Imaging features of primary breast sarcoma.

OBJECTIVE: This purpose of this study is to describe the imaging findings in patients who presented with a diagnosis of primary breast sarcoma. MATERIALS AND METHODS: A search was performed of the pathology database at a single institution for patients with a histopathologic diagnosis of primary breast sarcoma or pure sarcomatoid carcinoma and who underwent preoperative mammography, sonography, or MRI. Patients with malignant phyllodes tumors were excluded. The imaging studies were retrospectively reviewed using the American College of Radiology BI-RADS lexicon. We documented clinical presentation, histopathologic characteristics, axillary nodal status, and the presence of distant metastases. RESULTS: Twenty-four women were included in the study; their mean age was 56 years (range, 21-86 years), and the mean tumor size was 6.1 cm (range, 0.9-15 cm). Only one tumor was identified in each patient. The predominant mammographic finding was a noncalcified oval mass with indistinct (9/14 [64%]) margins. Sonography most commonly revealed an oval (19/22 [86%]) solid mass with indistinct margins (17/22 [77%]). The masses were frequently hypoechoic (18/21 [86%]) and hypervascular (17/20 [85%]) and had posterior acoustic enhancement (13/21 [62%]). MRI showed a round or oval T2-hyperintense mass with irregular margins in four of five (80%) patients, and inhomogeneous enhancement was most common (3/4 [75%]). CONCLUSION: Primary breast sarcoma has imaging features that are not typically seen in infiltrating ductal carcinoma. A large oval hypervascular mass with indistinct margins should raise the suspicion for a primary breast sarcoma and prompt biopsy.

Outcome analysis of 9-gauge MRI-guided vacuum-assisted core needle breast biopsies.

OBJECTIVE: The purpose of this article is to correlate 9-gauge MRI-guided vacuum-assisted breast biopsy with surgical histologic findings to determine the upgrade rate and to correlate the frequency of MRI-guided vacuum-assisted breast biopsy cancer diagnosis with breast MRI indications and enhancement characteristics of targeted lesions. MATERIALS AND METHODS: A database search was performed of all MRI-guided vacuum-assisted breast biopsies performed from January 1, 2005, to September 31, 2010. The breast MRI indications, history, age, risk factors, lesion size, enhancement characteristics, and pathologic diagnoses at MRI-guided vacuum-assisted breast biopsy and at surgery were documented. Fisher exact test and analysis of variance were used for statistical analysis. RESULTS: A total of 218 lesions underwent MRI-guided vacuum-assisted breast biopsy in 197 women (mean age, 52 years; range, 28-76 years), of which 85 (39%) had surgical correlation. Of the 218 lesions, 48 (22%) were malignant, 133 (61%) were benign, and 37 (17%) were high risk according to MRI-guided vacuum-assisted breast biopsy. Ten of 85 lesions (12%) were upgraded to malignancy at surgery, with a final malignancy rate of 25%. The frequency of malignancy was significantly higher in patients presenting for diagnostic (50/177 [28%]) versus screening (4/41 [10%]; p < 0.05) evaluation, patients with ipsilateral cancer (22/49 [45%]; p < 0.001), and lesions with washout kinetics (34/103 [33%]; p < 0.05) and was relatively higher in lesions with nonmasslike enhancement (26/76 [34%]; p = 0.07), which represented ductal carcinoma in situ in the majority of cases (17/26 [65%]; p < 0.005). CONCLUSION: Patients with ipsilateral cancer who have additional suspicious lesions identified on MRI require careful evaluation and biopsy to exclude additional sites of cancer that may impact surgical management.