title: Imaging features and diagnosis of tuberculosis of the breast.
abstract: OBJECTIVE
  To outline the pathophysiology, clinical presentation, imaging features, and relevant investigations of the different subtypes of breast tuberculosis (TB).
  
  
  METHODS
  A review was undertaken of all cases (33 in total) of breast TB presenting to Barts Health NHS Trust within a 10-year period, including patient demographics, imaging features, and route of diagnosis.
  
  
  RESULTS
  Thirty-three cases of proven granulomatous TB of the breast were identified (11 mastitis obliterans, 10 nodular caseous form, five sclerosing form, four disseminated disease, and three abnormal axillary lymph nodes). No cases of miliary breast TB were identified. Fine-needle aspiration cytology aided diagnosis in six patients (<20% of cases); however, the majority of patients required further investigation; namely core biopsy. Over a third of patients (12/33) had multiple clinic attendances prior to diagnosis. Mean delay in diagnosis was 3.7 months (median 0 months, IQR= 3).
  
  
  CONCLUSIONS
  Breast TB is a rare challenging diagnosis with a wide range of imaging features. Core biopsy is essential for definitive diagnosis. A multidisciplinary approach involving surgeons, radiologists, TB consultants, and microbiologists is required, coupled with a high index of clinical suspicion in order to aid timely diagnosis, and initiate prompt treatment to reduce complications.
authors.affiliation: Barts Health NHS Trust, London, United Kingdom. Electronic address: charlottefreya.longman@bartshealth.nhs.uk.
authors.forename: C F
authors.initials: CF
authors.lastname: Longman
authors.affiliation: Barts Health NHS Trust, London, United Kingdom.
authors.forename: T
authors.initials: T
authors.lastname: Campion
authors.affiliation: Barts Health NHS Trust, London, United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Butler
authors.affiliation: Barts Health NHS Trust, London, United Kingdom.
authors.forename: T D
authors.initials: TD
authors.lastname: Suaris
authors.affiliation: Barts Health NHS Trust, London, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Khanam
authors.affiliation: Barts Health NHS Trust, London, United Kingdom.
authors.forename: H
authors.initials: H
authors.lastname: Kunst
authors.affiliation: Barts Health NHS Trust, London, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Tiberi
authors.affiliation: Barts Health NHS Trust, London, United Kingdom.
authors.forename: S A
authors.initials: SA
authors.lastname: O'Keeffe
mesh_terms: D000328:Adult; D019411:Clinical Laboratory Techniques / Q000379:methods; D057210:Delayed Diagnosis / Q000517:prevention & control*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008413:Mastitis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology*; D010173:Palpation / Q000379:methods; D014376:Tuberculosis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology*; D016217:Ultrasonography, Mammary / Q000379:methods*