Fibrocystic Changes of the Breast: Radiologic-Pathologic Correlation of MRI

Area of Science:

• Radiology
• Pathology
• Oncology

Background:

• Breast MRI has high sensitivity but limited positive predictive value for cancer detection.
• Approximately 75% of MRI-guided biopsies yield benign results, often described as fibrocystic change (FCC).
• FCC is a colloquial term encompassing various benign breast entities that can enhance on MRI.

Purpose of the Study:

• To correlate benign breast pathologies, often termed FCC, with their appearance on MRI.
• To guide management decisions following benign MRI-guided biopsy results.
• To improve radiologic-pathologic correlation for enhancing breast lesions.

Main Methods:

• Review of benign breast entities commonly associated with FCC.
• Analysis of MRI characteristics (enhancement patterns, kinetics) of these benign lesions.
• Correlation of imaging findings with histopathologic diagnoses.

Main Results:

• Benign entities comprising FCC, including proliferative (e.g., ductal hyperplasia, adenosis) and nonproliferative (e.g., cysts, metaplasia, fibrosis) lesions, can exhibit diverse MRI enhancement patterns.
• Diffuse FCC often presents as non-mass enhancement (NME) with persistent kinetics.
• Focal FCC may appear as masses or foci with variable enhancement, including washout kinetics.

Conclusions:

• Recognizing the MRI features of benign entities within FCC is essential for accurate interpretation of MRI-guided biopsies.
• A benign, concordant biopsy result for FCC entities may warrant follow-up MRI in 12 months.
• Effective radiologic-pathologic correlation relies on integrating MRI features with histological findings.