Focal asymmetric breast density: mammographic, sonographic and pathological correlation in 97 lesions--a call to restrain biopsies.
BACKGROUND
The imaging parameters that mandate further diagnostic workup in focal asymmetric breast densities are not clearly defined.


OBJECTIVE
To identify indications for further workup in FABD by comparing mammographic and ultrasonographic findings with the pathology results of women with FABD.


METHODS
Ninety-four women (97 FABD) were referred for core needle biopsy after incidental discovery of FABD on routine mammograms (n=83) or on diagnostic mammograms performed for palpable masses (n=11). Clinical data included the patient's age, use of hormone replacement therapy, family history of breast cancer, and the presence of a palpable mass. Mammograms and sonograms were evaluated for lesion size and location, associated calcifications, architectural distortion, and change from previous examinations when available. Two patient groups emerged according to the pathological findings and the data were compared.


RESULTS
The average age, size and location of the lesions in the malignant (n=5) and benign (n=92) groups were similar. There was a significant difference (P<0.05) for the presence of a clinically palpable mass (60% vs. 9%, respectively), a cluster of calcifications (60% vs. 12%), associated architectural distortion (exclusively in the malignant group) and a solid mass on sonography (50% vs. 9%). The malignant group had a higher rate of family history of breast cancer and HRT use.


CONCLUSIONS
FABD usually present a benign etiology and can safely be managed by follow-up. The presence of an architectural distortion, a cluster of malignant-appearing or indeterminate calcifications, a sonographic mass with features of possible malignancy, or a clinically palpable mass mandates tissue diagnosis.
Sperber
Fani
F
Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Metser
Ur
U
Gat
Andrea
A
Shalmon
Anat
A
Yaal-Hahoshen
Neora
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000706:statistics & numerical data*; D001940:Breast / Q000033:anatomy & histology / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology; D002114:Calcinosis; D005260:Female; D020249:Hormone Replacement Therapy / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D010173:Palpation; D012189:Retrospective Studies; D012307:Risk Factors; D016217:Ultrasonography, Mammary; D019564:Unnecessary Procedures; D014600:Utilization Review