ARRS 2022 Abstracts

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E1495. A Wolf in Sheep’s Clothing: When Breast Cancer Masquerades as a Benign-Appearing Circumscribed Mass
Authors
  1. Lawrence McDermott; Rutgers New Jersey Medical School
  2. Samuel Elias; Rutgers New Jersey Medical School
  3. Magdalena Salvador; Rutgers New Jersey Medical School
Background
Careful assessment of the mammographic margins of breast masses is a crucial tool in stratifying their risk of malignancy. Classically, circumscribed breast masses are often regarded as benign, possibly representing cysts or fibroadenomas. However, in certain circumstances, breast cancers can masquerade as benign-appearing circumscribed masses. The challenge for the radiologist is to seek out related findings, which can prompt them to have a greater degree of caution when evaluating certain masses. This presentation is a case-based study of important findings which radiologists should integrate into their evaluation of circumscribed masses.

Educational Goals / Teaching Points
The goals of this presentation are to review the current approach to evaluating the margins of a mammographic mass; to illustrate and discuss clinical and radiologic findings which may indicate a more malignant etiology of a circumscribed mass; and to familiarize radiologists with these pathologic diagnoses to develop an index of suspicion when approaching these radiological presentations.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will begin by reviewing the landmark trials that helped identify and define malignant and benign features of breast masses. We will then present a pictorial review of clinical and radiological features of pathology-proven malignant circumscribed breast masses. Each case presentation will begin with the clinical context of the patient and continue with a detailed discussion and review of all relevant imaging, including mammography, ultrasound, and MRI. Each case will conclude with a teaching point highlighting the clinical clues and imaging findings that the reader can carry into clinical practice.

Conclusion
Indeed, the adage “patients do not read the textbook” rings loud and true. There are times when a seemingly benign circumscribed mass requires further workup and biopsy. Our goal is to share the lessons we have learned in these deceptive situations with our colleagues, so that we may better recognize these subtle malignancies and facilitate prompt and accurate diagnoses.