Yonsei Med J.  2012 Nov;53(6):1203-1210. 10.3349/ymj.2012.53.6.1203.

Histological Analysis of Benign Breast Imaging Reporting and Data System Categories 4c and 5 Breast Lesions in Imaging Study

• Kim MJ
• Kim D
• Jung W
• Koo JS

• KMID: 1414265
• DOI: http://doi.org/10.3349/ymj.2012.53.6.1203

Abstract

PURPOSE
The objective of this study was to analyze the histology of breast lesions categorized as Breast Imaging Reporting and Data System (BI-RADS) 4c or 5 breast lesions during the imaging evaluation, but diagnosed as benign during the histological evaluation.
MATERIALS AND METHODS
We retrospectively reviewed 71 breast lesions categorized as BI-RADS 4c or 5 during imaging study, but diagnosed as benign upon histological evaluation.
RESULTS
Breast lesions were classified into six groups upon histological analysis: intraductal papilloma (18 cases), inflammatory group (15 cases), fibroepithelial tumor (14 cases), clustered microcalcification (10 cases), minimal histological alteration (10 cases), and adenosis (4 cases). Sclerosis and architectural complexity were associated with most of the biopsies that were morphologically similar to malignancy.
CONCLUSION
Among 71 cases categorized as 4c or 5 during the imaging study, but diagnosed as benign upon histological examination, intraductal papilloma was the most frequently identified histological lesion. These 71 cases exhibited histological characteristics of sclerosis and/or complex/complicated features that should be histologically differentiated from malignancy during evaluation.

Keyword

Breast; biopsy; histology; breast imaging reporting and data system

MeSH Terms

Biopsy
Breast Diseases/*diagnosis
Breast Neoplasms/*diagnosis/*radiography
Female
Humans
Retrospective Studies

Figure

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  Fig. 1 Radiological and histological features of the IP group of category 4c or 5 lesions. The papilloma group showed histological features of florid-type usual ductal hyperplasia (A, H&E, ×100), entrapped and distorted glands in the sclerotic stroma (B, H&E, ×100), slender papillary fronds (C, H&E, ×200), and a complex sclerosing lesion with a stromal fibrosis zone with entrapped and distorted glands accompanying usual ductal hyperplasia and papilloma (D, H&E, ×12). IP with slender papillary fronds appeared as an intracystic isoechoic mass with a papillary frond (arrow) on ultrasonogram (E) and a complex sclerosing lesion appeared as a 1.0-cm sized irregular-shaped hypoechoic nodule with a spiculated margin and non-parallel orientation (F). The lateral view revealed a spiculated lesion (G). IP, intraductal papilloma.

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  Fig. 2 Radiological and histological features of the adenosis and CMC groups of category 4c or 5 lesions. The adenosis group showed sclerosing adenosis (A, H&E, ×100), presenting as an irregularly spiculated hypoechoic mass on sonogram (E) and extensive involvement (B, H&E, ×40). CMC was observed in the intraluminal space of columnar cell change (C, H&E, ×40) and ossifying-type calcification showed central calcification with a rim of ossifying eosinophilic matrix (D, H&E, ×200), which appeared as echogenic foci (F, arrows) in a spiculated mass on sonogram. CMC, clustered microcalcification.

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  Fig. 3 Radiological and histological features of the fibroepithelial tumor group of category 4c or 5 lesions. Fibroadenoma demonstrated a sclerosing stromal component in the entire tumor lesion (A, H&E, ×40) and an intracanalicular growth pattern of the epithelial component (B, H&E, ×40). An oval microlobulated hypoechoic mass was observed on sonogram (D) and a hyperdense mass was observed on mammogram (E). Complex fibroadenoma showed variably sized cysts (arrow) and sclerosing adenosis (arrowhead) (C, H&E, ×12). CMC, clustered microcalcification.

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  Fig. 4 Radiological and histological features of the inflammatory group of category 4c or 5 lesions. The inflammatory group demonstrated fat necrosis with calcification (A, H&E, ×100), granulomatous lobular mastitis complicated with abscess (B, H&E, ×100) and mammary duct ectasia showing an ecstatic duct, periductal sclerosis and lymphoplasma cell infiltration (C, H&E, ×12), which appeared as an irregular, markedly hypoechoic mass with posterior shadowing on sonogram (D).

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  Fig. 5 Radiological and histological features of MHA of category 4c or 5 lesions. MHA did not show specific histological findings other than stromal fibrosis (A, H&E, ×100). The transverse sonogram showed an irregular microlobulated hypoechoic nodule with posterior shadowing (caliper, B), which was seen as an isodense mass on mammogram (arrow in C). MHA, minimal histological alteration.

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