnosis in the majority of complex diagnostic
cases.
All available US technologies assist in the
division of patients into the following groups:
Patients with normal breast, which do not •
demand further thorough examination or follow-up. They are to undergo breast exam once
in 1–2 years.
Patients with breast lesions that do not •
demand surgical treatment. They are subject
to follow-up with breast examination once in
6–12 months.
Patients with breast masses suspicious for •
malignancy. Further examinations (such as
breast biopsy) are necessary. Subsequent sur-
gery may apply.
High quali fi cation and cooperation of doctors
of different specialties, following the principles of
continuity of diagnostic process, and utilization of
all available technologies enable rational planning
of diagnostic and medical tactics with improvement
in the diagnosis of breast tumors and signi fi cant
increase in the ef fi cacy of their treatment.
Fig. 6.7 Medullary breast
carcinoma. ( a ) Grayscale
US. ( b ) Pappenheim-stained
image of a section; original
magni fi cation, ×1,000
1396 Ultrasound Features of Different Types of Breast Cancer
a
b
Example of US Report in a Patient with Breast
Carcinoma
Date:
Name: B.
Age: 52
The fi rst day of last menses:
Breasts are mainly presented by adipose tis-
sue. Glandular tissue is up to 11 mm thick.
Fibrous tissue is expressed moderately in all
quadrants. Lactiferous ducts within the right
breast are moderately dilated up to 0.4 cm, mainly
in outer quadrants. A homogeneous hypoechoic
lesion of 2.3 × 3.1 cm in size of irregular starlike
shape with indistinct, rough boundaries is located
in the upper-outer quadrant (10 o’clock position)
of the right breast. The lesion is hypovascular
with CDI, PDI, and 3DPD (3 color pixels in the
central area). It demonstrates intense irregular
hard (blue) staining with sonoelastography.
Enlarged axillary lymph nodes are detected on
the right side up to 1.0–2.2 cm in size and
hypoechoic with irregular structure and disorganized blood fl ow pattern. The lymph nodes of
over groups are not enlarged.
140
Fig. 6.8 Tubular breast
carcinoma. ( a ) Grayscale
US. ( b ) H&E-stained image
of a section; original
magni fi cation, ×100
6 Ultrasound Features of Different Types of Breast Cancer
a
b
CONCLUSION: Right breast lesion suspicious for carcinoma. Sonographic signs of
metastasis in the right axillary lymph nodes.
Biopsy of the lesion and right axillary
lymph nodes is recommended.
Differential Diagnosis of Breast Diseases
7
The incidence of breast diseases in fertile women is
10–65 % (Zabolotskaya et al. 2002 ) . All breast
changes can be divided into two basic groups: tumoral
and non-tumoral processes. The diagnosis of breast
diseases should always implicate oncologic concern.
Breast carcinoma is differentiated with the big group
of benign focal and diffuse breast changes.
Benign breast changes are observed most
often. They confer abnormalities with various
clinical, morphological, and etiological features.
There are several types of classi fi cations. For
example, the following classi fi cation is used for
practical purposes in Russia since 1985:
I. Diffuse mastopathy
1. With prevalence of a glandular component
(adenosis)
2. With prevalence of a fi brous component
3. With prevalence of a cystic component
4. Mixed type
II. Nodular mastopathy
III. Benign tumors and tumorlike processes
1. Adenoma
2. Fibroadenoma
3. Intraductal papilloma
4. Cyst
IV. Special types
1. Phyllodes tumor
7.1 Benign Lesions
Fibroadenoma is a benign breast tumor from the
group of mixed connective tissue and epithelial
tumors. It accounts for 95 % of all benign breast
lesions (Zabolotskaya 2006 ) . It demonstrates a
well-circumscribed nodule, which can be easily
displaced against the surrounding tissues.
Fibroadenoma most often affects fertile women of
20–45 years. The size of a lesion can be different
but usually does not exceed 3 cm. Fibroadenoma
is as a rule represented with a solitary nodule,
although it can be multiple in 20 % of cases and
bilateral in 10 % (Korzhenkova 2004 ) . Sometimes
it exhibits fast growth, especially in puberty and
after an abortion. Fibroadenomas tend to regress
with age that is accompanied with hyalinosis and
stromal calci fi cation.
Malignant transformation of fi broadenoma is
an uncommon feature (5 %). Lobular cancer in
situ arises most often in these cases (Sinyukova
et al. 2007 ) .
Depending on histological structure, fi broadenoma can have several types: intracanalicular,
pericanalicular, mixed, and juvenile.
Fibroadenoma usually demonstrates the following US features (Fig. 7.1 ):
Solid breast lesion of decreased or usual •
echodensity
Homogeneous structure (rare cases of heteroge-•
neous structure result from fl uid incorporations,
calci fi cations, or echogenic fi brous structures)
Always accurate contours •
Smooth or lobulated borders, which depend •
on histological type
Sometimes with posterior echo enhancement •
Mobile at compression the US probe •
A- or hypovascular in CDI, PDI, and 3DPD •
Irregular mosaic staining with US elastography •
A.N. Sencha et al., Breast Ultrasound,
DOI 10.1007/978-3-642-36502-7_7, © Springer-Verlag Berlin Heidelberg 2013
141