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So it is called c , because small masses can be obscured. A 'Mass' is a space occupying 3D lesion seen in two different projections. If a potential mass is seen in only a single projection it should be called a 'asymmetry' until its three-dimensionality is confirmed. The images show a fat-containing lesion with a popcorn-like calcification. All fat-containing lesions are typically benign. These image-findings are diagnostic for a hamartoma - also known as fibroadenolipoma.

Always make sure that a mass that is found on physical examination is the same as the mass that is found with mammography or ultrasound. Location and size should be applied in any lesion, that must undergo biopsy. The density of a mass is related to the expected attenuation of an equal volume of fibroglandular tissue. High density is associated with malignancy. It is extremely rare for breast cancer to be low density. Here multiple round circumscribed low density masses in the right breast.

These were the result of lipofilling, which is transplantation of body fat to the breast. Here a hyperdense mass with an irregular shape and a spiculated margin. Notice the focal skin retraction. The term architectural distortion is used, when the normal architecture is distorted with no definite mass visible. This includes thin straight lines or spiculations radiating from a point, and focal retraction, distortion or straightening at the edges of the parenchyma.

The differential diagnosis is scar tissue or carcinoma. Architectural distortion can also be seen as an associated feature. For instance if there is a mass that causes architectural distortion, the likelihood of malignancy is greater than in the case of a mass without distortion. Notice the distortion of the normal breast architecture on oblique view yellow circle and magnification view.

A resection was performed and only scar tissue was found in the specimen. Findings that represent unilateral deposits of fibroglandulair tissue not conforming to the definition of a mass. Here an example of global asymmetry. In this patient this is not a normal variant, since there are associated features, that indicate the possibility of malignancy like skin thickening, thickened septa and subtle nipple retraction. Ultrasound not shown detected multiple small masses that proved to be adenocarcinoma.

All types of asymmmetry have different border contours than true masses and also lack the conspicuity of masses.

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Asymmetries appear similar to other discrete areas of fibroglandulair tissue except that they are unitaleral, with no mirror-image correlate in the opposite breast. An asymmetry demonstrates concave outward borders and usually is interspersed with fat, whereas a mass demonstrates convex outward borders and appears denser in the center than at the periphery.

The use of the term "density" is confusing, as the term "density" should only be used to describe the x-ray attenuation of a mass compared to an equal volume of fibroglandular tissue. In the atlas calcifications were classified by morphology and distribution either as benign, intermediate concern or high probability of malignancy. In the version the approach has changed. Since calcifications of intermediate concern and of high probability of malignancy all are being treated the same way, which usually means biopsy, it is logic to group them together.

Calcifications are now either typically benign or of suspicious morphology. Within this last group the chances of malignancy are different depending on their morphology BI-RADS 4B or 4C and also depending on their distribution. There is one exception of the rule: an isolated group of punctuate calcifications that is new, increasing, linear, or segmental in distribution, or adjacent to a known cancer can be assigned as probably benign or suspicious.

Read more on breast calcifications. The arrangement of calcifications, the distribution, is at least as important as morphology.

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These descriptors are arranged according to the risk of malignancy:. Associated features are things that are seen in association with suspicious findings like masses, asymmetries and calcifications. Associated features play a role in the final assessment. Special cases are findings with features so typical that you do not need to describe them in detail, like for instance an intramammary lymph node or a wart on the skin.

Many descriptors for ultrasound are the same as for mammography. For instance when we describe the shape or margin of a mass. Special cases - cases with a unique diagnosis or pathognomonic ultrasound appearance:. When additional imaging studies are completed, a final assessment is made. Always try to avoid this category by immediately doing additional imaging or retrieving old films before reporting.

Benign Breast Diseases Radiology Pathology Risk Assessment

Even better to have the old examinations before starting the examination. This patient presented with a mass on the mammogram at screening, which was assigned as BI-RADS 0 needs additional imaging evaluation. Additional ultrasound demonstrated that the mass was caused by an intramammary lymph node. Don't forget to mention in the report that the lymph node on US corresponds with the noncalcified mass on mammography.

In the paragraph on location we will discuss how we can be sure that the lymph node that we found with ultrasound is indeed the same as the mammographic mass. The breasts are symmetric and no masses, architectural distortion or suspicious calcifications are present. Use BI-RADS 1 if there are no abnormal imaging findings in a patient with a palpable abnormality, possible a palpable cancer, BUT add a sentence recommending surgical consultation or tissue diagnosis if clinically indicated.

Like BI-RADS 1, this is a normal assessment, but here, the interpreter chooses to describe a benign finding in the mammography report, like:. It is not expected to change over the follow-up interval, but the radiologist would prefer to establish its stability. Lesions appropriately placed in this category include:. Here a non-palpable sharply defined mass with a group of punctate calcifications. Continue with follow up images. Follow-up at 6, 12 and 24 months showed no change and the final assessment was changed into a Category 2.

Nevertheless the patient and the clinician preferred removal, because the radiologist was not able to present a clear differential diagnosis. At 12 month follow up more than five calcifications were noted in a group. This proved to be DCIS with invasive carcinoma. This category is reserved for findings that do not have the classic appearance of malignancy but are sufficiently suspicious to justify a recommendation for biopsy.

By subdividing Category 4 into 4A, 4B and 4C , it is encouraged that relevant probabilities for malignancy be indicated within this category so the patient and her physician can make an informed decision on the ultimate course of action. This finding is sufficiently suspicious to justify biopsy. A benign lesion, although unlikely, is a possibility. This could be for instance ectopic glandular tissue within a heterogeneously dense breast. The pathologist could report to you that it is sclerosing adenosis or ductal carcinoma in situ. Both diagnoses are concordant with the mammographic findings.

Highly Suggestive of Malignancy. The current rationale for using category 5 is that if the percutaneous tissue diagnosis is nonmalignant, this automatically should be considered as discordant. Here images of a biopsy proven malignancy. On the initial mammogram a marker is placed in the palpable tumor. Due to the dense fibroglandular tissue the tumor is not well seen. Ultrasound demonstrated a 37 mm mass with indistinct and angular margins and shadowing. After chemotherapy the tumor is not visible on the mammogram. There may be variability within breast imaging practices, members of a group practice should agree upon a consistent policy for documenting.

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When you use more modalities, always make sure, that you are dealing with the same lesion. For instance a lesion found with US does not have to be the same as the mammographic or physical finding. Sometimes repeated mammographic imaging with markers on the lesion found with US can be helpful.

Cysts can be aspirated or filled with air after aspiration to make sure that the lesion found on the mammogram is caused by a cyst. Here images that you've seen before. They are of a patient with a new lesion found at screening.

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With ultrasound an intramammary lymph node was found, but we weren't sure whether this was the same as the mass on the mammogram. Continue with the mammographic images after contrast injection. Contrast was injected into the node and a repeated mammogram was performed. Here we have proof that the mass is caused by an intramammary lymph node, since the mammographic mass contains the contrast. This patient presented with a tumor in the left breast. However in the right breast a group of amorphous and fine pleomorphic calcifications was seen. Ultrasound examination was performed.

Ultrasound of the region demonstrated an irregular mass, which proved to be an adenocarcinoma with fine needle aspiration FNA. To find out whether the mass was within the area of the calcifications, contrast was injected into the mass. The mass is evidently in another region of the breast. Now a vacuum assisted biopsy has to be performed of the calcifications, because maybe we are dealing with DCIS in one area and an invasive carcinoma in another area.

Mass Longest axis of a lesion and a second measurement at right angles. In a spiculated mass the spiculations should not be included. Architectural distortion and Asymmetries Approximation of its greatest linear dimension. Calcifications The distribution should be measured by approximation of its greatest linear dimension. Indication for examination Painful mobile lump, lateral in right breast. No previous history of breast pathology. Mammography Overall breast composition: b. Scattered areas of fibroglandular density.

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Lateral in the right breast, concordant with the palpable lump, there is a mass with an oval shape and margin, partially circumscribed and partially obscured. The mass is equal dense compared to the fibroglandular tissue. Location: Right breast, 9 o'clock position, middle third of the breast.

Additional US of the mass: Concordant with the lump and the mass on the mammogram there is an oval simple cyst, parallel orientation, circumscribed, Anechoic with posterior enhancement. Size : 3,5 x 1,5 cm. In the right breast at least 2 more smaller cysts. The palpable mass is a simple cyst.

There are at least two more, smaller cysts present in the right breast. The palpable cyst was painful, after informed consent uncomplicated puncture for suction of the cyst was performed. Referral from general practitioner. Mobile lump, lateral in left breast, since 2 months. No previous exams available. Findings Mammography : Overall breast composition: a.

The breasts are almost entirely fatty. Lateral in the left breast, at 3 o'clock position in the posterior third of the breast, concordant with the palpable lump there is a 3 cm hyperdense mass with a rounded, but also irregular shape. The margins are partially circumscribed and partially not circumscribed with some microlobulations.

The palpable mass is concordant with a solid mass, predominantly well circumscribed. In this year old patient the differential diagnosis consists of an atypical fibroadenoma or a phyllodes. Management After informed consent of the patient a 14G core needle biopsy was performed, two specimens were obtained.

No complications. It was discussed with the patient and the referring general practitioner, that in case of BI-RADS 4 a referral to the breast clinic is advised. The patient and the referring general practitioner preferred to await the results of the biopsy. Addendum The biopsy showed a fibro-epithelial lesion, probably a benign phyllodes. Referral to the breast clinic was now strongly indicated and was put in motion by the general practitioner after telephone consultation. Diagnosis after excision: 3 cm highly cellular fibroadenoma.

Standard Reporting Describe the indication for the study. There are many types of benign breast conditions. Your health care provider may use the term fibrocystic change to describe a range of benign breast conditions. Some benign breast conditions can cause discomfort or pain and need treatment. Many benign breast conditions mimic the signs and symptoms of breast cancer. These conditions will need follow-up tests and sometimes a biopsy for diagnosis. If you need a biopsy, try not to panic or worry.

In the U. Still, a biopsy is needed to know whether or not something is cancer. Learn about benign breast conditions in men. Benign breast conditions are not breast cancer.

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  • However, some types especially those with abnormal-looking cells, such as hyperplasia increase the risk of breast cancer. Learn more about hyperplasia and breast cancer risk. A few factors can increase the risk of benign breast conditions, including [ ]:.

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    Some lifestyle factors during childhood and the teen years may affect the risk of benign breast conditions in adulthood. Some factors may increase risk. For example, drinking alcohol during the teen years may increase the risk of benign breast conditions [ ]. Other factors may decrease risk. For example, eating foods that contain carotenoids such as melons, carrots, sweet potatoes and squash , nuts including peanut butter and beans during the teen years may lower risk the risk of benign breast conditions [ , ]. Also, girls who are heavy at age 10 may have a lower risk of benign breast conditions in young adulthood than girls who are lean at age 10 [ ].

    Similarly, women who were heavy as children and teens may have a lower risk of breast cancer than women who were lean in their youth [ ]. However, being heavy during childhood and the teen years is not advised as it increases the risk of heart disease and many other health conditions in adulthood [ 36 ]. Learn about lifestyle factors in childhood and the teen years that may affect breast cancer risk.

    Benign breast conditions differ from each other in how the cells and their growth patterns look under a microscope. For example, hyperplasia looks different from a fibroadenoma. If you are diagnosed with a benign breast condition or are told you have a fibrocystic change , your health care provider can tell you which type you have, if it needs treatment and if it increases your risk of breast cancer.

    Some benign breast conditions are described below. This is not meant to be an exhaustive list. Hyperplasia describes an overgrowth proliferation of cells. There are 2 main types of hyperplasia—usual and atypical. Both increase the risk of breast cancer, but atypical hyperplasia does so to a greater degree [ 37 ].

    For women with atypical hyperplasia who also have a greater than 20 percent lifetime risk of invasive breast cancer, there are special breast cancer screening recommendations. Estimate your lifetime risk or learn more about risk. The National Comprehensive Cancer Network NCCN recommends women with atypical hyperplasia who have a greater than 20 percent lifetime risk of invasive breast cancer [ 38 ]:. This care helps ensure if breast cancer does develop, it's caught early when the chances of survival are highest.

    Women with atypical hyperplasia who have a less than 20 percent lifetime risk of invasive breast cancer and women with usual hyperplasia are recommended to get the same breast cancer screening as women at average risk. Learn more about breast cancer screening for women at higher risk. The NCCN recommends women with atypical hyperplasia strongly consider taking a risk-lowering drug tamoxifen or raloxifene to lower their risk of developing breast cancer [ 39 ].

    These drugs can lower the risk of breast cancer in women with atypical hyperplasia by 86 percent [ 39 ]. There are no special breast cancer risk-lowering recommendations for women with usual hyperplasia. Learn more about tamoxifen and raloxifene. Cysts are fluid-filled sacs that are almost always benign. Cysts don't increase the risk of breast cancer [ 40 ]. Most cysts are too small to feel.

    Some, however, are large and may feel like lumps in the breast and may cause breast pain [ 40 ]. Some researchers have suggested dietary factors, such as caffeine , might increase the risk of cysts. However, few data support a link between cysts and diet or other lifestyle factors [ 41 ]. Fibroadenomas are solid benign tumors. They are most common in women ages [ 42 ]. Most fibroadenomas don't increase the risk of breast cancer [ 42 ]. Learn more about the early detection and diagnosis of fibroadenomas.

    They are usually close to the nipple and can cause nipple discharge and pain. You may feel a lump. They occur most often in women ages [ 43 ]. Intraductal papillomas are removed with surgery, but don't need any other treatment [ 42 ]. If you have one intraductal papilloma, it doesn't increase the risk of breast cancer unless it has abnormal cells or there is ductal carcinoma in situ DCIS in the nearby tissue [ 40, ]. Having 5 or more intraductal papillomas may increase the risk of breast cancer [ 42 ]. It may be painful and you may feel a lump.

    Sclerosing adenosis may be found on a mammogram. Because it has a distorted shape, it may be mistaken for breast cancer. A biopsy may be needed to rule out breast cancer. Sclerosing adenosis doesn't need treatment [ 42 ].