APPLICATIONS OF CURRENT TECHNOLOGY
Complex Cystic Breast Masses: Diagnostic Approach and ImagingPathologic Correlation1
See accompanying test at http:// www.rsna.org /education/rg_cme.html
Devang J. Doshi, MD ● David E. March, MD ● Giovanna M. Crisi, MD, PhD ● Bret F. Coughlin, MD Complex cystic breast masses demonstrate both anechoic (cystic) and echogenic (solid) components at ultrasonography (US). US is used to identify and characterize such masses and to guide percutaneous biopsy. Numerous pathologic entities may produce complex cystic breast lesions or may be associatedwith them, and biopsy is usually indicated. Common benign ﬁndings include ﬁbrocystic changes, intraductal or intracystic papilloma without atypia, and ﬁbroadenoma. Common atypical ﬁndings include atypical ductal hyperplasia, atypical papilloma, atypical lobular hyperplasia, and lobular carcinoma in situ. Malignant ﬁndings include ductal carcinoma in situ, inﬁltrating ductal carcinoma, andinﬁltrating lobular carcinoma. If the biopsy approach is tailored to the individual patient and if the imaging features are closely correlated with ﬁndings at pathologic analysis, US-guided percutaneous biopsy may be used effectively to diagnose and to guide management of complex cystic masses.
LEARNING OBJECTIVES FOR TEST 2
After reading this article and taking the test, the reader will be able to:Recognize the imaging features of complex cystic breast masses. Describe current biopsy techniques used to diagnose complex cystic breast masses. Identify the common pathologic diagnoses of complex cysts in the breast.
TEACHING POINTS See last page
ductal carcinoma in situ, H-E
RadioGraphics 2007; 27:S53–S64 ● Published online10.1148/rg.27si075508 ● Content Codes:
the Departments of Radiology (D.J.D., D.E.M., B.F.C.) and Pathology (G.M.C.), Baystate Medical Center–The Western Campus of Tufts University School of Medicine, 759 Chestnut St, Springﬁeld, MA 01199. Recipient of a Certiﬁcate of Merit award for an education exhibit at the 2006 RSNA Annual Meeting. Received February 21, 2007; revision requested April 2 andreceived April 23; accepted May 3. All authors have no ﬁnancial relationships to disclose. Address correspondence to D.J.D. (e-mail: email@example.com). RSNA, 2007
RG f Volume 27
Cystic breast lesions are commonly observed at ultrasonography (US) performed for the evaluation of palpable or mammographically detected breastmasses. Complex cysts contain cystic and solid components and are associated with a variety of benign, atypical, and malignant pathologic diagnoses. Complex cystic breast masses have a substantial chance of being malignant; malignancy was reported in 23% (1) and 31% (2) of cases in two series. For that reason, percutaneous or surgical biopsy is usually indicated. Techniques that may be used forsampling of complex cystic breast masses include ﬁne-needle aspiration, core-needle biopsy (with an automated spring-loaded or vacuum-assisted device), and surgical excision. This article reviews the imaging evaluation of complex cystic breast masses, various approaches to percutaneous biopsy, and common pathologic diagnoses.
Many patients withcomplex cystic masses have undergone recent mammography, which may help characterize the mass, depict associated microcalciﬁcations (Fig 1), and show additional suspicious lesions (3). If a lesion appears fat-containing at mammography, it represents a benign entity such as an oil cyst or galactocele, and biopsy can be avoided. For lesions that are proved malignant at biopsy, mammography may...