Tattoo Pigment Migration Within the Breast and Axilla: Radiologic-Pathologic Correlation

Tattoo pigment migration can appear on breast imaging, including mammography and ultrasound, where it may mimic malignant findings. In the literature, 19 cases have been reported. Here, we describe an additional three cases. Most published cases involve women undergoing screening mammography with incidental identification of pigment migration. On imaging, pigment can present as high-density deposits on mammography and echogenic foci on ultrasound, mimicking calcifications. Reported sites of deposition most commonly include axillary lymph nodes and intramammary nodes. If no other morphologic abnormalities are identified and the findings can be confidently attributed to tattoo pigment, biopsy is not necessary. Histopathologically, tattoo pigment appears as aggregates of granular exogenous material. If biopsy is performed and confirms pigment migration, patients may resume risk-appropriate screening without further intervention.