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Characteristic Malignant Features Not Common in Metaplastic Carcinoma

January 6, 2008
Written by: , Filed in: Breast Imaging
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The objective of a recent study was to compare imaging features of invasive ductal carcinomas and metaplastic breast carcinomas.

The study shows that metaplastic carcinomas often do not show typical malignant features on mammography.

Methodology
The authors reviewed mammographic and sonographic imaging features of 43 metaplastic breast carcinomas and 43 tumor-stage-matched invasive ductal carcinomas. In addition, the age of women and histopathological features of these carcinomas were reviewed.

Results
Among the study population, the median age of patients with metaplastic breast carcinoma was younger than that of those with invasive ductal carcinoma. A higher percentage of metaplastic carcinomas was palpable at the time of presentation. Most metaplastic carcinomas were estrogen and progesterone receptor-negative and HER-2/Neu receptor-negative.

On mammography, metaplastic carcinomas appeared most commonly as non-calcified round or oval masses with circumscribed or indistinct margins. The majority of metaplastic carcinomas did not show typical malignant features on ultrasound. Metaplastic carcinomas more often had circumscribed and indistinct margins, as well as posterior acoustic enhancement, than did invasive ductal carcinomas.

Reviewer’s Comments
Mammographic and sonographic features of metaplastic carcinomas are not often suggestive of malignancy.

Reviewer’s Comments
Both invasive ductal carcinomas and metaplastic carcinomas most commonly present as palpable masses. Invasive ductal carcinomas typically appear as irregular masses with spiculated margins and associated pleomorphic calcium deposits on mammography, and irregular masses with posterior acoustic shadowing and angular margins on sonography. These malignant features of invasive ductal carcinomas are not often manifested by metaplastic carcinomas.

Although metaplastic carcinomas are uncommon, they most commonly present as palpable masses in patients whose median age at the time of presentation is younger than that of patients with invasive ductal carcinomas.

Prognosis of metaplastic carcinomas is often less favorable than that of invasive ductal carcinomas, and these disseminate hematogenously. Therefore, it is important for the radiologist to consider metaplastic carcinomas when evaluating palpable solid masses, even when masses may not have typical malignant features on mammography or sonography.

Author: Bokran Won, MD

Reference:
Yang WT, Hennessy B, et al. Imaging Differences in Metaplastic and Invasive Ductal Carcinomas of the Breast.
AJR; 2007; 189 (December): 1288-1293

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