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Palpable Breast Masses

Is There a Role for Percutaneous Imaging-Guided Core Biopsy?

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.

View larger version (108K): [in a new window]   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.

View larger version (158K): [in a new window]   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).

View larger version (168K): [in a new window]   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).

View larger version (161K): [in a new window]   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)

View larger version (100K): [in a new window]   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).

View larger version (84K): [in a new window]   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.

View larger version (146K): [in a new window]   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.

View larger version (152K): [in a new window]   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.

View larger version (182K): [in a new window]   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).

View larger version (116K): [in a new window]   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)

View larger version (159K): [in a new window]   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.

View larger version (141K): [in a new window]   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.

View larger version (125K): [in a new window]   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)

View larger version (172K): [in a new window]   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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