Fibrocystic Changes of the Breast: Radiologic–Pathologic Correlation of MRI

Abstract Breast MRI provides high sensitivity but modest positive predictive value for identifying breast cancers, with approximately 75% of MRI-guided biopsies returning benign pathologies. Fibrocystic change (FCC) is a descriptive term used colloquially by many radiologists (and falling out of favor with many pathologists) to refer to several benign entities encountered in the breast. Many of the benign entities believed to comprise FCC can show enhancement on MRI. Recognizing the pathologic correlates of these enhancing lesions should help guide management after such a result on MRI-guided biopsy. Premenopausal women may present with clinical symptoms attributed to FCC, including pain, nipple discharge, breast lumps, or discrete masses. Benign entities associated with FCC include proliferative lesions such as usual ductal hyperplasia and sclerosing adenosis, and nonproliferative lesions including cysts, apocrine metaplasia, and stromal fibrosis. Fibrocystic change can be diffuse or focal. Diffuse FCC usually presents as non-mass enhancement (NME), often with persistent kinetics. Focal FCC can present as an irregular mass or focus with variable enhancement patterns including washout kinetics. Following a benign concordant MRI-guided biopsy result of one or more of the above entities, follow-up with MRI in 12 months is reasonable. Accurate radiologic–pathologic correlation can be achieved when careful review of histologic findings is carried out in the context of MRI features.

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The Positive Outcome of MRI-Guided Vacuum Assisted Core Needle Breast Biopsies is not Influenced by a Prior Negative Targeted Second-Look Ultrasound

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2017.03.003 ◽

2017 ◽

Vol 68 (4) ◽

pp. 401-408 ◽

Cited By ~ 1

Author(s):

Romuald Ferré ◽

Shaza AlSharif ◽

Ann Aldis ◽

Benoît Mesurolle

Keyword(s):

High Risk ◽

Magnetic Resonance ◽

Breast Mri ◽

Positive Outcome ◽

Synchronous Carcinoma ◽

Second Look ◽

Guided Biopsy ◽

Imaging Characteristics ◽

Mri Features ◽

Mri Guided

Purpose The study sought to investigate the outcome of breast magnetic resonance–guided biopsies as a function of the indication for magnetic resonance imaging (MRI), the MRI features of the lesions, and the performance or not of a targeted second-look ultrasound (SLUS) prior breast MRI-guided biopsy. Methods We identified 158 women with MRI-detected breast lesions scheduled for MRI-guided biopsy (2007-2013). Patient demographics, performance of targeted SLUS, imaging characteristics, and subsequent pathology results were reviewed. Results Three biopsies were deferred, and 155 lesions were biopsied under MRI guidance (155 women; median age 55.14 years; range 27-80 years). Ninety-eight women underwent a SLUS prior to the MRI-guided biopsy (63%). Of the 155 biopsied lesions, 23 (15%) were malignant, 106 (68%) were benign, and 26 (17%) were high risk. Four of 15 surgically excised high-risk lesions were upgraded to malignancy (27%). Most of the biopsied lesions corresponded to non–mass-like enhancement (81%, 126 of 155) and most of the biopsies (52%, 81 of 155) were performed in a screening context. No demographic or MRI features were associated with malignancy. No differences were noted between the 2 subgroups (prior SLUS vs no prior SLUS) except for the presence of a synchronous carcinoma associated with a likelihood of targeted SLUS before MRI-guided biopsy ( P = .001). Conclusion A negative SLUS does not influence the pathology outcome of a suspicious lesion biopsied under MR guidance.

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Pure Fibrocystic Change Diagnosed at MRI-guided Vacuum-assisted Breast Biopsy: Imaging Features and Follow-up Outcomes

Journal of Breast Imaging ◽

10.1093/jbi/wbz090 ◽

2020 ◽

Vol 2 (2) ◽

pp. 141-146

Author(s):

Shu-Tian Chen ◽

Satoko Okamoto ◽

Bruce L Daniel ◽

James Covelli ◽

Wendy B DeMartini ◽

...

Keyword(s):

Breast Biopsy ◽

Breast Mri ◽

Lesion Size ◽

Imaging Features ◽

Mri Features ◽

Fibrocystic Change ◽

Mri Guided ◽

Lesion Regression ◽

Mri Characteristics

Abstract Objective Fibrocystic change (FCC) is considered one of the most common benign findings in the breast and may be commonly seen on breast MRI. We performed this study to identify MRI characteristics of pure FCC on MRI-guided vacuum-assisted breast biopsy (VABB) without other associated pathologies and describe the findings on MRI follow-up and outcomes. Methods A retrospective review was performed for 598 lesions undergoing 9-gauge MRI-guided VABB at our institution from January 2015 to April 2018, identifying 49 pure FCC lesions in 43 patients. The associations between variables and lesion changes on follow-up MRI were analyzed using exact Mann-Whitney tests and Fisher’s exact tests. Results MRI features of pure FCC are predominantly clumped nonmass enhancement (19/49, 39%) or irregular masses with initial fast/late washout kinetics (9/49, 18%). There was no upgrade to high-risk or cancerous lesions among the 11 patients (25.6%) who underwent surgery. There were 22 pure FCC lesions in 19 (44.2%) patients who had follow-up MRI (mean 18.0 months, range 11–41 months) showing regression (13, 59%), stability (8, 36%), or progression (1, 5%) of the lesion size, and no cancers were found on follow-up at the site of the MRI biopsy for fibrocystic changes. No patient demographics or lesion features were associated with lesion regression or stability (P > 0.05). Conclusion Our study shows that MRI features of VABB-proven FCC lesions may mimic malignancy. After VABB of pure FCC, given that adequate sampling has been performed, a 12-month follow-up MRI may be reasonable.

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Outcomes of Clinical and Surgical Assessment of Women with Pathological Nipple Discharge

The American Surgeon ◽

10.1177/000313480607200205 ◽

2006 ◽

Vol 72 (2) ◽

pp. 124-128 ◽

Cited By ~ 17

Author(s):

Hernan I. Vargas ◽

M. Perla Vargas ◽

Kamal Eldrageely ◽

Katherine D. Gonzalez ◽

Iraj Khalkhali

Keyword(s):

Effective Means ◽

Nipple Discharge ◽

Imaging Studies ◽

Predictive Values ◽

Image Guided ◽

Guided Biopsy ◽

Mammary Duct ◽

Ductal Hyperplasia ◽

Duct Excision ◽

Sensitivity Specificity

There is no consensus about the diagnostic approach to pathologic nipple discharge (PND). We hypothesize that lactiferous duct excision (microdochectomy) or image-guided biopsy are safe and effective means of diagnosis of PND. Eighty-two patients with PND underwent history and physical exam followed by breast sonography and mammogram. Image-guided biopsy was done if imaging studies were positive, whereas microdochectomy was done if normal. Discharge was unilateral (96%), bloody (79%), and spontaneous (62%). The sensitivity, specificity, positive and negative predictive values for the detection of neoplasia were 0.07, 1.0, 1.0, and 0.4 for mammography and 0.26, 0.97, 0.91, and 0.48 for sonography, respectively. Tissue diagnosis revealed papillary lesion (57%), mammary duct ectasia (33%), breast cancer (5%), and inflammatory/infectious (5%) causes. Hemorrhagic discharge associated with pregnancy or infections was managed successfully without surgery. After a median follow-up of 18 months, no PND recurrence was seen, but one patient developed cancer in a different location after diagnosis of atypical ductal hyperplasia. In conclusion, imaging studies provide confirmatory information and a biopsy target when positive. Negative imaging does not reliably exclude neoplasia or malignancy. Microdochectomy provides a sensible and effective approach in the workup of patients with PND.

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Predicting Patients Found to Have Malignancy at Nipple Duct Surgery

Breast Care ◽

10.1159/000504528 ◽

2019 ◽

Vol 15 (5) ◽

pp. 491-497

Author(s):

Nour Alshurbasi ◽

Christopher W. J. Cartlidge ◽

Stanley R. Kohlhardt ◽

Sirwan M. Hadad

Keyword(s):

Malignant Disease ◽

Ductal Carcinoma ◽

Nipple Discharge ◽

Benign Disease ◽

Presenting Symptoms ◽

Benign Pathology ◽

Fibrocystic Change ◽

Ductal Hyperplasia ◽

Malignant Lesions ◽

Duct Excision

Introduction: The unexpected diagnosis of breast cancer following total duct excision is distressing for patients. Despite advances in radiology and the description of suspicious nipple discharge, pre-operative diagnosis of malignancy still evades us. The aim of this study was to review the pathological findings of total duct excision and microdochectomy with reference to pre-operative symptoms, ultrasound, or mammographic findings and identify features associated with increased likelihood of malignant disease. Methods: Data were collected retrospectively of all patients who underwent total duct excision surgery in a single centre (2011–2017). Pre-operative demographics, symptoms, and imaging findings were recorded and correlated with subsequent pathology. Results: 214 patients underwent total duct excision; data were available for 211. Median age was 53 years. 175/211 (82.9%) patients had benign pathology (duct ectasia, papilloma without atypia, fibrocystic change) on final histological examination, 21/211 (10%) had “risk” lesions (papilloma with atypia, atypical ductal hyperplasia), and 15/211 (7.1%) had malignancy (ductal carcinoma in situ). Of the 15 patients with malignant lesions, 6/15 (40%) had normal imaging (M1, U1). 71/211 (33.6%) had normal imaging (M1, U1): 60/71 (84.5%) had benign disease, 5/71 (7%) had “risk” lesions, and 6/71 (8.5%) had malignant lesions. 83/211 (39.3%) patients presented with bloody discharge: 64/83 (77.1%) had benign pathology, 9/83 (10.8%) risk, and 10/83 (12%) malignancy. 38/211 (18%) patients presented with non-bloody discharge: 32/38 (84.2%) had benign disease, 4/38 (10.5%) risk, and 2/38 (5.3%) malignant lesions. Conclusion: Neither imaging nor presenting symptoms correlate with the likelihood of malignant disease being present at final pathology. Even with advances in pre-operative diagnosis, total duct excision remains an essential diagnostic and therapeutic procedure.

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Magnetic Resonance Imaging–Guided Vacuum-Assisted Breast Biopsy: An Initial Experience in a Community Hospital

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2009.06.007 ◽

2009 ◽

Vol 60 (4) ◽

pp. 196-200 ◽

Cited By ~ 5

Author(s):

Paul Friedman ◽

Sean Enis ◽

Jeremy Pinyard

Keyword(s):

Magnetic Resonance Imaging ◽

High Risk ◽

Magnetic Resonance ◽

Breast Biopsy ◽

Resonance Imaging ◽

Community Based ◽

Guided Biopsy ◽

Ductal Hyperplasia ◽

Mri Guided

Objective To evaluate the effectiveness in diagnosing mammographically and sonographically occult breast lesions by using magnetic resonance imaging (MRI) guided vacuum-assisted breast biopsy in patients who presented to a community-based hospital with a newly established breast MRI program. Methods The records of 142 consecutive patients, median age of 55 years, who had undergone MRI-guided biopsy at our institution between July 2006 and July 2007 were reviewed. From these patients, 197 mammographically and sonographically occult lesions were biopsied at the time of discovery. The pathology was then reviewed and correlated with the MRI findings. Results Cancer was present and subsequently discovered in 8% of the previously occult lesions (16/197) or 11% of the women studied (16/142). Of the cancerous lesions, 56% were invasive carcinomas (9/16) and 44% were ductal carcinomas in situ (7/16). Fourteen percent of the discovered lesions (28/197) were defined as high risk and included atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar. In total, occult cancerous and high-risk lesions were discovered in 22% of the found lesions (44/197) or 31% of the women who underwent MRI-guided biopsy (44/142). Conclusions This study demonstrated that detection of cancerous and high-risk lesions can be significantly increased when an MRI-guided biopsy program is introduced at a community-based hospital. We believe that as radiologists gain confidence in imaging and histologic correlation, community-based hospitals can achieve similar rates of occult lesion diagnosis as those found in data emerging from academic institutions.

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Use of MRI-Guided Biopsy for Selection and Follow-up of Men Undergoing Hemi-gland Cryoablation of Prostate Cancer

Urology ◽

10.1016/j.urology.2018.11.052 ◽

2019 ◽

Vol 126 ◽

pp. 158-164 ◽

Cited By ~ 2

Author(s):

Steve R. Zhou ◽

Demetrios N. Simopoulos ◽

Rajiv Jayadevan ◽

Ely R. Felker ◽

Merdie K. Delfin ◽

...

Keyword(s):

Prostate Cancer ◽

Guided Biopsy ◽

Mri Guided

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Abstract No. 341: Targeted MRI Guided Biopsy after Transplantation with MR Visible Magnetocapsules (MCs) Containing Human Islets

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2007.12.393 ◽

2008 ◽

Vol 19 (2) ◽

pp. S125

Author(s):

D.A. Woodrum ◽

T. Link ◽

W.D. Gilson ◽

R. Liddell ◽

B.P. Barnett ◽

...

Keyword(s):

Human Islets ◽

Guided Biopsy ◽

Mri Guided ◽

Targeted Mri ◽

Mr Visible

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Clinical characteristics and surgical treatments of primary hepatic angiosarcoma

BMC Gastroenterology ◽

10.1186/s12876-021-01743-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lei Jiang ◽

Lijun Xie ◽

Ge Li ◽

Hang Xie ◽

Zhao Fang ◽

...

Keyword(s):

Malignant Tumor ◽

Transarterial Chemoembolization ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Past History ◽

Hepatic Lobectomy ◽

Hepatic Angiosarcoma ◽

Mri Features ◽

Primary Hepatic Angiosarcoma ◽

Surgical Treatments

Abstract Purpose Primary hepatic angiosarcoma is a very rare and highly malignant tumor with poor prognosis. It is difficult to diagnose because of the lack of typical clinical features, and the treatment protocols for PHA are also not clear. Therefore, this study wants to find out the clinical characteristics and surgical treatments of primary hepatic angiosarcoma. Methods Among 8990 patients diagnosed with primary malignant tumor of the liver from January 2000 to December 2019 in our hospital, only four patients were diagnosed with primary hepatic angiosarcoma. The demographics, clinical manifestation, past history, serology test results, MRI features, pathology, treatment modality and prognosis of four patients were collected and analyzed. Results Three of four patients had no clinical symptoms, while one patient's symptom was abdominal pain. The levels of tumor markers of all four patients were within the normal reference range and serological tests were negative for hepatitis B and C virus. The MRI imaging findings of all four patients were mixed mass with highly disordered vascular characteristics. All four patients were misdiagnosed preoperatively. One patient who underwent hepatic lobectomy was still alive for about 18 months after surgery. One patient who underwent hepatic lobectomy has survived for only 6 months due to severe pneumonia. The other two patients who received transarterial chemoembolization survived 16 months and 11 months respectively. Conclusion The clinical symptoms of primary hepatic angiosarcoma are not typical, and primary hepatic angiosarcoma is easily misdiagnosed. The typical imaging manifestations are structural disorder and heterogeneous tumor. Hepatic lobectomy and transarterial chemoembolization may be important surgical treatments to improve the prognosis of patients.

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