Ultrasonographic features and clinical implications of benign palpable breast lesions in young women

Abstract

Purpose: The purpose of this study was to describe the breast ultrasonography (US) features and to investigate whether performing a core biopsy is warranted in young women having palpable solid breast masses.

Methods: A total of 76 solid palpable masses in 68 consecutive women (≤25 years old) underwent tissue diagnosis by percutaneous core biopsy. Two radiologists, who were blinded to the clinical history and histopathology, independently evaluated the US features according to Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The frequency of benign and malignant descriptor terms that were used to characterize the lesions were compared to the final pathology.

Results: All 76 palpable solid masses yielded benign pathology. On the US, the shape of the mass was described by radiologists 1 and 2 as oval or round (63.2% and 71.1%), margin as circumscribed (68.4% and 77.6%) and orientation as parallel (85.5% and 90.8%); the frequency of using all three benign descriptors was 61.8% and 68.5%, respectively. Suspicious descriptors were used less frequently by radiologists 1 and 2 including irregular shape (9.2% and 13.1%), non-circumscribed margin (31.6% and 22.4%) and non-parallel orientation (14.5% and 9.2%); the frequency of using all three suspicious descriptors was 9.2% and 11.8%, respectively.

Conclusion: Despite the variable US features, breast malignancy seems extremely low in 25 years or younger women for palpable breast lesions. Using the BI-RADS lexicon, US accurately predicted benignity in about two thirds of our patients, supporting US surveillance as a safe alternative to invasive tissue sampling in this setting.

Keywords: Breast; Breast diseases; Ultrasonography; Young adult.

Fig. 1.. A 23-year-old woman with left breast palpable concern.

Ultrasonogram shows corresponding mass (between crosshairs) with characteristics described as “oval, circumscribed and parallel” by both radiologists. Biopsy yielded fibroadenoma.

Fig. 2.. A 20-year-old woman with left breast palpable concern.

Ultrasonogram shows corresponding mass (between crosshairs) with characteristics described as “irregular, non-circumscribed and nonparallel” by both radiologists. Biopsy yielded stromal fibrosis.