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When Is a Diagnosis of Sclerosing Adenosis Acceptable at Core Biopsy?¹

¹ From the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Md (H.K.G.), and Departments of Pathology (O.B.I.) and Radiology (W.A.B.) and Greenebaum Cancer Center (W.A.B.), University of Maryland, 419 W Redwood St, Suite 110, Baltimore, MD 21201. From the 2000 RSNA scientific assembly. Received April 18, 2002; revision requested June 19; final revision received November 6; accepted November 27. Address correspondence to W.A.B. (e-mail: waberg@umaryland.edu).

View larger version (192K): [in a new window]   Figure 1. Photomicrograph of sclerosing adenosis at 11-gauge vacuum-assisted biopsy of clustered amorphous calcifications (arrows). Stromal fibrosis causes compression and obliteration of the epithelial profiles, which are increased in number. The resulting architectural distortion is evident. (Hematoxylin-eosin stain; original magnification, x4.)

View larger version (21K): [in a new window]   Figure 2. Diagram of the study population. ALH = atypical lobular hyperplasia, IDC = invasive ductal carcinoma, ILC = invasive lobular carcinoma.

View larger version (110K): [in a new window]   Figure 3a. Images in a 40-year-old woman with history of prior contralateral cancer, with sclerosing adenosis, radial sclerosing lesion, and multiple small foci of invasive ductal (tubular) and lobular carcinoma. (a) Craniocaudal spot magnification mammogram shows 15-mm spiculated mass (arrow). (b) Photomicrograph of 11-gauge stereotactic biopsy specimen initially interpreted as only sclerosing adenosis. Because of the highly suspicious mammographic findings, excision was recommended. Second review demonstrated this associated radial sclerosing lesion at core biopsy as suggested by the central elastosis (arrowheads). (Hematoxylin-eosin stain; original magnification, x20.) (c) Low-power microscopic view of the excisional specimen shows a portion of the radial sclerosing lesion. A small (2-mm in diameter) focus of invasive ductal (tubular) carcinoma (arrow) is noted adjacent to and involving the sclerosing lesion. Other scattered foci of tumor manifested as isolated nests of cells and single cells. (Hematoxylin-eosin stain; original magnification, x15.) (d) High-power microscopic view of invasive ductal (tubular) carcinoma at excisional histopathologic examination (close-up of area marked in c). Note that individual duct profiles (arrowheads) lack an outer myoepithelial layer, which is compatible with tubular carcinoma. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (130K): [in a new window]   Figure 3b. Images in a 40-year-old woman with history of prior contralateral cancer, with sclerosing adenosis, radial sclerosing lesion, and multiple small foci of invasive ductal (tubular) and lobular carcinoma. (a) Craniocaudal spot magnification mammogram shows 15-mm spiculated mass (arrow). (b) Photomicrograph of 11-gauge stereotactic biopsy specimen initially interpreted as only sclerosing adenosis. Because of the highly suspicious mammographic findings, excision was recommended. Second review demonstrated this associated radial sclerosing lesion at core biopsy as suggested by the central elastosis (arrowheads). (Hematoxylin-eosin stain; original magnification, x20.) (c) Low-power microscopic view of the excisional specimen shows a portion of the radial sclerosing lesion. A small (2-mm in diameter) focus of invasive ductal (tubular) carcinoma (arrow) is noted adjacent to and involving the sclerosing lesion. Other scattered foci of tumor manifested as isolated nests of cells and single cells. (Hematoxylin-eosin stain; original magnification, x15.) (d) High-power microscopic view of invasive ductal (tubular) carcinoma at excisional histopathologic examination (close-up of area marked in c). Note that individual duct profiles (arrowheads) lack an outer myoepithelial layer, which is compatible with tubular carcinoma. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (159K): [in a new window]   Figure 3c. Images in a 40-year-old woman with history of prior contralateral cancer, with sclerosing adenosis, radial sclerosing lesion, and multiple small foci of invasive ductal (tubular) and lobular carcinoma. (a) Craniocaudal spot magnification mammogram shows 15-mm spiculated mass (arrow). (b) Photomicrograph of 11-gauge stereotactic biopsy specimen initially interpreted as only sclerosing adenosis. Because of the highly suspicious mammographic findings, excision was recommended. Second review demonstrated this associated radial sclerosing lesion at core biopsy as suggested by the central elastosis (arrowheads). (Hematoxylin-eosin stain; original magnification, x20.) (c) Low-power microscopic view of the excisional specimen shows a portion of the radial sclerosing lesion. A small (2-mm in diameter) focus of invasive ductal (tubular) carcinoma (arrow) is noted adjacent to and involving the sclerosing lesion. Other scattered foci of tumor manifested as isolated nests of cells and single cells. (Hematoxylin-eosin stain; original magnification, x15.) (d) High-power microscopic view of invasive ductal (tubular) carcinoma at excisional histopathologic examination (close-up of area marked in c). Note that individual duct profiles (arrowheads) lack an outer myoepithelial layer, which is compatible with tubular carcinoma. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (158K): [in a new window]   Figure 3d. Images in a 40-year-old woman with history of prior contralateral cancer, with sclerosing adenosis, radial sclerosing lesion, and multiple small foci of invasive ductal (tubular) and lobular carcinoma. (a) Craniocaudal spot magnification mammogram shows 15-mm spiculated mass (arrow). (b) Photomicrograph of 11-gauge stereotactic biopsy specimen initially interpreted as only sclerosing adenosis. Because of the highly suspicious mammographic findings, excision was recommended. Second review demonstrated this associated radial sclerosing lesion at core biopsy as suggested by the central elastosis (arrowheads). (Hematoxylin-eosin stain; original magnification, x20.) (c) Low-power microscopic view of the excisional specimen shows a portion of the radial sclerosing lesion. A small (2-mm in diameter) focus of invasive ductal (tubular) carcinoma (arrow) is noted adjacent to and involving the sclerosing lesion. Other scattered foci of tumor manifested as isolated nests of cells and single cells. (Hematoxylin-eosin stain; original magnification, x15.) (d) High-power microscopic view of invasive ductal (tubular) carcinoma at excisional histopathologic examination (close-up of area marked in c). Note that individual duct profiles (arrowheads) lack an outer myoepithelial layer, which is compatible with tubular carcinoma. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (120K): [in a new window]   Figure 4. Craniocaudal spot magnification mammogram in a 43-year-old woman with an indistinctly marginated mass containing clustered punctate microcalcifications (arrow). Eleven-gauge vacuum-assisted biopsy yielded sclerosing adenosis.

View larger version (155K): [in a new window]   Figure 5a. Images in a 43-year-old woman with bilateral masses due to sclerosing adenosis. (a, b) Palpable, circumscribed mass (indicated with a radiopaque marker) in the outer left breast containing a single coarse calcification (arrow) both at (a) mammography and (b) transverse sonography (10-MHz). The mass yielded sclerosing adenosis at 14-gauge sonographically guided core biopsy. (c) Mediolateral spot magnification mammogram reveals amorphous and punctate calcifications (arrowheads) within an indistinctly marginated mass in the right breast, which developed 5 years later. (d) Photomicrograph reveals focus of sclerosing adenosis with calcifications (arrowheads) at stereotactically guided 11-gauge biopsy, with associated fibrocystic changes. (Hematoxylin-eosin stain; original magnification, x20.)

View larger version (205K): [in a new window]   Figure 5b. Images in a 43-year-old woman with bilateral masses due to sclerosing adenosis. (a, b) Palpable, circumscribed mass (indicated with a radiopaque marker) in the outer left breast containing a single coarse calcification (arrow) both at (a) mammography and (b) transverse sonography (10-MHz). The mass yielded sclerosing adenosis at 14-gauge sonographically guided core biopsy. (c) Mediolateral spot magnification mammogram reveals amorphous and punctate calcifications (arrowheads) within an indistinctly marginated mass in the right breast, which developed 5 years later. (d) Photomicrograph reveals focus of sclerosing adenosis with calcifications (arrowheads) at stereotactically guided 11-gauge biopsy, with associated fibrocystic changes. (Hematoxylin-eosin stain; original magnification, x20.)

View larger version (98K): [in a new window]   Figure 5c. Images in a 43-year-old woman with bilateral masses due to sclerosing adenosis. (a, b) Palpable, circumscribed mass (indicated with a radiopaque marker) in the outer left breast containing a single coarse calcification (arrow) both at (a) mammography and (b) transverse sonography (10-MHz). The mass yielded sclerosing adenosis at 14-gauge sonographically guided core biopsy. (c) Mediolateral spot magnification mammogram reveals amorphous and punctate calcifications (arrowheads) within an indistinctly marginated mass in the right breast, which developed 5 years later. (d) Photomicrograph reveals focus of sclerosing adenosis with calcifications (arrowheads) at stereotactically guided 11-gauge biopsy, with associated fibrocystic changes. (Hematoxylin-eosin stain; original magnification, x20.)

View larger version (147K): [in a new window]   Figure 5d. Images in a 43-year-old woman with bilateral masses due to sclerosing adenosis. (a, b) Palpable, circumscribed mass (indicated with a radiopaque marker) in the outer left breast containing a single coarse calcification (arrow) both at (a) mammography and (b) transverse sonography (10-MHz). The mass yielded sclerosing adenosis at 14-gauge sonographically guided core biopsy. (c) Mediolateral spot magnification mammogram reveals amorphous and punctate calcifications (arrowheads) within an indistinctly marginated mass in the right breast, which developed 5 years later. (d) Photomicrograph reveals focus of sclerosing adenosis with calcifications (arrowheads) at stereotactically guided 11-gauge biopsy, with associated fibrocystic changes. (Hematoxylin-eosin stain; original magnification, x20.)

View larger version (134K): [in a new window]   Figure 6. Mediolateral spot magnification mammogram in a 54-year-old woman with clustered amorphous calcifications (arrow) due to sclerosing adenosis, which was proven at 11-gauge vacuum-assisted stereotactic biopsy.