Virginia Commonwealth University Breast Imaging

Woman watering plants.

Common Diagnoses

Following a breast imaging procedure, you may be diagnosed with one of the following conditions or we may recommend further evaluation.

Lymph Nodes

Lymph nodes are normal structures found underneath the arms and commonly in the breasts, as well as other areas of the body, and serve as filters that help fight infections. In women with breast cancer, cancer cells can sometimes be found in the lymph nodes, which is why they are sampled using a needle or removed at the time of surgery for a sentinel lymph node biopsy. Evaluation of the lymph nodes under the arm is done as part of staging a breast cancer to determine the extent of the cancer.

Cysts

Cysts are fluid pockets commonly found in normal breast tissue, particularly around the time of menopause. They can produce a lump that can fluctuate in size and associated tenderness with the menstrual cycle, but many produce no symptoms and are found during mammography and ultrasound. Cysts are considered benign and do not turn into cancer. Having cysts does not increase your risk for breast cancer.

A mammogram view of possible cysts.

A round lump (arrows) or mass, is seen on the mammogram. An ultrasound is done to determine if this is a fluid-filled cyst. The diagnosis of a cyst cannot be established on physical examination or with mammography alone.

An ultrasound of fluid-filled cysts.

On ultrasound, fluid-filled cysts are characterized as “black holes” (arrows) with sharp (circumscribed) borders. Also note the whiteness deep to the black hole this is called posterior acoustic enhancement and is a feature of most cysts.

Fibroadenomas

These benign tumors are common in women in their 30s and 40s; approximately 20 percent of patients have multiple fibroadenomas. They can produce a lump that can fluctuate in size and associated tenderness with the menstrual cycle, but many produce no symptoms and are found during mammography and ultrasound. After menopause, fibroadenomas may decrease in size and develop calcifications. They do not turn into cancer and do not increase your risk for breast cancer.

An ultrasound view.

A lump (arrows) or mass is seen with sharp (circumscribed) margins. An ultrasound is done to determine if this is a fluid-filled cyst or solid.

An ultrasound of possible fibroadenomas.

Ultrasound is used to further characterize palpable and mammographic findings. Compared with cysts, fibroadenomas are not jet black inside but gray (arrows), and the borders are sharp. Masses with the mammographic and sonographic features shown here are unlikely to represent breast cancer; however, if there is any question or concern, a biopsy can be done to determine the nature of the mass. Six-month follow up with ultrasound to assure that the mass is stable is a good alternative in some patients with these findings.

A view of a fibroadenoma mass.

A fibroadenoma (arrows) is present with dense, coarse calcifications (double arrows). These types of calcifications are distinctive and when seen, whether alone or in a mass, a biopsy is not needed.

Papillomas

Papillomas are benign tumors that are like little polyps that develop in milk ducts. They may produce nipple discharge — and in fact are the most common cause of spontaneous nipple discharge — but do not usually produce a lump.

A view of possible papillomas.

In this patient, contrast outlines (single arrows) a duct that is wider than normal (dilated), and the contrast column is disrupted by the presence of a tumor (double arrow). About half of the patients presenting with spontaneous nipple discharge are found to have papillomas, which are benign, non-cancerous tumors. The tiny, blunt-tipped needle used to inject the contrast is seen at the edge of the film (wide arrow).

Atypical Ductal Hyperplasia (ADH)

ADH is considered a premalignant lesion. If diagnosed on a core biopsy, an excisional (surgical) biopsy is recommended. ADH is commonly diagnosed on needle biopsies done for microcalcifications detected on a mammogram.

Lobular Carcinoma In Situ (LCIS)

Unlike ductal carcinoma in situ, LCIS is not considered to be true cancer, but a risk marker lesion. Patients with LCIS are at an increased risk for the subsequent development of breast cancer, with the risk applying equally to both breasts.

Ductal Carcinoma In Situ (DCIS)

DCIS is an early form of breast cancer situated inside the milk duct. In this type of cancer, deposits of calcium develop in the duct and these deposits can be seen on a mammogram.

A view of ductal carcinoma in situ.

Ductal carcinoma in situ typically presents with microcalcifications (arrows) that are linear and often demonstrate a linear orientation, as in this patient. This is cancer that is contained in the milk ducts and precedes the development of a lump or mass and invasive cancer. The ability to identify this early form of breast cancer is one of the main benefits of mammography.

Invasive Ductal Carcinoma

The most common type of tumor, invasive ductal carcinoma makes up 65 percent of all breast cancers. It typically presents as a lump that may be detected on physical examination or with mammography, ultrasound or MRI.

A view of invasive ductal carcinoma.

A mass (single arrows) with indistinct and spiculated borders (double arrows). Compare this appearance with that shown for the cyst and fibroadenoma. Indistinct and spiculated margins as shown here are suggestive of invasive ductal carcinoma, the most common type of breast cancer.

An ultrasound view of a mass.

A mass (arrows) with indistinct and spiculated margins is seen corresponding to the mammographic finding. The black appearance seen deep to the mass is called “shadowing” and is a feature of some cancers. If the mass is seen on ultrasound, an ultrasound-guided biopsy can be done easily and expeditiously.

Invasive Lobular Carcinoma

Invasive lobular carcinoma is a less common type of cancer that makes up 10 percent of all breast cancers. It can be subtle in presentation and may not be apparent on physical examination or mammography.

A view of invasive lobular carcinoma.

In this patient, the changes related to breast cancer are not as obvious in that there is no mass or lump, or microcalcifications, but rather the right breast is smaller than the left and there is a subtle increase in the density compared with the left. Invasive lobular carcinoma is often more subtle in its appearance, compared with invasive ductal carcinoma. There are also some scattered benign calcifications.

Mucinous Carcinoma

Also called colloid carcinoma, mucinous carcinoma represents approximately 2 percent of all breast cancers. A subtype of invasive ductal carcinoma, it commonly presents as a mass detected mammographically. The cancer cells are surrounded by mucoid material.

Inflammatory Carcinoma

Inflammatory carcinoma is a rare form of invasive ductal carcinoma; its presentation simulates a mastitis, or infection. The breast is usually not very tender, but is swollen, red and warmer compared with the other breast, while the skin is stretched and thickened similar to an orange peel. Most patients also have enlarged axillary lymph nodes.

“Just very attentive and cordial to me; remembered me from my last visit. Very patient.”

– Excerpt from a VCU Breast Imaging patient satisfaction survey.

Virginia Commonwealth University Medical Center VCU Breast Imaging