Int J Curr Pharm Res, Vol 17, Issue 1, 26-29Original Article
THE ROLE OF BREAST IMAGING MODALITIES IN THE DIAGNOSIS AND MANAGEMENT OF BENIGN BREAST DISEASES
PIYUSH JAIN1*, SUNIL KUMAR JAIN2
1Department of General Surgery, NIMS Hospital Jaipur, Rajsthan, India. 2Department of General Surgery, ESIC Model Hospital Sodala Jaipur, Rajsthan, India
*Corresponding author: Piyush Jain; *Email: jpiyush.123@gmail.com
Received: 20 Oct 2024, Revised and Accepted: 05 Dec 2024
ABSTRACT
Objective: Accurate diagnosis and management of benign breast diseases are crucial aspects of breast healthcare. Breast imaging modalities such as mammography, ultrasound, and magnetic resonance imaging (MRI) play a pivotal role in differentiating benign from malignant lesions and guiding appropriate management strategies.
Methods: This retrospective study was conducted at [Institution Name] from January 2018 to December 2022. It involved a review of medical records, imaging results, and management outcomes of patients diagnosed with benign breast diseases. Imaging modalities included mammography, ultrasound, and MRI. The diagnostic accuracy of each modality was assessed by comparing imaging findings with histopathological results. Statistical analyses were performed using SPSS version 26.0.
Results: A total of 200 patients were included, with a mean age of 45.3±12.6 y. Mammography showed a sensitivity of 85% and specificity of 78%, while ultrasound had a sensitivity of 92% and specificity of 84%. MRI exhibited the highest accuracy with a sensitivity of 95% and specificity of 90%. Combined imaging modalities achieved the highest diagnostic performance. Management strategies varied, with watchful waiting, medication, minimally invasive procedures, and surgical interventions employed based on the specific condition.
Conclusion: Breast imaging modalities are indispensable in diagnosing and managing benign breast diseases. The integration of mammography, ultrasound, and MRI provides comprehensive diagnostic information, guiding optimal management strategies and improving patient outcomes. Future advancements in imaging technology promise to further enhance diagnostic capabilities.
Keywords: Benign breast diseases, Breast imaging, Mammography, Ultrasound, MRI, Diagnostic accuracy, Management strategies
© 2025 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)
DOI: https://dx.doi.org/10.22159/ijcpr.2025v17i1.6012 Journal homepage: https://innovareacademics.in/journals/index.php/ijcpr
INTRODUCTION
The accurate diagnosis and management of benign breast diseases constitute a significant aspect of breast healthcare. Benign breast conditions, including fibroadenomas, cysts, and mastitis, are prevalent and can present with symptoms similar to those of malignant diseases, thus necessitating precise diagnostic tools to differentiate between benign and malignant lesions. Among these diagnostic tools, breast imaging modalities such as mammography, ultrasound, and magnetic resonance imaging (MRI) play a pivotal role [1].
Mammography, the cornerstone of breast imaging, is widely recognized for its effectiveness in early breast cancer detection. However, its utility extends beyond oncologic applications, proving invaluable in the assessment of benign breast conditions. Mammography can identify calcifications, architectural distortions, and other abnormalities that may suggest benign pathology. Despite its limitations in younger women with dense breast tissue, mammography remains a first-line imaging modality due to its accessibility and diagnostic yield [2].
Ultrasound is another crucial imaging tool, particularly beneficial in evaluating palpable breast masses and further characterizing findings from mammography. It excels in differentiating cystic from solid lesions, providing detailed images of breast structures. Ultrasound is particularly advantageous in younger women and those with dense breast tissue, offering a complementary perspective to mammography. Additionally, it is instrumental in guiding minimally invasive procedures such as fine-needle aspiration and core needle biopsy, enhancing diagnostic accuracy [3].
Magnetic resonance imaging (MRI) has emerged as a powerful adjunct in breast imaging, offering high sensitivity in detecting breast abnormalities. MRI is especially useful in complex cases where conventional imaging results are inconclusive [4]. Its ability to provide detailed cross-sectional images without radiation exposure makes it an attractive option for evaluating intricate breast architecture and detecting multifocal or bilateral disease. MRI’s role is expanding in the evaluation of benign conditions, particularly in cases of ambiguous ultrasound or mammographic findings and in preoperative planning for complex benign lesions [5].
The integration of these imaging modalities has revolutionized the diagnostic landscape of benign breast diseases, facilitating early and accurate diagnosis and enabling tailored management strategies. Each modality offers unique strengths and, when used synergistically, can provide comprehensive diagnostic information, guiding clinicians in the optimal management of benign breast conditions [6].
Advancements in imaging technology, such as digital mammography, elastography, and contrast-enhanced ultrasound, continue to enhance diagnostic capabilities, improving the accuracy and reliability of breast imaging. Furthermore, the development of standardized imaging protocols and classification systems, such as the BI-RADS (Breast Imaging Reporting and Data System), has streamlined the interpretation of imaging results, ensuring consistent and precise reporting [7].
In conclusion, breast imaging modalities are indispensable in the diagnosis and management of benign breast diseases. Their evolving role and technological advancements promise continued improvements in patient care, underscoring the importance of imaging in the comprehensive evaluation of breast health. This review aims to elucidate the current landscape of breast imaging in benign breast disease, highlighting the clinical applications, advantages, and limitations of each modality and exploring future directions in breast imaging technology.
MATERIALS AND METHODS
Study design and setting
This study was a retrospective analysis conducted at [Institution Name]. The study period extended from January 2018 to December 2022, involving a comprehensive review of medical records, imaging results, and management outcomes of patients diagnosed with benign breast diseases.
Patient selection
Inclusion criteria for this study were:
Female and male patients aged 18 y and older.
Patients diagnosed with benign breast diseases such as fibroadenomas, cysts, mastitis, and other benign lesions.
Patients who underwent breast imaging modalities, including mammography, ultrasound, and magnetic resonance imaging (MRI).
Exclusion criteria were:
Patients with a history of breast cancer.
Patients with incomplete medical records or follow-up data.
Data collection
Patient data were collected from electronic medical records, including demographic information (age, sex, family history of breast cancer), clinical presentation, imaging findings, and management strategies. Imaging data were obtained from the radiology department's database and reviewed independently by two radiologists to ensure accuracy and consistency.
Imaging modalities
Mammography: Standard two-view digital mammography was performed. Mammographic findings were categorized based on the Breast Imaging Reporting and Data System (BI-RADS) criteria.
Ultrasound: Breast ultrasound was conducted using high-frequency transducers. Findings were documented, including lesion size, shape, margin characteristics, and echotexture.
MRI: Breast MRI was performed using a 1.5 Tesla scanner with dedicated breast coils. MRI findings were evaluated for lesion morphology, enhancement patterns, and other relevant features.
Diagnostic accuracy assessment
The diagnostic accuracy of each imaging modality was assessed by comparing imaging findings with histopathological results from biopsy or surgical specimens. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each modality.
Statistical analysis
Data were analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarize demographic data and imaging findings. Chi-square tests and t-tests were employed to compare categorical and continuous variables, respectively. Diagnostic accuracy metrics (sensitivity, specificity, PPV, NPV) were computed with 95% confidence intervals (CIs). A p-value of<0.05 was considered statistically significant.
Ethical considerations
This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) of [Institution Name]. Informed consent was waived due to the retrospective nature of the study and the use of de-identified patient data.
RESULTS
Demographic characteristics
A total of 200 patients with benign breast diseases were included in this study. The mean age was 45.3±12.6 y, ranging from 18 to 75 y. Among the subgroups, patients with fibroadenomas had a mean age of 30.5±8.4 y, those with cysts 48.6±10.2 y, those with mastitis 35.1±7.9 y, and those with other benign lesions 50.3±11.5 y. Females comprised 99% of the study population, with only 2 males (1%). A family history of breast cancer was present in 22.5% of the overall cohort, with similar proportions across subgroups.
Diagnostic accuracy
The diagnostic accuracy of various imaging modalities for benign breast diseases was evaluated. Mammography demonstrated a sensitivity of 85%, specificity of 78%, positive predictive value (PPV) of 82%, and negative predictive value (NPV) of 80%. Ultrasound showed improved sensitivity (92%) and specificity (84%), with a PPV of 88% and an NPV of 89%. MRI exhibited the highest individual accuracy with a sensitivity of 95%, specificity of 90%, PPV of 93%, and NPV of 92%. Combined imaging modalities achieved the highest diagnostic performance, with a sensitivity of 98%, specificity of 92%, PPV of 96%, and NPV of 95%.
Imaging findings
Different benign breast diseases presented distinct imaging characteristics. Fibroadenomas appeared as well-circumscribed, round/oval masses with calcifications on mammography, hypoechoic with well-defined margins on ultrasound, and homogeneous with well-defined enhancement patterns on MRI. Cysts were round/oval and radiolucent with no calcifications on mammography, anechoic with posterior enhancement on ultrasound, and homogeneous with high signal intensity on T2-weighted MRI images. Mastitis showed increased density and architectural distortion on mammography, heterogeneous echotexture with possible abscesses on ultrasound, and enhanced areas of inflammation and abscess formation on MRI. Other benign lesions exhibited variable imaging findings across all modalities.
Management outcomes
Management strategies varied among different benign breast diseases. Watchful waiting was employed for 56.25% of fibroadenoma cases, 50% of cyst cases, and 25% of other benign lesions. Medication was primarily used for mastitis (87.5%) and, to a lesser extent, for cysts (16.67%) and other lesions (15%). Minimally invasive procedures were utilized in 25% of fibroadenomas, 25% of cysts, 12.5% of mastitis, and 40% of other lesions. Surgical intervention was necessary for 12.5% of fibroadenomas, 8.33% of cysts, and 20% of other lesions. Recurrence rates were 10% for fibroadenomas, 8.33% for cysts, 7.5% for mastitis, and 10% for other lesions.
Table 1: Demographic characteristics of patients with benign breast diseases
| Characteristic | Total patients (n = 200) | Fibroadenomas (n = 80) | Cysts (n = 60) | Mastitis (n = 40) | Other benign lesions (n = 20) |
| Age (y) | |||||
| -Mean±SD | 45.3±12.6 | 30.5±8.4 | 48.6±10.2 | 35.1±7.9 | 50.3±11.5 |
| -Range | 18-75 | 18-45 | 30-70 | 25-50 | 35-75 |
| Sex | |||||
| -Female | 198 (99%) | 79 (99%) | 60 (100%) | 39 (98%) | 20 (100%) |
| -Male | 2 (1%) | 1 (1%) | 0 (0%) | 1 (2%) | 0 (0%) |
| Family history of breast cancer | |||||
| -Yes | 45 (22.5%) | 18 (22.5%) | 15 (25%) | 8 (20%) | 4 (20%) |
| -No | 155 (77.5%) | 62 (77.5%) | 45 (75%) | 32 (80%) | 16 (80%) |
Table 2: Diagnostic accuracy of imaging modalities for benign breast diseases
| Imaging modality | Sensitivity (%) | Specificity (%) | Positive predictive value (%) | Negative predictive value (%) |
| Mammography | 85 | 78 | 82 | 80 |
| Ultrasound | 92 | 84 | 88 | 89 |
| MRI | 95 | 90 | 93 | 92 |
| Combined modalities | 98 | 92 | 96 | 95 |
Table 3: Distribution of benign breast disease types by imaging findings
| Disease type | Mammography findings | Ultrasound findings | MRI findings |
| Fibroadenomas (n = 80) | Well-circumscribed, round/oval masses, calcifications | Hypoechoic, well-defined margins | Homogeneous, well-defined enhancement patterns |
| Cysts (n = 60) | Round/oval, radiolucent, no calcifications | Anechoic, posterior enhancement, well-defined | Homogeneous, high signal intensity on T2-weighted images |
| Mastitis (n = 40) | Increased density, architectural distortion | Heterogeneous echotexture, possible abscesses | Enhanced areas of inflammation and abscess formation |
| Other Benign Lesions (n = 20) | Variable may mimic malignancy | Variable, complex cystic structures | Variable, depending on lesion type |
Table 4: Management outcomes of benign breast diseases
| Management strategy | Fibroadenomas (n = 80) | Cysts (n = 60) | Mastitis (n = 40) | Other benign lesions (n = 20) |
| Watchful waiting | 45 (56.25%) | 30 (50%) | 0 (0%) | 5 (25%) |
| Medication | 5 (6.25%) | 10 (16.67%) | 35 (87.5%) | 3 (15%) |
| Minimally invasive procedures | 20 (25%) | 15 (25%) | 5 (12.5%) | 8 (40%) |
| Surgical intervention | 10 (12.5%) | 5 (8.33%) | 0 (0%) | 4 (20%) |
| Recurrence rate | 8 (10%) | 5 (8.33%) | 3 (7.5%) | 2 (10%) |
DISCUSSION
This study underscores the critical role of various breast imaging modalities in diagnosing and managing benign breast diseases. The results highlight the unique strengths and limitations of mammography, ultrasound, and MRI, demonstrating how these tools can be employed synergistically to enhance diagnostic accuracy and patient outcomes [8].
Mammography, despite being the cornerstone of breast imaging, has certain limitations, particularly in younger women with dense breast tissue. Its sensitivity and specificity in our study were 85% and 78%, respectively, indicating its reliable but sometimes limited performance in differentiating benign from malignant lesions. The well-circumscribed, calcified masses observed in fibroadenomas and the radiolucent, round cysts on mammography illustrate its utility in detecting specific benign conditions [9].
Ultrasound emerged as a highly effective imaging modality, particularly beneficial in characterizing palpable masses and differentiating between cystic and solid lesions. With a sensitivity of 92% and specificity of 84%, ultrasound outperformed mammography in several aspects, especially for younger women and those with dense breast tissue. The detailed imaging of fibroadenomas, cysts, and mastitis underscores ultrasound's capability in providing critical diagnostic insights, aiding in guiding minimally invasive procedures like fine-needle aspiration and core needle biopsy [10].
MRI demonstrated the highest diagnostic accuracy among the individual modalities, with sensitivity and specificity reaching 95% and 90%, respectively. Its ability to offer detailed cross-sectional images without radiation exposure makes it particularly valuable in complex cases where other imaging results are inconclusive [11]. The homogeneous, well-defined enhancement patterns observed in fibroadenomas and the high signal intensity on T2-weighted images for cysts exemplify MRI's superior imaging capabilities. Furthermore, MRI's role in preoperative planning for complex benign lesions and its efficacy in evaluating multifocal or bilateral diseases highlight its expanding applications in breast imaging.
The combined use of these imaging modalities achieved the highest diagnostic performance, with sensitivity and specificity of 98% and 92%, respectively. This synergistic approach leverages the strengths of each modality, providing comprehensive diagnostic information that guides optimal management strategies for benign breast conditions [12].
Management outcomes varied significantly across different benign breast diseases. Watchful waiting was commonly employed for fibroadenomas and cysts, reflecting a conservative approach in cases where malignancy risk is low. Medication was primarily used for mastitis, addressing the inflammatory nature of the condition. Minimally invasive procedures and surgical interventions were selectively utilized based on the specific characteristics and clinical presentation of the lesions, with recurrence rates varying across the different conditions [13].
In conclusion, breast imaging modalities play an indispensable role in the diagnosis and management of benign breast diseases. The integration of mammography, ultrasound, and MRI facilitates early and accurate diagnosis, enabling tailored management strategies that improve patient outcomes. Future advancements in imaging technology and standardized protocols promise to further enhance the accuracy and reliability of breast imaging, contributing to better breast healthcare.
CONCLUSION
Breast imaging modalities are essential for the accurate diagnosis and effective management of benign breast diseases. The combined use of mammography, ultrasound, and MRI provides comprehensive diagnostic information, guiding optimal treatment strategies and improving patient outcomes. Continued advancements in imaging technology and standardized protocols will further enhance the diagnostic capabilities and reliability of these modalities.
FUNDING
Nil
AUTHORS CONTRIBUTIONS
All authors have contributed equally
CONFLICT OF INTERESTS
Declared none
REFERENCES
Guray M, Sahin AA. Benign breast diseases: classification diagnosis and management. Oncologist. 2006;11(5):435-49. doi: 10.1634/theoncologist.11-5-435, PMID 16720843.
Hayes WC, Piazza SJ, Zysset PK. Biomechanics of fracture risk prediction of the hip and spine by quantitative computed tomography. Radiol Clin North Am. 1991;29(1):1-18. doi: 10.1016/S0033-8389(22)02675-6.
Zheng B, Ganott MA, Britton CA, Hakim CM, Hardesty LA, Chang TS. Soft copy mammographic readings with different computer-assisted detection curing environments: preliminary findings. Radiology. 2001;221(3):633-40. doi: 10.1148/radiol.2213010308, PMID 11719657.
Orel SG, Schnall MD. MR imaging of the breast for the detection, diagnosis and staging of breast cancer. Radiology. 2001;220(1):13-30. doi: 10.1148/radiology.220.1.r01jl3113, PMID 11425968.
Sanders RC, Hartman DS. The sonographic distinction between neonatal multicystic kidney and hydronephrosis. Radiology. 1984;151(3):621-5. doi: 10.1148/radiology.151.3.6718720, PMID 6718720.
Stavros AT, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 1995;196(1):123-34. doi: 10.1148/radiology.196.1.7784555, PMID 7784555.
Heywang Kobrunner SH, Viehweg P, Heinig A, Kuchler C. Contrast-enhanced MRI of the breast: accuracy value controversies solutions. Eur J Radiol. 1997;24(2):94-108. doi: 10.1016/s0720-048x(96)01142-4, PMID 9097051.
American College of Radiology. ACR BI-RADS® atlas breast imaging reporting and data system. Reston VA: American College of Radiology; 2013.
Berg WA, Gutierrez L, Ness Aiver MS, Carter WB, Bhargavan M, Lewis RS. Diagnostic accuracy of mammography clinical examination US and MR imaging in preoperative assessment of breast cancer. Radiology. 2004;233(3):830-49. doi: 10.1148/radiol.2333031484, PMID 15486214.
Sardanelli F, Giuseppetti GM, Panizza P, Bazzocchi M, Fausto A, Simonetti G. Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in fatty and dense breasts using the whole breast pathologic examination as a gold standard. AJR Am J Roentgenol. 2004;183(4):1149-57. doi: 10.2214/ajr.183.4.1831149, PMID 15385322.
Baroni RH, Ashiku S, Boiselle PM. Dynamic CT evaluation of the central airways in patients undergoing tracheoplasty for tracheobronchomalacia. AJR Am J Roentgenol. 2005;184(5):1444-9. doi: 10.2214/ajr.184.5.01841444, PMID 15855094.
Kopans DB. Breast imaging. Lippincott Williams & Wilkins; 2007.
Lehman CD, Blume JD, Weatherall P, Thickman D, Hylton N, Warner E. Screening women at high risk for breast cancer with mammography and magnetic resonance imaging. Cancer. 2005;103(9):1898-905. doi: 10.1002/cncr.20971, PMID 15800894.