Abstract
Objectives: is to evaluate the mammographic focal asymmetric breast densities FABD in order to highlight which FABD might need further workup through detailed ultrasonographic characterization and comparison with the pathological results in indicated cases.
 Methods: A cross sectional analytic study was performed in the Oncology Teaching Hospital/Medical City from March 2018 to November 2018. The study included 70 women who attended the Main Referral Center for Early Detection of Breast Tumors with focal asymmetric breast densities FABD were detected by mammography. The focal asymmetry was analyzed and the other associated findings were assessed and registered. While breast ultrasound was performed for all patients, fine needle aspiration (FNA) was carried out for cases with suspicious findings on ultrasound and any FNA suspicious or malignant lesion was subsequently biopsied and the results were recorded.
 Results: mammographic FABD was found in the right breast in 37 cases (52.9%) and in the left in 33 cases (47.1%). The upper outer quadrant (UOQ) was the most common location of FABD (43 cases). In 25 cases (34.2%) with FABD, there was no abnormality found on ultrasound, but normal looking breast parenchymal tissue. Ultrasound had shown benign findings in 30 cases (44.2%). On the other hand, suspicious and/or malignant features were observed in 15 cases (22.4%) which subsequently proved to be malignant by FNA and biopsy. Architectural distortion or grouped microcalcifications and a clinically palpable FABD were associated with malignant FABD; no benign FABD revealed to be associated with these findings.
 Conclusion: The finding of FABD is common on mammography and mostly represents a benign entity of normal breast parenchymal tissue. However; it may indicate an underlying hidden malignancy especially in the presence of superadded mammographic findings as ill-defined mass, architectural distortion or grouped microcalcification.
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