Benign Meme Lezyonları
Özet
Kadınlarda memeye bağlı klinik başvuru nedeni çoğunlukla benign meme değişikliklerine bağlıdır. Vakaların sadece %3 ile %6’sı meme kanseri nedenlidir. Kadınlarda en sık görülen kanser türü meme kanseridir; hastalarda ana odak meme kanseri olduğundan meme değişiklikleri kaygıya neden olur ve tanı süreci gerektirirler (1).
Meme lezyonların radyolojik olarak tanı ve takibi, gereklilik halinde histolojik olarak malignite ekartasyonu yapılmalıdır (2).
Fibrokistik değişiklikler kadınlarda oldukça yaygın olup 30 yaş üstü kadınların %50 sinde görülür. Fibroadenomlar kadınların %25’inde görülürler; memenin en sık görülen benign tümörüdür ve tedavi gerektirmezler. İntraduktal papillomlar benign meme tümörlerinin %5-10'unu oluşturur ve patolojik meme başı akıntısına neden olur. Mastit, infeksiyöz ve nonenfeksiyoz nedenlerle meme parankimin inflamasyonudur. Benign meme lezyonlarının malignite gelişme riski çok düşüktür. Ancak içlerinde malignite riski gelişme riski bulunanların ayrımı yapılması ve şüphe durumunda perkutan biyopsi ile doğrulanması gerekir (1).
Benign meme lezyonlarının klinik ve radyolojik olarak görüntüleme bulgularını gözden geçirmek, radyologların zamanında doğru tanısı ve takibi açısından yardımcı olacaktır.
In women, clinical breast-related presentations are most often due to benign breast changes. Only 3% to 6% of cases are due to breast cancer. Breast cancer is the most common type of cancer in women, and since the primary concern for patients is breast cancer, breast changes often cause anxiety and require diagnostic evaluation (1).
Radiological diagnosis and follow-up of breast lesions, and histological exclusion of malignancy if necessary, should be performed (2).
Fibrocystic changes are very common in women, occurring in 50% of women over the age of 30. Fibroadenomas are found in approximately 25% of women; they are the most common benign tumors of the breast and do not require treatment. Intraductal papillomas account for 5-10% of benign breast tumors and can cause pathological nipple discharge. Mastitis is an inflammation of the breast parenchyma, which can be due to infectious or non-infectious causes. Although the risk of malignancy developing from benign breast lesions is very low, distinguishing lesions with a potential risk of malignancy is crucial, and confirmation by percutaneous biopsy is necessary when malignancy is suspected (1).
Reviewing the clinical and radiological imaging findings of benign breast lesions will help radiologists in terms of timely accurate diagnosis and follow-up.
Referanslar
Stachs A, Stubert J, Reimer T et al. Benign Breast Disease in Women. Dtsch Arztebl Int. 2019;116(33-34): 565-574. doi: 10.3238/arztebl.2019.0565.
Klassen CL, Hines SL, Ghosh K. Common benign breast concerns for the primary care physician. Cleve Clin J Med. 2019;86(1): 57-65. doi: 10.3949/ccjm.86a.17100.
Malherbe K, Khan M, Fatima S. Fibrocystic Breast Disease. 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
Kour A, Sharma S, Sambyal V, et al. S. Risk Factor Analysis for Breast Cancer in Premenopausal and Postmenopausal Women of Punjab, India. Asian Pac J Cancer Prev. 2019;20(11): 3299-3304. doi: 10.31557/APJCP.2019.20.11.3299.
Kowalski A, Okoye E. Breast Cyst. 2023 Sep 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
Dyrstad SW, Yan Y, Fowler AM et al. Breast cancer risk associated with benign breast disease: systematic review and meta-analysis. Breast Cancer Res Treat. 2015;149(3): 569-575. doi: 10.1007/s10549-014-3254-6.
Ciurea AI, Iacoban CG, Herţa HA, et al. Breast cystic lesions: Not so simple after all? An ultrasonographic tactical approach. Med Ultrason. 2018;1(1): 95-99. doi: 10.11152/mu-1163.
Rao AA, Feneis J, Lalonde C et al. A Pictorial Review of Changes in the BI-RADS Fifth Edition. Radiographics. 2016;36(3): 623-639. doi: 10.1148/rg.2016150178.
Stavros AT (ed). Breast Ultrasound. Lippincott Williams & Wilkins, 2004.
Stefan E, Sebeni M, Damian OP, et al. Mammography and ultrasonography in postoperative evaluation of the breast. European Congress of Radiology 2013/C-1427. doi:10.1594/ecr2013/C-1427.
Athanasiou A, Aubert E, Vincent Salomon A, et al. Complex cystic breast masses in ultrasound examination. Diagn Interv Imaging. 2014;95(2): 169-179. doi: 10.1016/j.diii.2013.12.008.
Baker JA, Soo MS, Rosen EL. Artifacts and pitfalls in sonographic imaging of the breast. AJR Am J Roentgenol. 2001;176(5): 1261-1266. doi: 10.2214/ajr.176.5.1761261.
Sinn HP, Elsawaf Z, Helmchen B, et al. Early Breast Cancer Precursor Lesions: Lessons Learned from Molecular and Clinical Studies. Breast Care (Basel). 2010;5(4): 218-226. doi: 10.1159/000319624.
Cohen MA, Newell MS. Radial Scars of the Breast Encountered at Core Biopsy: Review of Histologic, Imaging, and Management Considerations. AJR Am J Roentgenol. 2017;209(5): 1168-1177. doi: 10.2214/AJR.17.18156.
Farshid G, Buckley E. Meta-analysis of upgrade rates in 3163 radial scars excised after needle core biopsy diagnosis. Breast Cancer Res Treat. 2019;174(1): 165-177. doi: 10.1007/s10549-018-5040-3.
Calhoun BC, Collins LC. Recommendations for excision following core needle biopsy of the breast: a contemporary evaluation of the literature. Histopathology. 2016;68(1): 138-151. doi: 10.1111/his.12852.
Tot T, Tabár L. The role of radiological-pathological correlation in diagnosing early breast cancer: the pathologist's perspective. Virchows Arch. 2011 Feb;458(2): 125-31. doi: 10.1007/s00428-010-1005-6.
Racz JM, Carter JM, Degnim AC. Challenging Atypical Breast Lesions Including Flat Epithelial Atypia, Radial Scar, and Intraductal Papilloma. Ann Surg Oncol. 2017;24(10): 2842-2847. doi: 10.1245/s10434-017-5980-6.
Hartmann LC, Sellers TA, Frost MH, et al. Benign breast disease and the risk of breast cancer. N Engl J Med. 2005;353(3): 229-237. doi: 10.1056/NEJMoa044383.
Alsharif S, Aldis A, Subahi A, et al. Breast MRI Does Not Help Differentiating Radial Scar With and Without Associated Atypia or Malignancy. Can Assoc Radiol J. 2021;72(4): 759-766. doi: 10.1177/0846537120930360.
El-Wakeel H, Umpleby HC. Systematic review of fibroadenoma as a risk factor for breast cancer. Breast. 2003;12(5): 302-307. doi: 10.1016/s0960-9776(03)00123-1.
Krings G, Bean GR, Chen YY. Fibroepithelial lesions; The WHO spectrum. Semin Diagn Pathol. 2017;34(5): 438-452. doi: 10.1053/j.semdp.2017.05.006.
Heywang-Köbrunner Sylvia H. Thieme Verlag. Stuttgart: 2015. SI: Bildgebende Mammadiagnostik; pp. 292–308.
Tan BY, Acs G, Apple SK, et al. Phyllodes tumours of the breast: a consensus review. Histopathology. 2016;68(1): 5-21. doi: 10.1111/his.12876.
Tomkovich KR. Interventional radiology in the diagnosis and treatment of diseases of the breast: a historical review and future perspective based on currently available techniques. AJR Am J Roentgenol. 2014;203(4): 725-733. doi: 10.2214/AJR.14.12994.
Zhang M, Arjmandi FK, Porembka JH et al. Imaging and Management of Fibroepithelial Lesions of the Breast: Radiologic-Pathologic Correlation. Radiographics. 2023;43(11): e230051. doi: 10.1148/rg.230051.
Lee SJ, Trikha S, Moy L, et al. ACR Appropriateness Criteria® Evaluation of Nipple Discharge. J Am Coll Radiol. 2017;14(5S): S138-S153. doi: 10.1016/j.jacr.2017.01.030.
Dupont SC, Boughey JC, Jimenez RE, et al. Frequency of diagnosis of cancer or high-risk lesion at operation for pathologic nipple discharge. Surgery. 2015;158(4): 988-994. doi: 10.1016/j.surg.2015.05.020.
Langer F, Hille-Betz U, Kreipe HH. Papilläre Läsionen der Mamma [Papillary lesions of the breast]. Pathologe. 2014;35(1): 36-44. doi: 10.1007/s00292-013-1839-1.
Eiada R, Chong J, Kulkarni S, et al. Papillary lesions of the breast: MRI, ultrasound, and mammographic appearances. AJR Am J Roentgenol. 2012;198(2):264-271. doi: 10.2214/AJR.11.7922.
Mulligan AM, O'Malley FP. Papillary lesions of the breast: a review. Adv Anat Pathol. 2007;14(2): 108-119. doi: 10.1097/PAP.0b013e318032508d.
Wen X, Cheng W. Nonmalignant breast papillary lesions at core-needle biopsy: a meta-analysis of underestimation and influencing factors. Ann Surg Oncol. 2013;20(1): 94-101. doi: 10.1245/s10434-012-2590-1.
Rageth CJ, O‘Flynn EAM, Pinker K, et al. Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) Breast Cancer Res Treat. 2019;174:279–296. doi: 10.1007/s10549-018-05071-1.
Eiada R, Chong J, Kulkarni S, et al. Papillary lesions of the breast: MRI, ultrasound, and mammographic appearances. AJR Am J Roentgenol. 2012;198(2): 264-271. doi: 10.2214/AJR.11.7922.
Peters F. Die nonpuerperale Mastitis. Gynäkologe. 2001;34:930–939.
World Health Organisation. WHO. Geneva: 2000. Mastitis: causes and management.
Angelopoulou A, Field D, Ryan CA, Stanton C, Hill C, Ross RP. The microbiology and treatment of human mastitis. Med Microbiol Immunol. 2018;207:83–94.
Rashid T, Sae-Kho TM, Heuvelhorst KL, et al. Breast imaging of infectious disease. Br J Radiol. 2023;96(1143): 20220649. doi: 10.1259/bjr.20220649.
Boakes E, Woods A, Johnson N, Kadoglou N. Breast Infection: a review of diagnosis and management practices. Eur J Breast Health. 2018;14:136–143.
Dixon JM, Ravisekar O, Chetty U, et al. Periductal mastitis and duct ectasia: different conditions with different aetiologies. Br J Surg. 1996;83:820–822.
Lam E, Chan T, Wiseman SM. Breast abscess: evidence based management recommendations. Expert Rev Anti Infect Ther. 2014;12:753–762.
Freeman CM, Xia BT, Wilson GC, et al. Idiopathic granulomatous mastitis: A diagnostic and therapeutic challenge. Am J Surg. 2017;214:701–706.
Johnstone KJ, Robson J, Cherian SG, et al. Cystic neutrophilic granulomatous mastitis associated with Corynebacterium including Corynebacterium kroppenstedtii. Pathology. 2017;49:405–412.
Barreto DS, Sedgwick EL, Nagi CS, et al. Granulomatous mastitis: etiology, imaging, pathology, treatment, and clinical findings. Breast Cancer Res Treat. 2018;171:527–534.
