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This study aimed to assess their characteristics and clinical course of each histologic type of the behavior of phyllodes tumor (PT). We retrospectively reviewed 124 patients with PTs who underwent surgical treatment from 2003 to 2011. PTs were classified as benign, borderline, and malignant using surgical specimens. The clinicopathological characteristics according to solitary and multiple lesions on ipsilateral breast and histological change after local recurrence were examined. The median patient age was 42 years (range 12–72 years). The final pathologic diagnosis was benign PTs in 95 patients (76.6%), borderline PTs in 21 (16.9%), and malignant PTs in 8 (6.5%). The size of benign PTs [median 4.2 cm (range 1–21 cm)] was significantly smaller than that of malignant PTs [median 11.3 cm (range 6–27 cm)] (p

Elf5 is a transcription factor previously shown to be involved in regulating cell differentiation in both normal and pathological breast tissues. Pertinently, Elf5 was reported to interact with the FOXA1 transcription factor, a pivotal regulatory factor in a subset of AR overexpressing triple negative cancer (TNBC) cases. We examined the correlation among AR, FOXA1, and Elf5 expression in a series of TNBC cases. The cases were retrieved from surgical pathological files of Tohoku University Hospital Japan and consisted of 60 cases operated between the year 1999 and 2007. An additional cohort cases of 51 TNBC ductal carcinoma in situ was used to compare invasive and non-invasive TNBC. In our cohort, 47% of all carcinomas were positive for Elf5, with a significantly higher proportion of Elf5 positive cases occurring in the younger age groups (p = 0.0061). Elf5 immunoreactivity was not associated with any other clinicopathological factors examined in this study. However, Elf5 expression was associated with decreased overall and disease-free survival of the patients (Peto–Peto modification of Gehan–Wilcoxon test, OS p = 0.132, DFS p = 0.1 (LI cutoff 10%); OS p = 0.038, DFS p = 0.021 (LI cutoff 50%)). Of particular interest, its effects on survival were more pronounced in the EGFR−/CK5/6− (non-basal surrogate) than the EGFR+ and/or CK5/6+ (basal-surrogate) subtype of TNBC. Elf5 is present in TNBC and its status was significantly correlated with overall survival of the patients. Further studies examining possible interactions between Elf5 and other factors in TNBC could contribute to disentangling TNBC biology.

To assess magnetic resonance imaging (MRI) and ultrasound (US) evaluation of invasive lobular carcinoma after primary systemic therapy compared to the primary surgery group. A total of 218 breasts with invasive lobular carcinoma (ILC), which were diagnosed by core needle biopsy and underwent surgery between 2004 and 2010 in St. Luke’s International Hospital, were reviewed. Of these, 44 breasts received primary systemic therapy (PST) and the residual 174 breasts underwent surgery first. Before surgery, MRI and second-look US were performed. Patients whose extent of lesion from MRI and US was over 90° were recommended to receive total mastectomy. Diagnostic image evaluation was categorized from the final pathology. A negative margin of breast-conserving surgery (BCS) and mastectomy which has over 90° tumor extent in pathology were regarded as “appropriate”. A positive margin of BCS was regarded as “underestimated”. “Overestimation” was determined when the pathological extension was small enough for BCS although MRI and US diagnosis was over 90°. Of 44 breasts which received PST, 26 breasts received BCS as initial surgery. Of these, 14 (53.8 %) breasts were “underestimated”. Of these 14, 5 breasts received additional total mastectomy. Of 174 breasts that received surgery first, 121 (69.5 %) breasts received BCS as the initial surgery. Of these, 46 (38.0 %) breasts were “underestimated” and 6 breast of these 46 received additional total mastectomy. “Underestimated” rate was similar in the two groups, but the additional total mastectomy rate was significantly higher in the PST group (p = 0.025). There were no “overestimations”. The “appropriate” rate was similar between the PST (68.2 %) and surgery-first groups (73.6 %). Although 68.2 % of ILC patients were evaluated “appropriately” even after PST, higher additional total mastectomy rates should be considered when selecting the surgical procedure.

Microinvasive breast cancer (T1mi) is considered as a precursor of invasive cancer developing from ductal carcinoma in situ (DCIS). This study discussed the clinicopathological and immunohistochemical features of T1mi by comparing those of ductal carcinoma in situ (Tis) and T1a to assess the nature and causes of the progression of Tis into invasive cancer. Three hundred and ninety-two Tis, 32 T1mi, and 141 T1a lesions which were pathologically diagnosed in surgical specimens between 2006 and 2009 were analyzed retrospectively. T1mi was defined as a tumor no greater than 1 mm in its greatest dimensions, and T1a was defined as a tumor larger than 1 mm but no greater than 5 mm. The frequency of the comedo type was significantly higher in T1mi (68.8%) than in Tis (13.8%) (p

Elastography is widely used as a diagnostic tool for the diagnosis of invasive breast cancer. However, no study has yet shown if elastography for diagnosing mucinous carcinoma is as useful as that for diagnosing the usual invasive carcinoma. Mucinous carcinoma is considered as a soft tumor. In this study, we used elastography to evaluate the elasticity of mucinous carcinoma. Among 1,015 patients who underwent surgery for primary breast cancer between February 2007 and August 2008 in our facility, the final pathological diagnosis showed only 32 mucinous carcinomas. We evaluated 16 of the 32 mucinous carcinoma patients who underwent preoperative elastography. There were 13 cases of the pure-type and 3 cases of the mixed-type mucinous carcinoma. B-mode ultrasound (US) imaging showed mass formation in 16 patients. The elasticity score was 2 in 1 case (8%), 3 in 3 cases (23%), 4 in 7 cases (54%), and 5 in 2 cases (15%). The fat-to-lesion ratio (FLR) was evaluated in 7 cases. The mean value of the FLR was 12 (range 3–30). Twelve of the 16 (75%) cases had an elastography score of 4 or 5. Although mucinous carcinoma had an elastography score similar to that of usual invasive carcinoma, elastography may be useful for distinguishing mucinous carcinoma from benign fibroadenoma.

Triple negative (TN) breast cancer is characterized as having a high malignancy potential and a poor prognosis. An understanding of the radiological features of TN DCIS will enable the early detection of intractable TN invasive breast cancer. Our cohort of 494 DCIS patients, including 18 TN DCIS cases (3.6%), was diagnosed and treated between January 2006 and November 2009. We reviewed the TN DCIS cases in order to assess mammogram (MMG), ultrasound (US), magnetic resonance imaging (MRI), and pathology findings. Routine diagnostic MMG, US, and MRI were performed before surgery in our institution. The average age of TN DCIS patients was 54.2 years (40–73). MMG findings were as follows: no abnormal findings (n = 4), masses (n = 3), focal asymmetric density (n = 2), architectural distortion (n = 5), and calcifications (n = 4). US findings included low echoic masses (n = 17) and architectural distortion (n = 4). MRI findings (two patients did not undergo this examination) included mass (n = 6) and non-mass-like enhancements (n = 10). The average lesion measured 3.3 cm in diameter (0.5–8.5 cm). The histological findings were non-comedo type (n = 9) and mixed type including some comedo components (n = 9). Notably, our study revealed that only 22% of TN DCIS cases were detected via mammographic abnormal calcifications. This percentage was less than in non-TN DCIS cases. TN DCIS cases were detected mainly because of masses or asymmetry. US and MRI findings of TN DCIS revealed the same features considered to be common DCIS findings. We diagnosed TN DCIS in 3.6% of our cohort including 494 DCIS patients. Incidences of TN DCIS with mammographic abnormal calcifications were fewer than those of non-TN DCIS cases.

Recently, Architectural distortion (AD) has been detected via ultrasonography (US) even in the absence of a definitive mass; however, the clinical significance of this finding is yet unknown. The purpose of this study is to elucidate the causes of AD, as revealed by US. Breast echo was undergone by 931 patients between January and December 2005. The study comprised 45 patients (4.8%) in the age range of 28–76 years (mean 49.8 years) whose images revealed AD despite the absence of mass formation. To investigate the causes of this AD, we retrospectively reviewed the medical records of these patients. In 10 of 45 cases in which US revealed AD, the distortion was attributed to the biopsy procedures. Of these ten patients, seven underwent Mammotome biopsy, two underwent open biopsy; one underwent core-needle biopsy. Seven patients had previous histories of neoadjuvant chemotherapy for breast cancer. Fifteen lesions were benign, and 13 lesions were malignant disease pathologically. Emphasis on the increasing value of AD detection by US and professional awareness of this fact are of tremendous importance.

Neoadjuvant chemotherapy has recently become common therapy for breast cancer. This work studied whether or not the effects of neoadjuvant chemotherapy can be predicted from morphological features of breast cancer in initial diagnostic imaging.A total of 186 cases who underwent neoadjuvant chemotherapy at this hospital in 2006 were studied. Morphological features were classified into four categories. One is a type of invasive carcinoma that tends to grow along the mammary ducts (type A1), another is a type of expansively growing invasive carcinoma that is relatively well-defined (type A2), a third is a type of irregularly shaped mass that retracts surrounding tissue (type A3), and the fourth is a mixed type. Thus, the effects of neoadjuvant chemotherapy on carcinomas of the four types were compared on the basis of image and pathological findings. Effects of neoadjuvant chemotherapy were classified into three categories of enlarged mass, pCR, and other, with the latter indicating no change or shrinkage.Of the 186 total cases, 72 were classified as type A1, 31 as type A2, 52 as type A3, and 31 as a mixed type. Seven of 31 cases of type A2 (22.6%) were cases of an enlarged mass, revealing a high percentage of such cases. Dividing cases into type A2 and other types and looking at the proportion of cases of an enlarged mass thus indicated a significantly higher tendency. pCR was achieved in 6 of 31 cases with type A2 (19.4%). Here, also, the proportion of type A2 cases was significantly higher.Morphological features prior to neoadjuvant chemotherapy can contribute to determining the effects of the therapy. Expansively growing well-defined masses contain lesions at both extremes, tending to enlarge in some instances or instead allowing pCR, so the course of therapy must be carefully followed when performing neoadjuvant chemotherapy.

Patients with mammograms showing architectural distortion often have an invasive carcinoma with noticeable fibrosis, such as scirrhous carcinoma or invasive lobular carcinoma. However, architectural distortion is also seen in some cases of ductal carcinoma in situ (DCIS).Of the 316 patients operated on in our hospital from October 2003 to June 2004, 54 were histopathologically diagnosed as having DCIS (excluding cases with microinvasion). Of these 54 patients, 5 exhibited architectural distortion on the preoperative mammogram. The aim of this study was to correlate the radiologic and pathologic features of DCIS showing architectural distortion on the mammogram.The mammograms of the 5 patients revealed clusters of calcifications in the architectural distortion. Sclerosis was seen in the interstitium around the DCIS in 3 cases, and DCIS components were found in Cooper's ligament in 4 cases. In 2 cases, sclerosing adenosis was seen in the background of the DCIS.It is generally accepted that architectural distortion in DCIS is due to sclerosing adenosis, but sclerosis in the interstitium around the DCIS and presence of DCIS components in Cooper's ligament proved to be the cause of architectural distortion in the cases described here. Since architectural distortion is also seen in DCIS cases, we think that besides the diagnosis of malignancy, the presence or absence of infiltration should be histopathologically established before surgery.

One of the main roles of neoadjuvant chemotherapy for breast cancer is to shrink large tumors to increase patient eligibility for breast conserving surgery. Three dimensional MR Mammography (3D-MRM) can detect tumor extension more accurately compared with mammography and Ultrasonography (US). Therefore, the shrinkage pattern observed on 3D-MRM was analyzed with regard to several pathological factors.A total of 27 breast cancer cases were examined by 3D-MRM before and after neoadjuvant chemotherapy. The volume reduction and shrinkage patterns were assessed and compared with the pathological diagnosis.There were two shrinkage patterns. Twelve of 25 evaluable breast cancers (48%) showed a concentric shrinkage pattern while 13 cases (52%) showed a dendritic shrinkage pattern. The cases with concentric shrinkage were good candidates for breast conserving surgery, But tumors showing dendritic shrinkage often had positive margins necessitating mastectomy. Pathologically, tumors with a papillotubular pattern, Estrogen receptor (ER) positivity, low nuclear grade and c-erbB 2 negativity tended to show dendritic shrinkage.3D-MRM is a useful modality for evaluating whether breast conserving surgery can be safely done in the neoadjuvant setting.

Three dimensional MR Mammography (3D-MRM) can detect tumor extension more accurately than mammography or ultrasound. There are two shrinkage patterns observed by 3D-MRM after neoadjuvant chemotherapy. Concentric shrinkage is a good indication for breast conserving surgery. On the other hand, a dendritic pattern was represent ductal spread. Therefore, we developed MRM guided mapping to aid BCS for tumors showing a dendritic pattern.Fifteen patients consisting of 8 stage II (T3.5 cm) cases and 7 stage IIIa cases aged 39 to 61 years (mean 47-8 years) were treated with AT neoadjuvant chemotherapy with the aim of performing breast conserving surgery. All patients were examined by 3D-MRM before and after neoadjuvant chemotherapy. Breast conserving surgery indications were determined by tumor volume reduction and shrinkage patterns on 3D-MRM. Supine position mapping using MRM was performed for dendritic type tumors. FDG-PET was simultaneously performed for one case with bilateral breast cancer.Breast conserving surgery was performed for 13 of the 15 cases. One case underwent re-operating and mastectomy because of a positive margin. One case had microscopically positive margin and received boost radiation. Therefore, 11 of 15 cases (73.3%) underwent BCS and achieved negative margins under MRM guidance. PET scanning can detect residual tumor and occult metastasis but it is not suitable for mapping because of its spatial resolution.3D-MRM is a useful modality to select appropriate cases for breast conserving surgery after neoadjuvant chemotherapy. FDG-PET can also detect residual tumor or occult metastasis but it may not be suitable for mapping. Because both examinations have potential, further evaluation of their clinical efficacy is necessary.