Which patients require or can skip biopsy for breast clustered microcysts? Predictive findings of breast cancer and mucocele-like tumor

Abstract

The patients who exhibit clustered microcysts with MG findings (mass, focal asymmetry, coarse heterogeneous calcifications and fine pleomorphic calcifications) appear to require biopsy.

Unusual Changing Calcification Patterns on the Mammogram in a Pure Mucocele-Like Lesion of the Breast: A Case Report

“…Microscopically, the cysts are lined by flat to cuboidal epithelium in benign mucocele-like lesion; whereas, the epithelium may exhibit proliferative changes ranging from usual ductal hyperplasia to atypical ductal hyperplasia, and neo-plastic proliferations in situ or invasive carcinoma [1]. The later introduced the term, mucocele-like tumor, which is synonymous with the initial term, mucocele-like lesion [4]. The exact pathogenesis of mucocele-like lesion had not yet been revealed; however, Rosen hypothesized that excess production of mucin or a ductal obstruction may contribute to the distension of a duct or cyst, and incidental trauma from daily activity may cause a rupture and extravasation of mucin [6].…”

“…Extravasated mucin develops into dystrophic calcification, which enables mammographic detection of mucocele-like lesions [5,17]. Conversely, the presence of calcification on mammogram infers the presence of a mucin pool [4]. Radiologically, the most common reported features of mucocele-like lesions were microcalcifications on mammography [2,3,18].…”

“…Radiologically, the most common reported features of mucocele-like lesions were microcalcifications on mammography [2,3,18]. In the literature, the calcification morphology of mucocele-like lesion on mammogram is predominantly described as coarse [4,5,18–21] or pleomorphic [18,22], which largely fits the range of coarse heterogeneous calcifications of indeterminate concern in the BI-RADS classification [4,5]. The morphologic features of calcifications in are infrequently reported as round [16,18], punctate [16,18,22], amorphous [16], lucent-centered [22], crescentic (tea-cup) [17], and fine pleomorphic [16,18].…”

“…Cysts frequently contain microscopic calcifications [1]. Reflecting such pathologic characteristics, the radiologic features of mucocele-like lesion of the breast are mainly coarse heterogeneous microcalcifications on mammography and various cystic lesions on sonography [3,4]. Despite its rarity, increased detection, likely due to a large volume of breast cancer screenings, sometimes poses diagnostic challenges for radiologists.…”

Reducing Unnecessary Biopsy and Follow-up of Benign Cystic Breast Lesions

“…A 0.5-cm cluster of cysts was the initial finding, and that did not clearly correlate with the irregular, mostly solid complex 0.5-cm mass seen 1 year later (5). The other eight malignancies were all from one series from Japan (6). These malignancies included six ductal carcinomas in situ and two invasive carcinomas.…”