• Asian Pacific Journal of Cancer Prevention
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• v.15 no.6
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• pp.2771-2776
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• 2014

Background: Breast cancer screening and higher quality mammography have resulted in an increase in the diagnosis of ductal carcinoma in situ worldwide. We compared the incidence and other factors in our cases of ductal carcinoma in situ between two recent decades. Materials and Methods: Medical records of cases of ductal carcinoma in situ who had been admitted to the surgery wards of the Cancer Institute of Tehran, Iran were evaluated from March 1993 to March 2003 as phase 1, and from April 2003 to April 2013 as phase 2. Results: Ratio of ductal carcinoma in situ to overall breast cancer was 1.27 and 3.93 in phases 1 and 2, respectively. Rates of excisional or incisional biopsies versus core needle biopsies and clinically versus mammographically detected cases as well as median size of tumors dropped between the 2 phases while a substantial rise in the number of patients attending for screening was seen in this time period. Surgical treatments followed a trend from modified radical mastectomy and axillary lymphatic dissection toward breast conserving surgery and sentinel node dissection or no axillary intervention. Conclusions: Our study shows a considerable trend toward earlier detection of breast cancer and evolution of treatment strategies toward standard less invasive surgery of DCIS in Iran.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.8
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• pp.3733-3736
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• 2016

HER2/neu is a well-established prognostic and predictive factor for invasive breast cancer. However, the role of HER2/neu in ductal breast carcinoma in situ (DCIS) is debated and recent data have suggested that it is mainly linked to in situ local recurrence. Although molecular data suggest that atypical ductal hyperplasia (ADH) and duct carcinoma in situ (DCIS) are related lesions, albeit with vastly different clinical implications, the role of HER2/neu expression in atypical ductal hyperplasia is not well defined either. The aim of this study was to evaluate over expression of HER2/neu in DCIS and cases of ADH in comparison with invasive breast carcinoma. Archival primary breast carcinoma paraffin blocks (n=15), DCIS only (n=10) and ductal epithelial hyperplasia and other breast benign lesions (n=25) were analyzed for HER2/neu immunoexpression. Follow up was available for 40% of the patients. HER2/neu was positive in 80%of both DCIS and invasive carcinoma, and 67% of atypical ductal hyperplasia (ADH) cases. Thus at least a subset of patients with preinvasive breast lesions were positive, which strongly suggests a role for Her2/neu in identifying high-risk patients for malignant transformation. Although these are preliminary data, which need further studies of gene amplification within these patients as well as a larger patient cohort with longer periods of follow up, they support the implementation of routine Her2/neu testing in patients diagnosed as pure DCIS and in florid ADH.

• The Korean Journal of Cytopathology
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• v.11 no.2
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• pp.75-81
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• 2000

Cathepsin D is a protease which is known to facilitate invasion and metastasis of breast carcinoma. Overexpression of cathepsin D is associated with poor clinical outcome and biologic aggressiveness of the breast cancer. We underwent immunocytochemical assay(ICA) for cathepsin D in fine needle aspiration cytology(FNAC) specimens from the breast carcinoma and benign breast diseases. In FNAC specimens cathepsin D was expressed in 21(42.9%) out of 49 cases of invasive ductal carcinoma, whereas negative result was observed in all 15 cases of benign breast diseases including 7 fibroadenomas, 6 fibrocystic diseases, and 2 benign ductal hyperplasias. Among the 11 FNAC specimens from ductal carcinoma in situ(DCIS), cathepsin D was expressed in 3 cases(27.3%). In FNAC specimens immunocytochemistry for cathepsin D showed positive result in 24 out of 60 carcinomas(sensitivity, 40%) and negative result in 15 out of all 15 benign breast diseases(specificity, 100%). No significant correlation was noted between cathepsin D expression in FNAC specimen and clinicohistological characteristics of the breast carcinoma, such as hormone receptors and cell differentiation. In conclusion, ICA of cathepsin D in FNAC specimens thought to be a good adjunct to differentiate malignancy from benign breast diseases.

• Investigative Magnetic Resonance Imaging
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• v.19 no.2
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• pp.127-130
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• 2015

Direct injection of foreign material, such as liquid paraffin and silicone, into the breast can induce a foreign body granulomatous reaction and fibrosis, resulting in hard, nodular breast masses and architectural distortion that can mimic neoplasm. Conventional methods, including physical examination, mammography, and ultrasonography are of little use to differentiate between foreign body-induced mastopathy and breast cancer. In patients with foreign body injection such as breast augmentation, dynamic contrast enhanced MR imaging is an excellent imaging modality. Here, the authors report the MR imaging and pathological findings of ductal carcinoma in situ (DCIS) with multicystic changes in a 41-year-old woman with a previous history of interstitial mammoplasty by paraffin injection.

• The Korean Journal of Nuclear Medicine Technology
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• v.18 no.1
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• pp.140-144
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• 2014

Purpose: The recent surge in breast carcinoma patients is reported in a variety of statistics. Breast cancer occurs mainly from duct and lobulus: 85% is from the breast ducts. The present study is aimed to distinguish the difference in $SUV_{max}$ changing over time by identifying the type of cancers attacking from the duct. Materials and Methods: The subjects of the study are 291 female breast cancer patients who have visited the present PET/CT center from July 1, 2012 to July 23, 2013. Based on the pathological results, 248 IDC (invasive ductal carcinoma) patients and 43 DCIS (ductal carcinoma in situ) patients were selected. In the same manner as the general PET/CT scan (3.7 MBq/Kg), F-FDG was injected, followed by the primary test (Routine tests) after 1 hr, and the secondary test (Delay test) after another hr. $SUV_{max}$ was measured after setting ROI in the lesion based on the data from the two tests. Results: As the comparative result of the change in the lesion $SUV_{max}$ between the two groups, IDC group's $SUV_{max}$ showed M=7.11 and SD=5.405 in the primary test and increased M=7.11 and SD=5.405 in the secondary test (P<0.05); DCIS group's $SUV_{max}$ showed M=2.739, SD=1.229 in the primary test and increased M=2.614, SD=1.470 in the secondary test (P<0.05). Conclusion: As the comparative result of $SUV_{max}$ over time between the groups, IDC showed increased $SUV_{max}$ in the secondary test (Delay test) compared to the primary test (Routine test) (P=0.000); DCIS showed decreased $SUV_{max}$ in the secondary test (Delay test) compared to the primary test (Routine test) (P=0.039). It was confirmed through this study that the change in $SUV_{max}$ has occurred over time by the type of breast cancer (IDC or DCIS) occurring from the breast ducts. However, the onset of breast cancers (ILC, LCIS) from the lobulus was not discussed due to the lack of samples. Future research on the breast cancers from the lobulus is suggested.

• Applied Microscopy
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• v.51
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• pp.6.1-6.9
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• 2021

Histopathology is a well-established standard diagnosis employed for the majority of malignancies, including breast cancer. Nevertheless, despite training and standardization, it is considered operator-dependent and errors are still a concern. Fractal dimension analysis is a computational image processing technique that allows assessing the degree of complexity in patterns. We aimed here at providing a robust and easily attainable method for introducing computer-assisted techniques to histopathology laboratories. Slides from two databases were used: A) Breast Cancer Histopathological; and B) Grand Challenge on Breast Cancer Histology. Set A contained 2480 images from 24 patients with benign alterations, and 5429 images from 58 patients with breast cancer. Set B comprised 100 images of each type: normal tissue, benign alterations, in situ carcinoma, and invasive carcinoma. All images were analyzed with the FracLac algorithm in the ImageJ computational environment to yield the box count fractal dimension (Db) results. Images on set A on 40x magnification were statistically different (p = 0.0003), whereas images on 400x did not present differences in their means. On set B, the mean Db values presented promising statistical differences when comparing. Normal and/or benign images to in situ and/or invasive carcinoma (all p < 0.0001). Interestingly, there was no difference when comparing normal tissue to benign alterations. These data corroborate with previous work in which fractal analysis allowed differentiating malignancies. Computer-aided diagnosis algorithms may beneficiate from using Db data; specific Db cut-off values may yield ~ 99% specificity in diagnosing breast cancer. Furthermore, the fact that it allows assessing tissue complexity, this tool may be used to understand the progression of the histological alterations in cancer.

• Journal of the Korean Society of Radiology
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• v.17 no.5
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• pp.743-749
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• 2023

Breast ductal carcinoma in situ(DCIS) refers to cases in which breast epithelial cells have become malignant but are still limited to normal ducts, and has been increasing rapidly in recent years. In this case, a two-year follow-up revealed findings on mammography and ultrasonography that indicated a small mass classified as BI-RADS Category 3, However far from typical malignant tumor these findings were. In the second year of follow-up, a hypoechoic mass with an indistinct boundary of the right breast in the 6 o'clock direction, on mammography appeared to be about 2.1×1.3 cm in size, and biopsy diagnosed it as ductal carcinoma. Since ductal endothelial cancer has no characteristic clinical findings and can show positive clinical and imaging findings in the early stages, regular follow-up is considered important for early diagnosis, and detection of ductal endothelial cancer through mammography and ultrasound is important for improving the prognosis of all breast cancer patients. During the initial examination conducted four years ago, we reported cases of intra ductal cancer in which asymmetric shading, microcalcification, and branched mass, indicative of intra ductal cancer, were observed during follow-up. It is advisable to concurrently explore methods for reducing X-ray dosage to mitigate potential side effects of contrast medium.

• Journal of Preventive Medicine and Public Health
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• v.31 no.4 s.63
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• pp.592-603
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• 1998

This study was conducted to estimate incidence rate of female breast cancer in a defined area of Chungchongbuk-do in Korea. The presumptive breast cancer cases were selected from two different sources, i.e., medical utilization database of the National Health Insurance Corporation and the database from the National Cancer Registry. Medical students visited each hospital where the presumptive cases had been treated as a breast cancer patient, and made a dictation of medical record of each patient based on the claims stored in the Insurance Corporation from January to December 1995. The diagnoses in the claims included one of the following diagnostic codes; ICD-9 174-175(malignant neoplasms of the breast), 233(carcinoma in situ of the breast and genito-urinary system)or ICD-10 C50(malignant neoplasms of the breast), D05(carcinoma in situ of the breast and genito-urinary system). Each case has been confirmed as having a breast cancer by a breast surgeon through a medical record review. Age-standardized incidence rate of female breast cancer to the Korean population was estimated to be 10.5(95%confidence interval : 8.1-12.9)per 100,000 persons in 1995. Age-standardized rate to the world population was 9.8 per 100,000 persons, and the truncated rate for ages 35-64 was 27.2 per 100,000 persons. Validity of these estimates is discussing in comparison with previous methods of incidence estimation in Korea.

• Journal of Biomedical Engineering Research
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• v.18 no.4
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• pp.357-364
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• 1997

The early detection of breast cancer is clearly a key ingredient for reducing breast cancer mortality. Microcalcification is the only visible feature of the DCIS's(ductal carcinoma in situ) which consist 15 ~ 20% of screening-detected breast cancer. Therefore, the analysis of the shapes and distributions of microcalcifications is very significant for the early detection. The automatic detection procedures have b(:on the concern of digital image processing for many years. We proposed here one efficient method which is essentially statistical pattern classification accelerated by one representative feature, correlation coefficient. We compared the results by this additional feature with results by a simple gray level thresholding. The average detection rate was increased from 48% by gray level feature only to 83% by the proposed method The performances were evaluated with TP rates and FP counts, and also with Bayes errors.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.5
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• pp.2673-2678
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• 2016

Background: It is unclear as to whether the size ratio elastographic technique is useful for assessing ultrasound-detected ductal carcinoma-in-situ (DCIS) masses since they commonly lack a significant desmoplastic reaction. The objectives of this study were to determine the accuracy of this elastographic technique in DCIS and examine if there was any histopathological correlation with the grey-scale strain patterns. Materials and Methods: Female patients referred to the radiology department for image-guided breast biopsy were prospectively evaluated by ultrasound elastography prior to biopsy. Histological diagnosis was the gold standard. An elastographic size ratio of more than 1.1 was considered malignant. Elastographic strain patterns were assessed for correlation with the DCIS histological architectural patterns and nuclear grade. Results: There were 30 DCIS cases. Elastographic sensitivity for detection of malignancy was 86.7% (26/30). 10/30 (33.3%) DCIS masses demonstrated predominantly white elastographic strain patterns while 20/30 (66.7%) were predominantly black. There were 3 (10.0%) DCIS masses that showed had a co-existent bull's-eye sign and 7 (23.3%) other masses had a co-existent toothpaste sign, a strain pattern that has never been reported in the literature. Four out of 4/5 comedo DCIS showed a predominantly white strain pattern (p=0.031) while 6/7 cases with the toothpaste sign were papillary DCIS (p=0.031). There was no relationship between the strain pattern and the DCIS nuclear grade. Conclusions: The size ratio elastographic technique was found to be very sensitive for ultrasound-detected DCIS masses. While the elastographic grey-scale strain pattern should not be used for diagnostic purposes, it correlated well with the DCIS architecture.