Benign Breast Diseases: Radiology - Pathology - Risk Assessment

by Catherine N. Chinyama

Overview

Widespread use of mammography results in detection of small cancers with favourable prognosis, as well as an array of indeterminate lesions, the majority of which turn out to be histologically benign. This book gives a detailed account of the radiology and pathology of benign breast diseases, with emphasis on screen-detected lesions, including discussion of risk assessment, to assist clinicians in the follow-up of their patients. Related lesions are dealt with consecutively in the same chapter, giving the reader an opportunity for comparison. The book is well illustrated with radiological and pathological correlation of mostly screening-detected images including mucocele-like and columnar cell lesions. All professionals who care for patients with breast diseases, such as breast surgeons, radiologists, pathologists and breast care nurses, will find the book highly useful for the management of patients with benign or indeterminate breast lesions in a multidisciplinary setting.

Product Details

ISBN-13:	9783642621468
Publisher:	Springer Berlin Heidelberg
Publication date:	11/05/2012
Edition description:	2004
Pages:	150
Product dimensions:	7.60(w) x 10.63(h) x 0.02(d)

About the Author

Dr. Chinyama qualified with Honours Degree in Medicine in Harare, Zimbabwe, Trained in Breast Pathology at St. Bartholomew's Hospital, London and Bristol South West Breast Screening Unit in Bristol,UK. Worked as Senior Lecturer/Honorary Consultant in Histopathology at Guy's and St.Thomas' Hospital, London. Currently working as a Consultant Pathologist, Princess Elizabeth Hospital, Guernsey, Channel Islands.

Table of Contents

	Preface	VII
	Acknowledgements	VIII
	Abbreviations used	XIV
1	Radiology of Benign Breast Disease
1.1	Overview of Benign Breast Disease	1
1.2	Mammography	2
1.2.1	BI-RADS Assessment Categories	2
1.2.1.1	Assessment is Incomplete	2
1.2.1.2	Assessment is Complete-Final Categories	2
1.2.2	Advantages of Category Reporting	2
1.3	Ultrasonography	3
1.4	Magnetic Resonance Imaging	4
1.5	Image-Guided Diagnostic Procedures	4
1.5.1	Fine Needle Aspiration Cytology	5
1.5.2	Wide Bore Needle Core Biopsies	5
1.5.3	Directional Vacuum-Assisted Core Biopsy	8
	References	8
2	Surgery of Benign Breast Disease
2.1	Why Excise Benign Breast Lesions?	10
2.2	Probably Benign Lesions Excised to Exclude Malignancy	11
2.2.1	Atypical Ductal Hyperplasia	11
2.2.2	Lobular Neoplasia	11
2.2.3	Radial Scar	12
2.2.4	Columnar Cell Lesions	12
2.2.5	Mucocele-like Lesions	12
2.2.6	Microglandular Adenosis	12
2.2.7	Papillary Lesions	12
2.2.8	Fibroadenoma	14
2.3	Guide-Wire Localisation Excision Biopsy	14
2.4	Follow-up Versus Excision of Indeterminate Lesions	14
	References	14
3	Pathology of Benign Breast Disease
3.1	Diagnostic Specimens in Benign Disease	16
3.1.1	Processing Localisation Excision Biopsies	16
3.1.2	Ancillary Stains in Benign Breast Disease	17
3.2	Reporting Fine Needle Aspiration Cytology	17
3.3	Reporting Needle Core Biopsies	18
3.4	Pathological and Radiological Correlations	18
	References	19
4	Fibro-epithelial Lesions
4.1	Fibroadenoma	21
4.1.1	Mammographic Features of Fibroadenoma	21
4.1.2	Sonographic Features of Fibroadenoma	22
4.1.3	Magnetic Resonance Imaging of Fibroadenoma	22
4.1.4	Is the Fibroadenoma Associated with Risk of Malignancy?	22
4.1.5	Should a Pathologically Proven Fibroadenoma be Excised?	23
4.2	Fibroadenomatoid Hyperplasia	24
4.3	Hamartoma	28
4.3.1	Mammographic Features of Hamartoma	28
4.3.2	Sonographic Features of Hamartoma	30
4.3.3	Histological Features of a Hamartoma	31
	References	32
5	Infiltrative Pseudo-malignant Lesions
5.1	Radial Scar	35
5.1.1	Pathogenesis of the Radial Scar	35
5.1.2	Mammographic Features of the Radial Scar	36
5.1.3	Sonographic Features of the Radial Scar	36
5.1.4	Is the Radial Scar a Pre-malignant Lesion?	36
5.2	Sclerosing Adenosis	42
5.2.1	Radiological Features of Sclerosing Adenosis	42
5.2.2	Clinical Significance of Sclerosing Adenosis	42
5.3	Apocrine Adenosis	48
5.3.1	Clinical Significance of Apocrine Adenosis	48
5.4	Microglandular Adenosis	50
5.4.1	Radiological Features of Microglandular Adenosis	51
5.4.2	Clinical Significance of Microglandular Adenosis	51
5.4.3	Pathological Features of Microglandular Adenosis	51
	References	55
6	Hyperplastic Epithelial Lesions
6.1	Epithelial Hyperplasia of Usual Type	57
6.1.1	Clinical Significance of Ductal Epithelial Hyperplasia of Usual Type	57
6.1.2	Molecular Pathology of Epithelial Hyperplasia of Usual Type	60
6.2	Atypical Ductal Hyperplasia	61
6.2.1	The Concept of Atypical Epithelial Hyperplasia	61
6.2.2	Current Pathological Criteria for the Diagnosis of Atypical Ductal Hyperplasia	61
6.2.3	Mammographic Features of Atypical Ductal Hyperplasia	61
6.2.4	Clinical Significance of Atypical Ductal Hyperplasia	63
6.2.5	Management of Patients with Atypical Ductal Hyperplasia	63
6.2.6	Molecular Pathology of Atypical Ductal Hyperplasia	64
6.3	Atypical Lobular Hyperplasia	64
6.3.1	Clinical Significance of Atypical Lobular Hyperplasia	64
6.3.2	What is the Risk of Bilateral Cancer in Patients with Atypical Lobular Hyperplasia?	66
6.3.3	Management of Patients with Atypical Lobular Hyperplasia	66
6.3.4	The Concept of Lobular Neoplasia	66
6.3.5	Comparison of Atypical Lobular Hyperplasia and Atypical Ductal Hyperplasia	67
6.4	Intraductal Papillomas	67
6.4.1	Radiological Features of Intraductal Papillomas	70
6.4.2	Are Intraductal Papillomas Pre-malignant?	70
6.4.3	Supportive Evidence for Intraductal Papillomas as Pre-malignant Lesions	71
6.4.4	What is the Subsequent Risk of Breast Cancer Associated with Intraductal Papillomas?	72
6.5	Pregnancy-like Change	76
	References	82
7	Cystic Lesions
7.1	Fibrocystic Change	85
7.1.1	Possible Aetiological Factors and Pathogenesis of Fibrocystic Change	85
7.1.2	What is the Stimulus that Evokes the Metaplastic Process?	87
7.1.3	Mammographic Features of Fibrocystic Change	87
7.1.4	Sonographic Features of Fibrocystic Change	88
7.1.5	Pneumocystography	88
7.1.6	Magnetic Resonance Imaging of Cysts	88
7.1.7	Management of Cysts	88
7.1.8	Clinical Significance of Fibrocystic Change	89
7.1.9	Molecular Pathology of Fibrocystic Change	92
7.2	Duct Ectasia	93
7.2.1	Possible Aetiological Factors and Pathogenesis of Duct Ectasia	93
7.2.2	Mammographic Features of Duct Ectasia	94
7.2.3	Clinical Significance of Duct Ectasia	94
7.3	Comparison of Fibrocystic Change and Duct Ectasia	96
	References	99
8	Mucocele-like Lesions	101
	References	106
9	Columnar Cell Lesions
9.1	Blunt Duct Adenosis	107
9.2	Columnar Cell Hyperplasia	115
9.3	Literature Review	115
9.3.1	Columnar Metaplasia	115
9.3.2	Atypical Lobule	116
9.3.3	Clinging Carcinoma	116
9.3.4	Hypersecretory Hyperplasia with Atypia	116
9.3.5	Cancerisation of Small Ectatic Ducts lined by Atypical Cells with Apocrine Snouts	116
9.3.6	Columnar Alteration with Prominent Snouts and Secretions	116
9.3.7	Pre-tubular Metaplasia	117
9.3.8	Atypical Cystic Lobule	117
9.4	Proposed Nomenclature for Columnar Cell Lesions	117
9.5	Clinical Significance of Columnar Cell Lesions	118
9.5.1	Immunocytochemistry Patterns in Columnar Cell Lesions	118
	References	118
10	Calcification in Benign Lesions
10.1	Overview of Mammographic Calcification	120
10.2	Assessing Micro-calcification	121
10.3	The Nature of Breast Calcification	121
10.4	Vascular Calcification	124
	References	126
11	Non-epithelial Lesions
11.1	Fat Necrosis	127
11.1.1	Radiological Features of Fat Necrosis	127
11.1.2	Pathological Features of Fat Necrosis	128
11.2	Focal Fibrosis	132
11.3	Post-surgical Scarring	134
	References	137
12	Risk Assessment in Benign Breast Disease
12.1	The Concept of Risk Assessment in Benign Disease	138
12.1.1	Definitions	138
12.1.2	Relative Risk Versus Absolute Risk	139
12.2	Radiological Risk Factors	139
12.2.1	Wolfe's Breast Parenchymal Patterns	139
12.2.2	Parenchymal Patterns and Risk of Breast Cancer	140
12.2.3	Effect of Hormone Replacement Therapy on Breast Density	141
12.3	Pathological Risk Factors	143
	References	144
	Subject Index	147

Editorial Reviews

From the reviews:

"The advent of breast screening … now means that the breast team is regularly presented with a variety of benign pathological diagnoses and an understanding of the clinical relevance of these is essential. This text aims to contribute towards this understanding. … Pathological slides are beautifully reproduced in full colour … . a comprehensive text on the pathology and risk assessment of benign breast disease which is well illustrated with pathological slides. … it would represent useful supplementary reading for non-pathologists … ." (Dr. J Litherland, RAD Magazine, July, 2005)

"Catherine Chinyama has made a creditable attempt to bring order to the often confusing field of benign breast disease. … The main focus of the book is on radiologic and pathological findings in benign breast disease … . The book is remarkably well illustrated … . The figures are informative … . The range of benign breast disease covered in the book is broad … . thisvery useful book will interest any clinician, radiologist, or pathologist who deals with benign breast disease … ." (Pamela J. Goodwin, The New England Journal of Medicine, September, 2004)

From the Publisher