Identification of differentiating sonographic features between fibroadenomas and malignant tumors of the breast mimicking fibroadenomas: 10-year experience in 421 histologically verified cases

Abstract

Purpose

Ultrasound is a highly effective imaging tool for assessing abnormalities within the breast. However, especially the identification of malignant tumors of the breast mimicking fibroadenomas (MTMF) by means of breast ultrasound can be challenging. This study aimed to identify reliable imaging characteristics of MTMF.

Materials and Methods

This retrospective study was approved by the local ethics review board. After screening 623 patients, 421 cases with histologically verified fibroadenomas and MTMF between 2011 and 2021 were included. Sonographic features were compared to histopathological results and an algorithm-based quantitative ranking of predictors contributing most to the correct classification of malignant tumors was conducted.

Results

A total of 363 benign, 18 intermediate, and 40 malignant lesions were analyzed. Algorithm-based quantitative ranking showed that the most predictive features indicating malignancy were a hyperechoic rim (gain ratio merit 0.135 ± 0.004), an irregular border (0.057 ± 0.002), perilesional stiffening (0.054 ± 0.002), pectoral contact (0.051 ± 0.003), an irregular shape (0.029 ± 0.001), and irregular vasculature (0.027 ± 0.002).

Conclusion

Ultrasound findings for fibroadenomas vary, making identification of MTMF challenging. Features such as indistinct margins and increased perilesional echogenicity are predictors for malignancy and should be considered during sonographic evaluation of fibroadenomas and MTMF.

Zusammenfassung

Ziel

Fibroadenome sind relativ häufige benigne Läsionen der weiblichen Brust, jedoch kann die sonografische Unterscheidung zwischen gutartigen Fibroadenomen und malignen fibroadenom-imitierenden Tumoren der Brust eine Herausforderung darstellen. Ziel dieser Studie war es, zuverlässige Bildgebungsmerkmale zur Identifizierung fibroadenom-ähnlicher maligner Tumoren festzustellen.

Material und Methode

Nach Screening von 623 Patienten wurden 421 Fälle mit histologisch verifizierten Fibroadenomen und fibroadenom-ähnlichen malignen Tumoren eingeschlossen. Die sonografischen Merkmale wurden mit dem histopathologischen Resultat verglichen, und eine algorithmusbasierte quantitative Rangordnung der Prädiktoren, die am meisten zur korrekten Klassifikation intermediärer und maligner Tumoren beitrugen, wurde durchgeführt.

Ergebnisse

Insgesamt wurden 363 benigne, 18 intermediäre und 40 maligne Brustläsionen eingeschlossen. Die algorithmusbasierte quantitative Rangordnung zeigte, dass die am prädiktivsten Merkmale für Malignität ein hyperechogener Randsaum (gain ratio merit 0,135 ± 0,004), unregelmäßige Ränder (0,057 ± 0,002), periläsionale Verhärtung (0,054 ± 0,002), pektoraler Kontakt (0,051 ± 0,003), unregelmäßige Form (0,029 ± 0,001) und eine chaotische Gefäßversorgung (0,027 ± 0,002) waren.

Schlussfolgerung

Bildgebende Charakteristika für Fibroadenome im Ultraschall variieren, was die Identifizierung von malignen fibroadenom-imitierenden Tumoren erschweren kann. Bei der sonografischen Beurteilung sollten daher klassische Malignitätskriterien wie unscharfe Berandung oder periläsionale Echo-Genitätssteigerung beachtet werden.

Keywords

breast cancer - breast diagnostics - fibroadenoma - ultrasound - elastography

Publication History

Received: 20 June 2024

Accepted after revision: 06 November 2024

Article published online:
04 February 2025

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