CRITERIA OF BENIGNITY AND MALIGNANCY OF CICUMSCRIBED BREAST MASS: ABOUT A SERIE OF 55 CASES

1. CRITERIA OF BENIGNITY AND MALIGNANCY OF CICUMSCRIBED BREAST MASS: ABOUT A SERIE OF 55 CASES Z.OUERGHI; N.DALI; A.MANAMANI A; A. BEN TEKAYA; I.MARZOUK; L.BEN FARHAT; L.HENDAOUI DEPARTMENT OF DIAGNOSTIC IMAGING MONGI SLIM HOSPITAL. LA MARSA BR5

2. Introduction • A circumscribedbreast mass isdefined as a round or ovalbreastlesionwelldemarcated • It may correspond to differentdiagnosis - Benignlesiondominated by cyst and fibroadenoma - Malignantlesionsuch as medullary, papillary or mucinouscarcinoma or wellcircumscribedductalcarcinoma…

3. Introduction The aim of ourworkis to analyze the mammographic and ultrasonographiccriteria of benignity and malignancy of circumscribedbreast masses through a serie of 55 observations

4. Materials and methods • This is a serie of 55 women • The ageisrangingfrom 28 to 76 oldyears • All patients have received a mammogram and a breastultasound • 43 of themunderwentbiopsyunderultrasound guidance, the others 12 patients weremonitored ( followed up ) by breastultrasound

5. Result (1) On mammography: • The masses densitywas : - high in 25 cases - low in 26 cases - Radiolucent in one case - Mixed in three cases • Calcifications werepresent in 10 cases whichtwowerebenign « popcorn » like in fibroadenoma and eightweremalignant in invasive ductalcarcinoma

6. Result (1) On mammography: • The halo signwaspresent in 19 cases • Themarginwas: - regular in 17 cases - lobulated in 21 cases - spiculated in 17 cases

7. WELL DEMARCATED AND SLIGHTLY DENSE MASSES FIBROADENOMA with « popcorn » like calcifications CYST FIBROADEMA

8. WELL DEMARCATED MASSES CONTAINING FAT DENSITY HAMARTOMA with calcifications LIPOMA HAMARTOMA

9. LOBULATED AND STRONGLY DENSE MASSES INFILTRATING DUCTAL CARCINOMA

10. SPICULATED MASSES WITH BRANCHED AND VERMICULAR CALCIFICATIONS INFILTRATING DUCTAL CARCINOMA

11. WELL DEMARCATED MASS ILL DEMARCATED MASSES INFILTRATING DUCTAL CARCINOMA

12. Result (2) In ultrasound: • The lesionsechogenecitywas : - Hypoechoic in 47 cases in whoum 20 were homogenous and 27 wereheteregenous - Hyperechoic in 7 cases - Anechoic in one case • The long axis was : - Widerthentall in 28 cases - Taller thenwide 27 cases

13. Result (2) • Posterioracousticfeaturewas : - A shadowing in 15 cases - An enhancement in 15 cases - Unaffected in 13 cases

14. FIBROADENOMA WELL DEFINED HOMOGENOUS MASSES WITH POSTERIOR ACOUSTIC ENHANCEMENT AND WIDER THEN TALL LONG AXIS

15. FIBROADENOMA CONTAINING LITTLE CYSTS CONTAINING POP CORN  LIKE CALCIFICATIONS

16. FIBROADENOMA STRONGLY CALCIFICATED LOBULATED

17. FIBROCYSTIC MASTOPATHY HAMARTOMA WELL DEFINED HETEROGENOUS MASS ISOECHOIC TO THE MAMMARY GLAND LOBULATED HYOECHOIC MASS CONTAINING LITTLE CYSTS

18. INFILTRATING DUCTAL CARCINOMA LOBULATED HETEROGENOUS MASSES WITH TALLER THAN WIDE LONG AXIS

19. INFILTRATING DUCTAL CARCINOMA SPICULATED MASSES WITH POSTERIOR SHADOWING

20. Result (3) • Of the 43 patients whounderwentbiopsy the pathologyresultshows : - Infiltratingductalcarcinoma in 24 cases - A metastasis of melanoma in one case - A fibroadenoma in 11 cases - A fibrocysticmastopathy in 8 cases - A lipoma in one case - An hamartoma in 2 cases

21. Discussion The large number of biopsies performed for benignbreastabnormalities has long been recognized as a seriousproblem. the mammographic and ultrasonographicfeatures for differentiatingbenignfrommalignantsolid mass can help to decrease the number of biopsies performed for benignsolid masses.

22. Discussion In order to detectsmall cancers in breast screening, itis essential to have highquality images. Radiologistsreadingmammogramsshoudbetrained in the recognition of the malignant and benignsigns of breast masses, becausebreast cancer may not show typicalmalignantfeatures.

23. Discussion The mammograhicfeatures of a breast mass are essentially: - the shape - the margin - the mass density - the calcifications Skin thikening, nippleretractionand architectural distorsion associated to a breast mass canbemalignantsigns

25. Discussion Ultrasonographydoescontribuate the differentiation of benign versus malignant if the mass is not visible atmammography. In womenyougerthan 30 years, in whom mammographyislessuseful, ultrasonographyis oftenconsidered the modality of choice to initiate the evaluation of a breast mass.

26. Discussion The ultrasonographicfeatures of a breast mass are essentially: - the shape - the margin - the orientation or long axis - the echotexture - the posterioracousticfeatures - the lesionboundary

29. Conclusion The radiologist must be informed about the radiological criteria of benignity and malignancy of circumscribed breast mass. Given the frequency of breast cancer, which affects one in ten women, in any doubt a biopsy should be indicated to give the definitive diagnosis.

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