| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
1 Division of Diagnostic Radiology, The University of Texas M. D. Anderson
Cancer Center, 1515 Holcombe Blvd., Box 57, Houston, TX 77030.
2 Department of Diagnostic Radiology, Kelsey-Seybold Clinic, 2727 W. Holcombe
Blvd., Houston, TX 77025.
3 Division of Pathology, The University of Texas M. D. Anderson Cancer Center,
Houston, TX 77030.
Received July 1, 2002;
accepted after revision August 22, 2002.
Address correspondence to A. C. Kushwaha.
Abstract
 Top Abstract IntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
MATERIALS AND METHODS. We retrospectively reviewed our institutional database for records of all vacuum-assisted stereotactic core-needle biopsies performed during a 4-year period. Five hundred thirty-eight lesions were biopsied, of which 302 (56%) were benign. Apocrine metaplasia was diagnosed in 37 lesions. In 11 of these 37 lesions, apocrine metaplasia made up more than 50% of the lesion sampled.
RESULTS. On mammography, eight cases (73%) appeared as new or increasing calcifications, and three cases (27%) appeared as new or enlarging equal-density masses (0.6-1.2 cm). Calcifications were heterogeneous in five lesions (63%), amorphous in two (25%), and punctate in one (12%); one heterogeneous cluster of calcifications (12%) also contained milk of calcium. The pattern of calcification distribution was clustered in five lesions (63%), multiple clusters in two (25%), and linear in one (12%). Two masses (67%) were lobular, and one (33%) was round. Two borders (67%) were microlobulated, and one (33%) was circumscribed.
CONCLUSION. Apocrine metaplasia is a benign condition commonly associated with other fibrocystic changes. Lesions composed of more than 50% focal apocrine metaplasia are relatively uncommon. A new or enlarging lobular, microlobulated mass or heterogeneous calcification cluster may represent apocrine metaplasia. Because no distinguishing mammographic features are present to require follow-up by imaging, needle biopsy is required for definitive diagnosis.
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
In our experience with stereotactic biopsies, we have occasionally encountered the diagnosis of apocrine metaplasia. To determine whether focal apocrine metaplasia has any distinctive mammographic characteristics, we evaluated the mammographic appearance of apocrine metaplasia diagnosed by vacuum-assisted stereotactic core-needle biopsy and correlated mammographic and histopathologic findings in 11 cases of apocrine metaplasia in 10 women.
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
One breast pathologist retrospectively reviewed the histopathologic slides of these 37 lesions. We defined focal apocrine metaplasia as a lesion containing 50% or greater apocrine metaplasia. The pathologist determined that 11 of these lesions (found in 10 patients) contained apocrine metaplasia in more than 50% of the lesions sampled. These 11 lesions were included as the basis for analysis. Ten of these lesions had been sampled using an 11-gauge needle, and one lesion had been sampled using a 14-gauge needle. The number of core samples that had been obtained ranged from six to 18 (mean, 10). Institutional review board approval was obtained for this project.
All 11 patients underwent mammography before the stereotactic core-needle biopsy was performed. Mammograms of all 11 lesions and prior films of seven lesions were available for review. Diagnostic mammographic views were available for all 11 lesions and included a 90° lateral image and magnification images in both the craniocaudad and lateral medial positions for nine lesions. The other two lesions were imaged with spot compression views in the craniocaudal and lateral medial positions.
Two board-certified radiologists who practice full-time breast imaging reviewed the mammograms of all 11 lesions. A third board-certified radiologist who practices full-time breast imaging reviewed the images to resolve any discrepancies between the first and second reviewers. The reviewers classified the lesions in accordance with the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon [4]. Patients with masses seen on mammography had a complete sonographic evaluation of the breast before the stereotactic biopsy was performed. One of the radiologists reviewed the three sonographic reports.
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
On the mammograms, eight (73%) of the 11 lesions appeared as new or increasing calcifications, and three (27%) of 11 lesions presented as new or enlarging masses. The calcifications were heterogeneous in five lesions (63%) (Fig. 1A,1B), amorphous in two lesions (25%), and punctate in one lesion (12%). One heterogeneous cluster of calcifications also contained milk of calcium. The pattern of distribution of the calcifications was grouped or clustered in five lesions (63%), multiple clusters in two lesions (25%), and linear in one lesion (12%). Of the three lesions that appeared as masses, two (67%) were lobular, and one (33%) was round. All three were equal-density masses: Two (67%) had microlobulated borders (Fig. 2) and one (33%) had circumscribed borders. The greatest dimension of the masses ranged from 0.6 to 1.2 cm (mean, 0.9 cm). None of the masses were palpable.
|
|
|
All three patients with masses had undergone sonography of the breast, which revealed no masses correlating with those seen on mammography.
The average number of passes during biopsy was 10. In the patients with calcification, calcifications were seen in an average of four cores. Review of the histopathologic findings of all cases showed the typical features of dilated cystic acini lined by apocrine metaplastic epithelium (Fig. 3A,3B). Cystic apocrine metaplasia is composed of flat and cuboidal cells that may form a single layer or exhibit proliferative change resulting in isolated blunt papillae. The cells, which are usually evenly spaced, contain round nuclei with homogeneous, moderately dense chromatin. The cytoplasm is typically finely granular and uniformly stained [1].
|
|
Associated calcifications in the cystic spaces were noted on pathologic review in eight (73%) of the 11 lesions. One lesion also showed focal ductal hyperplasia without atypia, and another lesion showed sclerosing adenosis. Mammography after biopsy showed that either the size or the number of calcifications in all of the biopsied lesions had decreased.
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
Cystic disease of the breast probably evolves in the following sequence: microscopic disease to mammographically and sonographically detectable disease to palpable macrocysts. This is the radiologic correlate to the histologic theory of lobular unfolding related to cyst development [2]. Concerning that theory, Wellings and Alpers [2] describe metaplastic change of the lobular cells of the terminal ductal—lobular unit. The lobules slowly distend from the progressive secretions of the metaplastic apocrine cells. There is an intermediate papillary or microcystic stage in the evolution to the end product of a distended terminal ductal—lobular unit with flattened aprocrine metaplastic cells lining a cyst cavity [2]. We believe that we evaluated the mammographically detectable threshold of apocrine metaplasia; this threshold would correlate with the micropapillary or microcystic pathologic stage. All three of our patients with mammographic masses had undergone sonography of the breast, but none had a mass that was detectable on sonography. Eight of 11 lesions had suspicious microcalcifications on mammography. We do not routinely perform sonography to detect calcifications at our institution.
On mammography, combined findings of a new or enlarging lobular, equal-density mass with microlobulated margins suggest that apocrine metaplasia should be included in the differential diagnosis. In addition, new or increasing heterogeneous calcifications that are grouped or clustered should also prompt one to consider apocrine metaplasia in the differential diagnosis. We do not believe that apocrine metaplasia has any distinguishing mammographic features to suggest that this mammographic lesion could be followed by imaging. We believe that these new or enlarging lesions not detectable on sonography should be considered as suspicious findings. We suggest that these lesions undergo needle biopsy.
This recommendation differs from a previously published recommendation regarding the management of apocrine metaplasia [6]. In that study, Warner et al. [6] suggested that the combination of a low or equal-density mass on mammography and an anechoic septate lesion on sonography can be given a short-term follow-up. Our recommendations differ because our study group did not have sonographically detectable disease, and most of the lesions were microcalcifications. Of the 17 masses evaluated by Warner et al., 13 masses were seen on sonography and contained calcifications. Warner et al. based their recommendation on combined mammographic and sonographic characteristics. At our institution, if a mammographic finding is also visualized on sonography, a sonographically guided biopsy is performed or a short-term follow-up is recommended on the basis of the sonographic and mammographic features. Our recommendations from this study are based solely on mammographic findings. The lesions in our study population may represent an earlier stage of apocrine metaplasia than did those in cases studied by Warner et al.
Our study revealed no pathognomonic or characteristic mammographic findings specific to apocrine metaplasia that could be used to delay or avoid a biopsy. Apocrine metaplasia is a benign proliferative fibrocystic condition that can present in a variety of forms, ranging from a small cluster of calcifications to a macrocyst. Apocrine metaplasia should be considered in the differential diagnosis when a stereotactic biopsy is recommended for a microlobulated mass or for one or more clusters of new or increasing heterogeneous or amorphous calcifications.
Acknowledgments
We thank Angela Lynch and Mariann Crapanzano for assistance in the
preparation of this manuscript.
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  W. A. Berg Sonographically Depicted Breast Clustered Microcysts: Is Follow-Up Appropriate? Am. J. Roentgenol., October 1, 2005; 185(4): 952 - 959. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
