Diagnostic Imaging Pathways - Staging of Breast Cancer

Image Gallery

Image 1 (Breast Mammography): Stellate lesion with malignant calcification. In addition, there is inversion of the nipple and adjacent skin thickening. The features are highly suspicious for a breast carcinoma.

Breast Carcinoma

Image 2a (Mammogram, right breast): A non-calcified 22mm mass is present in the upper inner quadrant of the right breast.

Image 2b (Ultrasound, right breast): Ultrasound of the same lesion showed an ill-defined solid mass with irregular margins, distortion of adjacent stroma and posterior acoustic shadowing, features which are suspicious for malignancy. Biopsy confirmed an invasive ductal carcinoma.

Breast Carcinoma with Nodal Involvement

Image 3a and 3b (Breast Ultrasound): An irregular, hypoechoic area of parenchyma measuring 20mm in diameter is located in the upper outer quadrant/axillary tail region of the right breast. The features are suspicious for a breast carcinoma.

Image 3c (Sentinel Lymph Node Scintigraphy): Imaging from the same patient using antimony colloid (99mTc Sb Colloid) administered under imaging guidance in a peritumoural and intradermal location in relation to the right upper, outer quadrant breast carcinoma. Imaging was performed for 2.5 hours. Towards the end of this imaging period, there was faint uptake of activity high in the right axilla, likely representing nodal activity and this was marked on the skin.

Image 4a: Mastectomy showing an irregular pale tumour (arrow) with surrounding fibrosis consistent with a breast carcinoma.

Image 5 (H&E, x10): Histological section of a typical invasive lobular carcinoma showing the classical alignment of single cells in rows.

Metastatic Breast Carcinoma

Image 6 (H&E, x2.5): Histological section of a lymph node with metastatic breast carcinoma. The pale areas represent extensive replacement of the nodal parenchyma with solid sheets of malignant cells. Few residual follicles with germinal centres are present (arrows).