Journal of the K orea n Radi ologica l S ocie ty , 1994 ; 30 ( 1) : 193- 196 Ultrasonographic Evaluation of Fibroadenoma in the Breast: Primary Signs of Mass' Choon SikYoon , M.D ., Mi Hye Kim , M.D ., Chang SooAhn , M.D. , Ki Keun Oh , M.D PURPOSE : To evaluate the ultrasonomammographic findings of breast fibroa<.:- enoma . METHODS AND MATERIALS: We evaluated the ultrasonographîc findings of histopathologically proved 135 fibroadenomas in 103 patients from January 1986 to September 1990, retrospectively. The ultrasonographic examinations were perfor- med with a hand held linear array 5MHz transducer(Acuson 128(USA). Aloka 650, 280(Japan)). Asonopad was also used during the examinations. RESULTS: The common ultrasonographic findings of fibroadenomas usually showed smooth contour in 120 lesions(88.9% ), oval or round shape in 114Iesions(84. 4% ), uniform homogeneous echogenecity in 106 lesions(78.5% ), intermediate hypoechoic internal echo pattern in 105 lesions(77.8% ), thin boundary echo in 117 lesions(86.7% ), lateral shadowings in 97 lesions(72% ), and posterior acoustic en- hancement in 56 lesions(41%). The longitudinal / transverse ratio of fibroadenoma was revealed between 0.2and 1. 14 (meanO .58) and usuallyunder 1.0 (68.9%). CONCLUSION: Finally, most of fibroadenomas are easily diagnosed by ultra- sonography but if differential diagnosis from malignant breast mass is difficult due to atypical appearance, other combined modalities such as filmmammography , fine needle aspiration biopsy and MRI are necessary . Index Words : Breast neoplasm Breast US dignosis INTRODUCTION Fibroadenoma is the most common breast tumor in young women under the age of 15 and is usually detected by the patient as a small mobile , painless breast mass. Most tumors grow until the size of 2 -3 cm in diameter and then cease to grow , except those under hormonal stimulation . Tumors that reach a diameter of 6.0cm or larger are termed giant fibroadenomas (1). In an old patient , the fibroadenomas may undergo necrosis with subsequent formation of typical coarse ' Departme nt o fD iag n ostic R adio l ogy , College of Medi ci ne , Yon sei U niversity Received F ebruary 12, Anep ted Jul y8 , 1 993 Ad dr ess re p ri nt ed requ est t o: Ch oon Sik Yoon , M.D., D epartmen t of Di agnost ic Ra d iology , Yon sei Uni versity Coll ege of Medi c in e , D ogok - do ng 146- 92, Kangnam- gu , Seou l, Korea , Te l. (82-2) 569-01 10 calcification as large dense clumps on film - mammo- graphy We think the oriental women have smaller and denser DY pattern breast on film - mamography than the western women , so ultrasonographic examination is more for the evaluation of a breast mass. We studied the ultrasonographic findings of fibroadenoma in the breas t. MATERIALS and METHODS We reviewed the ultrasonograph ic findings of histopathologically proved 135 fi broadenomas in 103 patients from January 1986 to September 1990. The ultrasonographic examinations were pertormed with a 1 i near array 5MHz transduce r( Acuson 128(USA) , Aloka 650 , 280(Japan )). A sonopad was used during the examinations - 193-
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Journal of the Korean Radiologica l Society, 1994 ; 30( 1) : 193- 196
Ultrasonographic Evaluation of Fibroadenoma in the Breast: Primary Signs of Mass'
Choon SikYoon, M.D ., Mi Hye Kim, M.D ., Chang SooAhn, M.D. , Ki Keun Oh, M.D
PURPOSE : To evaluate the ultrasonomammographic findings of breast fibroa<.:enoma.
METHODS AND MATERIALS: We evaluated the ultrasonographîc findings of histopathologically proved 135 fibroadenomas in 103 patients from January 1986 to September 1990, retrospectively. The ultrasonographic examinations were performed with a hand held linear array 5MHz transducer(Acuson 128(USA). Aloka 650,
280(Japan)). Asonopad was also used during the examinations. RESULTS: The common ultrasonographic findings of fibroadenomas usually
showed smooth contour in 120 lesions(88.9%), oval or round shape in 114Iesions(84. 4%), uniform homogeneous echogenecity in 106 lesions(78.5% ), intermediate hypoechoic internal echo pattern in 105 lesions(77.8% ), thin boundary echo in 117 lesions(86.7%), lateral shadowings in 97 lesions(72% ), and posterior acoustic enhancement in 56 lesions(41%). The longitudinal / transverse ratio of fibroadenoma was revealed between 0.2and 1 .14 (meanO.58) and usuallyunder 1.0 (68.9%).
CONCLUSION: Finally, most of fibroadenomas are easily diagnosed by ultrasonography but if differential diagnosis from malignant breast mass is difficult due to atypical appearance, other combined modalities such as filmmammography, fine needle aspiration biopsy and MRI are necessary.
Index Words : Breast neoplasm Breast US dignosis
INTRODUCTION
Fibroadenoma is the most common breast tumor in young women under the age of 15 and is usually detected by the patient as a small mobile , painless breast mass. Most tumors grow until the size of 2 -3 cm in diameter and then cease to grow, except those under hormonal stimulation .
Tumors that reach a diameter of 6.0cm or larger are termed giant fibroadenomas(1).
In an old patient , the fibroadenomas may undergo necrosis with subsequent formation of typical coarse
'Department ofD iagnostic Radiology, College of Medicine, Yonsei University Received February 12, Anepted July8, 1993 Address reprinted requ est to: Choon Sik Yoon, M.D., Departmentof Diagnostic Radiology, Yonsei University College of Medicine, Dogok-dong 146-92,
Kangnam-gu , Seou l, Korea, Tel. (82-2) 569-01 10
calcification as large dense clumps on film - mammography
We think the oriental women have smaller and denser DY pattern breast on film -mamography than the western women , so ultrasonographic examination is more helpf비 for the evaluation of a breast mass. We studied the ultrasonographic findings of fibroadenoma in the breast.
MATERIALS and METHODS
We reviewed the ultrasonograph ic findings of histopathologically proved 135 fibroadenomas in 103 patients from January 1986 to September 1990. The ultrasonographic examinations were pertormed with a 1 i near array 5MHz transducer(Acuson 128(USA) , Aloka 650, 280(Japan)). A sonopad was used during the examinations
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Journ al of the Korean Radiological Society, 1994; 30( 1) : 193- 196
/rπ1、Xξ上.?
a ; Transverse diameter b ; Longitudinal diameter
Fig . 1. Schematic figure of Longitudinal /Transverse ratio LlT ratio=b/a
Fig . 2. Fibroadenoma with typical ultrasonographic findings Ultrasonography shows a round homogeneous hypoechoic mass with a well defined smooth margin , thin boundary ech。 ’
posterior wall enhancement and bilaterallateral shadowing(arrow)
The longitudinal/transverse ratio of fibroadenoma was measured according to the Tajima’s method(11) (Fig. 1)
RESUlT
Eight cases were in the 2nd decade(7.8 % ), 40 cases in the 3rd decade(38.8%), 29 cases in the 4th decade (28.2 % ) and 26 cases in the 5th decade(25.2 % ). Most fibroadenomas were measured 1 -2cm in their long diameter( 52.6%)(Table 1). Seventeen of al1103 patients had multiple fibroadenomas(16.5 %). The common ultrasonographic findings of fibroadenomas were
Fig . 3. Fibroadenoma with atypical ultrasonogrpahic findings Ultrasonography shows an irregular lobulated margin , thick boundary echo and central posterior shadowing.
showed smooth contour in 120 lesions(88.9%), oval or round shape in 114 lesions(84.4%) , uniform homogeneous echogenecity in 106 lesions(78.5 % ), intermediate hypoechoic internal echo pattern in 105 lesions(77.8 % ), thin boundary echo in 117 lesions(86 7 %), lateral shadowings in 97 lesions(72 %), and posterior acoustic enhancement in 56lesions(41 % )(Table 2)(Fig. 2)
Atypical findings of fibroadenomas in ultrasonography were irregular contour , lobulated shape , low or strong internal echo , thick boundary echoes and posterior shadowing(Fig. 3)
The longitudinal /transverse ratio of fibroadenoma was between 0.2 and 1.14(mean 0.58) and usually under 1 이68. 9% )(Table 3)
DISCUSSION
In our cases , the most prevalent age group of fibroadenomas is between the 3rd and 4th decade (69%) , which is similar to the results of other studies(3 , 4)
Film - mammography of young women commonly show P2 or DY pattern breast according to the Wolf classification , so the detection of fibroadenomas in these dense breasts may be difficul t.
Multiple fibroadenomas in one or both breasts were
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Choon Sik Yoon , et a/: The Ultrasonographic Evaluation of Fibroadenoma in Breast
Table 1. Size Distribution
Largest diameter(cm)
Below1 .0
1.0-1.9
2.0-2.9
3.0-3.9
Above4.0
N。 01 lesions( %)
30(22.2%)
71(52.6%)
28(20.7%)
4( 3. 0%)
2( 1.5%)
135(100 %)
Table 2. Th e Ultrasonographic Findings olFibroadenoma
Findi ngs NO.ollesions(%)
Contour Smooth 120(889)
irregular 15(1 1.1)
Shape round 65(48 1)
oval 49(36.3)
lobulated 21(1 5.6)
Interna l echo unilorm 106(785)
non-un ilorm 29(21.5)
strong 26(19.2)
intermediate 105(77.8)
low 4( 3.0)
Boundaryecho thin 117(86.7)
thick 1 ( 0.7)
absent 17(126)
Attenuation ellect lateral shadowing 97(72.0)
posterior shadowing 2( 1,5)
posteri or en hancem ent 56(410)
Table 3. The LlT ratio 01 libroadenoma
LlT ratio'
BelowO.5
0.5-1 .0
Above 1.0
• LlT: Longigudin allTransverse
** M ean =0. 585 SD =0.165
No. 01 lesions( %)
39(28.9%)
93(68.9 %)
3(2.2%)
135(100%)
detected in 10 - 15 % of patients. The histopathologic fiadings of fibroadenoma are a mixture of proliferated fibrous stroma and secondarily increased epithelial ductal structures(2). We found multiple fibroadenomas in 16.5 % . Many authors have long claimed that breast sonography was valuable only because it enabled distinction between cystic and solid masses(2). Other studies in literatures dealed with the characteristic sonographic patterns of fibroadenomas as homogeneous hypoechoic masses with smooth margins or contour regularity , oval or round shape and intermediate posterior attenuation(5)
In our series, 80.8 % of fibroadenomas were hypoechoic , and the result is comparable with the reports of Beuglet(80 % , 1983) , Heywang(96 % , 1984) , and Fornage(92 % , 1989)(2, 6, 7)
Texidor et al. (1977) and COle - Beuglet et a l. (1983) reported that the shape of fibroadenomas was round (48%) or oval(37 %) , which is corresponded to our res미 ts , round shape(48.1 %) and oval shape(36.3 %)(6, 8). Contou r smoothness had been reported i n 75 -84 % of cases(4,6) and was found in 88.9 % of our cases. But contour irregularity was found in 11 .1 %
A homogenous uniform echotexture was reported in 48 -89 % of fibroadenomas and was found in 78.5 % of our series. Egan et a l. (1984) reported that lateral refractory edge effect was double pass of pulse echo (20%)(9) whereas we could find the effect more frequently (71 % ) and our result was similar to the Kwon ’s report(4)
McSweeny et al. (1985) reported that the relative amount of fibrous stromal tissue was responsible for the sonographic differences of internal echotexture and refractory effect of the fibroadenoma(1 이
We measured the longitudinal and transverse diameters of the fibroadenoma with the same method suggested by Tajima et al(1983)(1 1). The LlT ratio of the fibroadenoma was between 0.2 and 1.14(mean 0.58) and mostly in the range of 0.5 -1.0 in 93 lesions(68 9 %). Only3Iesionswereover1 .0
In conclusion , most of fibroadenomas were easily diagnosed with ultrasonography but some of them could not be differentiated from carcinoma due to the irregular contour , lobulated shape, heterogeneous internal echotexture and absence of lateral shadowings. So in doubtful cases , multimodality assessment of the mass, sonographic analysis including LlT ratio and US guided aspiration biopsy should be done to differentiate fibroadenomas from carcinomas.
*~ C그 고
1. Ackerman LV, Rosai J. Su rg ical pathology. St. Louis: Mosby,
1 974 : 906-908 2. Fornage BD, Lorigan JC, Andry E. Fibroadenoma 01 the breast
Sonographic apperarance. Radiology 1989 ; 172: 671-675 Gallager HS. Leis HP: Mammography in diseases 01 breast
3. The Breast, 1st Ed : 98, St. Lou is : Mosby company, 1978 4 권태흐1. 서정호1 정우흐1.오기근 유밤섬유선종의발사선잉상및병리
조직학적 세포형태의 비교연구 대한밤사선의학호|지 1986;22 57-68
5. Adler DD. Ultrasound 01 the benign breast conditions Semin US CT MR 1989 ; 10: 106-118
6. Cole-Beuglet C, Spori ano Rz , Kurtz AB, Goldberg BB Fibroadenoma 01 the breast: Sonomammography correlated with pathology in 122 patients. AJR 1983 ; 140' 369-375
7. Heywang SH, Lipsit ER, Glassman LM, Thomas MA Specilicity 。 1 ultrasonography in the diagnosis 01 benign breast masses. J Ultrasound Med 1984; 3: 453-461
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Journal of the Korean Radiological Society, 1994: 30( 1) : 193- 196
8. Texidor H, Kazam E. Combined mammographic sonographic 11 . TaJima T, Kubota M, Mitomi T, Nanri K, Sakurai 1, Kobayashi H
evaluation 01 the breast masses. AJR 1977; 128: 409-417 Longitudinal/transverse ratio 01 tumor echogram as a diag
9. Egan RL, Egan KL. Automated waterpath breast sonog raphy. nost ic criterion 01 breast ca rcinoma. Ultrasonic examination 01
AJR 1984 ; 143.499- the breast. 1st Ed . Chichester. John Wiley and Sons. 1983
10. McSweeney MB, Murphy CH. Whole breast sonography. 69-70
Radd iol Clin Nort h Am 1985; 23(1): 157
대한방사선의학회지 1994 :30( 1): 193- 196
유방 섬유선종의 초음파소견:종괴의 1차소견을 중심으로
윤춘식·김미혜·안창수·오기근
언세대학교 의과대학 진 단밤사선과학교실
목 적:유방의 대표적인 양성 종앙인 섬유선종의 특징적인 초음파 소견을 이해하고 다른종괴와의 감별에 도움을 받고자
연구를하였다.
대상 및 방법 : 1986년 1월부터 1990년 9월까지 병리조직학적으로 확진된 135여|의 섬유선종의 초음파소견을 종괴으1 1차적
이 소견을 중심으로 분석하였다. 초음파 검사는 Acuson 128, Aloka 650, 280어15MHz 탐촉자와 sonopad를 이용하였다.
결 과 : 20대가 40예 ( 38.8%)로 많았고 크기는 1-2cm가 가장 많았다. 총 103예중 16.5%인 17여|에서 2개이상의 섬유선종을
강고 있었다. 섬유선종의 특징적인 초음파 소견은 둥글거나 난원형 모양(84.4%) , 평활한 외형 (88.9%) , 균질한 에코음영(78.