{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T02:09:01Z","timestamp":1789006141266,"version":"build-2803163510"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2023,2,11]],"date-time":"2023-02-11T00:00:00Z","timestamp":1676073600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,2,11]],"date-time":"2023-02-11T00:00:00Z","timestamp":1676073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Ultrasonics"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>There have been several investigations of non-mass-like (NML) lesions on ultrasound (US) since Uematsu first described this approach, and it is a relatively new concept for breast examination. However, the results have varied, and there have been only a few studies related to the detailed histopathology of NML lesions on US. Here, we review the histopathology of NML lesions. NML lesions are pathologically benign, atypical, or malignant. There are two major findings of NML lesions on US: architectural distortion and calcifications. Architectural distortion pathologically indicates a fibrous change with ductal proliferation, invasive breast carcinoma, and carcinoma in situ. Histopathologically, microcalcifications are seen in both benign and malignant lesions, and it is important to distinguish between these lesions among NML lesions, particularly fibrocystic changes including adenosis and hyperplasia in the case of benign lesions and carcinoma in situ (ductal and lobular) in the case of malignant lesions. The differential major points may be whether NML lesions are associated with abundant hyperechoic foci, which indicate comedo necrosis on histology. They are usually high-grade carcinoma in situ that may be positive for HER2 or triple negativity. A recent report indicated that low-grade carcinoma in situ showed better survival than higher-grade carcinoma in situ, which is often accompanied by comedo necrosis on histology, reflecting visible microcalcification on US. NML lesions are considered to include a certain rate of low-grade carcinoma in situ. Therefore, more caution may be needed when detecting and managing NML lesions to avoid overdiagnosis and overtreatment as a result of this recent \u201clow-risk ductal carcinoma in situ\u201d concept.<\/jats:p>","DOI":"10.1007\/s10396-023-01286-y","type":"journal-article","created":{"date-parts":[[2023,2,11]],"date-time":"2023-02-11T09:05:36Z","timestamp":1676106336000},"page":"375-380","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Histopathology of non-mass-like breast lesions on ultrasound"],"prefix":"10.1007","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3441-7739","authenticated-orcid":false,"given":"Rin","family":"Yamaguchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidetaka","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaro","family":"Mihara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miki","family":"Yamaguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maki","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,2,11]]},"reference":[{"key":"1286_CR1","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/s12282-012-0364-z","volume":"19","author":"T Uematsu","year":"2012","unstructured":"Uematsu T. Non-mass-like lesions on breast ultrasonography: a systematic review. Breast Cancer. 2012;19:295\u2013301.","journal-title":"Breast Cancer"},{"key":"1286_CR2","doi-asserted-by":"crossref","unstructured":"Tab\u00e1r L, Tot T, Dean PB. VI Calcifications on mammogram. Teaching atlas of mammography. 4th edition: Thieme, 2012; 170\u20131.","DOI":"10.1055\/b-002-74296"},{"key":"1286_CR3","first-page":"64","volume":"6","author":"R Yamaguchi","year":"2017","unstructured":"Yamaguchi R, Tanaka M, Yamaguchi M, et al. Histology of microcalcifications. J Breast Thyroid Sonography. 2017;6:64\u20137 ((in Japanese)).","journal-title":"J Breast Thyroid Sonography"},{"key":"1286_CR4","doi-asserted-by":"publisher","first-page":"446","DOI":"10.11152\/mu-871","volume":"18","author":"J Lee","year":"2016","unstructured":"Lee J, Lee JH, Baik S, et al. Non-mass lesions on screening breast ultrasound. Med Ultrason. 2016;18:446\u201351.","journal-title":"Med Ultrason"},{"key":"1286_CR5","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1007\/s11547-014-0493-x","volume":"120","author":"ZL Wang","year":"2015","unstructured":"Wang ZL, Li N, Li M, et al. Non-mass-like lesions on breast ultrasound: classification and correlation with histology. Radiol Med. 2015;120:905\u201310.","journal-title":"Radiol Med"},{"key":"1286_CR6","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1177\/0284185116683574","volume":"58","author":"JW Park","year":"2017","unstructured":"Park JW, Ko KH, Kim EK, et al. Non-mass breast lesions on ultrasound: final outcomes and predictors of malignancy. Acta Radiol. 2017;58:1054\u201360.","journal-title":"Acta Radiol"},{"key":"1286_CR7","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1007\/s00330-020-07168-y","volume":"31","author":"KW Park","year":"2021","unstructured":"Park KW, Park S, Shon I, et al. Non-mass lesions detected by breast US: stratification of cancer risk for clinical management. Eur Radiol. 2021;31:1693\u2013706.","journal-title":"Eur Radiol"},{"key":"1286_CR8","doi-asserted-by":"crossref","first-page":"205846011877495","DOI":"10.1177\/2058460118774957","volume":"29","author":"HR Kim","year":"2018","unstructured":"Kim HR, Jung HK. Histopathology findings of non-mass cancers on breast ultrasound. Acta Radiol Open. 2018;29:2058460118774957.","journal-title":"Acta Radiol Open"},{"key":"1286_CR9","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1016\/j.ultrasmedbio.2017.01.008","volume":"43","author":"T Watanabe","year":"2017","unstructured":"Watanabe T, Yamaguchi T, Tsunoda H, et al. Ultrasound image classification of Ductal Carcinoma in Situ (DCIS) of the breast: analysis of 705 DCIS lesions. Ultrasound Med Biol. 2017;43:918\u201325.","journal-title":"Ultrasound Med Biol"},{"key":"1286_CR10","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.ultrasmedbio.2014.09.023","volume":"41","author":"ZQ Jin","year":"2015","unstructured":"Jin ZQ, Lin MY, Hao WQ, et al. Diagnostic evaluation of ductal carcinoma in situ of the breast: ultrasonographic, mammographic and histopathologic correlations. Ultrasound Med Biol. 2015;41:47\u201355.","journal-title":"Ultrasound Med Biol"},{"key":"1286_CR11","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1136\/jclinpath-2015-203506","volume":"69","author":"M Morita","year":"2016","unstructured":"Morita M, Yamaguchi R, Tanaka M, et al. Two progressive pathways of microinvasive carcinoma: low-grade luminal pathway and high-grade HER2 pathway based on high tumour-infiltrating lymphocytes. J Clin Path. 2016;69:890\u20138.","journal-title":"J Clin Path"},{"key":"1286_CR12","doi-asserted-by":"publisher","first-page":"1607","DOI":"10.1002\/cam4.715","volume":"5","author":"M Morita","year":"2016","unstructured":"Morita M, Yamaguchi R, Tanaka M, et al. CD8(+) tumor-infiltrating lymphocytes contribute to spontaneous \u201chealing\u201d in HER2-positive ductal carcinoma in situ. Cancer Med. 2016;5:1607\u201318.","journal-title":"Cancer Med"},{"key":"1286_CR13","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.crad.2019.10.009","volume":"75","author":"DS Gunawardena","year":"2020","unstructured":"Gunawardena DS, Burrows S, Taylor DB. Non-mass versus mass-like ultrasound patterns in ductal carcinoma in situ: is there an association with high-risk histology? Clin Radiol. 2020;75:140\u20137.","journal-title":"Clin Radiol"},{"key":"1286_CR14","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1001\/jamasurg.2015.0876","volume":"150","author":"Y Sagara","year":"2015","unstructured":"Sagara Y, Mallory MA, Wong S, et al. Survival benefit of breast surgery for low-grade ductal carcinoma in situ: a population-based cohort study. JAMA Surg. 2015;150:739\u201345.","journal-title":"JAMA Surg"},{"key":"1286_CR15","doi-asserted-by":"crossref","unstructured":"Francis A, Bartlett JMS, Billingham LJ, et al. The LORIS trial: a multicentre, randomized phase III trial of standard surgery versus active monitoring in women with newly diagnosed low risk ductal carcinoma in situ. Cancer Res. 2013;73:OT2\u20133-01.","DOI":"10.1158\/0008-5472.SABCS13-OT2-3-01"},{"key":"1286_CR16","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1093\/jjco\/hyx059","volume":"47","author":"C Kanbayashi","year":"2017","unstructured":"Kanbayashi C, Iwata H. Current approach and future perspective for ductal carcinoma in situ of the breast. Jpn J Clin Oncol. 2017;47:671\u20137.","journal-title":"Jpn J Clin Oncol"}],"container-title":["Journal of Medical Ultrasonics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10396-023-01286-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10396-023-01286-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10396-023-01286-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T03:35:44Z","timestamp":1689737744000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10396-023-01286-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,11]]},"references-count":16,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,7]]}},"alternative-id":["1286"],"URL":"https:\/\/doi.org\/10.1007\/s10396-023-01286-y","relation":{},"ISSN":["1346-4523","1613-2254"],"issn-type":[{"value":"1346-4523","type":"print"},{"value":"1613-2254","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,11]]},"assertion":[{"value":"30 September 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 November 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 February 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that there are no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Declaration of Helsinki of 1964 and its later versions.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical statements"}}]}}