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Focal Fibrosis of the Breast Diagnosed by a Sonographically Guided Core Biopsy of Nonpalpable Lesions

Imaging Findings and Clinical Relevance

Departments of Radiology (J.K.Y., E.-K.K., J.Y.K., M.J.K., K.K.O.), Surgery (B.-W.P.), and Pathology (W.I.Y.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology, National Health Insurance Corporation, IIsan Hospital, Koyang, Korea (J.K.Y.).

Address correspondence to Eun-Kyung Kim, MD, Department of Diagnostic Radiology, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Ku, Seoul 120-752, Korea. E-mail: ekkim{at}yumc.yonsei.ac.kr

Objective. The purpose of this study was to evaluate the frequency of focal fibrosis of the breast diagnosed by a sonographically guided core biopsy of nonpalpable lesions, to characterize imaging features, and to evaluate their clinical relevance. Methods. In a retrospective review of 724 lesions that underwent sonographically guided core biopsy of nonpalpable breast lesions, 62 cases had a diagnosis of focal fibrosis. Two radiologists analyzed the sonographic and mammographic findings according to the Breast Imaging Reporting and Data System. The results were compared with histologic findings at surgery or imaging findings during surveillance. Results. The incidence of focal fibrosis was 8.6% (62/724). Sonographic films were available in 56 cases, so 56 cases were reviewed for their sonographic findings. Among the mammograms reviewed, 64.7% (33/51) had negative findings. Among the sonograms reviewed, the most common features were oval shape (32/56, 57.1%), parallel orientation (36/56, 64.3%), microlobulated margin (24/56, 42.9%), abrupt interface (50/56, 89.3%), isoechoic pattern (42/56, 75.0%), and a lack of posterior acoustic features (45/56, 80.4%). The Breast Imaging Reporting and Data System final assessment was category 3 in 27 (48.2%) and category 4 in 29 (51.8%). Most of the category 4 lesions were category 4A (26/29, 89.7%). Surgical excision (n = 7) and follow-up for at least 1 year (n = 49) showed no malignancy. Conclusions. Focal fibrosis was found in 8.6% by a sonographically guided core biopsy of nonpalpable breast lesions. Most of the lesions were categorized as probably benign (category 3) or having a low suggestion of malignancy (category 4A). Focal fibrosis diagnosed at core biopsy can be managed with a 6-month follow-up protocol.

Key Words: breast abnormalities • breast biopsy • fibrous nodule • sonography

Abbreviations: BI-RADS • Breast Imaging Reporting and Data System

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