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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 13  |  Issue : 1  |  Page : 1-3

Galactocele ultrasonography and elastography imaging with pathological correlation


Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India

Date of Web Publication10-Sep-2018

Correspondence Address:
Dr. Suresh Vasant Phatak
Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_51_18

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  Abstract 


Objective: The objective of the study is to study the sonographic and strain elastographic features of galactocele in patients presenting in our hospital. Materials and Methods: This is a prospective observational study of all patients visiting our hospital with breast problems. This study was conducted at AVBRH hospital, Sawangi, Wardha, from March 2016 to July 2018. Most patients visiting the hospital with a clinical diagnosis of galactocele included in the study. Results: A total of 15 patients were included in the study. Sixty percent of patients belonged to the third decade of life (age between 21 and 30 years) followed by 20% from the fourth decade (age between 31 and 40 years). In our study, pregnancy and lactational period related galactoceles were more common than galactocele not related to pregnancy and lactation. Most galactoceles showed features of benign lesion on sonography. Conclusion: Galactoceles commonly appear on ultrasound as cystic or multicystic lesions with posterior acoustic enhancement. Blue-green-red appearance is seen in all cases on strain elastography.

Keywords: Benign breast disease, breast neoplasm, sonomammography


How to cite this article:
Phatak SV, Marfani GB. Galactocele ultrasonography and elastography imaging with pathological correlation. J Datta Meghe Inst Med Sci Univ 2018;13:1-3

How to cite this URL:
Phatak SV, Marfani GB. Galactocele ultrasonography and elastography imaging with pathological correlation. J Datta Meghe Inst Med Sci Univ [serial online] 2018 [cited 2018 Nov 21];13:1-3. Available from: http://www.journaldmims.com/text.asp?2018/13/1/1/240902




  Introduction Top


Galactoceles means cystic dilation of the ducts. Although most frequently found in lactating females, it can occur during the third trimester of pregnancy, which can mimic other breast lesions.[1] Galactocele is the breast lesion most commonly found during pregnancy and lactation.[2],[3] They can also occur in male patients ranging in age from infants to 75-years old. Various causes of galactocele include present or previous stimulation by prolactin, secretary breast epithelium, and some forms of ductal obstruction.[4]


  Materials and Methods Top


This was a prospective observational study carried out at AVBRH hospital at Sawangi (Meghe), Wardha, over a period of about 28 months starting from March 2016 to July 2018. Most patients visiting the hospital with a clinical diagnosis of galactocele included in the study. Few patients in higher age group had a diagnosis of benign breast lump. Ultrasonography (USG) was done for each case. All classical USG findings were analyzed in detail. Strain elastography was also performed in each case. Fine-needle aspiration and cytology was performed in every patient to confirm the diagnosis. Patients included were in the age group of 21–60 years.

Real-time ultrasound followed by strain elastography was performed with the Hitachi Aloka Arietta S70 with 12–18 MHz linear array transducer.

Technique

Each lesion was analyzed as per conventional ultrasound descriptors, i.e., shape, orientation, margin, lesion boundary, echostructure, and posterior acoustic features.

Once the optimum B-mode image was obtained, elastograms were acquired taking due care that the lesion remained in the imaging plane. The images from conventional sonography and sonographic elastography were displayed on the screen side by side as a single image.

The elasticity scores of the target lesions were assessed using the following Tsukuba scoring system described by Itoh et al.[5]

Tsukuba scoring system

A score of 1 indicated even strain for the entire hypoechoic lesion (i.e., the entire lesion was evenly shaded in green). A score of 2 means strain in most of the hypoechoic lesion, with some areas of no strain (i.e., the hypoechoic lesion had a mosaic pattern of green and blue). A score of 3 implies strain at the periphery of the hypoechoic lesion, with sparing of the center of the lesion (i.e., the peripheral part of lesion was green, and the central part was blue). A score of 4 shows no strain in the entire hypoechoic lesion (i.e., the entire lesion was blue, but its surrounding area was not included. A score of 5 indicated no strain in the entire hypoechoic lesion or in the surrounding area (i.e., both the entire hypoechoic lesion and its surrounding area were blue). Blue-green-red (BGR) represents typical artifactual three-layered aspect (BGR) encountered with cystic lesions.[5]

Pathological diagnosis

In all 15 cases included in the study, diagnosis was established by aspiration of milk-like fluid and cytology.


  Results Top


A total of 15 patients were included in the study during 28 months from March 2016 to July 2018. Nine (60%) patients belonged to the third decade of life (age between 21 and 30 years) followed by three (20%) from the fourth decade (age between 31 and 40 years), 2 (13%) from the fifth decade (age between 41 and 50 years), and one (7%) in the age group of 51–60 years [Table 1]. A history of recent pregnancy and lactation was present in majority of patients (60%). However, few cases who were seen in higher age group were not related to pregnancy and lactation period. Important sonographic features are seen are oval shape, circumscribed, cystic lesion with parallel orientation, hyperechoic echostructure, and posterior acoustic enhancement [Table 2]. In elastography, typical BGR appearance was observed in all cases [Table 3].
Table 1: Age group-wise incidence of galactocele

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Table 2: Sonographic findings of galactocele

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Table 3: Elastographic features of galactocele

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  Discussion Top


Galactocele is a cystic dilatation of the terminal ducts and ductules containing milk, so the appearance of a galactocele may vary during the monitoring. Initially it is seen on sonographic examination as anechoiec lesion which may contain internal septa as fresh milk has homogenously emulsified fat globules. Later, in the course of disease, the content becomes moderately echogenic, when the fat tends to form increasingly large and less emulsified globules, which are distributed unevenly or are suspended above the liquid component.[6] However, they can also share characteristics with malignant lesions, including solid internal echoes [Figure 1], irregular shape, and poorly circumscribed margins. The internal echoes may be homogeneous or heterogeneous, depending on their contents.[2],[7] Galactoceles are uncommon cause of breast lump usually occurring in lactating patients. In our study, majority (60%) of patients were breastfeeding at the time of clinical presentation. This is similar to the study of Stevens et al.[8] However, a study by Park et al. revealed that high proportion of patients was seen not related to pregnancy and lactation.[9] In our study, most of the galactoceles showed evidence of features suggestive of benign lesions such as oval shape, cystic lesions, homogeneous content and parallel orientation [Figure 2], hyperechoic echostructure, and posterior acoustic enhancement whereas a study conducted by Kim et al. revealed that many sonography features were suspicious of solid breast mass.[10] In strain elastography, typical BGR appearance was seen in all cases [Figure 3].
Figure 1: Ultrasonography breast showing oval solid appearing lesion due to debris within and typical blue-green-red appearance on strain elastography

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Figure 2: Ultrasonography breast well-defined oval wider than taller hyperechoic lesion showing homogeneous echostructure and posterior acoustic enhancement. Strain elastography reveals typical blue-green-red appearance

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Figure 3: Ultrasonography breast well-defined taller than wider breast lesion showing layering of contents and blue-green-red appearance on elastography

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A limitation of our study is small number of cases it involves. A large series is required for further studying the pathology of galactocele.


  Conclusion Top


Galactoceles can have a wide range of sonographic appearance and can mimic other breast pathologies including benign and malignant types. Well-defined lesion with a recent history of childbirth and lactation and distal acoustic enhancement is useful in confirming diagnosis. Elastography can help further characterization of these lesions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vashi R, Hooley R, Butler R, Geisel J, Philpotts L. Breast imaging of the pregnant and lactating patient: Physiologic changes and common benign entities. AJR Am J Roentgenol 2013;200:329-36.  Back to cited text no. 1
    
2.
Sawhney S, Petkovska L, Ramadan S, Al-Muhtaseb S, Jain R, Sheikh M, et al. Sonographic appearances of galactoceles. J Clin Ultrasound 2002;30:18-22.  Back to cited text no. 2
    
3.
Hosny IA, Salah Eldin L, Elghawabi HS. Radiological evaluation of palpable breast masses during pregnancy and lactation. Egypt J Radiol Nucl Med 2011;42:267-73.  Back to cited text no. 3
    
4.
Boyle M, Lakhoo K, Ramani P. Galactocele in a male infant: Case report and review of literature. Pediatr Pathol 1993;13:305-8.  Back to cited text no. 4
    
5.
Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, et al. Breast disease: Clinical application of US elastography for diagnosis. Radiology 2006;239:341-50.  Back to cited text no. 5
    
6.
Masciadri N, Ferranti C. Benign breast lesions: Ultrasound. J Ultrasound 2011;14:55-65.  Back to cited text no. 6
    
7.
Son EJ, Oh KK, Kim EK. Pregnancy-associated breast disease: Radiologic features and diagnostic dilemmas. Yonsei Med J 2006;47:34-42.  Back to cited text no. 7
    
8.
Stevens K, Burrell HC, Evans AJ, Sibbering DM. The ultrasound appearances of galactocoeles. Br J Radiol 1997;70:239-41.  Back to cited text no. 8
    
9.
Park MS, Ki Keun OH, Kim EK, Sung II L. Multifaces of sonographic findings of galactocele J Korean Radiol Soc 2000;42:699-703.  Back to cited text no. 9
    
10.
Kim MJ, Kim EK, Park SY, Jung HK, Oh KK, Seok JY, et al. Galactoceles mimicking suspicious solid masses on sonography. J Ultrasound Med 2006;25:145-51.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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