Mucocele-like Lesions of the Breast: Mammographic, Sonographic, and Pathologic Findings and Upgrade Rate
HHC Tsang, JWC Wai, JLF Chiu, OK Wong
Hong Kong J Radiol 2016;19:279-86
DOI: 10.12809/hkjr1615330
Objective: To describe the mammographic, sonographic, and pathologic appearance of mucocele-like lesions (MLLs) of the breast and to determine the upgrade rate following surgical excision.
Methods: All patients who attended Queen Elizabeth Hospital, Hong Kong from 1 January 2008 to 31 May 2014 with core needle biopsies (CNB) and MLL as one of the final pathological diagnoses or with mucinous material found within the specimens were identified. All available breast imaging, and pathology slides and reports were reviewed by radiologists and a pathologist specialised in breast imaging, respectively. The upgrade rate of MLL to high-risk lesion or to malignancy was obtained.
Results: Twelve patients had either MLL or mucinous material within their CNB specimen. Their mean age was 47 years (range, 31-77 years). The most common mammographic finding was grouped coarse heterogeneous calcifications (56%) and the most observed feature on ultrasound was lesions containing cystic components (71%). Of the 12 patients, six subsequently underwent excisional biopsy of their lesion. One of them had atypia shown on CNB and a final surgical specimen revealing MLL associated with ductal carcinoma in-situ. Of the five patients with CNB showing no atypia, three (60%) were upgraded — upgraded histology included one node-negative papillary carcinoma with foci of mucinous carcinoma and two with high-risk histology of atypical ductal hyperplasia.
Conclusion: MLLs of the breast have variable mammographic and sonographic appearances but the common radiological findings include presence of grouped heterogeneous calcifications mammographically and lesions containing cystic components sonographically. A significant proportion of lesions that yielded mucinous material or that were diagnosed as a MLL on percutaneous CNB without atypia were upgraded. Surgical excision is still warranted following a CNB diagnosis of MLL to allow evaluation of the entire area and to exclude the presence of atypia or carcinoma.
Authors’ affiliations:
HHC Tsang, JWC Wai, JLF Chiu: Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong
OK Wong: Department of Pathology, Queen Elizabeth Hospital, Jordan, Hong Kong
中文摘要
乳腺粘液囊腫樣病變：乳房X光造影、超聲和病理學特徵及分級提高率
曾凱晴、衛穎莊、趙朗峯、黃安傑
目的：描述乳腺粘液樣囊腫病變（MLL）的鉬靶、超聲和病理學特徵，並確定手術切除後的分級提高率。
方法：研究對象為2008年1月1日至2014年5月31日期間到香港伊利沙伯醫院接受粗針穿刺活檢（CNB），最終病理診斷為MLL或標本含粘液性成分的患者。分別由放射科醫生審查所有乳房影像，病理學醫生審查所有病理載片和報告。找出MLL病變升至高風險病變或惡性腫瘤的分級提高率。
結果：12例患者屬MLL或在其CNB標本中發現有粘液性成分。患者平均年齡47歲（介乎31至77歲）。最常見的乳房X光造影成像特徵為不均勻粗鈣化簇（56%），而超聲成像特徵最常見為包含囊性成分的病變（71%）。12例患者中有6例最終接受病灶切除活檢。其中1例CNB顯示非典型增生，最終手術標本顯示為導管原位癌相關性MLL。5例接受CNB的患者未發現非典型增生，3例（60%）分級提高：包括1例為淋巴結陰性乳頭狀癌伴發粘液癌，另兩例為高危性乳腺導管上皮非典型增生。
結論：MLL的乳房X光造影和超聲影像特徵多變，但X光造影可見常見的不均勻的粗鈣化簇，以及超聲上含有囊性成分的病變。產生粘液性成分的病灶或經皮CNB診斷為不伴非典型增生的MLL病灶中，相當部分的分級有見提高。如果經皮CNB診斷有MLL，則需進行手術切除以評估整個區域和排除非典型增生或癌的存在。