Breast Cancer Look-Alikes on Exam and Mammogram
Most of us have known someone who hadbreast cancerdespite a normal mammogram.
What are some conditions that might be mistaken for breast cancer but are otherwise benign?
In fact, sometimes these can completely overlap (the purpose of this article).
Istockphoto.com / Stock Photo©Anetlanda
Mammograms have a specificity of 93%.
This means that 7% of the time when a mammogram strongly suggests cancer, it is something else.
Radiologists give a mammogram a number known as the Breast Imaging Reporting and Data System orBI-RADS classification.
Of these women, 12% will need a biopsy done.
Of these biopsies, 60% will be benign.
Breast Ultrasound Findings With Breast Cancer
Breast ultrasoundexams are an important supplement when used along with mammograms.
Breast Biopsy and Cancer
Abreast biopsyis a definitive test if a cancer is suspected.
There are several we will look at here.
Conditions that resemble cancer on exam or imaging are listed below.
Let’s look at each of these a bit closer.
Fat Necrosis
Fat necrosis of the breast literally means “dead fat.”
It is usually preceded by an injury to the breast from a car accident or sports injury.
Radiation for breast cancer can also cause fat necrosis, raising concern over a possiblerecurrence.
These lumps usually feel hard and are sometimes tender.
There may be discharge from a nipple.
A biopsy may need to be done to confirm the diagnosis.
Radial Scar
Radial scarsare a star-shaped breast masses that are often benign but may beprecancerous.
Radial scars do not cause breast lumps but may causebreast pain.
On mammogram, large radial scars can appear star-like with spikey borders.
They are fairly uncommon and occur most often in women between the ages of 40 and 60.
They can be brought on by inflammation, breast surgery, or hormonal changes.
To confuse matters even more, there are sometimes cancerous cells hiding within a radial scar.
Treatment often includes antibiotics, rest, and management of breastfeeding.
Granulomatous mastitisis a variant of mastitis often brought on by rheumatoid conditions, sarcoidosis, or tuberculosis.
It can also be idiopathic.
Sarcoidosis
Sarcoidosisis a benign condition marked by the formation ofgranulomasthroughout the body.
The problem of sarcoidosis is of greater concern for women who have already been diagnosed with early-stage breast cancer.
On exam, diabetic mastopathy appears as a large, painless breast mass that can imitate breast cancer.
It is triggered by a combination of inflammation and dense fibrosis in the breasts.
On these studies, the condition appears as ill-defined masses.
A core needle biopsy is usually needed to make the diagnosis.
It is not certain what causes this condition but it appears to run in families.
On mammogram and ultrasound, fibromatosis can mimic breast cancer findings.
The diagnosis is usually made with a core needle biopsy.
While usually benign, they arise from Schwann cells, cells found in the nervous system.
These tumors are often fibrotic causing skin retraction and fixation to the fascia underlying the breast.
This results in a lump which appears fixed, similar to a breast cancer.
They are also usually very hard, similar to cancer as well.
On imaging studies such as mammogram they also resemble cancer.
They tend to have well-defined borders but with spiculation suggestive of cancer.
Spindle Cell Lesions
Breast lesions containing spindle cells are a challenge on many levels.
In addition, both benign and cancerous breast lumps can have spindle cells.
Myofibroblastoma is an unusual benign breast tumor that falls under the category of spindle cell lesions.
They may occur in both women and men and can be challenging to diagnose.
Stay in the driver’s seat and expect answers as well.
American Cancer Society.Breast Cancer Signs and Symptoms.
American College of Radiology.ACR BI-RADS Atlas.
American Cancer Society.Surgical Breast Biopsy.
Soto-Gomez N, Peters JI, Nambiar AM.Diagnosis and management of sarcoidosis.Am Fam Physician.
