Imaging and Pathological Correlation in Spectrum of Fibrocystic Breast Disease and its Mimics – our Experience

Fibrocystic change (FCC) of the breast is one of the most common benign breast diseases commonly observed between 20-50 years, with a peak in the perimenopausal age group. Patients present with various symptoms such as lump in the breast, mastalgia (commonly related to the menstrual cycles) or nipple discharge.

In our retrospective study, which included 172 patients, the imaging findings were observed by ultrasound and X-ray mammogram. Based on the Breast Imaging Reporting and Data System (BI-RADS) guidelines given by the AmericanCollege ofRadiology (ACR), our imaging findings were classified as BI-RADS 2 in benign lesions, an d complicated cysts were classified as probably benign - BI-RADS 3. Indeterminate findings were classified as suspicious lesions and BI-RADS 4a/b/c. Imaging and histopathological correlation was performed.

Ultrasound findings revealed diffuse/bilateral abnormalities with the most common finding being simple cysts followed in descending order by complicated cysts, clustered cysts, complex solid cystic masses, solid lesions, duct ectasia, and intraductal lesions. Mammogram showed dense (type C or D) fibro glandular pattern obscuring the lesions, followed by well-defined/partly obscured opacities. Simple cysts and complicated cysts showed predominant features of cyst formation on HPE. Atypical hyperplasia was seen in ductal and complex solid cystic mass lesions.

It is essential for radiologists to be familiar with imaging and pathological findings of fibrocystic disease of the breast for further workup and management.