Mammographic findings and Ultrasonography characteristics of the
patient with invasive ductal carcinoma of the breast In King
Chulalongkorn Memmorial Hospital (KCMH)
Author: Kewalee Sasiwimolphan, MD.
Adviser: Assoc.Prof. Darunee Boonjunwetwat, MD.
Address:Department of Radiology, Faculty of Medicine, King Chulalongkorn
Memorial Hospital
Abstract
Purpose: To review mammographic and ultrasonograhic findings of invasive
ductal carcinoma (IDC) of breast in King Chulalongkorn Memorial Hospital.
Materials and methods: A total of 263 proven cases of IDC of breast who 252
mammographic studies and 233 ultrasoud studies were retrospective
reviewed for mammographic findings and ultrasonographic characteristics.
Result: Two hundred and twenty two abnormal masses have found in
mammography. Another 30 cases who mammographic findings show no
mass lesions, however adjunction ultrasound images can detected lesions.
The most common mammographic findings of IDC are abnormal mass with
irregular shape (86.5%). The most frequent margin of mass from
mammography are spiculate margin (39.6%) which most are histological
grade 1 and 2 (77.27%) follow by ill-defined margin (33.7%). Malignant-type
microcalcifications are observed in 111 cases (44%) and the most common
type of microcalcifications is granular type (52.3%). Mammography is better
than ultrasonography in depicting microcalcification (111 Vs 58 lesions).
Axillary lymphadenopathy was detected in 46% of cases. Ultrasonography is
better than mammography in depicting soft tissue masses. Two hundred and
forty four lesions have found in ultrasonography. The most common
ultrasound characteristics for IDC of breast cancer is irregular shape (80%)
and thick echogenic rim (80%). Nearly most of lesions are hypoechoic lesions
(hypoechoic lesions 83.2% and very low echoic lesions 7.38%). Most frequent
posterior attenuation from ultrasonography is posterior enhancement (29.5%)
follow by posterior shadowing (28.3%). In-group of posterior enhancement
mostly is lesions in histological grade 3 and 2, while in posterior shadow
group most lesions are in grade 1 and 2. Color doppler study, available in 240
lesions, found that 79.9% have one or more feeding vessels to lesions.
Conclusion: Classical features of breast cancer in mammography can found
only small number of cases such as spiculate margin (39.6%), mostly in
histological grade 1 (12.5%) and 2 (64.7%). Multiple suggestive malignancy
signs such as irregular shape, malignant microcalcification, axillary
lymphadenopathy, skin thickening should be use to increase confidence of
diagnostic. Most common malignant features of breast cancer such as
irregular mass, angular margin, thick echogenic rim and color doppler for
feeding vessels searching are detected. Posterior shadowing of the mass tend
to be found in grade 1 and 2 tumor, whereas posterior acoustic enhancement
tend to be found in grade 3 tumor. Adjunctive ultrasonography was suggested
to improved diagnosis. Therefore, IDC may paradoxically display similar
imaging features to benign mass.