Abstract
BackgroundMultiple breast lesions resembling fibroadenomas are a common imaging finding in patients presenting to the mammography unit at Dr George Mukhari Academic Hospital in the North-West district of Tshwane, South Africa. Patients often present with multiple lesions, up to 20 lesions per breast. These lesions often have atypical features on ultrasound and/or a clinical history of growth is commonly given. Phyllodes tumours may be indistinguishable from fibroadenomas and breast cancers may on occasion present with benign features, which can lead to misdiagnosis. Breast magnetic resonance imaging (bMRI) evaluation of lesions resembling fibroadenomas may improve accurate assessment and identification of lesions requiring biopsy.ObjectivesTo assess the reliability of bMRI to characterise lesions resembling fibroadenomas on ultrasound, using the Breast Imaging-Reporting and Data System (BI-RADS) and Kaiser scoring systems with histopathological correlation.MethodA quantitative, prospective, investigative study was performed with a sample size of 100 breast lesions among a total of 35 patients at Dr George Mukhari Academic Hospital. Patients were recruited after a breast ultrasound investigation revealed lesions resembling fibroadenomas, but with an indication for ultrasound-guided biopsy, for example, very large size, atypical features on ultrasound or a history of recent growth. The bMRI was performed prior to the ultrasound-guided breast biopsies. Three investigators independently evaluated the bMRI and applied BI-RADS descriptors to each lesion. The Kaiser score was then calculated for each lesion. Statistics were calculated using Pearson’s and Spearman’s coefficients for inter-reader variability, kappa scores for BI-RADS and Kaiser score correlation with histology.ResultsEvaluation with bMRI, BI-RADS and the Kaiser scoring system showed statistically significant correlation with each other and with histopathology results for each lesion. There was statistically significant agreement among the investigators regarding the interpretation of the lesions and allocation of appropriate BI-RADS scores.ConclusionMultiple lesions resembling fibroadenomas can be evaluated with bMRI when multiple breast biopsies would not be feasible. With a good imaging protocol and technique, adequate interpretation skills by the radiologist and the use of the Kaiser scoring system, an accurate diagnosis can be achieved.
Highlights
Fibroadenomas of the breast are one of the most common benign masses female patients present with to their health care practitioner
Patients were recruited after a breast ultrasound investigation revealed lesions resembling fibroadenomas but with an indication for ultrasound-guided biopsy, for example, very large size, atypical features on ultrasound, a history of recent growth, age of first presentation above 35 or patient anxiety
The ultrasound examinations were performed by the radiology residents and/or general radiologist on rotation in mammography at the time of the patient’s initial presentation
Summary
Fibroadenomas of the breast are one of the most common benign masses female patients present with to their health care practitioner. It affects women mostly of childbearing age and is a cause of concern for these patients, especially in the era of breast cancer awareness.[1] Some patients present with multiple and/or rapidly growing lesions.[1] These findings warrant further investigation, resulting in referral to the radiologist. Their growth patterns are described as intra-canalicular or peri-canalicular.[2] Fibroadenomas are abnormalities of normal development and involution of breast tissue and form part of the broader group of fibroepithelial lesions. Breast magnetic resonance imaging (bMRI) evaluation of lesions resembling fibroadenomas may improve accurate assessment and identification of lesions requiring biopsy
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