Type:
Educational Exhibit
Keywords:
Inflammation, Cancer, Abscess, Education, Diagnostic procedure, Biopsy, Ultrasound, MR, Mammography, Oncology, Interventional non-vascular, Breast
Authors:
L. Moreno Domínguez, M. Duque Muñoz, J. Lloret Del Hoyo, C. Lechuga Vazquez, M. Montes Fernández, M. J. Ciudad Fernandez, B. Lannegrand Menéndez, N. Sánchez Rubio; Madrid/ES
DOI:
10.26044/ecr2019/C-2496
Background
Benign breast lesions may present with malignant imaging features and mimic carcinoma.
We present cases of lesions initially assessed as suspicious on different imaging modalities according to the American College of Radiology Breast Imaging Reporting and Data System (BIRADS).
Because of their suspicious imaging features a core needle biopsy was done and then proved to be benign on pathologic study.
These benign conditions can present with imaging features of breast cancer like masses or architectural distortion on mammography,
ultrasound or MRI.
Mammographic features predictive of malignancy include masses with spiculated margins (PPV 81%) and irregular shape (PPV 73%).
On ultrasound imaging features predictive of malignancy are masses with spiculated margins (PPV 86%),
irregular shape (PPV 62%) and non-parallel orientation (PPV 62%).
On MRI suggests malignancy a mass with spiculated margins (PPV 88%),
rim enhancement (PPV 79%) or washout (type III) kinetics (PPV 87%).
Benign breast lesions that can mimic breast carcinoma include four groups:
A) Iatrogenic or trauma-related breast lesions
a. Fat necrosis
B) Inflammation
a. Mastitis and abscess
b. Idiopathic granulomatous lobular mastitis
c. Diabetic mastopathy
d. Sarcoidosis.
C) Non-proliferative and proliferative diseases
a. Fibrocystic change (FC)
b. Sclerosing adenosis (SA)
c. Stromal fibrosis (SF)
D) Benign breast tumors
a. Fibroadenoma
Familiarity with these benign breast lesions that mimic malignancy will enable radiologists to establish radiologic-pathologic concordance.
Benign pathologic results can be accepted when they are concordant with clinical and imaging features,
allowing the patient to be managed conservatively.
However,
when they are discordant it may be prudent to repeat core biopsy or to perform excisional biopsy.