Granulomatous mastitis (GM) is a recognized, but an uncommon cause of breast mass. Awareness of this condition is important, because it can clinically as well as radiologically mimic breast carcinoma. In this study, we present the imaging features of a series of 10 cases with proved diagnosis of granulomatous mastitis with emphasis on magnetic resonance (MR) findings. All those patients who were histologically proven to have GM of the breast were analyzed. Their files were reviewed and data recorded for demographic, clinical presentation and imaging appearances. The imaging features of the lesions by mammography, ultrasound, and magnetic resonance imaging were analyzed. Of the 305 patients who were surgically treated, 10 (3%) cases proved to have GM. All the patients were females with age ranging from 27 to 53 years (average 38 years and median age 36 years). Guided core biopsy was performed in all cases for confirmation of diagnosis followed by either excision biopsy (in five cases) or lumpectomy (in five cases). The final histopathologic results were chronic granulomatous inflammation consistent with tuberculosis in four cases and GM with acute inflammation, but unknown etiology in four cases and GM due to duct ectasia in two cases. GM, a rare breast condition, should be considered in the differential diagnosis of patients with a breast mass associated with inflammatory change. Routine breast imaging with US, MG, or MRI, the condition from malignant lesions and biopsy, still remains the only method of definite diagnosis.

BACKGROUND AND OBJECTIVES:Fischer developed a scoring system in 1999 that made identifying malignant lesions much easier for inexperienced radiologists. Our study was performed to assess whether this scoring system would help beginners to accurately diagnose breast lesions on magnetic resonance (MR) imaging and to assess the correlation between the magnetic resonance mammography Breast Imaging Reporting and Data System (MRM BI-RADS) grade and the final diagnosis.PATIENTS AND METHODS:The lesion morphology and contrast kinetics of 63 masses in 41 patients were evaluated on MRI and accorded a MRM BI-RADS final assessment category using the Fischer scoring system. The accuracy was evaluated after the final diagnosis was obtained by tissue sampling and follow-up imaging.RESULTS:There were 25 malignant and 30 benign lesions. Eight lesions were seen by MRI only and we could not verify their pathology since we did not have MR-guided biopsy facilities at the time of the study. On MR mammography, the proven carcinomatous lesions were characterized as BI-RADS category V in 16 (64%), category IV in 7 (28%), and category III in 2 (8%) lesions. Benign lesions were graded as category V in 3 (10%), category IV in 6 (20%), and category III in 3 (10%), category II in 10 (33%) and category I in 8 (27%) lesions. The MRM BI-RADS category accurately predicted malignancy in 92% and a benign pathology in 70% of the lesions. The overlap between the MRM features of chronic inflammatory lesions and carcinomas resulted in a lower accuracy in diagnosing benign as compared to malignant lesions.CONCLUSION:The MRM BI-RADS lexicon using the Fischer scoring system is useful and has a high predictive value, especially for malignant breast lesions, and is easy to apply. Overlapping features between benign inflammatory and malignant lesions might yield a reduced accuracy in inflammatory pathologies.

The MRM BI-RADS lexicon using the Fischer scoring system is useful and has a high predictive value, especially for malignant breast lesions, and is easy to apply. Overlapping features between benign inflammatory and malignant lesions might yield a reduced accuracy in inflammatory pathologies.

Objective: To report our initial experience of breast magnetic resonance imaging (MRI) in Kuwait in order to identify and characterize breast lesions. Subjects and Methods: In 58 patients ranging in age from 25 to 64 years, breast MRI was performed as a problem-solving tool (29); for suspicious local relapse of the treated breast (6); to search for a primary breast cancer in patients with metastatic axillary lymph nodes (5); for local staging of breast cancer (5); breast implants (6); screening in high-risk patients (3), and differentiation between inflammation and inflammatory carcinoma (4). Sagittal fat-saturated T₂ and axial T₁ images were obtained before, and axial fat-saturated T₁ and dynamic sagittal fat-saturated T₁-weighted images after contrast enhancement in a 1.5-tesla closed magnet. The diagnostic criteria were based on the morphology and kinetics of the lesion. Findings were validated by tissue sampling or radiological follow-up. Results: Seventy breast lesions (25 malignant, 38 benign and 7 lesions detected by MRI only) were identified in the 58 patients. The sensitivity, specificity, and positive and negative predictive values of MRI in diagnosing malignant breast lesions were 96, 67, 71 and 95%, respectively, while the accuracy was 80%. Conclusion: This initial experience is comparable to other published data. Future plans for improving image spatial resolution and MR-guided procedures have been taken into consideration.

Objective: High resolution ultrasonography (US) has played a significant role in the study of salivary gland (SG) pathology and has surpassed sialography in the study of SG tumours. This report discusses the sonographic features of SG tumours examined during the last 5 years. The value of these features as diagnostic indicators of the nature (benign or malignant) and histotype of these tumours is assessed. Methods: High resolution ultrasonography was used in the study of 83 cases of salivary tumours, 78 of which were of the parotid gland and 5 of the submandibular gland. Sixty-six (80%) of these tumours were benign. An US scanner with a 7.5-MHz real-time linear probe was used. The diseased SG was examined in multiple planes to fully delineate and locate the lesions and to characterize their sonographic features. Results: US detected and correctly located all tumours. The sonographic features of the various tumour categories studied are presented with special emphasis on diagnostically significant ones. The value of these features as diagnostic indicators of the nature (benign or malignant) and the histotype of these tumours is assessed. In this study, the rate of correct US identification of tumour benignity was 100% in a group of 15 adenolymphomas and 12 benign non-epithelial tumours, and 94% in a group of 34 pleomorphic adenomas. Five cases of recurrent pleomorphic adenoma were also studied. Correct US identification of malignancy was achieved in 82% of malignant tumours (15 carcinomas and 2 isolated primary non-Hodgkin’s lymphomas of the parotid gland). US identification of the specific tumour histotype was quite successful in the case of benign tumours with an accuracy of 84% in pleomorphic adenoma, 93% in adenolymphoma, and 100% in vascular tumours and lipoma. Only 1 of the 17 malignant tumours (a carcinomatous pleomorphic adenoma) was specifically identified. Conclusion: Based on the diagnostic capabilities of US revealed in this study as well as its operational advantages, US is strongly recommended as the first-line imaging procedure for all masses at the SG regions, to be followed by US-guided fine needle aspiration biopsy particularly for equivocal cases.