Pure and mixed tubular carcinoma of the breast: mammographic and sonographic differential features

Abstract

Objective: We wanted to evaluate the mammographic and sonographic differential features between pure (PT) and mixed tubular carcinoma (MT) of the breast.

Materials and methods: Between January 1998 and May 2004, 17 PTs and 14 MTs were pathologically confirmed at our institution. The preoperative mammography (n = 26) and sonography (n = 28) were analyzed by three radiologists according to BI-RADS.

Results: On mammography, a mass was not detected in eight patients with PT and in one patient with MT (57% vs. 8%, respectively, p = 0.021), which was statistically different. The other findings on mammography and sonography showed no statistical differences between the PT and MT, although the numerical values were different. When the lesions were detected mammographically, an irregularly shaped mass with a spiculated margin was more frequently found in the MT than in the PT (100% vs. 83%, respectively, p = 0.353). On sonography, all 28 patients presented with a mass and most lesions showed as not being circumscribed, hypoechoic masses with an echogenic halo. Surrounding tissue changes and posterior shadowing were more frequently found in the MT than in the PT (75% vs. 50%, respectively, p = 0.253, 58% vs. 19%, respectively, p = 1.000). An oval shaped mass was more frequently found in the PT than in the MT (44% vs. 25%, respectively; p = 0.434).

Conclusion: PT and MT cannot be precisely differentiated on mammography and sonography. However, the absence of a mass on mammography or the presence of an oval shaped mass would favor the diagnosis of PT. An irregularly shaped mass with surrounding tissue change and posterior shadowing on sonography would favor the diagnosis of MT and also a less favorable prognosis.

Fig. 1

A 46-year-old woman with pure tubular carcinoma (95% tubular component) with a palpable lump in the right breast. A. Mammogram shows no definite abnormal focal lesion and both breasts are diffusely dense. B. Sonography shows an approximately 0.9-cm sized, spiculated, irregularly shaped hypoechoic mass (arrows) in the subareolar area of the right breast.

Fig. 2

A 41-year-old woman with pure tubular carcinoma (95% tubular component) with painful palpable lump in the upper outer quadrant of the right breast. A. Mammography shows an about 1.5-cm sized oval shaped isodense mass with an obscured margin (arrows) in the upper outer quadrant of the right breast. B. Sonography shows an about 1.2-cm sized oval shaped hypoechoic mass with a microlobulated margin (arrows) in the right breast.

Fig. 3

A 43-year-old woman with mixed tubular carcinoma (70% tubular component) with a palpable lump in the right breast. A. Mammography shows a long spiculated mass with central lucency (arrows) in the right breast. B. Specimen mammography shows benign calcifications (circle) in the long spiculated mass. C. Sonography shows an approximately 1.2-cm sized, irregularly shaped hypoechoic mass with an indistinct margin and calcifications (arrow), and posterior shadowing.