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Breast
Histopathologic Diagnoses
Malignant Lesions
Invasive Ductal Carcinoma NST, Grade 1, 2, 3
Invasive Ductal Carcinoma NST, Grade 1, 2, 3
Kanchan Phalak, MD; Deanna L. Lane, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Invasive ductal carcinoma (IDC), no special type (NST)

          • Synonyms

            • Infiltrating ductal carcinoma

          • Definitions

            • Grading
              • Grade 1: Well differentiated
              • Grade 2: Moderately differentiated
              • Grade 3: Poorly differentiated
            • Invasive (infiltrating): Extension of tumor cells through duct basement membrane
            • "Ductal" implies tumors derived from ductal epithelium vs. "lobular" carcinomas from lobules
              • E-cadherin retained in ductal lesions, lost in lobular lesions
            • IDC NST does not meet criteria for special type
              • Special types of IDC: Medullary, mucinous, tubular, invasive micropapillary
            • Microinvasion: Invasive carcinoma with no focus measuring > 0.1 cm, typically in association with DCIS

          IMAGING

          • General Features

            • Mammographic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Image-Guided Biopsy

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          Selected References

                                          1. Amin MB et al: AJCC Cancer Staging Manual. American College of Surgeons, 2018
                                          2. Lee SJ et al: Correlation of tumor uptake on breast-specific gamma imaging and fluorodeoxyglucose PET/CT with molecular subtypes of breast cancer. Medicine (Baltimore). 97(43):e12840, 2018
                                          3. Narayanan D and Berg WA: Dedicated Breast Gamma Camera Imaging and Breast PET: Current Status and Future Directions. PET Clin. 13(3):363-381, 2018
                                          4. Parikh U et al: Ductal Carcinoma In Situ: The Whole Truth. AJR Am J Roentgenol. 210(2):246-255, 2018
                                          5. Patel BK et al: Initial Experience of Tomosynthesis-Guided Vacuum-Assisted Biopsies of Tomosynthesis-Detected (2D Mammography and Ultrasound Occult) Architectural Distortions. AJR Am J Roentgenol. 210(6):1395-1400, 2018
                                          6. Plichta JK et al: Anatomy and Breast Cancer Staging: Is It Still Relevant? Surg Oncol Clin N Am. 27(1):51-67, 2018
                                          7. Rakha EA et al: Impact of breast cancer grade discordance on prediction of outcome. Histopathology. 73(6):904-915, 2018
                                          8. Wang C et al: Can imaging kinetic parameters of dynamic contrast-enhanced magnetic resonance imaging be valuable in predicting clinicopathological prognostic factors of invasive breast cancer? Acta Radiol. 59(7):813-821, 2018
                                          9. Wilson PC et al: Breast cancer histopathology is predictive of low-risk Oncotype Dx recurrence score. Breast J. 24(6):976-980, 2018
                                          10. Au FW et al: Histological Grade and Immunohistochemical Biomarkers of Breast Cancer: Correlation to Ultrasound Features. J Ultrasound Med. 36(9):1883-1894, 2017
                                          11. Bahl M et al: Breast Cancer Characteristics Associated with 2D Digital Mammography versus Digital Breast Tomosynthesis for Screening-detected and Interval Cancers. Radiology. 171148, 2017
                                          12. Heacock L et al: Feasibility analysis of early temporal kinetics as a surrogate marker for breast tumor type, grade, and aggressiveness. J Magn Reson Imaging. ePub, 2017
                                          13. Nyante SJ et al: The association between mammographic calcifications and breast cancer prognostic factors in a population-based registry cohort. Cancer. 123(2):219-227, 2017
                                          14. Robson M et al: Olaparib for Metastatic Breast Cancer in Patients with a Germline BRCA Mutation. N Engl J Med. 377(6):523-533, 2017
                                          15. Chesebro AL et al: Developing Asymmetries at Mammography: A Multimodality Approach to Assessment and Management. Radiographics. 36(2):322-34, 2016
                                          16. Doebar SC et al: Extent of ductal carcinoma in situ according to breast cancer subtypes: a population-based cohort study. Breast Cancer Res Treat. 158(1):179-87, 2016
                                          17. Meshkat B et al: A comparison of clinical-pathological characteristics between symptomatic and interval breast cancer. Breast. 24(3):278-82, 2015
                                          18. Daveau C et al: Histological grade concordance between diagnostic core biopsy and corresponding surgical specimen in HR-positive/HER2-negative breast carcinoma. Br J Cancer. 110(9):2195-200, 2014
                                          19. Schwartz AM et al: Histologic grade remains a prognostic factor for breast cancer regardless of the number of positive lymph nodes and tumor size: a study of 161 708 cases of breast cancer from the SEER Program. Arch Pathol Lab Med. 138(8):1048-52, 2014
                                          20. Aguiar FN et al: Comparison of nuclear grade and immunohistochemical features in situ and invasive components of ductal carcinoma of breast. Rev Bras Ginecol Obstet. 35(3):97-102, 2013
                                          21. Aho M et al: Correlation of sonographic features of invasive ductal mammary carcinoma with age, tumor grade, and hormone-receptor status. J Clin Ultrasound. 41(1):10-7, 2013
                                          22. Cunningham JE et al: Mind the gap: racial differences in breast cancer incidence and biologic phenotype, but not stage, among low-income women participating in a government-funded screening program. Breast Cancer Res Treat. 137(2):589-98, 2013
                                          23. Irshad A et al: Assessing the role of ultrasound in predicting the biological behavior of breast cancer. AJR Am J Roentgenol. 200(2):284-90, 2013
                                          24. SEER Stat Fact Sheets: Breast. http://seer.cancer.gov/statfacts/html/breast.html#incidence-mortality. Accessed February 17, 2013
                                          25. Sun Y et al: Clinical usefulness of breast-specific gamma imaging as an adjunct modality to mammography for diagnosis of breast cancer: a systemic review and meta-analysis. Eur J Nucl Med Mol Imaging. 40(3):450-63, 2013
                                          26. Zheng J et al: Invasive ductal carcinoma of the breast: correlation between tumor grade determined by ultrasound-guided core biopsy and surgical pathology. AJR Am J Roentgenol. 200(1):W71-4, 2013
                                          27. Arvold ND et al: Pathologic characteristics of second breast cancers after breast conservation for ductal carcinoma in situ. Cancer. 118(24):6022-30, 2012
                                          28. Blaichman J et al: Sonographic appearance of invasive ductal carcinoma of the breast according to histologic grade. AJR Am J Roentgenol. 199(3):W402-8, 2012
                                          29. Boisserie-Lacroix M et al: Radiological features of triple-negative breast cancers (73 cases). Diagn Interv Imaging. 93(3):183-90, 2012
                                          30. Evans A et al: Invasive breast cancer: relationship between shear-wave elastographic findings and histologic prognostic factors. Radiology. 263(3):673-7, 2012
                                          31. Gokalp G et al: Malignant spiculated breast masses: dynamic contrast enhanced MR (DCE-MR) imaging enhancement characteristics and histopathological correlation. Eur J Radiol. 81(2):203-8, 2012
                                          32. Gupta S et al: Molecular phenotypes of ductal carcinoma-in-situ and invasive ductal carcinoma: a comparative study. Indian J Pathol Microbiol. 55(1):43-6, 2012
                                          33. Mavaddat N et al: Pathology of breast and ovarian cancers among BRCA1 and BRCA2 mutation carriers: results from the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA). Cancer Epidemiol Biomarkers Prev. 21(1):134-47, 2012
                                          34. Song WJ et al: The Risk Factors Influencing between the Early and Late Recurrence in Systemic Recurrent Breast Cancer. J Breast Cancer. 2012 Jun;15(2):218-23. doi: 10. 4048/jbc. PubMed Central PMCID: PMC3395746, 2012
                                          35. Tadwalkar RV et al: Breast-specific gamma imaging as an adjunct modality for the diagnosis of invasive breast cancer with correlation to tumour size and grade. Br J Radiol. 85(1014):e212-6, 2012
                                          36. Jiang L et al: Mammographic features are associated with clinicopathological characteristics in invasive breast cancer. Anticancer Res. 31(6):2327-34, 2011
                                          37. Perez EA et al: Four-year follow-up of trastuzumab plus adjuvant chemotherapy for operable human epidermal growth factor receptor 2-positive breast cancer: joint analysis of data from NCCTG N9831 and NSABP B-31. J Clin Oncol. 29(25):3366-73, 2011
                                          38. Wang CL et al: Positron emission mammography: correlation of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 status and 18F-FDG. AJR Am J Roentgenol. 197(2):W247-55, 2011
                                          39. Rakha EA et al: Breast cancer prognostic classification in the molecular era: the role of histological grade. Breast Cancer Res. 12(4):207, 2010
                                          40. Ildefonso C et al: The mammographic appearance of breast carcinomas of invasive ductal type: relationship with clinicopathological parameters, biological features and prognosis. Eur J Obstet Gynecol Reprod Biol. 136(2):224-31, 2008
                                          41. Kim SH et al: Correlation of ultrasound findings with histology, tumor grade, and biological markers in breast cancer. Acta Oncol. 47(8):1531-8, 2008
                                          42. Lee SH et al: Correlation between high resolution dynamic MR features and prognostic factors in breast cancer. Korean J Radiol. 2008 Jan-Feb;9(1):10-8. doi: 10. 3348/kjr. PubMed Central PMCID: PMC2627175, 2008
                                          43. Rakha EA et al: Prognostic significance of Nottingham histologic grade in invasive breast carcinoma. J Clin Oncol. 26(19):3153-8, 2008
                                          44. Schrading S et al: Mammographic, US, and MR imaging phenotypes of familial breast cancer. Radiology. 246(1):58-70, 2008
                                          45. Kuhl C: The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology. 244(2):356-78, 2007
                                          46. Kuhl CK: Current status of breast MR imaging. Part 2. Clinical applications. Radiology. 244(3):672-91, 2007
                                          47. Bartella L et al: Nonpalpable mammographically occult invasive breast cancers detected by MRI. AJR Am J Roentgenol. 186(3):865-70, 2006
                                          48. Jinguji M et al: Rim enhancement of breast cancers on contrast-enhanced MR imaging: relationship with prognostic factors. Breast Cancer. 13(1):64-73, 2006
                                          49. Smith-Bindman R et al: Does utilization of screening mammography explain racial and ethnic differences in breast cancer? Ann Intern Med. 144(8):541-53, 2006
                                          50. Rosenberg J et al: The effect of age, race, tumor size, tumor grade, and disease stage on invasive ductal breast cancer survival in the U.S. SEER database. Breast Cancer Res Treat. 89(1):47-54, 2005
                                          51. Rotstein AH et al: Ultrasound characteristics of histologically proven grade 3 invasive ductal breast carcinoma. Australas Radiol. 49(6):476-9, 2005
                                          52. Elston CW et al: Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. 41(3A):154-61, 2002
                                          53. McIlhenny C et al: Optimum number of core biopsies for accurate assessment of histological grade in breast cancer. Br J Surg. 89(1):84-5, 2002
                                          54. Lamb PM et al: Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast. Clin Radiol. 55(1):40-4, 2000
                                          55. Kuhl CK et al: Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology. 211:101-10, 1999
                                          56. Pinder SE et al: The importance of the histologic grade of invasive breast carcinoma and response to chemotherapy. Cancer. 83(8):1529-39, 1998
                                          57. Nixon AJ et al: Relationship of tumor grade to other pathologic features and to treatment outcome of patients with early stage breast carcinoma treated with breast-conserving therapy. Cancer. 78(7):1426-31, 1996
                                          58. Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995
                                          59. Lampejo OT et al: Evaluation of infiltrating ductal carcinomas with a DCIS component: correlation of the histologic type of the in situ component with grade of the infiltrating component. Semin Diagn Pathol. 11(3):215-22, 1994
                                          60. Elston CW et al: Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. 19(5):403-10, 1991
                                          61. Bloom HJ et al: Histological grading and prognosis in breast cancer; a study of 1409 cases of which 359 have been followed for 15 years. Br J Cancer. 11(3):359-77, 1957
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Invasive ductal carcinoma (IDC), no special type (NST)

                                                  • Synonyms

                                                    • Infiltrating ductal carcinoma

                                                  • Definitions

                                                    • Grading
                                                      • Grade 1: Well differentiated
                                                      • Grade 2: Moderately differentiated
                                                      • Grade 3: Poorly differentiated
                                                    • Invasive (infiltrating): Extension of tumor cells through duct basement membrane
                                                    • "Ductal" implies tumors derived from ductal epithelium vs. "lobular" carcinomas from lobules
                                                      • E-cadherin retained in ductal lesions, lost in lobular lesions
                                                    • IDC NST does not meet criteria for special type
                                                      • Special types of IDC: Medullary, mucinous, tubular, invasive micropapillary
                                                    • Microinvasion: Invasive carcinoma with no focus measuring > 0.1 cm, typically in association with DCIS

                                                  IMAGING

                                                  • General Features

                                                    • Mammographic Findings

                                                      • Ultrasonographic Findings

                                                        • MR Findings

                                                          • Nuclear Medicine Findings

                                                            • Image-Guided Biopsy

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  Selected References

                                                                                  1. Amin MB et al: AJCC Cancer Staging Manual. American College of Surgeons, 2018
                                                                                  2. Lee SJ et al: Correlation of tumor uptake on breast-specific gamma imaging and fluorodeoxyglucose PET/CT with molecular subtypes of breast cancer. Medicine (Baltimore). 97(43):e12840, 2018
                                                                                  3. Narayanan D and Berg WA: Dedicated Breast Gamma Camera Imaging and Breast PET: Current Status and Future Directions. PET Clin. 13(3):363-381, 2018
                                                                                  4. Parikh U et al: Ductal Carcinoma In Situ: The Whole Truth. AJR Am J Roentgenol. 210(2):246-255, 2018
                                                                                  5. Patel BK et al: Initial Experience of Tomosynthesis-Guided Vacuum-Assisted Biopsies of Tomosynthesis-Detected (2D Mammography and Ultrasound Occult) Architectural Distortions. AJR Am J Roentgenol. 210(6):1395-1400, 2018
                                                                                  6. Plichta JK et al: Anatomy and Breast Cancer Staging: Is It Still Relevant? Surg Oncol Clin N Am. 27(1):51-67, 2018
                                                                                  7. Rakha EA et al: Impact of breast cancer grade discordance on prediction of outcome. Histopathology. 73(6):904-915, 2018
                                                                                  8. Wang C et al: Can imaging kinetic parameters of dynamic contrast-enhanced magnetic resonance imaging be valuable in predicting clinicopathological prognostic factors of invasive breast cancer? Acta Radiol. 59(7):813-821, 2018
                                                                                  9. Wilson PC et al: Breast cancer histopathology is predictive of low-risk Oncotype Dx recurrence score. Breast J. 24(6):976-980, 2018
                                                                                  10. Au FW et al: Histological Grade and Immunohistochemical Biomarkers of Breast Cancer: Correlation to Ultrasound Features. J Ultrasound Med. 36(9):1883-1894, 2017
                                                                                  11. Bahl M et al: Breast Cancer Characteristics Associated with 2D Digital Mammography versus Digital Breast Tomosynthesis for Screening-detected and Interval Cancers. Radiology. 171148, 2017
                                                                                  12. Heacock L et al: Feasibility analysis of early temporal kinetics as a surrogate marker for breast tumor type, grade, and aggressiveness. J Magn Reson Imaging. ePub, 2017
                                                                                  13. Nyante SJ et al: The association between mammographic calcifications and breast cancer prognostic factors in a population-based registry cohort. Cancer. 123(2):219-227, 2017
                                                                                  14. Robson M et al: Olaparib for Metastatic Breast Cancer in Patients with a Germline BRCA Mutation. N Engl J Med. 377(6):523-533, 2017
                                                                                  15. Chesebro AL et al: Developing Asymmetries at Mammography: A Multimodality Approach to Assessment and Management. Radiographics. 36(2):322-34, 2016
                                                                                  16. Doebar SC et al: Extent of ductal carcinoma in situ according to breast cancer subtypes: a population-based cohort study. Breast Cancer Res Treat. 158(1):179-87, 2016
                                                                                  17. Meshkat B et al: A comparison of clinical-pathological characteristics between symptomatic and interval breast cancer. Breast. 24(3):278-82, 2015
                                                                                  18. Daveau C et al: Histological grade concordance between diagnostic core biopsy and corresponding surgical specimen in HR-positive/HER2-negative breast carcinoma. Br J Cancer. 110(9):2195-200, 2014
                                                                                  19. Schwartz AM et al: Histologic grade remains a prognostic factor for breast cancer regardless of the number of positive lymph nodes and tumor size: a study of 161 708 cases of breast cancer from the SEER Program. Arch Pathol Lab Med. 138(8):1048-52, 2014
                                                                                  20. Aguiar FN et al: Comparison of nuclear grade and immunohistochemical features in situ and invasive components of ductal carcinoma of breast. Rev Bras Ginecol Obstet. 35(3):97-102, 2013
                                                                                  21. Aho M et al: Correlation of sonographic features of invasive ductal mammary carcinoma with age, tumor grade, and hormone-receptor status. J Clin Ultrasound. 41(1):10-7, 2013
                                                                                  22. Cunningham JE et al: Mind the gap: racial differences in breast cancer incidence and biologic phenotype, but not stage, among low-income women participating in a government-funded screening program. Breast Cancer Res Treat. 137(2):589-98, 2013
                                                                                  23. Irshad A et al: Assessing the role of ultrasound in predicting the biological behavior of breast cancer. AJR Am J Roentgenol. 200(2):284-90, 2013
                                                                                  24. SEER Stat Fact Sheets: Breast. http://seer.cancer.gov/statfacts/html/breast.html#incidence-mortality. Accessed February 17, 2013
                                                                                  25. Sun Y et al: Clinical usefulness of breast-specific gamma imaging as an adjunct modality to mammography for diagnosis of breast cancer: a systemic review and meta-analysis. Eur J Nucl Med Mol Imaging. 40(3):450-63, 2013
                                                                                  26. Zheng J et al: Invasive ductal carcinoma of the breast: correlation between tumor grade determined by ultrasound-guided core biopsy and surgical pathology. AJR Am J Roentgenol. 200(1):W71-4, 2013
                                                                                  27. Arvold ND et al: Pathologic characteristics of second breast cancers after breast conservation for ductal carcinoma in situ. Cancer. 118(24):6022-30, 2012
                                                                                  28. Blaichman J et al: Sonographic appearance of invasive ductal carcinoma of the breast according to histologic grade. AJR Am J Roentgenol. 199(3):W402-8, 2012
                                                                                  29. Boisserie-Lacroix M et al: Radiological features of triple-negative breast cancers (73 cases). Diagn Interv Imaging. 93(3):183-90, 2012
                                                                                  30. Evans A et al: Invasive breast cancer: relationship between shear-wave elastographic findings and histologic prognostic factors. Radiology. 263(3):673-7, 2012
                                                                                  31. Gokalp G et al: Malignant spiculated breast masses: dynamic contrast enhanced MR (DCE-MR) imaging enhancement characteristics and histopathological correlation. Eur J Radiol. 81(2):203-8, 2012
                                                                                  32. Gupta S et al: Molecular phenotypes of ductal carcinoma-in-situ and invasive ductal carcinoma: a comparative study. Indian J Pathol Microbiol. 55(1):43-6, 2012
                                                                                  33. Mavaddat N et al: Pathology of breast and ovarian cancers among BRCA1 and BRCA2 mutation carriers: results from the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA). Cancer Epidemiol Biomarkers Prev. 21(1):134-47, 2012
                                                                                  34. Song WJ et al: The Risk Factors Influencing between the Early and Late Recurrence in Systemic Recurrent Breast Cancer. J Breast Cancer. 2012 Jun;15(2):218-23. doi: 10. 4048/jbc. PubMed Central PMCID: PMC3395746, 2012
                                                                                  35. Tadwalkar RV et al: Breast-specific gamma imaging as an adjunct modality for the diagnosis of invasive breast cancer with correlation to tumour size and grade. Br J Radiol. 85(1014):e212-6, 2012
                                                                                  36. Jiang L et al: Mammographic features are associated with clinicopathological characteristics in invasive breast cancer. Anticancer Res. 31(6):2327-34, 2011
                                                                                  37. Perez EA et al: Four-year follow-up of trastuzumab plus adjuvant chemotherapy for operable human epidermal growth factor receptor 2-positive breast cancer: joint analysis of data from NCCTG N9831 and NSABP B-31. J Clin Oncol. 29(25):3366-73, 2011
                                                                                  38. Wang CL et al: Positron emission mammography: correlation of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 status and 18F-FDG. AJR Am J Roentgenol. 197(2):W247-55, 2011
                                                                                  39. Rakha EA et al: Breast cancer prognostic classification in the molecular era: the role of histological grade. Breast Cancer Res. 12(4):207, 2010
                                                                                  40. Ildefonso C et al: The mammographic appearance of breast carcinomas of invasive ductal type: relationship with clinicopathological parameters, biological features and prognosis. Eur J Obstet Gynecol Reprod Biol. 136(2):224-31, 2008
                                                                                  41. Kim SH et al: Correlation of ultrasound findings with histology, tumor grade, and biological markers in breast cancer. Acta Oncol. 47(8):1531-8, 2008
                                                                                  42. Lee SH et al: Correlation between high resolution dynamic MR features and prognostic factors in breast cancer. Korean J Radiol. 2008 Jan-Feb;9(1):10-8. doi: 10. 3348/kjr. PubMed Central PMCID: PMC2627175, 2008
                                                                                  43. Rakha EA et al: Prognostic significance of Nottingham histologic grade in invasive breast carcinoma. J Clin Oncol. 26(19):3153-8, 2008
                                                                                  44. Schrading S et al: Mammographic, US, and MR imaging phenotypes of familial breast cancer. Radiology. 246(1):58-70, 2008
                                                                                  45. Kuhl C: The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology. 244(2):356-78, 2007
                                                                                  46. Kuhl CK: Current status of breast MR imaging. Part 2. Clinical applications. Radiology. 244(3):672-91, 2007
                                                                                  47. Bartella L et al: Nonpalpable mammographically occult invasive breast cancers detected by MRI. AJR Am J Roentgenol. 186(3):865-70, 2006
                                                                                  48. Jinguji M et al: Rim enhancement of breast cancers on contrast-enhanced MR imaging: relationship with prognostic factors. Breast Cancer. 13(1):64-73, 2006
                                                                                  49. Smith-Bindman R et al: Does utilization of screening mammography explain racial and ethnic differences in breast cancer? Ann Intern Med. 144(8):541-53, 2006
                                                                                  50. Rosenberg J et al: The effect of age, race, tumor size, tumor grade, and disease stage on invasive ductal breast cancer survival in the U.S. SEER database. Breast Cancer Res Treat. 89(1):47-54, 2005
                                                                                  51. Rotstein AH et al: Ultrasound characteristics of histologically proven grade 3 invasive ductal breast carcinoma. Australas Radiol. 49(6):476-9, 2005
                                                                                  52. Elston CW et al: Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. 41(3A):154-61, 2002
                                                                                  53. McIlhenny C et al: Optimum number of core biopsies for accurate assessment of histological grade in breast cancer. Br J Surg. 89(1):84-5, 2002
                                                                                  54. Lamb PM et al: Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast. Clin Radiol. 55(1):40-4, 2000
                                                                                  55. Kuhl CK et al: Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology. 211:101-10, 1999
                                                                                  56. Pinder SE et al: The importance of the histologic grade of invasive breast carcinoma and response to chemotherapy. Cancer. 83(8):1529-39, 1998
                                                                                  57. Nixon AJ et al: Relationship of tumor grade to other pathologic features and to treatment outcome of patients with early stage breast carcinoma treated with breast-conserving therapy. Cancer. 78(7):1426-31, 1996
                                                                                  58. Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995
                                                                                  59. Lampejo OT et al: Evaluation of infiltrating ductal carcinomas with a DCIS component: correlation of the histologic type of the in situ component with grade of the infiltrating component. Semin Diagn Pathol. 11(3):215-22, 1994
                                                                                  60. Elston CW et al: Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. 19(5):403-10, 1991
                                                                                  61. Bloom HJ et al: Histological grading and prognosis in breast cancer; a study of 1409 cases of which 359 have been followed for 15 years. Br J Cancer. 11(3):359-77, 1957
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