Clinician's Guide to Imaging and Pathologic Findings in Benign Breast Disease

Abstract

The discussion of abnormal results of breast imaging and abnormal pathologic findings can be challenging for health care professionals and often is stressful for patients. Although most imaging findings and biopsy results are negative and do not infer a substantial increase in breast cancer risk, the subsequent conversation between the patient and her practitioner is more effective and informative with a thorough review of the pathologic results and an appreciation of the importance of radiologic-histologic concordance. This article provides insight into and understanding of breast imaging and biopsy techniques and of histologic findings as a means to timely and appropriate decision making and action by the patient and her health care professional. © 2010 Mayo Foundation for Medical Education and ResearchOn completion of this article, you should be able to (1)

Fibroadenomas and breast carcinoma: a possible answer to a frequently asked question. A pictorial essay

“…On microscopic examination, FAs are an admixture of stromal and cellular elements and arise from the terminal ductolobular unit, meaning that they are composed from stromal and epithelial cells normally found in the breast. FAs that have in their structure cysts larger than 3 mm, areas of sclerozing adenosis, epithelial calcifications or papillary changes are classified as complex FAs [6].…”

Study of clinical, imaging and pathological assessment of breast lumps: an observational study

“…2 Mammography is not very specific and sensitive in young women with dense breasts plus the non-availability of mammography machine at many health care centers, the need to include ultrasonography instead of mammography to the triple assessment was initiated and the modified triple test score (MTTS) was introduced which is an integration of clinical breast examination, fine needle aspiration cytology and ultrasonography. 3,4 Fine needle aspiration cytology (FNAC) predicts the presence of malignancy almost accurately, but in inconclusive reports, an additional test of Tru-cut needle biopsy is recommended. While open biopsy provides more data, it results in undesirable cosmetic problems.…”

Management of the High-Risk Breast Lesion

“…The overall incidence of fi nding CCLs by CNB has been increasing recently with a current prevalence of 3.7-10 % [ 13 ]. CCLs are not normally diagnosed on physical exam, but radiographically they can be associated with pleomorphic calcifi cations [ 4 ]. Histologically, CCLs are characterized by enlarged terminal ductal-lobular units with dilated acini lined with columnar cells and with associated apical snouts.…”

“…When malignancy is found in a surgical excision [ 7 ]. Additionally, the presence of multiple radiographic foci of ADH has been shown to increase the rate of associated malignancy identifi ed if excisional biopsy is subsequently performed (7 % for 1-2 foci vs. 39 % for >2 foci) [ 4 ]. In addition to discussion of the risk of concurrent malignancy, management of ADH must also include an estimation of the implied relative risk for future diagnosis of breast cancer.…”

“…** includes also the % of upgrade to ADH appearance to low-grade DCIS, with only quantitative differences. Typically, ADH is detected by screening mammography as microcalcifi cations in an asymptomatic patient, and ADH represents 10 % of radiographically detected lesions [ 4 ]. Morphologically, a diagnosis of ADH requires atypical but uniform epithelial cells which partially or completely fi ll the ductal spaces, with a maximal dimension of 2 mm for each focus, distinguishing it from low-grade DCIS [ 5 , 10 , 28 ] (Fig.…”