The potential of standard technologies for radiological diagnosis of posttraumatic breast abnormalities

Rationale: A  standard algorithm for the assessment of patients with breast trauma does not exist, as such trauma usually does not incur any significant health problems. However, according to existing clinical and work-up data and various radiological signs, posttraumatic abnormalities of the breast can mimic cancer lesions and complicate the differential diagnosis for a radiologist.

Aim: To evaluate the potential of digital mammography and breast ultrasound examination in the identification of breast posttraumatic abnormalities and to describe their semiotics.

Materials and methods: The study included 150  female patients aged 40  to 86  years (mean±SD, 60±11.9 years) with a history of breast trauma. Digital mammography with tomosynthesis (combined mode) and multiparametric ultrasound were able to identify breast abnormalities in 62 patients. The results of all assessments (n=62) were interpreted according to BI-RADS. Should any confirmation of the abnormalities be necessary, fine needle aspiration biopsy or core-biopsy with stereotaxic or ultrasound control were performed.

Results: At mammography, the typical posttraumatic abnormality in the breast was fat necrosis (n=54). It was represented as nodular masses with round (20/34; 58.8%) or oval shape (13/34; 38.2%) and circumscribed margins. In most cases, the masses contained eggshell calcification (27/34; 79.4%). In 35.1%  (19/54) of the cases fat necrosis was represented by various calcifications. At ultrasound, fat necrosis could be identified as avascular (40/40; 100%), mostly round (26/40; 65.0%), less frequently oval (12/40; 30.0%), and hypoechoic (19/40; 47.5%) masses with circumscribed margins. Atypical signs of fat necrosis (BIRADS 4) were found in 16.1% (10/62) of the cases, in which  7  (11.2%) core-biopsies with ultrasound control and  3  (4.8%) stereotaxic biopsies were performed. In all the cases, breast fat necrosis was confirmed, with various ratios of fibrous and necrotic fat tissue and lymphoid infiltration.

Conclusion: In most cases, standard radiological methods used in the diagnostic algorithm for posttraumatic breast lesions are sufficient for the diagnosis. In uncertain diagnostic cases, morphological verification seems necessary.