Invasive Ductal Carcinoma of the Breast

Jennifer Reilly, MD candidate
Kitt Shaffer, MD

May 11, 1998

Presentation

Imaging Findings

Mammograms demonstrate a 1.5 cm spiculated hyperdense mass in the right upper outer quadrant (arrow). A spot craniocaudal view provides better detail (arrow).

Differential Diagnosis

Diagnosis

Discussion

The classic signs of occult malignancy on mammogram include clustered microcalcifications and spiculated masses. Between 75% and 85% of spiculated lesions are later found to be malignant. Microcalficiations, which are generally associated with ductal carcinoma in situ (DCIS), are found to be malignant in 20-25% of biopsies. Other indirect signs of malignancy include architectural distortion, increasing tissue density, asymmetric breast tissue, and the presence of a single dilated duct. Benign lesions, in contrast, are typically well circumscribed lesions (less than 1 cm in diameter) without microcalcifications and do not change over time. Though benign fibroadenomas can calcify, such calcifications appear coarser, denser and larger than the microcalcifications associated with malignancy (classic “popcorn” calcifications). Breast masses can also be evaluated using ultrasound to determine whether they are solid or cystic. Ultrasound images are routinely obtained for non-spiculated masses noted on mammography.

Core needle biopsy is an attractive alternative to both surgical biopsy and fine needle aspiration (FNA) because

• it is highly accurate,
• it has been demonstrated by several studies to be as successful as surgical biopsy at acheiving diagnosis,
• it does not leave a scar,
• it is much less costly than surgery, and
• it has minimal associated morbidity.

For this patient, lumpectomy results confirmed the results of the core biopsy and the diagnosis of Stage IB invasive ductal breast CA. Invasive ductal carcinoma accounts for approximately 70% of breast cancers. It is often seen in associatation with DCIS. Invasive ductal CA often metastasizes to the axillary lymph nodes and is associated with a relatively poor prognosis compared with other types of breast cancer, such as medullary or tubular CA. Other common sites of metastases for invasive ductal CA include bone and intraparenchymal sites within the lung, liver and brain. Neither bone scan nor CXR demonstrated any evidence of metastases in this patient.

References

Burns RP. Image-guided breast biopsy. The American Journal of Surgery 1997; 173:9-11.

Cady B. Traditional and future management of nonpalpable breast cancer. The American Surgeon 1997; 63:55-58.

Harris JR, Morrow M, Bonadonna G. Cancer of the breast. In Cancer: Principles & Practice of Oncology. 4 ed. Devita VT et al, eds. Philadelphia: Lippincott, 1993:1264-1287.

Nguyen M et al. An update on core needle biopsy for radiologically detected breast lesions. Cancer 1996; 78:2340-2345.

Olson LK. Interpreting the mammogram report. American Family Physician 1993; 47:396-403.

Parker SH et al. Percutaneous large-core breast biopsy: a multi-institutional study. Radiology 1994; 193:359-364.

Svane G et al. Screening Mammography: Breast Cancer Diagnosis in Asymptomatic Women. St Louis:Mosby, 1993.

• Return to the Teaching Case Database search page
• Return to Professional Education
  
• About BrighamRAD

Dear Visitors: Nothing on this World Wide Web site should be considered medical advice. Only your own doctor can help you make decisions about your medical care. It is not the policy of the Brigham and Women's Hospital Department of Radiology to provide consultation on the World Wide Web or via e-mail. If you have a specific medical question or are seeking medical care, please call the Brigham and Women's Hospital toll-free physician referral line at 1-800-294-9999.

Is this a mirrored page?
The official homepage of the BrighamRAD Teaching Case Database is http://brighamrad.harvard.edu/education/online/tcd/tcd.html