I. Ductal carcinoma in situ (DCIS)
DCIS accounts for 20% – 30% of the census, 90% of DCIS are detected on X-ray due to calcification.
Pathology: derived from small ductal tumors in the breast, the cancer cells are confined to the ducts and have not invaded the base.
Staging : acne type , non-acne type
Clinical manifestations
Painless lump on palpation, some with Paget’s disease
Typical X-Ray
1. Cluster-like calcifications without masses in a “V”-shaped distribution;
2.Clusters of calcifications in a quadrant without masses in a circular or irregular shape, or multiple small clusters of calcifications in a scattered manner.
Infiltrative ductal carcinoma (IDC)
Most common: 60% of breast cancer
Development pattern.
Normal epithelium —- epithelial hyperplasia —– atypical hyperplasia —- ductal carcinoma in situ —- infiltrative ductal carcinoma
Pathology: cancer cells break through the basement membrane and infiltrate into the mesenchyme. Nests and cords of carcinoma are formed, and extensive fibers and interstitium can be found within the tumor.
Biological characteristics: infiltrative growth with indistinct boundary, no envelope, rarely seen hemorrhage and necrosis.
Clinical manifestations: painless masses
Typical x-ray manifestations.
1.Simple mass
2.Simple calcification
3.Structural distortion
4.Mass with calcification
5.X-ray negative
Infiltrative lobular carcinoma
It occupies the second place in primary breast cancer, accounting for 8% – 14%, moderately malignant, characterized by multifocal, multicentric and bilateral growth.
Pathology: The cancer cells are small in size, consistent in morphology, less cytoplasm, often in a single cord-like or linear arrangement, with concentric circles or molybdenum-like structures around the ducts or lobules.
Typical X-Ray manifestations: 1.
1.Structural distortion More common, not accompanied by calcification
2.Indeterminate calcification Calcification between benign and malignant
3, Focal asymmetric dense
4. Negative X-rays
Note: A mass with calcification is not a characteristic sign of invasive lobular carcinoma.