Skip to main content

Advertisement

Log in

Radiologic and Pathologic Correlation for Benign Breast Processes

  • Best Practice Approaches Breast Radiology-Pathology Correlation and Management (J Scheel and MR Kilgore, Section Editors)
  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

A majority of breast biopsies show benign breast pathologies. This review will familiarize practicing radiologists with the spectrum of imaging findings associated with benign breast lesions, which can help radiologists avoid unnecessary biopsies and identify the need for repeat biopsy in the setting of radiologic-pathologic discordance.

Recent Findings

This review focuses on describing the most common imaging and pathologic findings as well as clinical management for benign breast pathology including fibrocystic changes, fibroadenomatoid changes and fibroadenoma, tubular adenoma, pseudoangiomatous stromal hyperplasia, hamartomas, lactational changes, and superficial findings such as hemangiomas and epidermal inclusion cysts.

Summary

Benign breast pathologies represent a diagnostic challenge given the wide spectrum of imaging findings which may overlap with breast malignancy. This review focuses on understanding the radiologic and pathologic findings of benign breast processes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Dahabreh I, Wieland L, Adam G, et al. Core-needle and open surgical biopsy for diagnosis of breast lesions: an update to the 2009 report, https://www.ncbi.nlm.nih.gov/books/NBK246878/ (2014).

  2. D’Orsi C, Sickles E, Mendelson E, et al. ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. 5th ed. Reston, VA: American College of Radiology; 2013.

    Google Scholar 

  3. Shetty MK, Shah YP. Sonographic findings in focal fibrocystic changes of the breast. Ultrasound Q. 2002;18:35–40.

    Article  PubMed  Google Scholar 

  4. Cho SH, Park SH. Mimickers of breast malignancy on breast sonography. J Ultrasound Med. 2013;32:2029–36.

    Article  PubMed  Google Scholar 

  5. Berg WA, Arnoldus CL, Teferra E, et al. Biopsy of amorphous breast calcifications: pathologic outcome and yield at stereotactic biopsy. Radiology. 2001;221:495–503.

    Article  CAS  PubMed  Google Scholar 

  6. Doshi DJ, March DE, Crisi GM, et al. Complex cystic breast masses: diagnostic approach and imaging-pathologic correlation. Radiographics. 2007;27(Suppl 1):S53–64.

    Article  PubMed  Google Scholar 

  7. Chen J-H, Liu H, Baek H-M, et al. Magnetic resonance imaging features of fibrocystic change of the breast. Magn Reson Imaging. 2008;26:1207–14.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chen J-H, Nalcioglu O, Su M-Y. Fibrocystic change of the breast presenting as a focal lesion mimicking breast cancer in MR imaging. J Magn Reson Imaging. 2008;28:1499–505.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Maglione KD, Lee AY, Ray KM, et al. Radiologic-pathologic correlation for benign results after MRI-guided breast biopsy. AJR Am J Roentgenol. 2017;209:442–53 This article provides an updated review on Radiologic-Pathologic correlation for benign lesions on MRI.

    Article  PubMed  Google Scholar 

  10. Lerwill MF. Current practical applications of diagnostic immunohistochemistry in breast pathology. Am J Surg Pathol. 2004;28:1076–91.

    Article  PubMed  Google Scholar 

  11. Lopez-Garcia MA, Geyer FC, Lacroix-Triki M, et al. Breast cancer precursors revisited: molecular features and progression pathways. Histopathology. 2010;57:171–92.

    Article  PubMed  Google Scholar 

  12. Gaur S, Dialani V, Slanetz PJ, et al. Architectural distortion of the breast. AJR Am J Roentgenol. 2013;201:W662–70.

    Article  PubMed  Google Scholar 

  13. Hanson CA, Snover DC, Dehner LP. Fibroadenomatosis (fibroadenomatoid mastopathy): a benign breast lesion with composite pathologic features. Pathology. 1987;19:393–6.

    Article  CAS  PubMed  Google Scholar 

  14. Tan PE, Looi LM. Fibroadenomatoid mastopathy: another distractive breast lesion? Malays J Pathol. 1991;13:101–4.

    CAS  PubMed  Google Scholar 

  15. Kamal M, Evans AJ, Denley H, et al. Fibroadenomatoid hyperplasia: a cause of suspicious microcalcification on mammographic screening. AJR Am J Roentgenol. 1998;171:1331–4.

    Article  CAS  PubMed  Google Scholar 

  16. Chen Y, Bekhash A, Kovatich AJ, et al. Positive association of fibroadenomatoid change with HER2-negative invasive breast cancer: a co-occurrence study. PLoS One. 2015;10:e0129500.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Poulton TB, de Paredes ES, Baldwin M. Sclerosing lobular hyperplasia of the breast: imaging features in 15 cases. AJR Am J Roentgenol. 1995;165:291–4.

    Article  CAS  PubMed  Google Scholar 

  18. Rahman GA, Adeniji KA. Clinicopathological relationship between fibrocystic disease complex and breast cancer: a case report. J Surg Tech Case Rep. 2010;2:54–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Pick PW, Iossifides IA. Occurrence of breast carcinoma within a fibroadenoma. A review. Arch Pathol Lab Med. 1984;108:590–4.

    CAS  PubMed  Google Scholar 

  20. Sklair-Levy M, Sella T, Alweiss T, et al. Incidence and management of complex fibroadenomas. AJR Am J Roentgenol. 2008;190:214–8.

    Article  PubMed  Google Scholar 

  21. Goel NB, Knight TE, Pandey S, et al. Fibrous lesions of the breast: imaging-pathologic correlation. Radiographics. 2005;25:1547–59.

    Article  PubMed  Google Scholar 

  22. Hubbard JL, Cagle K, Davis JW, et al. Criteria for excision of suspected fibroadenomas of the breast. Am J Surg. 2015;209:297–301.

    Article  PubMed  Google Scholar 

  23. Sanchez R, Ladino-Torres MF, Bernat JA, et al. Breast fibroadenomas in the pediatric population: common and uncommon sonographic findings. Pediatr Radiol. 2010;40:1681–9.

    Article  PubMed  Google Scholar 

  24. Bezic J, Srbljin J. Breast fibroadenoma with pseudoangiomatous (PASH-like) stroma. Breast Dis. 2018;37:155–7.

    Article  PubMed  Google Scholar 

  25. Gordon PB, Gagnon FA, Lanzkowsky L. Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up. Radiology. 2003;229:233–8.

    Article  PubMed  Google Scholar 

  26. Duman L, Gezer NS, Balci P, et al. Differentiation between phyllodes tumors and fibroadenomas based on mammographic sonographic and MRI features. Breast Care (Basel). 2016;11:123–7.

    Article  Google Scholar 

  27. Yang X, Kandil D, Cosar EF, et al. Fibroepithelial tumors of the breast: pathologic and immunohistochemical features and molecular mechanisms. Arch Pathol Lab Med. 2014;138:25–36.

    Article  PubMed  Google Scholar 

  28. Huang I-C, Li P-C, Ding D-C. Recurrent juvenile fibroadenoma of the breast in an adolescent: a case report. Medicine (Baltimore). 2018;97:e10765.

    Article  Google Scholar 

  29. Kupsik M, Yep B, Sulo S, et al. Giant juvenile fibroadenoma in a 9-year-old: a case presentation and review of the current literature. Breast Dis. 2017;37:95–8.

    Article  PubMed  Google Scholar 

  30. Omar L, Gleason MK, Pfeifer CM, et al. Management of palpable pediatric breast masses with ultrasound characteristics of fibroadenoma: a more conservative approach. AJR Am J Roentgenol. 2019;212:450–5.

    Article  PubMed  Google Scholar 

  31. Mies C, Rosen PP. Juvenile fibroadenoma with atypical epithelial hyperplasia. Am J Surg Pathol. 1987;11:184–90.

    Article  CAS  PubMed  Google Scholar 

  32. Krings G, Bean GR, Chen Y-Y. Fibroepithelial lesions; The WHO spectrum. Semin Diagn Pathol. 2017;34:438–52 This article provides updated literature on the histologic spectrum of fibroepithelial lesions with a focus on practical challenges in diagnosis and overlap between fibroadenoma, juvenile fibroadenoma, and phyllodes tumor.

    Article  PubMed  Google Scholar 

  33. Jung J, Kang E, Chae SM, et al. Development of a management algorithm for the diagnosis of cellular fibroepithelial lesions from core needle biopsies. Int J Surg Pathol. 2018;26:684–92.

    Article  PubMed  Google Scholar 

  34. Pike AM, Oberman HA. Juvenile (cellular) adenofibromas. A clinicopathologic study. Am J Surg Pathol. 1985;9:730–6.

    Article  CAS  PubMed  Google Scholar 

  35. Roveda Júnior D, Badan GM. Campos MSD do A, et al. Juvenile fibroadenoma. Radiol Bras. 2018;51:136–7.

    Article  PubMed  Google Scholar 

  36. Sosin M, Pulcrano M, Feldman ED, et al. Giant juvenile fibroadenoma: a systematic review with diagnostic and treatment recommendations. Gland Surg. 2015;4:312–21.

    PubMed  PubMed Central  Google Scholar 

  37. Soo MS, Dash N, Bentley R, et al. Tubular adenomas of the breast: imaging findings with histologic correlation. AJR Am J Roentgenol. 2000;174:757–61.

    Article  CAS  PubMed  Google Scholar 

  38. Irshad A, Ackerman SJ, Pope TL, et al. Rare breast lesions: correlation of imaging and histologic features with WHO classification. Radiographics. 2008;28:1399–414.

    Article  PubMed  Google Scholar 

  39. Efared B, Sidibé IS, Abdoulaziz S, et al. Tubular adenoma of the breast: a clinicopathologic study of a series of 9 cases. Clin Med Insights Pathol. 2018;11:1179555718757499.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Tavassoli F. Benign Lesions. In: Pathology of the Breast. Stamford, CT: Appleton and Lange; 1999. p. 115–204.

    Google Scholar 

  41. Salemis NS, Gemenetzis G, Karagkiouzis G, et al. Tubular adenoma of the breast: a rare presentation and review of the literature. J Clin Med Res. 2012;4:64–7.

    PubMed  PubMed Central  Google Scholar 

  42. Miller MC, Johnson P, Kim S, et al. Tubular adenomas of the breast: a rare diagnosis. BMJ Case Rep; 2018. Epub ahead of print 27 August 2018. https://doi.org/10.1136/bcr-2018-224631.

  43. Gresik CM, Godellas C, Aranha GV, et al. Pseudoangiomatous stromal hyperplasia of the breast: a contemporary approach to its clinical and radiologic features and ideal management. Surgery. 2010;148:752–7 discussion 757-758.

    Article  PubMed  Google Scholar 

  44. Degnim AC, Frost MH, Radisky DC, et al. Pseudoangiomatous stromal hyperplasia and breast cancer risk. Ann Surg Oncol. 2010;17:3269–77.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Celliers L, Wong DD, Bourke A. Pseudoangiomatous stromal hyperplasia: a study of the mammographic and sonographic features. Clin Radiol. 2010;65:145–9.

    Article  CAS  PubMed  Google Scholar 

  46. Jones KN, Glazebrook KN, Reynolds C. Pseudoangiomatous stromal hyperplasia: imaging findings with pathologic and clinical correlation. AJR Am J Roentgenol. 2010;195:1036–42.

    Article  PubMed  Google Scholar 

  47. Powell CM, Cranor ML, Rosen PP. Pseudoangiomatous stromal hyperplasia (PASH). A mammary stromal tumor with myofibroblastic differentiation. Am J Surg Pathol. 1995;19:270–7.

    Article  CAS  PubMed  Google Scholar 

  48. Presazzi A, Di Giulio G, Calliada F. Breast hamartoma: ultrasound, elastosonographic, and mammographic features. Mini pictorial essay. J Ultrasound. 2015;18:373–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Kumar V, Abbas A, Fausto N. Robbins and Cotran Pathologic Basis of Disease. 7th ed. Philadelphia, PA: Elsevier Saunders; 2005.

    Google Scholar 

  50. Daya D, Trus T, D’Souza TJ, et al. Hamartoma of the breast, an underrecognized breast lesion. A clinicopathologic and radiographic study of 25 cases. Am J Clin Pathol. 1995;103:685–9.

    Article  CAS  PubMed  Google Scholar 

  51. Forte S, Ritz A, Kubik-Huch R, et al. Invasive ductal carcinoma detected within a fibroadenolipoma through digital breast tomosynthesis. Acta Radiol Open. 2019;8:2058460119865905.

    PubMed  PubMed Central  Google Scholar 

  52. Parker S, Saettele M, Morgan M, et al. Spectrum of Pregnancy- and lactation-related benign breast findings. Curr Probl Diagn Radiol. 2017;46:432–40.

    Article  PubMed  Google Scholar 

  53. diFlorio-Alexander RM, Slanetz PJ, Moy L, et al. ACR Appropriateness Criteria(®) Breast Imaging of Pregnant and Lactating Women. J Am Coll Radiol. 2018;15:S263–75 This article summarizes the American College of Radiology Appropriateness Criteria evidence-based guidelines for breast imaging of pregnant and lactating patients.

    Article  PubMed  Google Scholar 

  54. Chung M, Hayward JH, Woodard GA, et al. US as the primary imaging modality in the evaluation of palpable breast masses in breastfeeding women, including those of advanced maternal age. Radiology 2020; 201036. This recently published retrospective study outlines evidence-based guidelines for the use of ultrasound as the primary imaging modality for palpable abnormalities in lactating patients, including those of advanced maternal age.

  55. Joshi S, Dialani V, Marotti J, et al. Breast disease in the pregnant and lactating patient: radiological-pathological correlation. Insights Imaging. 2013;4:527–38.

    Article  PubMed  PubMed Central  Google Scholar 

  56. de Holanda AAR, Gonçalves AK da S, de Medeiros RD, et al. Ultrasound findings of the physiological changes and most common breast diseases during pregnancy and lactation. Radiol Bras 2016; 49: 389–396.

  57. O’Hara MF, Page DL. Adenomas of the breast and ectopic breast under lactational influences. Hum Pathol. 1985;16:707–12.

    Article  PubMed  Google Scholar 

  58. Vashi R, Hooley R, Butler R, et al. Breast imaging of the pregnant and lactating patient: physiologic changes and common benign entities. AJR Am J Roentgenol. 2013;200:329–36.

    Article  PubMed  Google Scholar 

  59. Barco Nebreda I, Vidal MC, Fraile M, et al. Lactating adenoma of the breast. J Hum Lact. 2016;32:559–62.

    Article  PubMed  Google Scholar 

  60. Parnes AN, Akalin A, Quinlan RM, et al. AIRP best cases in radiologic-pathologic correlation: lactating adenoma. Radiographics. 2013;33:455–9.

    Article  PubMed  Google Scholar 

  61. Tirada N, Dreizin D, Khati NJ, et al. Imaging pregnant and lactating patients. Radiographics. 2015;35:1751–65.

    Article  PubMed  Google Scholar 

  62. Expert Panel on Breast Imaging. ACR appropriateness criteria: breast imaging of pregnant and lactating women.

  63. Slavin JL, Billson VR, Ostor AG. Nodular breast lesions during pregnancy and lactation. Histopathology. 1993;22:481–5.

    Article  CAS  PubMed  Google Scholar 

  64. Schnitt S, Collins L. Biopsy interpretation of the breast. Philadelphia: Wolters-Kluwer/Lippincott-Wilkins and William; 2009.

    Google Scholar 

  65. Ameen R, Mandalia U, Marr AA, et al. Breast hemangioma: MR appearance with histopathological correlation. J Clin Imaging Sci. 2012;2:53.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Mesurolle B, Sygal V, Lalonde L, et al. Sonographic and mammographic appearances of breast hemangioma. AJR Am J Roentgenol. 2008;191:W17–22.

    Article  PubMed  Google Scholar 

  67. Glazebrook KN, Morton MJ, Reynolds C. Vascular tumors of the breast: mammographic, sonographic, and MRI appearances. AJR Am J Roentgenol. 2005;184:331–8.

    Article  PubMed  Google Scholar 

  68. Howitt B, Nascimento AF. Vascular lesions of the breast. Surg Pathol Clin. 2012;5:645–59.

    Article  PubMed  Google Scholar 

  69. Debnath D, Taribagil S, Al-Janabi KJS, et al. A large epidermoid cyst of breast mimicking carcinoma: a case report and review of literature. Int J Surg Case Rep. 2012;3:437–40.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Kucuk AI, Kocer B, Turan G, et al. A benign rare lesion of the breast: giant epidermal inclusion cyst. Cureus. 2018;10:e2650.

    PubMed  PubMed Central  Google Scholar 

  71. Paliotta A, Sapienza P, D’Ermo G, et al. Epidermal inclusion cyst of the breast: a literature review. Oncol Lett. 2016;11:657–60.

    Article  PubMed  Google Scholar 

  72. Fajardo LL, Bessen SC. Epidermal inclusion cyst after reduction mammoplasty. Radiology. 1993;186:103–6.

    Article  CAS  PubMed  Google Scholar 

  73. Kim HK, Kim SM, Lee SH, et al. Subcutaneous epidermal inclusion cysts: ultrasound (US) and MR imaging findings. Skeletal Radiol. 2011;40:1415–9.

    Article  PubMed  Google Scholar 

  74. Bergmann-Koester CU, Kolberg HC, Rudolf I, et al. Epidermal cyst of the breast mimicking malignancy: clinical, radiological, and histological correlation. Arch Gynecol Obstet. 2006;273:312–4.

    Article  PubMed  Google Scholar 

  75. Lam SY, Kasthoori JJ, Mun KS, et al. Epidermal inclusion cyst of the breast: a rare benign entity. Singapore Med J. 2010;51:e191–4.

    CAS  PubMed  Google Scholar 

  76. Kim SJ, Kim WG. Clinical and imaging features of a ruptured epidermal inclusion cyst in the subareolar area: a case report. Am J Case Rep. 2019;20:580–6.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Suhani AL, Meena K, et al. Squamous cell carcinoma arising in epidermal inclusion cyst of breast: a diagnostic dilemma. Breast Dis. 2015;35:25–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Diana L Lam.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Best Practice Approaches Breast Radiology-Pathology Correlation and Management

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cheung, H., Parker, E.U., Yu, M. et al. Radiologic and Pathologic Correlation for Benign Breast Processes. Curr Breast Cancer Rep 13, 381–397 (2021). https://doi.org/10.1007/s12609-021-00438-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12609-021-00438-8

Keywords

Navigation