E1768. The Good, the Bad, and the Ugly: Imaging Limitations, Corrections, and Differential Diagnosis for Giant Breast Masses
Authors
Claudia Cotes;
The University of Texas Health and Science Center at Houston
Steven Lee;
The University of Texas Health and Science Center at Houston
Abeer Abdelhafez;
The University of Texas Health and Science Center at Houston
Charisma Desai;
The University of Texas Health and Science Center at Houston
Angel Su;
The University of Texas Health and Science Center at Houston
Harnoor Singh;
The University of Texas Health and Science Center at Houston
Background
Giant breast masses comprise a great variety of breast pathologies that present as abnormalities greater than 5 cm in maximum dimension. Given their size, unpredictable behavior, and overlapping clinical and imaging presentation, these can be initially misunderstood or interpreted as suspicious or malignant at initial assessment. In addition, given their size, these masses can be difficult to evaluate on mammography and ultrasound. It is crucial for radiologists to understand these limitations and perform alterations in imaging technique to thoroughly evaluate these abnormalities, recognize the wide differential diagnosis, and provide adequate pathologic-radiologic concordance. The purpose of this exhibit is for the learner to 1. Review different pathologies that can present as giant breast masses, 2. Review the challenges in technique on mammography and ultrasound in the evaluation of giant breast masses and how to make corrections, 3. Understand the similarities of these breast masses and how to avoid pitfalls in diagnosis, and 4. Learn about the prognosis and management of large breast masses.
Educational Goals / Teaching Points
This exhibit will cover the following points. Common history and physical findings of large breast masses at presentation, sonographic and mammographic imaging limitations, during the evaluation of giant breast masses, technique tips and tricks for proper imaging evaluation of giant breast masses, common differential diagnosis, and management and prognosis.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Key points of this exhibit include technical limitations and how to correct for mammography (difficult positioning, incomplete visualization, limited penetration, limited compression) and ultrasound (shadowing and attenuation, incomplete visualization, artifact).
Conclusion
Imaging of giant breast masses is not a simple task. Given their size (more than 5 cm), multiple artifacts and limitations can be encountered on both, mammography and ultrasound evaluation. It is crucial for the radiologist to understand these limitations and make appropriate corrections to obtain optimal imaging characterization. With these corrections, radiologist will be able to assess these masses correctly and provide an accurate differential diagnosis and pathologic-radiologic correlation.
