The Ultrasonographic Characteristics of Focal Fibrocystic Change of the Breast and Analysis of Misdiagnosis

• Published in: Clinical breast cancer Vol. 22; no. 3; pp. 252 - 260
• Main Authors: Lin, Xueying, He, Yimi, Fu, Shiwei, Lin, Si, Xue, Ensheng, Lin, Liwu
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2022
• Subjects: Breast; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - surgery; Calcinosis; Capsules; Diagnostic Errors - prevention & control; Ductal carcinoma in situ; Female; Humans; Invasive ductal carcinoma; Malignant breast tumors; Retrospective Studies; Ultrasonography; Ultrasonography, Mammary; Breast; Ductal carcinoma in situ; Invasive ductal carcinoma; Ultrasonography; Malignant breast tumors
• ISSN: 1526-8209; 1938-0666; 1938-0666
• DOI: 10.1016/j.clbc.2021.08.004

To investigate ultrasonographic features and analyze causes of misdiagnosis of focal fibrocystic change (FC) of the breast.
The ultrasonographic features of 95 women (104 lesions) with postoperatively pathologically confirmed focal FC (Group 1) were retrospectively analyzed and compared with those of 105 women (107 lesions) with ductal carcinoma in situ (DCIS) (Group 2), and 164 women (177 lesions) with invasive ductal carcinoma (IDC) (Group 3).
There were significant differences in 12 features among groups. The sizes and distributions of cystic changes among the groups were significantly different. In group 1, the incidence of cystic changes was 75%(78/104), and the main manifestation was scattered cystic changes (88.5%, 69/78) and microcapsules (81.8%, 63/78). Among focal FC lesions, 36.5% were preoperative BI-RADS classifications 4b-5 (30.8% 4b and 4c). Lesions misdiagnosed as malignant showed solid or cystic solid mixed echoes, and 70.2% of group 1 were irregularly shaped, and 63.5% had unclear edges. In group 1, 5 cases had “hyperechoic halo,” 11.5% (12/104) appeared echo attenuation behind the mass, and 21 cases appeared punctate hyperechoic.
FC frequently exhibits low heterogeneity, scattered microcapsules with posterior enhancement, “pit-like” or “grid-like” changes, posterior enhancement, rare hyperechoic halo, calcification, and lack of blood supply. Certain focal FC are irregularly shaped with unclear edges, with malignant signs such as crab feet and burr, hyperechoic halo, and calcification, which ultrasound BI-RADS classification may easily misdiagnose as malignant. Local magnification function should be considered, and the internal structure should be carefully observed to prevent misdiagnosis.
Certain focal fibrocystic change (FC) of the breast can be misdiagnosed as malignant breast tumors for the similarities between FC and malignant breast tumors, reflected by changes in clinical characteristics, imaging findings, and pathologic changes. Fully understanding the ultrasonographic features of focal FC can improve the diagnostic level of the ACR BI-RADS US guidelines to reduce the numbers of unnecessary biopsies and surgeries.