J Korean Soc Radiol.  2019 Jul;80(4):728-739. 10.3348/jksr.2019.80.4.728.

Small Breast Cancer (≤ 5 mm): Ultrasonographic Features and Clinical and Pathological Characteristics

• Kwon HY
• Cha ES
• Lee JE
• Kim JH
• Chung J

• KMID: 2457450
• DOI: http://doi.org/10.3348/jksr.2019.80.4.728

Abstract

PURPOSE
To identify differences in ultrasonography (US) feature, clinical and pathological characteristics including immunohistochemical characteristics between small breast cancer (pathologic size ≤ 5 mm) and large breast cancer (> 5 mm).
MATERIALS AND METHODS
A total of 528 invasive breast cancer lesions in 475 patients were included. US features with clinical and pathological characteristics were evaluated according to pathologic size. US Breast Imaging-Reporting and Data System findings and final assessments were recorded for each lesion. Standard references were based on surgical pathologies.
RESULTS
Of 528 invasive breast cancer lesions, 62 were small breast cancers. Small breast cancers showed a higher rate of oval, round shape, parallel orientation; circumscribed margin; and iso/solid and cystic echo pattern, with no posterior feature. The final assessment of category 4 was also a dominant factor in small breast cancer. Early stage, asymptomatic state, and extensive ductal carcinoma in situ component were associated with small breast cancers.
CONCLUSION
Our results show that small breast cancers have less suspicious US features than large breast cancers.

MeSH Terms

Asymptomatic Diseases
Breast Neoplasms*
Breast*
Carcinoma, Intraductal, Noninfiltrating
Humans
Information Systems
Pathology
Ultrasonography

Figure

• 

  Fig. 1 Left breast cancer in a 44-year-old woman. A. Ultrasound image shows a 10-mm sized and irregular shaped mass (arrows). B. The vascularity is minimal at color Doppler ultrasound image. It was classified as BI-RADS category 4A and pathologically proved as invasive ductal carcinoma. C. An ultrasonography image showing another 5-mm sized round mass in the same breast quadrant. This lesion was also classified as BI-RADS category 4A. This small lesion was pathologically determined to be an invasive ductal carcinoma using ultrasound-guided core needle biopsy. The patient underwent breast-conserving surgery and the final diagnosis was invasive ductal carcinoma (T1a) with a multifocal ductal carcinoma in situ. BI-RADS = Breast Imaging-Reporting and Data System

• 

  Fig. 2 A 39-year-old woman with a screening-detected mass in the left breast. Ultrasound image showing a 4-mm sized mass (A) with a microlobulated margin. The vascularity is not evident (B). The mass was classified as Breast Imaging-Reporting and Data System category 4A, and ductal carcinoma in situ was pathologically confirmed using core needle biopsy. After breast-conserving surgery, the T1aN0 lesion was diagnosed to include an invasive ductal carcinoma with a pathologic size of 5 mm.

• 

  Fig. 3 A 64-year-old woman with a palpable lesion in the left breast. Ultrasound image showing a 9-mm sized mass with a complex cystic and solid pattern and microlobulated margin. The mass was classified as Breast Imaging-Reporting and Data System category 4A, and ductal carcinoma in invasive ductal carcinoma was pathologically confirmed using core needle biopsy. After a modified radical mastectomy, T1aN0 cancer, including an invasive ductal carcinoma with a pathologic size of 2 mm, was diagnosed.

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