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A pure mucocele-like lesion of the breast diagnosed on ultrasonography-guided core-needle biopsy: is imaging follow-up sufficient?

Park YJ, Kim EK - Ultrasonography (2014)

Bottom Line: The predominant Breast Imaging Reporting and Data System (BIRADS) category was 4A.All the lesions showed image-pathologic concordance.For pure MLL on US-guided CNB with image-pathologic concordance, close imaging follow-up might be considered instead of surgical excision.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the upgrade rate of ultrasonography (US)-guided core-needle biopsy (CNB) of the breast for a pure mucocele-like lesion (MLL), to evaluate the clinical and radiologic features, and to correlate the image-pathologic features further on to guide the management of MLL.

Methods: Between January 2003 and February 2013, 14-gauge US-guided CNB was performed in 18,111 cases. Thirty-two cases associated with MLL were identified, and five cases of MLLs associated with breast carcinoma or with other high-risk breast lesions (i.e., atypical ductal hyperplasia [ADH], papillary lesions, lobular carcinoma in situ, and radial scar complex) were excluded. Among these 27 pure MLLs, 21 cases with surgical or vacuum-assisted excision (VAE) pathology were included in our study. Medical records, mammograms, and ultrasonograms were reviewed for the clinical and radiologic features of the cases.

Results: Among the 21 cases with pure MLLs at CNB, the final pathology showed a 0% proportion of cases upgraded to malignancy. All the 21 cases with either surgical or VAE pathology were benign MLLs including three cases of focal involvement of ADH (14.3%). The common features were mammographic features of microcalcifications that were round in shape and had a grouped distribution. The US features included oval shape, circumscribed margin, parallel orientation, complex solid and cystic echo pattern, no posterior feature, and complex solid and cystic echoic masses. The predominant Breast Imaging Reporting and Data System (BIRADS) category was 4A. All the lesions showed image-pathologic concordance.

Conclusion: For pure MLL on US-guided CNB with image-pathologic concordance, close imaging follow-up might be considered instead of surgical excision.

No MeSH data available.


Related in: MedlinePlus

A 36-year-old woman with pure mucocele-like lesion (MLL).A. A magnification mammography mediolateral view shows grouped coarse heterogeneous microlcalcifications in the right upper breast. B. A transverse sonogram shows a 7-mm oval-shaped circumscribed marginated complex cystic and solid echoic lesion showing an intracystic mass (mixed cystic and solid appearance) with microcalcifications. The lesion was categorized as Breast Imaging Reporting and Data System (BI-RADS) category 4A. The pathologic result of core biopsy was pure MLL with microcalcifications, and it was considered concordant with the imaging findings. The mass was surgically excised and was proven to be benign MLL on surgical pathology.
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f1-usg-14036: A 36-year-old woman with pure mucocele-like lesion (MLL).A. A magnification mammography mediolateral view shows grouped coarse heterogeneous microlcalcifications in the right upper breast. B. A transverse sonogram shows a 7-mm oval-shaped circumscribed marginated complex cystic and solid echoic lesion showing an intracystic mass (mixed cystic and solid appearance) with microcalcifications. The lesion was categorized as Breast Imaging Reporting and Data System (BI-RADS) category 4A. The pathologic result of core biopsy was pure MLL with microcalcifications, and it was considered concordant with the imaging findings. The mass was surgically excised and was proven to be benign MLL on surgical pathology.

Mentions: Mammography was available in 19 cases, and the findings are summarized in Table 1. The lesion size in the four cases with asymmetry or mass without microcalcifications on mammography, was 10-16 mm (mean, 12 mm), that in three cases with a diffuse distribution of microcalcifications was larger than 10 mm, and that in seven cases with grouped microcalcifications was 5-18 mm (mean, 9.2 mm). Microcalcifications were the most common mammographic feature (47.6%), and most of them were round in shape (50.0%) and had a grouped distribution (70.0%) (Fig. 1). The US features are presented in Table 2. The mean size of the lesions was 9.2±1.9 mm. The representative US features were oval shape (95.2%), circumscribed margin (76.2%), parallel orientation (90.5%), complex solid and cystic echo pattern (95.2%), and no posterior feature (76.2%). The most predominant BI-RADS category was category 4A (42.8%). Microcalcifications were shown on US in 10 cases (47.6%). In all cases, microcalcifications were located in the mass. The classification of complex solid and cystic echoic masses is presented in Table 3. Nine lesions (45.0%) showed intracystic mass (mixed cystic and solid appearance) (Fig. 1), and five lesions (25.0%) showed cystic mass with thick walls and/or thick septations. All the lesions showed image-pathologic concordance.


A pure mucocele-like lesion of the breast diagnosed on ultrasonography-guided core-needle biopsy: is imaging follow-up sufficient?

Park YJ, Kim EK - Ultrasonography (2014)

A 36-year-old woman with pure mucocele-like lesion (MLL).A. A magnification mammography mediolateral view shows grouped coarse heterogeneous microlcalcifications in the right upper breast. B. A transverse sonogram shows a 7-mm oval-shaped circumscribed marginated complex cystic and solid echoic lesion showing an intracystic mass (mixed cystic and solid appearance) with microcalcifications. The lesion was categorized as Breast Imaging Reporting and Data System (BI-RADS) category 4A. The pathologic result of core biopsy was pure MLL with microcalcifications, and it was considered concordant with the imaging findings. The mass was surgically excised and was proven to be benign MLL on surgical pathology.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372707&req=5

f1-usg-14036: A 36-year-old woman with pure mucocele-like lesion (MLL).A. A magnification mammography mediolateral view shows grouped coarse heterogeneous microlcalcifications in the right upper breast. B. A transverse sonogram shows a 7-mm oval-shaped circumscribed marginated complex cystic and solid echoic lesion showing an intracystic mass (mixed cystic and solid appearance) with microcalcifications. The lesion was categorized as Breast Imaging Reporting and Data System (BI-RADS) category 4A. The pathologic result of core biopsy was pure MLL with microcalcifications, and it was considered concordant with the imaging findings. The mass was surgically excised and was proven to be benign MLL on surgical pathology.
Mentions: Mammography was available in 19 cases, and the findings are summarized in Table 1. The lesion size in the four cases with asymmetry or mass without microcalcifications on mammography, was 10-16 mm (mean, 12 mm), that in three cases with a diffuse distribution of microcalcifications was larger than 10 mm, and that in seven cases with grouped microcalcifications was 5-18 mm (mean, 9.2 mm). Microcalcifications were the most common mammographic feature (47.6%), and most of them were round in shape (50.0%) and had a grouped distribution (70.0%) (Fig. 1). The US features are presented in Table 2. The mean size of the lesions was 9.2±1.9 mm. The representative US features were oval shape (95.2%), circumscribed margin (76.2%), parallel orientation (90.5%), complex solid and cystic echo pattern (95.2%), and no posterior feature (76.2%). The most predominant BI-RADS category was category 4A (42.8%). Microcalcifications were shown on US in 10 cases (47.6%). In all cases, microcalcifications were located in the mass. The classification of complex solid and cystic echoic masses is presented in Table 3. Nine lesions (45.0%) showed intracystic mass (mixed cystic and solid appearance) (Fig. 1), and five lesions (25.0%) showed cystic mass with thick walls and/or thick septations. All the lesions showed image-pathologic concordance.

Bottom Line: The predominant Breast Imaging Reporting and Data System (BIRADS) category was 4A.All the lesions showed image-pathologic concordance.For pure MLL on US-guided CNB with image-pathologic concordance, close imaging follow-up might be considered instead of surgical excision.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the upgrade rate of ultrasonography (US)-guided core-needle biopsy (CNB) of the breast for a pure mucocele-like lesion (MLL), to evaluate the clinical and radiologic features, and to correlate the image-pathologic features further on to guide the management of MLL.

Methods: Between January 2003 and February 2013, 14-gauge US-guided CNB was performed in 18,111 cases. Thirty-two cases associated with MLL were identified, and five cases of MLLs associated with breast carcinoma or with other high-risk breast lesions (i.e., atypical ductal hyperplasia [ADH], papillary lesions, lobular carcinoma in situ, and radial scar complex) were excluded. Among these 27 pure MLLs, 21 cases with surgical or vacuum-assisted excision (VAE) pathology were included in our study. Medical records, mammograms, and ultrasonograms were reviewed for the clinical and radiologic features of the cases.

Results: Among the 21 cases with pure MLLs at CNB, the final pathology showed a 0% proportion of cases upgraded to malignancy. All the 21 cases with either surgical or VAE pathology were benign MLLs including three cases of focal involvement of ADH (14.3%). The common features were mammographic features of microcalcifications that were round in shape and had a grouped distribution. The US features included oval shape, circumscribed margin, parallel orientation, complex solid and cystic echo pattern, no posterior feature, and complex solid and cystic echoic masses. The predominant Breast Imaging Reporting and Data System (BIRADS) category was 4A. All the lesions showed image-pathologic concordance.

Conclusion: For pure MLL on US-guided CNB with image-pathologic concordance, close imaging follow-up might be considered instead of surgical excision.

No MeSH data available.


Related in: MedlinePlus