J Korean Soc Radiol.  2018 Dec;79(6):303-310. 10.3348/jksr.2018.79.6.303.

Incidental Breast Lesions on Chest CT: Clinical Significance and Differential Features Requiring Referral

• Choi YJ
• Kim TH
• Cha YJ
• Son EJ
• Gweon HM
• Park CH

• KMID: 2427377
• DOI: http://doi.org/10.3348/jksr.2018.79.6.303

Abstract

PURPOSE
To evaluate the CT features of incidental breast lesions on chest CT and to suggest useful criteria for referral to a specialized breast unit.
MATERIALS AND METHODS
Between May 2009 and April 2014, enhanced chest CT examination reports containing the key word "˜breast' were reviewed retrospectively. Patients who had incidental breast lesion and were referred to a specialized breast unit and then underwent pathological confirmation or follow-up over a 1-year period were included. Finally, 86 patients (all female, mean age, 48.9 ± 12.6 years) were enrolled. Two radiologists evaluated lesion characteristics, including size, shape, margins, and enhancement. The correlations between the CT features and pathologies were evaluated, and the diagnostic accuracy of CT features in various combinations was assessed.
RESULTS
Among the CT features, irregular shape, non-circumscribed margin, and high contrast enhancement were different between malignant and benign lesions (p < 0.05). The combination of non-circumscribed margin and high contrast enhancement had the highest accuracy (97.7%).
CONCLUSION
Reliable CT features for incidental malignant breast masses are irregular shape, non-circumscribed margin, and high contrast enhancement. The combination of non-circumscribed margin and high contrast enhancement could help distinguish incidental malignant breast lesions and indicate referral to a specialized breast unit.

MeSH Terms

Breast*
Female
Follow-Up Studies
Humans
Incidental Findings
Pathology
Referral and Consultation*
Retrospective Studies
Thorax*
Tomography, X-Ray Computed*

Figure

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  Fig. 1 Flow chart of patient selection.

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  Fig. 2 A 60-year-old woman underwent chest CT for a medical examination. A. Axial CT reveals a round, non-circumscribed mass with high contrast enhancement in the right upper medial quadrant of the breast. B. Two years later, tumor size increased from 8 mm to 10 mm. C. Sonography of the right breast at the corresponding location reveals hypoechoic mass with irregular margin. D. Pathological examination revealed infiltrative ductal carcinoma with desmoplastic stroma (hematoxylin-eosin stain, × 200).

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  Fig. 3 An 86-year-old woman underwent CT for a thyroid mass. A. Axial CT scan reveals a non-circumscribed, irregular mass with high contrast enhancement in the left upper medial quadrant of the breast. B. Sonography reveals a hypoechoic mass with irregular margin. C. Pathological examination revealed infiltrative ductal carcinoma (hematoxylin-eosin stain, × 200).

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