MAMMOGRAPHIC AND ULTRASONOGRAPHIC FINDINGS CHARACTERISTICS OF INVASIVE DUCTAL CARCINOMA OF THE BREAST IN KING CHULALONGKORN MEMMORIAL HOSPITAL (KCMH*)

Abstract

Purpose: Toreview mammographic, ultrasonograhic findings and histological grades of invasive ductal carcinoma (IDC) of breast in King Chulalongkorn Memorial Hospital.
Materials and methods: A total of 263 proven cases of IDC of breast and histological grading whose 252 mammographic studies and 233 ultrasoud studies were retrospective reviewed for mammographic and ultrasonographic features.
Results: Two hundred and twenty two abnormal masses have been found in 217 mammography. Another 35 cases whose mammographic findings showed no mass lesions; 5 were normal, 19 were asymmetrical density and 11 were architectural distortion and adjunction ultrasound images could detect these lesions. The most common mammographic findings of IDC were abnormal mass with irregular shape (86.5%). The most frequent margin of mass from mammography was spiculate margin (39.6%) which most were histological grade 1 and 2 (77.27%) followed by indistinct (ill-defined) margin (33.7%). Malignant-type microcalcifications were observed in 111 cases (44%) and the most common type of microcalcifications were granular type(52.3%). Mammography was better than ultrasonography in depicting microcalcifications (111 Vs 58 lesions). Axillary lymphadenopathy was detected in 46% of cases. Ultrasonography was better than mammography in depicting soft tissue masses. Two hundred and forty four lesions have been found by ultrasonography. The most common ultrasonographic findings for IDC of breast cancer were irregular shape (80%) and thick echogenic rim (80%). Nearly most of lesions were hypoechoic lesions (hypoechoic lesions 83.2% and very low echoic lesions 7.38%). Most frequent posterior attenuation from ultrasonography was posterior enhancement (29.5%) followed by posterior shadowing (28.3%). In-group of posterior enhancement lesions were mostly in histological grade 3 and 2, while in posterior shadow group most lesions were in grade 1 and 2. Doppler study, available in 240 lesions, found that 79.9% have one or more feeding vessels to lesions.
Conclusion: Mostcommon malignant mammographic features are spiculated margin (39.6%) and irregular shape (86.5%). Multiple suggestive malignancy signs such as malignant microcalcifications, axillary lymphadenopathy and skin thickening should be used to increase confidence of the diagnosis. Most common features on ultrasound are irregular mass, angular margin, thick echogenic rim and hypervascularity from Doppler study. Posterior shadowing of the mass tends to be found in grade 1 and 2 tumor, whereas posterior acoustic enhancement tends to be found in grade 3 tumor. Adjunctive ultrasonography was suggested to improved the confidence of diagnosis.