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Fibrocystic Change
Nicole S. Winkler, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Fibrocystic change (FCC): Spectrum of histopathologic changes, including cysts, fibrosis, apocrine metaplasia (AM), Ca⁺⁺, chronic inflammation, sclerosing adenosis (SA), and epithelial hyperplasia
                  • Cysts can be gross or microscopic
                • AM: Epithelial cells demonstrating secretory changes with abundant eosinophilic cytoplasm
                • Adenosis: Enlarged lobules with ↑ number of acini (tubules)
                • Usual ductal hyperplasia (UDH): > 1 layer of epithelial cells of variable morphology, no secondary spaces
                • Fibrosis: Densely collagenized stroma
                • SA: Adenosis around central duct with stromal sclerosis compressing duct lumina
                • Avoid term fibrocystic disease, as FCC is within spectrum of normal variation

              IMAGING

              • General Features

                • Mammographic Findings

                  • Ultrasonographic Findings

                    • MR Findings

                      • Image-Guided Biopsy

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Demirdover C et al: Is histological evaluation of reduction mammaplasty specimens worthwhile? Aesthet Surg J. ePub, 2018
                                          2. Oligane HC et al: Grouped amorphous calcifications at mammography: frequently atypical but rarely associated with aggressive malignancy. Radiology. 288(3):671-679, 2018
                                          3. Milosevic ZC et al: Breast dynamic contrast enhanced mri: fibrocystic changes presenting as a non-mass enhancement mimicking malignancy. Radiol Oncol. 51(2):130-6, 2017
                                          4. Berg WA et al: Quantitative maximum shear-wave stiffness of breast masses as a predictor of histopathologic severity. AJR Am J Roentgenol. 205(2):448-55, 2015
                                          5. diFlorio-Alexander RM et al: Breast MRI-detected cystic apocrine metaplasia: imaging features with microvessel analysis and histologic correlation. AJR Am J Roentgenol. 204(1):211-8, 2015
                                          6. Ochi M et al: Diffusion-weighted imaging (b value = 1500 s/mm(2)) is useful to decrease false-positive breast cancer cases due to fibrocystic changes. Breast Cancer. 20(2):137-44, 2013
                                          7. Lee SJ et al: MRI features of stromal fibrosis of the breast with histopathologic correlation. AJR Am J Roentgenol. 197(3):755-62, 2011
                                          8. Berg WA et al: Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am. 48(5):931-87, 2010
                                          9. Chen JH et al: Magnetic resonance imaging features of fibrocystic change of the breast. Magn Reson Imaging. 26(9):1207-1314, 2008
                                          10. Daly CP et al: Complicated breast cysts on sonography: is aspiration necessary to exclude malignancy? Acad Radiol. 15(5):610-7, 2008
                                          11. Chang YW et al: Sonographic differentiation of benign and malignant cystic lesions of the breast. J Ultrasound Med. 26(1):47-53, 2007
                                          12. Collins LC et al: The influence of family history on breast cancer risk in women with biopsy-confirmed benign breast disease: results from the Nurses' Health Study. Cancer. 107(6):1240-7, 2006
                                          13. Liberman L et al: Does size matter? Positive predictive value of MRI-detected breast lesions as a function of lesion size. AJR Am J Roentgenol. 186(2):426-30, 2006
                                          14. Berg WA: Sonographically depicted breast clustered microcysts: is follow-up appropriate? AJR Am J Roentgenol. 185(4):952-9, 2005
                                          15. Berg WA et al: Cystic lesions of the breast: sonographic-pathologic correlation. Radiology. 227(1):183-91, 2003
                                          16. Leung JW et al: Utility of targeted sonography in the evaluation of focal breast pain. J Ultrasound Med. 21(5):521-6; quiz 528-9, 2002
                                          17. Shetty MK et al: Sonographic findings in focal fibrocystic changes of the breast. Ultrasound Q. 18(1):35-40, 2002
                                          18. Berg WA et al: Biopsy of amorphous breast calcifications: pathologic outcome and yield at stereotactic biopsy. Radiology. 221(2):495-503, 2001
                                          19. Leung JW et al: Multiple bilateral masses detected on screening mammography: assessment of need for recall imaging. AJR Am J Roentgenol. 175(1):23-9, 2000
                                          20. Dupont WD et al: Breast cancer risk associated with proliferative breast disease and atypical hyperplasia. Cancer. 71(4):1258-65, 1993
                                          21. Nomura A et al: Epidemiologic characteristics of benign breast disease. Am J Epidemiol. 105(6):505-12, 1977
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Definitions

                                                        • Fibrocystic change (FCC): Spectrum of histopathologic changes, including cysts, fibrosis, apocrine metaplasia (AM), Ca⁺⁺, chronic inflammation, sclerosing adenosis (SA), and epithelial hyperplasia
                                                          • Cysts can be gross or microscopic
                                                        • AM: Epithelial cells demonstrating secretory changes with abundant eosinophilic cytoplasm
                                                        • Adenosis: Enlarged lobules with ↑ number of acini (tubules)
                                                        • Usual ductal hyperplasia (UDH): > 1 layer of epithelial cells of variable morphology, no secondary spaces
                                                        • Fibrosis: Densely collagenized stroma
                                                        • SA: Adenosis around central duct with stromal sclerosis compressing duct lumina
                                                        • Avoid term fibrocystic disease, as FCC is within spectrum of normal variation

                                                      IMAGING

                                                      • General Features

                                                        • Mammographic Findings

                                                          • Ultrasonographic Findings

                                                            • MR Findings

                                                              • Image-Guided Biopsy

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Demirdover C et al: Is histological evaluation of reduction mammaplasty specimens worthwhile? Aesthet Surg J. ePub, 2018
                                                                                  2. Oligane HC et al: Grouped amorphous calcifications at mammography: frequently atypical but rarely associated with aggressive malignancy. Radiology. 288(3):671-679, 2018
                                                                                  3. Milosevic ZC et al: Breast dynamic contrast enhanced mri: fibrocystic changes presenting as a non-mass enhancement mimicking malignancy. Radiol Oncol. 51(2):130-6, 2017
                                                                                  4. Berg WA et al: Quantitative maximum shear-wave stiffness of breast masses as a predictor of histopathologic severity. AJR Am J Roentgenol. 205(2):448-55, 2015
                                                                                  5. diFlorio-Alexander RM et al: Breast MRI-detected cystic apocrine metaplasia: imaging features with microvessel analysis and histologic correlation. AJR Am J Roentgenol. 204(1):211-8, 2015
                                                                                  6. Ochi M et al: Diffusion-weighted imaging (b value = 1500 s/mm(2)) is useful to decrease false-positive breast cancer cases due to fibrocystic changes. Breast Cancer. 20(2):137-44, 2013
                                                                                  7. Lee SJ et al: MRI features of stromal fibrosis of the breast with histopathologic correlation. AJR Am J Roentgenol. 197(3):755-62, 2011
                                                                                  8. Berg WA et al: Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am. 48(5):931-87, 2010
                                                                                  9. Chen JH et al: Magnetic resonance imaging features of fibrocystic change of the breast. Magn Reson Imaging. 26(9):1207-1314, 2008
                                                                                  10. Daly CP et al: Complicated breast cysts on sonography: is aspiration necessary to exclude malignancy? Acad Radiol. 15(5):610-7, 2008
                                                                                  11. Chang YW et al: Sonographic differentiation of benign and malignant cystic lesions of the breast. J Ultrasound Med. 26(1):47-53, 2007
                                                                                  12. Collins LC et al: The influence of family history on breast cancer risk in women with biopsy-confirmed benign breast disease: results from the Nurses' Health Study. Cancer. 107(6):1240-7, 2006
                                                                                  13. Liberman L et al: Does size matter? Positive predictive value of MRI-detected breast lesions as a function of lesion size. AJR Am J Roentgenol. 186(2):426-30, 2006
                                                                                  14. Berg WA: Sonographically depicted breast clustered microcysts: is follow-up appropriate? AJR Am J Roentgenol. 185(4):952-9, 2005
                                                                                  15. Berg WA et al: Cystic lesions of the breast: sonographic-pathologic correlation. Radiology. 227(1):183-91, 2003
                                                                                  16. Leung JW et al: Utility of targeted sonography in the evaluation of focal breast pain. J Ultrasound Med. 21(5):521-6; quiz 528-9, 2002
                                                                                  17. Shetty MK et al: Sonographic findings in focal fibrocystic changes of the breast. Ultrasound Q. 18(1):35-40, 2002
                                                                                  18. Berg WA et al: Biopsy of amorphous breast calcifications: pathologic outcome and yield at stereotactic biopsy. Radiology. 221(2):495-503, 2001
                                                                                  19. Leung JW et al: Multiple bilateral masses detected on screening mammography: assessment of need for recall imaging. AJR Am J Roentgenol. 175(1):23-9, 2000
                                                                                  20. Dupont WD et al: Breast cancer risk associated with proliferative breast disease and atypical hyperplasia. Cancer. 71(4):1258-65, 1993
                                                                                  21. Nomura A et al: Epidemiologic characteristics of benign breast disease. Am J Epidemiol. 105(6):505-12, 1977