This study was designed to determine whether the combined use of ultrasound (US) in mammography (MG) screening for women in their 40s could decrease the mortality rate. We selected 695 consecutive women who had been histopathologically diagnosed as having breast cancer at our facility between April 2012 and March 2016. Among them, 145 women in their 40s and 340 women in their 50s or older were enrolled, including asymptomatic cases detected by breast cancer screening (MG, US, or palpation) and symptomatic cases. Among the women with breast cancer in their 40s, the percentage of women with a low histological grade was somewhat higher (26.2% vs. 19.7%, P = 0.112) than that among women in their 50s or older, and the percentages of HER2―enriched and triple―negative subtype were significantly lower ([2.8, 9.1%, P = 0.014], [8.3, 16.5%, P = 0.018], respectively), while the presence of luminal B breast cancer was significantly higher (63.9, 46.3%, P < 0.001). In addition, the Ki67 value was slightly higher in dense breasts in women in their 50s or older, whereas it was significantly higher in non-dense breasts in women in their 40s (P = 0.034).
Furthermore, in non-dense breasts of women in their 40s, the percentage of luminal B breast cancer was especially high (dense: 59%, non-dense: 77%, P = 0.047), and the Ki67 value was significantly higher than that in non-dense breasts of women in their 50s or older (P = 0.044). In luminal B breast cancers in women in their 40s, there was no significant difference in the proliferative ability between the US-detected cases and the symptomatic cases, and it was significantly higher in the US-detected cases than in the MG-detected cases. Consequently, the combined use of US in MG screening for women in their 40s was thought to increase the possibility of the early detection of luminal B breast cancer with a high proliferative ability, contributing to an improvement in life expectancy.
We planned a "Mammography (MMG) Positioning Contest", focused only on mammography positioning, with the aim of improving the technique for photographing mammograms, and examined how to provide the best images necessary for review.
Soft copy (SC) and hard copy (HC) were mixed in the MMG submitted for the contest. In SCMMG, screen fitting display and screen capture are performed at the MMG workstation, and in HC-MMG, the images were uploaded to a high-luminance film illuminator and photographed with a digital camera, and then processed into image data for general-purpose PC; we then created an image file for review.
The judges were three doctors in the lead position on MMG in general. We provided to them encrypted the image file and sent to the e-mail address. They evaluated the images in their free time. The evaluation items were scored on a total score of 40 points, including 36 points for "Positioning" and 4 points for "Breast density (heterogeneously dense)", in order to evaluate the application conditions . In regard to the results of the examination, although there were slight differences in the median scores of the three judges, the results of each examination were correlated.
Also, the results of voting by the doctors or technicians who printed out the images showed the same tendency as the judges’ evaluations.
This method was considered to be valuable as a convenient and versatile method of evaluation of versatility .
Fibroadenoma (FA) is a common benign breast tumor, and carcinoma arising within an FA is very rare. We encountered a case of ductal carcinoma in situ (DCIS) that was mainly positioned in the epithelium of an FA. The patient was a ６１-year-old woman with a 10-mm left breast tumor. Mammography and ultrasonography examinations showed a tumor with a largely distinct margin and calcification between the tumor and the nipple. A core needle biopsy from the tumor demonstrated DCIS with stromal hyperplasia. Fine-needle aspiration cytology from a low echoic area with echogenic spots allowed for a diagnosis of malignancy. A partial mastectomy and sentinel node biopsy were performed under a diagnosis of DCIS with ductal spread toward the nipple. The pathological examination revealed an FA with DCIS largely replacing its epithelium and intraductal carcinoma outside the FA. Detailed evaluations of the tumor and the extratumoral findings were useful for the diagnosis of the tumor.
We report a rare case of breast carcinoma observed in the nipple. A 43-year-old female presented with calcifications in the right nipple detected by screening mammography. An elastically hard mass was found in the right nipple, with no erosion or redness, and the mammogram showed a cluster of pleomorphic calcifications. The right nipple presented with fine high-echo spots on an ultrasonogram and a pale contrast area on a magnetic resonance imaging (MRI) scan. Ductal carcinoma in situ (DCIS) was diagnosed based on a biopsy, and a partial resection and sentinel lymph node biopsy of the right breast was performed. A histopathological examination revealed DCIS at the nipple. Post-operative radiation therapy to the intact breast was performed, and a future nipple-areolar plastic surgery is planned.