Breast Imaging Essentials by Niketa Chotai & Supriya Kulkarni

Author:Niketa Chotai & Supriya Kulkarni
Language: eng
Format: epub
ISBN: 9789811514128
Publisher: Springer Singapore

Notes

Infiltrating Ductal Carcinoma (IDC)

Invasive ductal carcinomas show invasion of tumour cells beyond basement membrane. The commonest variety is the no special type (NST ) or not otherwise specified (NOS). Special types like medullary, mucinous, tubular carcinoma are seen in 10%.

Clinically, the patient may present with a firm, palpable mass, nipple or skin tethering or retraction. When the size of the breast cancer (Tsize) is >5 cm or there is involvement of surrounding structures such as skin/chest wall or invasion or extensive axillary metastases, it is termed as locally advanced breast cancer (LABC).

Mammographically, the commonest appearance is that of an irregular or spiculated, high-density mass. Associated architectural distortion and microcalcifications are common findings. Occasionally, the tumor may present as a focal asymmetry, developing density or circumscribed mass.

Ultrasound shows the classic spiculated mass that is taller than wide (antiparallel), posterior shadowing, growth along the Cooper’s ligament, distortion, ductal extension, and microcalcifications. Ultrasound also helps in axillary staging and guided intervention. Special types of IDC such as triple-negative cancers or mucinous cancers can appear as very benign-looking masses on ultrasound.

MRI has about 92% sensitivity for the detection of invasive disease and the negative predictive value is almost 98%. A classical IDC shows an irregular enhancing mass with washout. It may show rim enhancement, tumor heterogeneity, associated intraductal disease, involvement of surrounding structures and axillary disease. MRI is the best modality for staging and detection of contralateral synchronous cancer. It is also used in the assessment of response to neoadjuvant treatment.

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