Infiltrating Ductal Carcinoma- Solid Nodules -images

Ductal carcinoma implies that there is cancer in the form of solid nodules located in the ducts of the breast. Mammary ductal carcinoma is the most common type of breast cancer in women, (up to 80% of all breast cancers) It comes in two forms: ductal carcinoma in situ (DCIS), a noninvasive, possibly malignant, neoplasm that is still confined to the lactiferous ducts, where breast cancer most often originates, or invasive ductal carcinoma (IDC), which is an infiltrating, malignant and abnormal proliferation of neoplastic cells in the breast tissues.

Certainly a DCIS diagnosis is more favorable, as the cancer cells have not yet infiltrated the duct walls. Infiltrating ductal carcinoma is a more serious situation and must be treated aggressively.

The severity and classification of IDC is partly determined by the size and shape of the solid nodules found in the breast duct tissues, and are often quite visible from a sonographic image of the breast. In addition to the darkened shape of the mass itself, the radiologist may observe other abnormalities such as ductal extentions and microlobulations, microcalcifications, shadows, angular or spiculated margins, retroareolar infiltrations, and fibroadenomas.

I just want to let you know that I have created a newer version of this page with more up-to-date information on IDC Solid Nodules. However, this page still has some good material, so I would still use it as well as the new one.

Margins: Spiculated, Angular

The “margin” refers to the tumor’s edge, a kind of ‘transition-zone‘ between the mass and the surrounding fatty tissue. Spiculated (spoke-like) protrusions at the margin is highly suspicious of malignancy.

An ‘angular margin‘ is simply a pronounced ‘angled-off‘ projection from the mass. Any kind of irregular or jagged projection at the margin is suspcious of malignancy. Benign tumors tend to have regular, well-defined margins.

Ductal Extensions: Branch patterns, globular extensions, curvilinear extensions

A ductal extension, quite evident in the image below, is a pronounced projection from the main mass into the surrounding tissue. The presence of a number of these extensions sometimes resembles a ‘branch pattern‘, a spiculated pattern, a curvilinear shape, or simply a pronounced ‘angled‘ shape.

‘Branch pattern‘ extensions tend to indicate advancement of the tumor away from the nipple, while projections oriented and advancing toward the nipple are simply called ‘ductal extensions‘.

Microlobulations

Microlobulations are collections of many small ‘lobes or lobules‘ which have emerged on the surface of the main, solid mass. Larger numbers of microlobulations are thought to indicate a greater likelihood of malignancy.

(A microlobution is more like a ‘bump‘ rather than the pronounced shape of an ‘extension‘).

Shadowing

The presence of a darker, ‘shadowed‘ effect on a breast mass image is thought to be a positive indicator of malignancy, though is more common in lower to intermediate grade rather than aggressive tumors.

“Shadowing” refers to an ultrasound finding of ‘shadows‘ cast on the normal breast tissue. ‘Bright spots‘ block the ultrasound beam from passing deeper into the breast.

Microcalcifications

Microcalcifications are small mineral deposits which frequently occur scattered throughout the breast. They are generally discovered during an early screening and begin to accumulate before a mass develops. Microcalcifications will often continue to form as a tumor develops and spreads. Microcalcifications are not strong predictors of malignancy and occur with malignant tumors about 1/3 of the time. A finding of an irregular hypoechoic mass with an indistinct and microlobulated margin is possibly the most frequent ultrasound presentation in low or moderate grade DCIS.

The image below shows a retroareolar (‘behind the nipple’) infiltrationin the upper left region, also shadowing in the lower regions. There are also extensions and microcalcifications.

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For further reading, I suggest you visit this page with more information on IDC, and visit this page for more information on solid nodules.
Below is the most common Q&A… :

• What is Invasive Ductal Carcinoma (IDC)? The abnormal cancer cells that began forming in the milk ducts have spread beyond the ducts into other parts of the breast tissue. Invasive cancer cells can also spread to other parts of the body. It is also sometimes called infiltrative ductal carcinoma. IDC is the most common type of breast cancer, making up nearly 70% to 80% of all breast cancer diagnoses. ICD is also the type of breast cancer that can most commonly affects men.

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References

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3. National Comprehensive Cancer Network Practice Guidelines: screening for and evaluation of suspicious breast lesions. NCCN Proceedings. Oncology. 1998;12(11A):89-138.
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9. Raza S, Goldkamp AL, Chikarmane SA, Birdwell RL. US of breast masses categorized as BI-RADS 3, 4, and 5: pictorial review of factors influencing clinical management. (Radiographics.(Sept. 2010) 30(5):1199-213.
10. Su, Y., An, T., Wang, D., Tian, J. Evaluation of Ultrasonic Scores in Differential Diagnosis of Breast Solid Lesions. Journal of Diagnostic Medical Sonography (November/December 2009) vol. 25 no. 6, p. 310-315
11. Cho N, Moon WK, Cha JH, Kim SM, Han BK, Kim EK, Kim MH, Chung SY, Choi HY, Im JG.Differentiating benign from malignant solid breast masses: comparison of two-dimensional and three-dimensional US. Radiology. (July 2006) ;240(1):26-32.
12. Chen SC, Cheung YC, Lo YF, Chen MF, Hwang TL, Su CH, Hsueh S. Sonographic differentiation of invasive and intraductal carcinomas of the breast. Br J Radiol. (Sept.2003) 76(909):600-4.

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