A combination of BI-RADS MRI descriptors and clustered ring enhancement criteria is useful for the differential diagnosis of lesions showing non-masslike enhancement.

No abstract

(1)H MRS was useful for characterizing breast lesions measuring 15 mm or larger, and diffusion-weighted imaging was useful for characterizing lesions of any size. However, these two techniques still have potential pitfalls in relation to the diagnosis of nonmass breast lesions.

The visual pattern classification and adding Young's modulus measurements may improve characterization of solid breast masses.

Background. Endoscopic mastectomy has been reportedly associated with smaller scars and greater patient satisfaction; however, few reports on this topic have been made. The purpose of this retrospective study was to examine the early results of endoscopic nipple-sparing mastectomy (E-NSM) and to investigate the safety of this procedure. Methods. Between January 2002 and December 2005, a total of 87 patients with breast cancer but without skin and nipple involvement, including two cases of bilateral breast cancer, underwent E-NSM. In case of bloody nipple discharge and suspicious extension near the nipple as assessed by magnetic resonance imaging, the major ducts within the nipple were cored (nipple coring). In other cases, nipple coring was not performed. Results. Of the 89 breasts in 87 patients, 42 had tumors of [2 cm and 80 were diagnosed as having invasive carcinoma. Lymph node involvement was observed in 36 procedures. The overall rate of nipple necrosis was 18% (16 of 89). The rate of nipple necrosis among the procedures with nipple coring was statistically higher than that among those without nipple coring (7 of 17, 41%, vs. 9 of 72, 13%) (P = .01). Nipple involvement was observed in 2.2% (2 of 89). After a median follow-up period of 52 months, distant metastasis was observed in nine cases; no local recurrences occurred in this series.Conclusions. E-NSM is an oncologically safe procedure and an acceptable method in selected patients requiring a mastectomy. The higher rate of nipple necrosis may have been the result of a technical problem, indicating the need for continued improvement in nipple coring procedures.The removal of the nipple as part of a mastectomy has been routinely performed on the basis of the presumed risk of occult nipple involvement, which reportedly occurs in 5.6% to 58% of cases.1-11 However, many patients are dissatisfied with the reconstructed nipple for various reasons, including nipple projection, color matching, shape, size, texture, and position.12 A nipple-sparing mastectomy (NSM) is a procedure that can be applied as part of a skinsparing mastectomy, in which the nipple-areola complex (NAC) is preserved for cosmetic reasons. 9,11,[13][14][15][16][17][18][19] For patients without skin and nipple involvement, NSM has evolved as an alternative to a mastectomy with a safe oncologic profile and a better cosmetic outcome. 9,11,[13][14][15][16][17][18][19][20][21] In the early 1990s, endoscopic surgery of the breast was first applied for the treatment of patients with capsular contracture after breast augmentation. 22 Since then, it has been used for aesthetic breast surgery, breast lump excision, and breast surgery for breast cancer. [23][24][25][26][27][28][29][30][31][32][33][34] The addition of endoscopy to NSM for patients with breast cancer has been reportedly associated with smaller scars and greater patient satisfaction.27-29 However, few reports on endoscopic nipple-sparing mastectomy (E-NSM) have been made, and most of these studies had relatively short followup peri...

Clustered ring enhancement is thought to be a useful sign to differentiate between benign and malignant lesions, in addition to the BI-RADS MRI descriptors.

The combination of elastography and tissue quantification is thought to be a promising ultrasound technique for differential diagnosis of breast-mass lesions.

Non-mass-like breast lesions detected on MRI showing a clustered ring enhancement, a branching-ductal pattern, and clumped architecture should be evaluated further by biopsy (category 4), while lesions not showing these characteristics may be observed without unnecessary intervention (category 3a). Lesions showing a linear-ductal pattern may be followed carefully or evaluated by biopsy as needed (category 3b).