OBJECTIVE. The purpose of this study is to assess whether luminal A versus luminal B molecular subtypes of breast cancer affect the diagnostic utility of preoperative MRI evaluation of the axilla.MATERIALS AND METHODS. This study identified 125 patients who underwent preoperative breast MRI evaluation of tumors classifiable as luminal A or luminal B molecular subtypes between January 2012 and August 2014. The subtypes were classified on the basis of immunohistochemical staining surrogates combining receptor status and the Ki-67 proliferation index. Statistical analysis was performed using chi-square analysis and one-way ANOVA. When a statistically significant difference was found, follow-up analysis involving pairwise comparison using the Bonferroni correction was performed. Multivariate logistic regression analysis was also used to determine whether the molecular subtype was independently predictive of lymph node involvement.RESULTS. A total of 80 patients had tumors classifiable as the luminal A molecular subtype, whereas 45 patients had tumors classifiable as the luminal B subtype. Pathologically proven axillary lymph node (ALN) disease occurred statistically significantly more frequently in luminal B tumors (18/45 [40.0%]) than in luminal A tumors (11/80 [13.8%]; p < 0.01). In addition, pathologically proven ALN disease was 4.3 times more likely to occur in luminal B tumors after controlling for patient age, tumor size, and tumor grade (p < 0.01). We found no difference in the negative predictive value of the MRI assessment of the axilla when luminal A tumors were compared with luminal B tumors. The positive predictive value of MRI evaluation of ALNs is statistically significantly higher for luminal B tumors than for luminal A tumors (76.2% vs 28.0%, respectively; p = 0.004).CONCLUSION. With the use of molecular subtype classification including the Ki-67 proliferation index, suspicious nodes detected in luminal B tumors by MRI are likely to have positive findings and warrant preoperative tissue sampling. Conversely, in view of the high falsepositive rate of suspicious nodes detected in luminal A tumors by MRI, proceeding straight to sentinel lymph node biopsy for all cases, except for those with highly suspicious findings, is suggested. These results should, however, be validated in a larger prospective study.

Phyllodes tumor of the breast is rare and often resembles the more commonly seen fibroadenoma at imaging and histologically. As core biopsy cannot always distinguish the two, assessing radiologic-pathologic concordance is essential to guide appropriate clinical management. We review the imaging characteristics of phyllodes tumor at mammography, ultrasound, and MRI to help the interpreting radiologist be aware of key imaging features that should alert him to the possibility of a phyllodes tumor even if not verified by initial core biopsy.

Primary and secondary breast lymphomas are rare, accounting for approximately 0.15% of all breast malignancies.1,2 Most cases have been reported in women, with rare cases involving the male breast.3 The reported age range is 13 to 88 years; in the 15 cases we have seen, the age range is 52 to 95 years.2,4,5 Although multiple studies showed a slight preference for the involvement of the right breast, in our collection of cases no significant difference was found.

The nipple-areolar complex is often best evaluated as a separate region of the breast. Because of the intricacy of the anatomic structures and their superficial position, the diagnostic techniques required for optimal evaluation of the nipple-areolar complex differ from those routinely used to evaluate the whole breast. Although clinical examination and screening mammography are still of central importance, the adjunct use of multiple imaging modalities (ultrasonography, contrast material-enhanced magnetic resonance imaging, or both) as well as nonstandard mammographic views is often necessary to differentiate benign abnormalities from malignant ones. For accurate diagnosis, familiarity with a wide range of appearances of the normal anatomy, including congenital anomalies (eg, supernumerary nipples), is necessary, as is a thorough knowledge of the features of the benign and malignant processes that commonly occur in the nipple-areolar complex. Benign abnormalities may include mammary duct ectasia, nipple calcifications, cutaneous horn of the nipple, abscess of the Montgomery gland, and nipple adenoma. Malignant abnormalities may include Paget disease and primary lymphoma as well as carcinoma of the breast. Some conditions, such as nipple retraction and inversion, may have either a benign or a malignant cause. In such cases, a thorough radiologic assessment is especially important.

The purpose of this study was to determine whether there is a criterion that can be utilized to determine if excisional biopsy is indicated following the diagnosis of lobular neoplasia (LN) on core biopsy. Retrospective review of patient records with diagnosis of LN as highest risk diagnosis on core biopsy was performed. LN was defined to include both atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) and was categorized as focal or diffuse. The pathology was correlated with the mammographic finding to determine whether the diagnosis of LN was incidental or related to the mammographic finding. For those patients who did not undergo excision, follow-up data are presented along with treatment information. A total of 4,555 breast core biopsies were performed at our institution from January 1997 through March 2005. Of these, 35 patients were diagnosed with LN. Twenty six (74%) went on to excision and nine (26%) were followed. Biopsy was recommended for mammographically detected calcifications in the majority of cases. Twenty four (92%) of the 26 excised cases had focal LN and 2 of 26 (8%) had diffuse LN. Infiltrating lobular carcinoma was diagnosed in both cases of diffuse LN and no infiltrating carcinoma was seen when focal LN was diagnosed on core. Excision may not be necessary when a diagnosis of only focal LN is made on core biopsy. Diffuse LN may indicate an associated invasive cancer and should prompt excision.

OBJECTIVE. The purpose of this study was to determine whether there are imaging changes specific to partial breast radiation therapy with interstitial catheters or a single balloon.MATERIALS AND METHODS. The records of 43 of 83 patients treated with partial breast irradiation at our institution from June 1996 to October 2003 were retrospectively reviewed. The images of 27 patients who had received radiation by interstitial catheters and 16 who had received radiation by a single balloon were reviewed. Patients were examined for the presence of skin thickening, diffuse and focal increased density, mass, lucency, and calcifications. Fifteen initial sonograms were ordered to evaluate pain or focal findings on mammograms. In addition, two patients underwent one and one patient underwent three follow-up sonographic examinations.RESULTS. Mild to moderate skin thickening was present in 26 (60%) and no skin thickening in 17 (40%) of the 43 patients. Forty-one (95%) of the 43 patients had focal increased density. Diffuse increased density was seen in only one (2%) of the patients. There was no change in overall density in 2 (5%) of the patients. Fifteen (35%) of the 43 patients had mass or seroma at the first follow-up examination. Central lucency was present in 35 (81%) of 43 patients on at least one follow-up study. Calcification was present in 8 (19%) of 43 cases.CONCLUSION. Imaging findings after breast brachytherapy include the spectrum of findings seen with external beam radiation but are more focal. The focal findings may be alarming both clinically and radiographically, but biopsy can be avoided in most instances if information from the history is correlated with findings from continued follow-up of the patient's case.

The Breast JournalVolume 11, Issue 4 p. 292-293 Collagen Plug Metallic Marker Clip: Mammographic and Histopathologic Appearance Eva C. Gombos MD, Corresponding Author Eva C. Gombos MD Department of Radiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts, andAddress correspondence and reprint requests to: Eva C. Gombos, MD, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.Search for more papers by this authorLisa E. Esserman MD, Lisa E. Esserman MD Comprehensive Breast Center, andSearch for more papers by this authorShari-Lynn Odzer-Umlas MD, Shari-Lynn Odzer-Umlas MD Comprehensive Breast Center, andSearch for more papers by this authorSusan Weisberg MD, Susan Weisberg MD Comprehensive Breast Center, andSearch for more papers by this authorRobert J. Poppiti Jr. MD, Robert J. Poppiti Jr. MD Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FloridaSearch for more papers by this author Eva C. Gombos MD, Corresponding Author Eva C. Gombos MD Department of Radiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts, andAddress correspondence and reprint requests to: Eva C. Gombos, MD, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.Search for more papers by this authorLisa E. Esserman MD, Lisa E. Esserman MD Comprehensive Breast Center, andSearch for more papers by this authorShari-Lynn Odzer-Umlas MD, Shari-Lynn Odzer-Umlas MD Comprehensive Breast Center, andSearch for more papers by this authorSusan Weisberg MD, Susan Weisberg MD Comprehensive Breast Center, andSearch for more papers by this authorRobert J. Poppiti Jr. MD, Robert J. Poppiti Jr. MD Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FloridaSearch for more papers by this author First published: 27 June 2005 https://doi.org/10.1111/j.1075-122x.2005.21557.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume11, Issue4July/August 2005Pages 292-293 RelatedInformation

The Breast JournalVolume 11, Issue 2 p. 149-149 Basal Cell Carcinoma of the Skin Presenting as Microcalcifications on Screening Mammography Eva C. Gombos MD, Corresponding Author Eva C. Gombos MD Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts,Address correspondence and reprint requests to: Eva C. Gombos, MD, 74 Robinwood Ave., Needham, MA 02492, USA, or e-mail: galeva@hotmail.com.Search for more papers by this authorLisa E. Esserman MD, Lisa E. Esserman MD Comprehensive Breast CenterSearch for more papers by this authorRobert J. Poppiti Jr. MD, Robert J. Poppiti Jr. MD Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FloridaSearch for more papers by this author Eva C. Gombos MD, Corresponding Author Eva C. Gombos MD Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts,Address correspondence and reprint requests to: Eva C. Gombos, MD, 74 Robinwood Ave., Needham, MA 02492, USA, or e-mail: galeva@hotmail.com.Search for more papers by this authorLisa E. Esserman MD, Lisa E. Esserman MD Comprehensive Breast CenterSearch for more papers by this authorRobert J. Poppiti Jr. MD, Robert J. Poppiti Jr. MD Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FloridaSearch for more papers by this author First published: 23 February 2005 https://doi.org/10.1111/j.1075-122X.2005.21449.xCitations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume11, Issue2March 2005Pages 149-149 RelatedInformation

A 50-year-old woman presented for routine mammography (Fig. 1) with a history of malignant melanoma removed 2 years earlier from the skin of the left temple area. The surgical margins and six sentinel lymph nodes were free of tumor. Fine-needle aspiration (FNA) of her right breast revealed melanoma (Fig. 2). Malignant melanoma is the most common neoplasm to metastasize to the breast. Preparation of a cell block from the fine-needle aspirate and immunostaining can be useful in confirming the diagnosis. A combination of positive melanoma stains (S-100, HMB-45, Melan-A) and negative estrogen and progesterone stains may help to support the diagnosis (1–3).

The diagnosis of atypical intraductal epithelial hyperplasia (AIDH) constitutes 6.3% of the breast core biopsies performed at our institution. Seventy-nine cases that were diagnosed as AIDH on core biopsy and went through excisional biopsy were included. Sixty-four biopsies were performed by an image-guided 11-gauge vacuum device, 11 under sonographic guidance using 14-gauge needles and 4 by a sonographically guided 11-gauge vacuum device. The histopathology of the core biopsies and the surgical excisions were reviewed. Immunohistochemistry was performed on the consecutive sections of core biopsy specimens using high molecular weight cytokeratin (HMW-CK) (DAKO-Cytokeratin, 34βE12). At interpretation of the stain, intensity and percentage of positive cells were taken into account. The immunoprofiles of AIDH were categorized into four groups showing negative (i.e., no staining) or low-, moderate-, high-, and very high-intensity staining. Surgical excision of the 79 lesions revealed carcinoma in only 3 cases (4%)-two infiltrating carcinomas and one intraductal carcinoma—residual AIDH in 44 cases (56%), and epithelial hyperplasia or other benign lesions without atypia in 32 cases (40%). The HMW-CK stain was performed retrospectively on all of the core biopsies and 66 of them contained residual areas with AIDH for staining. Forty-nine (74%) were CK negative or stained with low intensity, but 17 cases (26%) had a moderate- to high-intensity stain. Our study showed a lower incidence of carcinoma on surgical excision following core biopsy for AIDH than other studies. The HMW-CK stain helped to characterize the nature of the intraductal proliferation and to confirm the presence of atypia, as has been previously reported, but frequently was inconclusive. The low incidence of carcinoma brings into question the need for surgical excision of all cases of AIDH diagnosed by core biopsy.

There are approximately 200 reported cases of breast tumors containing areas of bone. The majority of the neoplasms are sarcomas, phylloides tumors, or fibroadenomata. We present a case of osseous metaplasia mammographically detected by clustered heterogeneous calcifications. Stereotactic core biopsy revealed the presence of well-formed bone tissue without associated neolplasia. The case represents the first reported case of mammographically detected osseous metaplasia confirmed by core biopsy.

The objective of this article was to assess whether the presence of infiltrating or intraductal carcinoma at the margins of breast excision could be detected more accurately by 2-view rather than by 1-view specimen radiography. The authors took 2-view specimen radiographs of 50 consecutive surgical specimens of breast carcinomas. The original mammograms, the margins on the specimen radiographs, on-1 versus on-2 views, and the histopathologic findings at the specimen margins were correlated. Margins for each view were categorized as involved or not involved. On histopathologic examination 12 specimens had margins involved by the tumor. Tumor at the surgical margin on single-view specimen radiography was detected in 8 cases. Tumor was detected at the surgical margin on 2-view specimen radiographs in 11 cases. All the intraductal carcinomas in association with radiographic calcifications at or close to margins were seen on 2-view radiography. On specimen radiography, greater detail and number of calcifications were seen compared with the initial mammogram. Intraductal carcinoma grows within the ductal tree in an unpredictable fashion that can be close or into the margins. Two-view specimen radiographs showed tumor at the margin of the specimen more precisely, which can be particularly useful in cases of intraductal carcinoma.

The Breast JournalVolume 7, Issue 2 p. 129-130 Granulomatous Mastitis: Diagnosis by Ultrasound-Guided Core Biopsy Eva C. Gal-Gombos MD, Eva C. Gal-Gombos MD Comprehensive Breast Center andSearch for more papers by this authorLisa E. Esserman MD, Lisa E. Esserman MD Comprehensive Breast Center andSearch for more papers by this authorShari-Lynn Odzer MD, Shari-Lynn Odzer MD Comprehensive Breast Center andSearch for more papers by this authorSusan Weisberg MD, Susan Weisberg MD Comprehensive Breast Center andSearch for more papers by this authorChristopher Wilson MD, Christopher Wilson MD Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FloridaSearch for more papers by this authorRobert J. Poppiti Jr. MD, Robert J. Poppiti Jr. MD Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FloridaSearch for more papers by this author Eva C. Gal-Gombos MD, Eva C. Gal-Gombos MD Comprehensive Breast Center andSearch for more papers by this authorLisa E. Esserman MD, Lisa E. Esserman MD Comprehensive Breast Center andSearch for more papers by this authorShari-Lynn Odzer MD, Shari-Lynn Odzer MD Comprehensive Breast Center andSearch for more papers by this authorSusan Weisberg MD, Susan Weisberg MD Comprehensive Breast Center andSearch for more papers by this authorChristopher Wilson MD, Christopher Wilson MD Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FloridaSearch for more papers by this authorRobert J. Poppiti Jr. MD, Robert J. Poppiti Jr. MD Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FloridaSearch for more papers by this author First published: 06 April 2002 https://doi.org/10.1046/j.1524-4741.2001.007002129.xCitations: 9 Address correspondence and reprint requests to: Eva C. Gal-Gombos, MD, Mount Sinai Medical Center, 4306 Alton Rd., Miami Beach, FL 33140, U.S.A., or e-mail: galeva@hotmail.com Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume7, Issue2March/April 2001Pages 129-130 RelatedInformation