The purpose of this study was to evaluate the diagnostic utility of sonoelastography in differentiating benign from malignant non-palpable breast lesions. A total of 293 BI-RADS 3-5 (Breast Imaging Reporting And Data System) impalpable breast lesions in 278 women was evaluated with B-mode ultrasound (US) and subsequently with sonoelastography (SE) before performing US-guided biopsy. Among the 293 lesions (size up to 2 cm), 110 (37.5%) were histologically malignant and 183 (62.5%) benign. Lesions that were malignant or showed atypical ductal hyperplasia were referred for surgical excision, as well as 32 benign lesions showing discordance between US/SE results and histology. All other benign lesions had US follow-up at 6/12 months, showing stability. Overall performance of SE was lower than US, with sensitivity and specificity of 80% and 80.9%, respectively, for SE as compared with 95.4% and 87.4% for US. Statistical analysis showed no improvement in the joint use of SE and US over the use of US alone, whose performance, however, was very high in our study. SE is a simple, fast and non-invasive diagnostic method that may be a useful aid to US for less experienced radiologists in the assessment of solid non-palpable breast lesions, especially BI-RADS 3, where specificity was higher (88.7%).

KEYWORDSBreast; Ultrasound; Benign breast lesions.Abstract Benign breast diseases constitute a heterogeneous group of lesions arising in the mammary epithelium or in other mammary tissues, and they may also be linked to vascular, inflammatory or traumatic pathologies. Most lesions found in women consulting a physician are benign. Ultrasound (US) diagnostic criteria indicating a benign lesion are described as well as US findings in the most frequent benign breast lesions.Sommario Le lesioni mammarie benigne costituiscono un gruppo eterogeneo di manifestazioni, sia proprie dell'epitelio mammario, sia con origine dagli altri tessuti che costituiscono l'organo, sia con altra patogenesi (vascolare, flogistica e traumatica). Esse costituiscono il reperto più frequente che si osserva nella maggior parte dei casi nei quali una donna pensa di avere un problema al seno e si rivolge al medico o al radiologo. Vengono riproposti da un punto di vista ecografico i criteri diagnostici che orientano per la benignità ed i quadri iconografici che si riscontrano nelle principali lesioni mammarie benigne ecograficamente identificabili. ª

Non-palpable breast cancers are often in situ or smaller and have less nodal and distant metastases than palpable lesions. They represent a heterogeneous group of tumours, which may have different prognostic behaviour. We analysed a retrospective series of 982 non-palpable breast cancers assessed histologically at the National Cancer Institute of Milan from 1985 to 1995, following pre-operative mammography-guided localization. The association between mammographic data (parenchymal pattern and findings), patient age and tumour histology was investigated by review of clinical records and statistical modelling. We also investigated the association between the presence or absence of microcalcification as a mammographic finding and pathological tumour characteristics (tumour size, axillary nodes status and grading) or receptor status for oestrogen (ER) and progesterone (PgR). In situ disease or invasive tumour with an intraductal component, whether extensive or not, were commoner in young women and mammography more frequently showed a dense parenchymal pattern and microcalcifications in these cases. In older women (55 years or more), a fatty breast pattern, nodular opacities with or without microcalcifications, and invasive tumours of the ductal, lobular, mixed or other types were closely related. When the relationships between mammographic findings, pathological tumour characteristics and receptor status were investigated for invasive cancers, there was an association between the presence of microcalcifications and less favourable tumour characteristics.

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KEYWORDSColor Doppler; Breast; Mammary lesions.Abstract Has color Doppler a role in the evaluation of mammary lesions? A schematic review of color Doppler diagnostic criteria, indicating a benign or malignant lesion, are described. Malignant tumors have a tendency to show increased vascularization, but avascular tumors may be found as well as hypervascular benign tumors. Number of vessels, blood-flow velocity, and intra-tumoral vessel resistance assessed by color Doppler ultrasonography don't permit clear differentiation between malignant and benign tumors, but intra-tumoral blood-flow analysis well correlates with aggressiveness and histological grade of the mass, so a preoperative assessment using Color Doppler may give preliminary prognostic informations useful for therapeutic planning. Color Doppler ultrasound may be valuable also in assessing the efficacy of neoadjuvant chemotherapy and in particular of antiangiogenesis treatments. Color Doppler ultrasound has many other useful applications in the evaluation of diseases of the female and male breast, that are reviewed in the paper. Color Doppler however is not conceived as a stand-alone examination, but associated with Bmode ultrasound that is quite effective as a diagnostic tool, often not requiring Doppler informations.Sommario Il color Doppler ha un ruolo nella valutazione delle lesioni mammarie? Viene presentata una rassegna schematica dei criteri diagnostici color Doppler, che indicano la benignità o la malignità di una lesione. I tumori maligni hanno la tendenza a mostrare vascolarizzazione aumentata, ma si possono trovare tumori maligni avascolari, così come tumori benigni ipervascolarizzati. Numero di vasi, velocità del flusso, indici di resistenza non consentono una sicura differenziazione tra tumori maligni e benigni, ma l'analisi del flusso intratumorale si correla bene con l'aggressività ed il grado istologico della neoplasia, quindi una valutazione preoperatoria, utilizzando il Color Doppler, può fornire informazioni prognostiche preliminari utili per la pianificazione terapeutica. * Corresponding author.E-mail address: giabusil@tin.it (P. Busilacchi). Può essere utile anche per valutare l'efficacia della chemioterapia neoadiuvante e, in particolare di trattamenti antiangiogenesi. Il color Doppler ha molte altre applicazioni nella valutazione delle patologie della mammella femminile e maschile, che vengono esaminati nel presente articolo. Il color Doppler, tuttavia, non è concepito come un esame autonomo, ma associata all'ecografia B-mode, che è molto efficace come strumento diagnostico delle lesioni mammarie e che, spesso, non richiede informazioni Doppler. ª

Aims and background Women with BRCA1 or BRCA2 germline mutations have an elevated risk of developing breast and/or ovarian cancer. Because of the early onset of the disease, screening of this group of women should start at an earlier age than in the general population. The association of breast magnetic resonance imaging (BMRI) and ultrasonography (US) with mammography (MX) and clinical breast examination (CBE) in the regular surveillance of these individuals has been proposed and seems to improve the early detection of breast cancer. Methods Within a multicenter study started by the Istituto Superiore di Sanita (Rome), at the Istituto Nazionale Tumori of Milan (INT) we enrolled 116 women at high genetic risk for breast cancer; they were either BRCA1 or BRCA2 mutation carriers or had a strong family history of breast cancer. They underwent CBE, MX, US and BMRI once a year. Results Between June 2000 and April 2005, at INT 12 cancers were detected among the 116 screened individuals (10%). In this subgroup, 1 patient refused BMRI and in 2 cases US was not performed. With BMRI we found 11 cancers and 6 of them were detectable only by this technique. In these 6 cases, the size of the disease was less than 1 cm and MX was false negative due to irregularly nodular parenchyma in 4 cases and scar tissue or prosthesis in the other 2. US was not performed in 2 cases and was false negative in 4 cases. Three false positive results were found with BMRI: 1 case was considered suspect but related to hormonal influences; 1 case with the same pattern was sent for second-look US, which gave a negative result and BMRI review after 6 months showed normalization of the parenchyma; in the third case histology revealed the presence of adenosis. No false positive results were registered for MX. Conclusions The aim of secondary prevention is the detection of cancer at its earliest stage. BMRI screening in women with BRCA1 or BRCA2 mutations or at high familiar risk appears to be highly sensitive and may detect mammographically occult disease. The accuracy of MR imaging is higher than that of conventional imaging but the technique is flawed by a lower specificity. In order to avoid unnecessary biopsies we believe that the combination of BMRI and conventional imaging can be very useful in screening women with a high genetic risk of breast cancer, especially with second-look evaluation by means of US when BMRI yields the only positive diagnostic result. Second-look US has been demonstrated to be of critical importance both in recognizing false positive BMRI results and in guiding biopsies, when necessary.

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In population-based screens, tissue biopsy remains the standard practice for women with imaging that suggests breast cancer. We examined circulating microRNAs as minimally invasive diagnostic biomarkers to discriminate malignant from benign breast lesions. miRNAs were analyzed by OpenArray in a retrospective cohort of plasma samples including 100 patients with malignant (T), 89 benign disease (B), and 99 healthy donors (HD) divided into training and testing sets and a prospective cohort (BABE) of 289 women with suspicious imaging findings who underwent tissue biopsy. miRNAs associated with disease status were identified by univariate analysis and then combined into signatures by multivariate logistic regression models. By combining 16 miRNAs differentially expressed in the T vs. HD comparison, 26 signatures were also able to significantly discriminate T from B disease. Seven of them, involving 5 specific miRNAs (miR-625, miR-423-5p, miR-370-3p, miR-181c, and miR-301b), were statistically validated in the testing set. Among the 7 signatures, the discriminatory performances of 5 were confirmed in the prospective BABE Cohort. This study identified 5 circulating miRNAs that, properly combined, distinguish malignant from benign breast disease in women with a high likelihood of malignancy.