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

Main Article Content

Bhawna Dev
Udaya Vakamudi
Lasya Thambidurai
Leena Dennis Joseph
JaiPrakash Srinivasan


Benign breast diseases, BI-RADS Fibrocystic lesions, Mammogram, Ultrasound


Background: 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.

Materials and Methods: 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 American college of Radiology (ACR), our imaging findings were classified as BI-RADS 2 in benign lesions, 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.

Results: 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.

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


1. Cole P, Mark Elwood J, Kaplan SD. Incidence rates and risk factors of benign breast neoplasms. Am J Epidemiol 1978 ;108 :112–120. doi: 10.1093/oxfordjournals.aje.a112594.
2. Sarnelli R, Squartini F. Fibrocystic condition and" at risk" lesions in asymptomatic breasts: a morphologic study of postmenopausal women. Clin Exp Obstet Gynecol. 1991;18:271-9. doi: Not Available
3. Sangma MB, Panda K, Dasiah S. A clinico-pathological study on benign breast diseases. J Clin Diagn Res. 2013 Mar;7(3):503-6. doi: 10.7860/JCDR/2013/5355.2807.
4. ACR BI-RADS Atlas: Breast imaging reporting and data system. American College of Radiology 2013; ISBN:155903016X
5. Russo J, Russo IH. Development of the human breast. Maturitas. 2004 Sep 24;49(1):2-15. doi: 10.1016/j.maturitas.2004.04.011.
6. Hutson SW, Cowen PN, Bird CC. Morphometric studies of age related changes in normal human breast and their significance for evolution of mammary cancer. J Clin Pathol. 1985 Mar;38(3):281-7. doi: 10.1136/jcp.38.3.281.
7. Vorherr H. Fibrocystic breast disease: pathophysiology, pathomorphology, clinical picture, and management. Am J Obstet Gynecol 1986;154:161–179. doi: 10.1016/0002-9378(86)90421-7.
8. Wu C, Ray RM, Lin MG, Gao DL, Horner NK, Nelson ZC, et al. A case-control study of risk factors for fibrocystic breast conditions: Shanghai Nutrition and Breast Disease Study, China, 1995-2000. Am J Epidemiol. 2004 Nov 15;160(10):945-60. doi: 10.1093/aje/kwh318.
9. Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med 1985;312:146–151. doi: 10.1056/NEJM198501173120303.
10. Guray M, Sahin AA. Benign breast diseases: classification, diagnosis, and management. Oncologist. 2006 May;11(5):435-49. doi: 10.1634/theoncologist.11-5-435.
11. Donegan WL. Common benign conditions of the breast. In: Donegan WL, Spratt JS, eds. Cancer of the Breast, Fifth Edition. St. Louis, MO: Saunders, 2002:67–110.
12. O’Malley FP, Bane AL. The spectrum of apocrine lesions of the breast. Adv Anat Pathol 2004;11:1–9. doi: 10.1097/00125480-200401000-00001.
13. Taşkin F, Köseoğlu K, Unsal A, Erkuş M, Ozbaş S, Karaman C. Sclerosing adenosis of the breast: radiologic appearance and efficiency of core needle biopsy. Diagn Interv Radiol. 2011 Dec;17(4):311-6. doi: 10.4261/1305-3825.DIR.3785-10.2.
14. Lee KC, Chan JK, Gwi E. Tubular adenosis of the breast. A distinctive benign lesion mimicking invasive carcinoma. Am J Surg Pathol. 1996 Jan;20(1):46-54. doi: 10.1097/00000478-199601000-00005.
15. Henrot P, Leroux A, Barlier C, Génin P. Breast microcalcifications: the lesions in anatomical pathology. Diagn Interv Imaging. 2014 Feb;95(2):141-52. doi: 10.1016/j.diii.2013.12.011.
16. Quinn-Laurin V, Hogue JC, Pinault S, Duchesne N. Vacuum-assisted complete excision of solid intraductal/intracystic masses and complex cysts: Is follow-up necessary? Breast. 2017 Oct;35:42-47. doi: 10.1016/j.breast.2017.06.014.
17. Tavassoli FA, ed. Chapter 6. Ductal intraepithelial neoplasia. In: Pathology of the Breast, Second Edition. CT: Appleton & Lange, 1999:205–323.
18. Koerner FC. Epithelial proliferations of ductal type. Semin Diagn Pathol 2004;21:10–17. doi: 10.1053/j.semdp.2003.10.010.

Article Statistics :Views : 92 | Downloads : 63 : 13