Phyllodes Tumor

Findings: Mammogram shows a lobular hyper dense mass with partially circumscribed and partially obscured margins. No calcifications visible

Meaning : leaf-like in Greek, phyllodes tumors demonstrate papillary growth of epithelial lined stroma
Key point: Large rapidly growing circumscribed mass without calcifications
Mammography :Phyllodes tumors appear as a dense, round or oval masses with circumscribed or lobulated borders on mammography. Indistinct margins favor malignant transformation. Calcifications are rare but when present are coarse.
Ultrasonography: demonstrates an oval, round, or lobulated hypoechoic mass. Cystic spaces favor malignancy. Increased vascularity can be common .

T1W1/T2W1 :Phyllodes tumors appear heterogeneously hypointense on T1WI with slit like areas of increased T2WI representing fluid. Enhancement is typically rapid and suspicious kinetics can be observed in approximately 33% of cases.
Differential Diagnosis:
Typically occurring in younger women, fibroadenomas also appear as oval or lobulated mass but have dense, coarse calcifications, homogeneous echogenicity, and more moderate enhancement characteristics.
While there is some overlap with phyllodes tumors demonstrating malignant transformation, breast carcinoma is more likely to demonstrate indistinct margins. Pleomorphic calcifications also favor carcinoma.
Primary sarcoma of the breast is distinguished from phyllodes tumors by the absence of epithelial components. The clinical course of primary sarcoma of the breast is similar to malignant phyllodes tumors.

Ultrasound shows an irregularly shaped mass with heterogeneous echogenicity and ill-defined borders.

Treatment: is by surgical excision with greater than 1 cm margins. Mastectomy may be required for large tumors. Axillary node dissection is usually unnecessary. With respect to adjuvant therapy, radiation reduces local recurrence. Chemotherapy has demonstrated no benefit.

On Breast Elastography

Breast ultrasound elastography is 12% more sensitive than MR diffusion-weighted imaging (DWI) in determining malignancy of breast masses assessed as BI-RADS category 4, and it's almost 10% more accurate, according to a new study published in the January American Journal of Roentgenology.
Clinicians currently use B-mode sonography and dynamic contrast-enhanced MRI to classify breast lesions based on the standard BI-RADS categorizations. But newer techniques such as ultrasound elastography -- which assesses the softness or stiffness of breast tissue -- and DWI-MRI are being evaluated as adjuncts to these modalities in the hope of better identifying the character of a breast lesion.
Hiroko Satake, MD, of Nagoya University School of Medicine in Japan, and colleagues compared the abilities of ultrasound elastography and DWI-MRI to predict malignancy of breast masses. They found that not only was elastography more sensitive overall, it was more sensitive with lesions smaller than 1 cm -- more than 17% compared to DWI-MRI. In addition, it was more than 10% more accurate (AJR, January 2011, Vol. 196:1, pp. 202-209).
"Because malignant tumors predominantly are harder than benign tissues, [ultrasound elastography] significantly improves the differentiation between benign and malignant tissue," Satake and colleagues wrote. "[Our results] suggest that ultrasound elastography could be used to prevent unnecessary biopsies."
Satake's group included 115 breast masses categorized as BI-RADS 4 or 5; the masses were assessed according to combined findings from mammography, B-mode sonography, and dynamic contrast-enhanced MRI. Two radiologists retrospectively evaluated the elasticity scores of the masses using ultrasound elastography and the apparent diffusion coefficient (ADC) values using DWI-MRI.
"By accurately identifying benign tumors with imaging, we may be able to avoid sending patients for unnecessary biopsies," Satake and colleagues wrote. "Based on the results of our study, we recommend that patients with BI-RADS 4 masses should undergo biopsy if their ultrasound elasticity score is 4 or 5."
Of the 115 breast masses included in the study, 88 were malignant and 27 were benign. The mean diameter of the malignant lesions was 16.1 mm, the team found. The researchers compared BI-RADS assessment categories, elasticity scores, and ADC values between the benign and malignant masses. A lesion's elasticity score proved to be more sensitive and accurate in predicting malignancy than its ADC value, both overall and with lesions smaller than 1 cm.


by : Kate Madden Yee

Ultrasound effective in screening for endometrial cancer

Transvaginal ultrasound screening can detect endometrial cancer before symptoms appear in postmenopausal women, according to research from the U.K.

In a large-scale study to assess the performance of transvaginal ultrasound screening for endometrial cancer, a research team led by Ian Jacobs, of University College London, found that the modality yielded 81% sensitivity and 86% specificity.
The researchers analyzed data from the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), in which transvaginal ultrasound screening was performed on 37,038 women (Lancet Oncology, December 13, 2010).
Performance characteristics of endometrial thickness and endometrial abnormalities at detecting endometrial cancer within one year of transvaginal ultrasound screening were calculated. The researchers then evaluated the method's sensitivity and specificity for different risk groups, and the group performed modeling using epidemiological variables to assess a screening strategy for women at higher risk.
Of the 133 women diagnosed with endometrial cancer or atypical endometrial hyperplasia within one year of screening, 107 (81%) had an endometrial thickness of 5 mm or more. Most of the 36,731 women who did not have cancer had an endometrial thickness of less than 5 mm, according to the researchers.
At the optimum cutoff of 5.15 mm, transvaginal ultrasound would detect 80.5% of cancer cases, with a false-positive rate of 14.3% (85.7% specificity), they found. With this screening threshold, one case of endometrial cancer would be detected for every 47.7 women screened, according to the researchers.
The authors noted, however, that further studies are needed to examine transvaginal ultrasound screening's acceptability, health economics, and risk before routine population screening or targeted screening can be advocated.


by : Erik L. Ridely
published online in the Lancet Oncology.