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Objectives: Breast manifestations in patients with systemic lupus erythematosus (SLE) include primary lupus of the breast (i.e., lupus mastitis) and secondary manifestations of lupus such as lymphadenopathy or vascular calcifications. To clarify the spectrum of breast manifestations in patients with SLE, we reviewed the clinical, imaging, and pathological manifestations of breast diseases in SLE patients. Methods: We retrospectively reviewed cases of SLE patients with breast imaging performed in five centres from January 2010 to April 2020. Patient demographics, breast symptoms, imaging, and pathological findings, and their subsequent management, were reviewed. Results: A total of 16 cases were included. The mean follow-up period was 61 months. A palpable breast mass was the most frequent clinical presentation, followed by mastalgia and axillary swelling. A wide range of imaging findings was encountered on ultrasonography and/or mammography, including extensive calcifications in both breasts, breast masses with features suspicious for malignancy, fat necrosis, oedema, arterial calcifications, architectural distortion, and axillary lymphadenopathy. Two cases of lupus mastitis and a case of invasive ductal carcinoma were identified. Conclusion:No definite distinguishing features between lupus mastitis and breast malignancy were observed on imaging. Pathological correlation is recommended when imaging features suspicious for malignancy are demonstrated.

A 71-year-old male presented with an incidental finding of a 1.6-cm hypermetabolic oval nodule in the subareolar region of the left breast with maximum standardised uptake value of 3.5 on positron emission tomographycomputed tomography (PET-CT) [Figure 1]. He had stage IV colon cancer with multiple liver metastases. No abnormal lymph node was seen in the left axilla. Physical examination revealed a 1.5-cm firm mobile mass at the left breast subareolar region that was considered clinically suspicious.