Breast neoplasms

Changed by Mohammad Taghi Niknejad, 15 Mar 2024

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Disclosures - updated 11 Mar 2024: Nothing to disclose

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Breast neoplasms consist of a wide spectrum of pathologies from benign proliferations, high-risk lesions, precursor lesions, to to invasive malignancies. This article provides an overview for radiologists, with a focus on breast cancer. For a summary article for medical students and non-radiologists, see breast cancer (summary).

Epidemiology

Breast cancer is the most common nonskin malignancy in women. In the affluent populations of North America, Europe, and Australia, 6% of women develop invasive breast cancer before age 75, compared to a 2% risk in developing regions of Africa and Asia ⁸. The difference has been attributed to risks associated with a Westernized lifestyle, including high-calorie diet rich in fat and protein and physical inactivity ⁸.

Risk factors

increasing age ⁸
reproductive lifestyle factors increasing unopposed oestrogen load ⁸
- early menarche
- nulliparity, infertility, or, if parous, few children with late age at first delivery
- lack of breastfeeding
- late menopause
- unopposed oestrogen hormone replacement therapy
personal history of breast cancer or a high risk breast lesion
first degree relative with breast cancer
genetic mutations
thoracic radiation therapy⁸
alcohol consumption ⁸

Pathology

Classification

The main pathological classification of breast neoplasms is published by the World Health Organisation:WHO classification of tumours of the breast.

The vast majority of breast cancers are adenocarcinomas (99%). The most common types are ⁸:

invasive carcinoma of no special type (ductal carcinoma not otherwise specified): 40 40-75%
ductal carcinoma in situ: 20-25%
invasive lobular carcinoma: 5 5-15%

Categories of benign epithelial neoplasms include:

Non-epithelial malignancies are uncommon and include:

Immunophenotype

Three molecular biomarkers are routinely evaluated in invasive breast cancers because they have therapeutic implications:

oestrogen receptor (ER)
progesterone receptor (PR)
human epidermal growth factor receptor 2 (HER2; proto-oncogene Neu; receptor tyrosine-protein kinase erbB-2)

Staging

Staging of breast tumours is performed according to the TNM system published by the American Joint Committee on Cancer (AJCC) / Union for International Cancer Control (UICC):breast cancer (staging).

Radiographic appearance

Dedicated evaluation of the breast involves multiple imaging modalities to detect and localise lesions for biopsy. In all modalities, regional metastasis can be suspected by the presence of axillary adenopathy.

Mammography

Neoplasms have varied appearances, including masses, asymmetries,calcifications, or architectural distortions.

Ultrasound

Neoplasms can appear as masses or or architectural distortions.Calcifications ~~can~~ can sometimes be seen.

MRI

Neoplasms can manifest as masses ~~with~~ with or without enhancement,non-mass enhancement, or foci of of enhancement.

CT

Breast masses may be incidentally identified but CT is not the preferred modality for dedicated breast evaluation. If calcifications are visualised on CT, they are nearly all benign ⁹.

Radiology report

The use of a standard lexicon is recommended to enhance communication with referrers and audit performance:breast imaging-reporting and data system (BI-RADS).

-<p><strong>Breast neoplasms </strong>consist of a wide spectrum of pathologies from benign proliferations, <a href="/articles/high-risk-breast-lesion">high-risk lesions</a>, precursor lesions, to invasive malignancies. This article provides an overview for radiologists, with a focus on <strong>breast cancer</strong>. For a summary article for medical students and non-radiologists, see <a href="/articles/breast-cancer-summary">breast cancer (summary)</a>.</p><h4>Epidemiology</h4><p>Breast cancer is the most common nonskin malignancy in women. In the affluent populations of North America, Europe, and Australia, 6% of women develop invasive breast cancer before age 75, compared to a 2% risk in developing regions of Africa and Asia <sup>8</sup>. The difference has been attributed to risks associated with a Westernized lifestyle, including high-calorie diet rich in fat and protein and physical inactivity <sup>8</sup>.</p><h5>Risk factors</h5><ul>
+<p><strong>Breast neoplasms </strong>consist of a wide spectrum of pathologies from benign proliferations, <a href="/articles/high-risk-breast-lesion">high-risk lesions</a>, precursor lesions, to invasive malignancies. This article provides an overview for radiologists, with a focus on <strong>breast cancer</strong>. For a summary article for medical students and non-radiologists, see <a href="/articles/breast-cancer-summary">breast cancer (summary)</a>.</p><h4>Epidemiology</h4><p>Breast cancer is the most common nonskin malignancy in women. In the affluent populations of North America, Europe, and Australia, 6% of women develop invasive breast cancer before age 75, compared to a 2% risk in developing regions of Africa and Asia <sup>8</sup>. The difference has been attributed to risks associated with a Westernized lifestyle, including high-calorie diet rich in fat and protein and physical inactivity <sup>8</sup>.</p><h5>Risk factors</h5><ul>
~~-<li><a href="/articles/ataxia-telangiectasia">ataxia telangiectasia</a></li>~~
+<li><a href="/articles/ataxia-telangiectasia-1">ataxia telangiectasia</a></li>
~~-<a href="/articles/multiple-endocrine-neoplasia-type-1-2">MEN1</a> <sup>10</sup>~~
+<a href="/articles/multiple-endocrine-neoplasia-type-1-2">MEN1</a> <sup>10</sup>
~~-<a href="/articles/complications-of-thoracic-radiation-therapy">thoracic radiation therapy</a> <sup>8</sup>~~
+<a href="/articles/complications-of-thoracic-radiation-therapy">thoracic radiation therapy</a> <sup>8</sup>
-</ul><h4>Pathology</h4><h5>Classification</h5><p>The main pathological classification of breast neoplasms is published by the <a href="/articles/world-health-organizatin-who">World Health Organisation</a>: <a href="/articles/who-classification-of-tumors-of-the-breast">WHO classification of tumours of the breast</a>.</p><p>The vast majority of breast cancers are adenocarcinomas (99%). The most common types are <sup>8</sup>:</p><ul>
+</ul><h4>Pathology</h4><h5>Classification</h5><p>The main pathological classification of breast neoplasms is published by the <a href="/articles/world-health-organizatin-who">World Health Organisation</a>: <a href="/articles/who-classification-of-tumors-of-the-breast">WHO classification of tumours of the breast</a>.</p><p>The vast majority of breast cancers are adenocarcinomas (99%). The most common types are <sup>8</sup>:</p><ul>
~~-<a href="/articles/invasive-ductal-carcinoma">invasive carcinoma of no special type</a> (ductal carcinoma not otherwise specified): 40-75%</li>~~
+<a href="/articles/invasive-breast-carcinoma-of-no-special-type-1">invasive carcinoma of no special type</a> (ductal carcinoma not otherwise specified): 40-75%</li>
~~-<a href="/articles/invasive-lobular-carcinoma">invasive lobular carcinoma</a>: 5-15%</li>~~
~~-</ul><p>Categories of benign epithelial neoplasms include: </p><ul>~~
+<a href="/articles/invasive-lobular-carcinoma">invasive lobular carcinoma</a>: 5-15%</li>
+</ul><p>Categories of benign epithelial neoplasms include: </p><ul>
~~-<a href="/articles/breast-sarcoma">breast sarcomas</a> (0.5-3% <sup>6</sup>)</li>~~
+<a href="/articles/breast-sarcoma">breast sarcomas</a> (0.5-3% <sup>6</sup>)</li>
-</ul><h5>Staging</h5><p>Staging of breast tumours is performed according to the TNM system published by the American Joint Committee on Cancer (AJCC) / Union for International Cancer Control (UICC): <a href="/articles/breast-cancer-staging-1">breast cancer (staging)</a>.</p><h4>Radiographic appearance</h4><p>Dedicated evaluation of the breast involves multiple imaging modalities to detect and localise lesions for biopsy. In all modalities, regional metastasis can be suspected by the presence of <a href="/articles/unilateral-axillary-lymphadenopathy-differential">axillary adenopathy</a>.</p><h5>Mammography</h5><p>Neoplasms have varied appearances, including <a href="/articles/breast-mass">masses</a>, <a href="/articles/asymmetry-mammography">asymmetries</a>, <a href="/articles/breast-calcifications">calcifications</a>, or <a href="/articles/breast-architectural-distortion-1">architectural distortions</a>. </p><h5>Ultrasound</h5><p>Neoplasms can appear as <a href="/articles/breast-mass">masses</a> or <a href="/articles/breast-architectural-distortion-1">architectural distortions</a>. <a href="/articles/breast-calcifications">Calcifications</a> can sometimes be seen.</p><h5>MRI</h5><p>Neoplasms can manifest as <a href="/articles/breast-mass">masses</a> with or without enhancement, <a href="/articles/non-mass-enhancement-breast-mri">non-mass enhancement</a>, or <a href="/articles/focus-breast-mri">foci</a> of enhancement.</p><h5>CT</h5><p>Breast masses may be incidentally identified but CT is not the preferred modality for dedicated breast evaluation. If calcifications are visualised on CT, they are nearly all benign <sup>9</sup>.</p><h4>Radiology report</h4><p>The use of a standard lexicon is recommended to enhance communication with referrers and audit performance: <a href="/articles/breast-imaging-reporting-and-data-system-bi-rads">breast imaging-reporting and data system (BI-RADS)</a>.</p>
+</ul><h5>Staging</h5><p>Staging of breast tumours is performed according to the TNM system published by the American Joint Committee on Cancer (AJCC) / Union for International Cancer Control (UICC): <a href="/articles/breast-cancer-staging-1">breast cancer (staging)</a>.</p><h4>Radiographic appearance</h4><p>Dedicated evaluation of the breast involves multiple imaging modalities to detect and localise lesions for biopsy. In all modalities, regional metastasis can be suspected by the presence of <a href="/articles/unilateral-axillary-lymphadenopathy-differential">axillary adenopathy</a>.</p><h5>Mammography</h5><p>Neoplasms have varied appearances, including <a href="/articles/breast-mass">masses</a>, <a href="/articles/asymmetry-mammography">asymmetries</a>, <a href="/articles/breast-calcifications">calcifications</a>, or <a href="/articles/breast-architectural-distortion-1">architectural distortions</a>. </p><h5>Ultrasound</h5><p>Neoplasms can appear as <a href="/articles/breast-mass">masses</a> or <a href="/articles/breast-architectural-distortion-1">architectural distortions</a>. <a href="/articles/breast-calcifications">Calcifications</a> can sometimes be seen.</p><h5>MRI</h5><p>Neoplasms can manifest as <a href="/articles/breast-mass">masses</a> with or without enhancement, <a href="/articles/non-mass-enhancement-breast-mri">non-mass enhancement</a>, or <a href="/articles/focus-breast-mri">foci</a> of enhancement.</p><h5>CT</h5><p>Breast masses may be incidentally identified but CT is not the preferred modality for dedicated breast evaluation. If calcifications are visualised on CT, they are nearly all benign <sup>9</sup>.</p><h4>Radiology report</h4><p>The use of a standard lexicon is recommended to enhance communication with referrers and audit performance: <a href="/articles/breast-imaging-reporting-and-data-system-bi-rads">breast imaging-reporting and data system (BI-RADS)</a>.</p>

Images Changes:

Image 23 Mammography (MLO) ( update )

Caption was changed:

Axillary nodes - benign

Image 26 X-ray (Frontal) ( create )

Caption was added:

Case 22: therapeutic and prophylactic mastectomy with implant reconstruction

Position was set to 26.

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