Mimickers of breast malignancy: imaging findings, pathologic concordance and clinical management

Abstract

Many benign breast entities have a clinical and imaging presentation that can mimic breast cancer. The purpose of this review is to illustrate the wide spectrum of imaging features that can be associated with benign breast diseases with an emphasis on the suspicious imaging findings associated with these benign conditions that can mimic cancer. As radiologic-pathologic correlation can be particularly challenging in these cases, the radiologist’s familiarity with these benign entities and their imaging features is essential to ensure that a benign pathology result is accepted as concordant when appropriate and that a suitable management plan is formulated.

Biochemical “decoding” of breast ultrasound images with optoacoustic tomography fusion: First-in-human display of lipid and collagen signals on breast ultrasound

“…For example, sclerosing adenosis or stromal fibrosis (benign fibrotic conditions) of the breast are localized area of fibrosis within the breast characterized by the presence of dense collagen bundles [10] . These benign conditions are unfortunately common mimickers of breast malignancy on US, resulting in unnecessary invasive procedures such as breast biopsies [4] , [12] . In our representative case, the US-OT derived collagen was in agreement with the histopathology analysis showing the presence of dense collagen in areas of fibrosis within the normal excised breast tissue.…”

Reducing Unnecessary Biopsies Using Digital Breast Tomosynthesis and Ultrasound in Dense and Nondense Breasts

“…Several factors affect the interpretation of two-dimensional images and may be responsible for the high number of recalls, particularly in women with dense breasts. Summation artefacts caused by the superimposition of dense tissue on benign lesions may mimic breast cancer, which may have resulted in the high rate of unnecessary recalls [ 15 , 22 ]. False-positive or negative recall at screening may be due to perceptual or cognitive errors caused by factors such as poor lesion visibility and subtle or atypical cancer appearances [ 23 ].…”

“…Mammographic abnormalities such as calcifications, masses with indistinct, spiculated or circumscribed margins, and asymmetries are frequent features of breast cancer [ 15 , 22 , 25 ]. Mammographic features such as calcifications and discrete masses constituted the largest proportion of benign biopsies.…”

“…To the best of our knowledge, the current study was the first to compare DBT and ultrasound assessments of recalled lesions across dense and nondense breasts. Previous studies [ 15 , 25 ] that focused on ultrasound showed that mimickers of breast cancer with benign morphologic ultrasound features could be safely managed with ultrasound follow-up to establish stability and confirm benign status. In dense breasts, ultrasound was found to be a satisfactory alternative to biopsy for solid lesions with benign morphological ultrasound features because of the high negative predictive value (99.8%) [ 32 ]; this may reduce anxiety for women recalled for assessment.…”

“…Unnecessary recalls increase the cost of screening, may cause psychosocial harm due to false-positive alarms, and can deter women from rescreening [ 11 , 12 ]. Digital breast tomosynthesis (DBT) and ultrasound can mitigate the limitations associated with DM, allowing for a more detailed evaluation of breast tissue and suspicious lesions by minimising superimposition of parenchymal densities [ 13 , 14 , 15 ]. In the United Kingdom National Health Service Breast Screening Programme, DBT assessment of women recalled at DM screening led to a 33% reduction in the benign biopsy rate [ 16 ], with lower false positives across mammographic features such as mass lesions and asymmetric densities.…”