Palpable Breast Masses
Is There a Role for Percutaneous Imaging-Guided Core Biopsy?
Laura Liberman1,
Lauren A. Ernberg1,
Alexandra Heerdt2,
Maureen F. Zakowski3,
Elizabeth A. Morris1,
Linda R. LaTrenta1,
Andrea F. Abramson1 and
D. David Dershaw1
1
Department of Radiology, Breast Imaging Section, Memorial Sloan-Kettering
Cancer Center, 1275 York Ave., New York, NY 10021.
2
Department of Surgery, the Breast Service, Memorial Sloan-Kettering Cancer
Center, New York, NY 10021.
3
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
10021.
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Fig. 1A. —57-year-old woman with palpable lump in right upper inner quadrant.
Collimated mediolateral oblique mammogram obtained after placement of
radiopaque skin marker over palpable lump shows irregular spiculated mass
measuring approximately 1.2 cm (arrow). Fine-needle aspiration under
guidance of palpation by surgeon yielded benign ductal epithelial cells and
adipose tissue, a diagnosis that was discordant with imaging findings.
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Fig. 1B. —57-year-old woman with palpable lump in right upper inner quadrant.
Real-time sonogram of right upper inner quadrant shows hypoechoic solid mass
with irregular borders that is taller than it is wide (arrows).
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Fig. 1C. —57-year-old woman with palpable lump in right upper inner quadrant.
Sonogram obtained during sonographically guided 14-gauge automated core biopsy
shows needle (solid arrows) traversing lesion (open
arrow).
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Fig. 1D. —57-year-old woman with palpable lump in right upper inner quadrant.
Photomicrograph of core biopsy material shows infiltrating ductal carcinoma
with high histologic grade and intermediate nuclear grade. Patient was
referred for one-stage therapeutic surgery. (H and E, x100)
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Fig. 2A. —52-year-old woman with palpable lump in right lower outer quadrant.
Collimated 90° lateral magnified mammogram of right breast shows 1-cm mass
with pleomorphic calcifications in 9-o'clock axis corresponding to palpable
lump, as denoted by radiopaque skin marker. Second nonpalpable mass measuring
0.6 cm was seen in right 11-o'clock axis (arrow).
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Fig. 2B. —52-year-old woman with palpable lump in right lower outer quadrant.
Specimen radiograph obtained after stereotactic biopsy of both masses was
performed shows calcifications (arrows). Histologic analysis yielded
infiltrating ductal carcinoma, poorly differentiated, from both sites. Patient
was treated with mastectomy.
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Fig. 3A. —52-year-old woman with vaguely palpable lump in inferior right
breast. Collimated photograph of craniocaudal right mammogram shows partially
obscured lobulated 1.3-cm mass (arrows) in right breast at 6-o'clock
axis.
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Fig. 3B. —52-year-old woman with vaguely palpable lump in inferior right
breast. Real-time sonogram shows hypoechoic solid circumscribed mass
(arrows) corresponding to mammographic finding.
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Fig. 3C. —52-year-old woman with vaguely palpable lump in inferior right
breast. Sonogram obtained during sonographically guided core biopsy shows
needle traversing lesion (arrow).
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Fig. 3D. —52-year-old woman with vaguely palpable lump in inferior right
breast. Photomicrograph of core biopsy material reveals fragment of benign
fibroadenoma, with epithelial cells surrounded by dense hyalinized stroma.
Histologic and imaging findings were concordant and patient was spared from
undergoing surgery. (H and E, x40)
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Fig. 4A. —32-year-old woman with vaguely palpable mass in axillary tail of
left breast. Mediolateral oblique mammogram shows irregular indistinct mass
(arrows) in left axillary tail.
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Fig. 4B. —32-year-old woman with vaguely palpable mass in axillary tail of
left breast. Longitudinal sonographic image of palpable lump in axillary tail
of left breast, shows irregular hypoechoic 1.6-cm solid mass (arrows)
abutting pectoral muscle.
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Fig. 4C. —32-year-old woman with vaguely palpable mass in axillary tail of
left breast. Photomicrograph of material obtained at sonographically guided
core biopsy (using 14-gauge needle and short excursion gun) shows focus of
markedly atypical cells in fibrous mammary stroma. (H and E, x400)
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Fig. 4D. —32-year-old woman with vaguely palpable mass in axillary tail of
left breast. Photomicrograph of material obtained at subsequent surgical
excision yielded ductal carcinoma in situ (open arrow) and
infiltrating ductal carcinoma (1.8 cm). Some of this infiltrating carcinoma is
growing as small tubular structures (solid arrow). Axillary lymph
node dissection revealed negative findings. (H and E, x100)
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