Teaching File Case - Patient: 12754Peer Reviewed and Certified - Approved by: Robert A Jesinger M.D. - 2009-02-11 12:51:40-05
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Infiltrating Ductal Carcinoma of the Breast Infiltrating ductal carcinoma represents 80% of all infiltrating, or invasive, primary breast carcinomas. It is subclassified into many subtypes pathologically which help to determine prognosis.
Mammographically, almost any density, with or without suspicious calcifications, can be infiltrating ductal carcinoma. The more irregular, lobulated, or spiculated the border, the more likely it is to be malignant.
Sonographically, infiltrating carcinomas tend to be hypoechoic to normal fibrous breast tissue and demonstrates internal echoes and posterior acoustic shadowing. Irregular borders are suspicious and lesions that are taller than they are wide are also worrisome.
On MRI evaluation, breast carcinomas tend to enhance more avidly than any other tissue in the breast. Additionally, time-enhancement curves that show rapid peak enhancement and then early washout are suggestive of malignancy.
Ultimately, a tissue specimen is needed to diagnose breast cancer. Several approaches to obtaining a biopsy specimen are available. A mammographic or sonographic needle localization in preparation for an excisional biopsy is performed when there is a high likelihood of malignancy, when other modalities are not available or possible, or when the patient desires this method after discussing the options with her surgeon and mammographer. Core biopsies can be performed using various modalities, including stereotactically (using a mammography technique), sonographically, and more recently, using special MRI equipment.
