Tattoo Pigment in an Intramammary Lymph Node Mimicking Breast Malignancy.

There are many patterns of microcalcification in mammography. Distinguishing between these patterns can be challenging. A malignant cause needs to be assessed through further diagnostic workup. We present a case of a 36-year-old BRCA1 mutation carrier, presenting with a small mass containing calcification on her screening mammogram. A vacuum-assisted biopsy under tomosynthesis guidance was performed and demonstrated an intramammary lymph node showing prominent extracellular black pigment. To our knowledge, this is the first case report of tattoo pigment mimicking breast malignancy on mammography.

Large Non-enhancing Breast Cancer on Breast Magnetic Resonance Imaging: A Case Report.

A 55-year-old female presented with vague symptoms in the lateral left breast. Digital breast tomosynthesis and breast ultrasound showed no focal lesion, and magnetic resonance imaging (MRI) was subsequently performed. No suspicious enhancement was seen on MRI; in particular, no suspicious lesion was seen in the area of clinical concern. In view of persisting focal mastalgia and vague parenchymal changes in the symptomatic area on repeat targeted ultrasound, a core biopsy was performed. Final pathology after left mastectomy with axillary clearance showed a 42 mm grade 2 invasive ductal carcinoma. Ten out of 15 lymph nodes contained metastatic carcinoma. This case report presents a large ductal breast cancer with no enhancement on breast MRI. Factors that may contribute to the non-detection of breast cancers on MRI studies will be discussed.

Why is microcalcification missed on mammography?

INTRODUCTION: Ductal carcinoma in situ (DCIS) is often only mammographically evident as microcalcification. Although the overall percentage of screening cases with histologically proven DCIS microcalcification is small, the clinical relevance of missing this finding is significant. The current guidelines in Australia for breast screening departments are for double reading of mammograms to reduce both perceptive and interpretative error. METHODS: This retrospective study identified patients from a state screening program with histologically proven DCIS whose mammograms showed microcalcification. The initial double reader results were documented according to the 5-point grading scale of BreastScreen Tasmania, and discrepancies between readers were noted. Mammographic factors such as breast density, lesion location, morphology, distribution, size and presence on previous imaging were assessed for significant influence on inter-reader discrepancy. Histological evidence of invasion and grade of malignancy were also analysed. RESULTS: Of 65 identified cases, 29 (45%) showed that one of the two readers had not flagged the microcalcification on the report. Analyses revealed no significant difference in reader discrepancy with any of the analysed factors including breast density, size of microcalcification or presence on previous imaging. Twenty-five of 29 (86%) cases of discrepancy were perceptive. CONCLUSION: Breast screening reading for microcalcification is poorly correlated to mammographic or histological features. The majority of errors were perceptive rather than interpretative. Double reading is advocated as standard practice to reduce perceptive error.

Mammographic screening for breast cancer: A review.

In 2011, BreastScreen Australia celebrated 20 years of mammographic screening for breast cancer in Australia. There has been a reduction in mortality from breast cancer over the last two decades, coincident with mammographic screening. However, there are concerns that mammographic screening may result in overdiagnosis of breast cancer and that the reduction in mortality from breast cancer is the result of better treatment rather than screening. This article reviews the evidence on which mammographic screening for breast cancer is based, considers the issue of overdiagnosis of breast cancer by screening mammography, and assesses the role of screening mammography in the reduction in breast cancer mortality seen over the last two decades.

Brachial plexus tumor simulating an axillary metastasis from breast carcinoma.

An ipsilateral axillary mass was detected on pre-operative ultrasound in a 79-year-old woman with newly diagnosed breast carcioma. The mass had sonographic features that were initially thought to represent a lymph node completely replaced by metastatic disease. Though ultrasound-guided axillary fine-needle aspiration was attempted, it could not be performed due to pain. At surgery, the mass was found to be a brachial plexus tumor.

A pilot study of trimodality breast imaging surveillance in young women at high risk of breast cancer in Western Australia.

OBJECTIVE: To determine whether a surveillance program including clinical breast examination (CBE) and three screening modalities (magnetic resonance imaging [MRI], high-resolution ultrasound [U/S] and mammographic x-ray [MMX]) was feasible, and whether it could improve detection of pathological lesions in young women at high risk of developing breast cancer. DESIGN, SETTING AND PARTICIPANTS: Western Australian women aged 50 years or under at high risk of developing breast cancer were recruited to our study. For a 2-year period, they were offered breast MRI and U/S scans in addition to their annual MMX and CBE. Our study was conducted between June 2002 and October 2005. MAIN OUTCOME MEASURES: Number and type of cancerous or precancerous lesions; recall rates after screening; comparative sensitivity of screening modalities. RESULTS: Of 102 women approached, 72 agreed to participate. Fifteen lesions were detected, of which three were significant: a metastatic papillary cancer in an axillary lymph node, a borderline lesion (multiple papillomatosis with atypia), and a papilloma. All 15 lesions were visible on MRI, and four were detected by MRI only. Only one lesion was visible on all three imaging modalities. Nothing significant was detected by CBE. The recall rate after MRI scans fell from 9/72 (12.5%) in the first year to 5/67 (7.5%) in the second year. CONCLUSION: Our study gave valuable experience in a team approach to screening MRI, and showed that MRI can detect more lesions than MMX or U/S in women at high risk of developing breast cancer. Screening U/S may not add value to MMX and MRI screening, and we suggest a single oblique-view MMX may be used in some cases.