title: Posterior breast cancer - mammographic and ultrasonographic features.
abstract: OBJECTIVE
  Posterior breast cancers are located in the prepectoral region of the breast. Owing to this distinctive anatomical localization, physical examination and mammographic or ultrasonographic evaluation can be difficult. The purpose of the study was to assess possibilities of diagnostic mammography and breast ultrasonography in detection and differentiation of posterior breast cancers.
  
  
  METHODS
  The study included 40 women with palpable, histopathological confirmed posterior breast cancer. Mammographic and ultrasonographic features were defined according to Breast Imaging Reporting and Data System (BI-RADS) lexicon.
  
  
  RESULTS
  Based on standard two-view mammography 87.5%, of the cases were classified as BI-RADS 4 and 5 categories, while after additional mammographic views all the cases were defined as BI-RADS 4 and 5 categories. Among 96 mammographic descriptors, the most frequent were: spiculated mass (24.0%), architectural distortion (16.7%), clustered micro-calcifications (12.6%) and focal asymmetric density (12.6%). The differentiation of the spiculated mass was significantly associated with the possibility to visualize the lesion at two-view mammography (p = 0.009), without the association with lesion diameter (p = 0.083) or histopathological type (p = 0.055). Mammographic signs of invasive lobular carcinoma were significantly different from other histopathological types (architectural distortion, p = 0.003; focal asymmetric density, p = 0.019; association of four or five subtle signs of malignancy, p = 0.006). All cancers were detectable by ultrasonography. Mass lesions were found in 82.0% of the cases. Among 153 ultrasonographic descriptors, the most frequent were: irregular mass (15.7%), lobulated mass (7.2%), abnormal color Doppler signals (20.3%), posterior acoustic attenuation (18.3%). Ultrasonographic BI-RADS 4 and 5 categories were defined in 72.5% of the cases, without a significant difference among various histopathological types (p = 0.109).
  
  
  CONCLUSIONS
  Standard two-view mammography followed by additional mammographic projections is an effective way to demonstrate the spiculated mass and to classify the prepectoral lesion as category BI-RADS 4 or 5. Additional ultrasonography can overcome the mimicry of invasive lobular breast carcinoma at mammography.
authors.affiliation: Institute of Oncology and Radiology of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia. abjankovic@open.telecom.rs
authors.forename: Ana
authors.initials: A
authors.lastname: Janković
authors.affiliation: Institute of Oncology and Radiology of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Mirjan
authors.initials: M
authors.lastname: Nadrljanski
authors.affiliation: Institute of Oncology and Radiology of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Vesna Plesinac
authors.initials: VP
authors.lastname: Karapandzić
authors.affiliation: Institute of Oncology and Radiology of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Nebojsa
authors.initials: N
authors.lastname: Ivanović
authors.affiliation: Institute of Oncology and Radiology of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Radojicić
authors.affiliation: Institute of Oncology and Radiology of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Zorica
authors.initials: Z
authors.lastname: Milosević
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000648:ultrastructure*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014463:Ultrasonography