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Breast
Signs and Symptoms
Skin
Skin Thickening
Skin Thickening
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          TERMINOLOGY

          • Definitions

            • Skin thickening: Thickness > 2 mm
              • Can be focal or diffuse
              • Normal skin thicker in periareolar region, inframammary fold, parasternally, up to 3 mm
            • Peau d'orange = skin resembles peel of orange: Thickened, with prominent skin pores, often also erythematous
              • Implies lymphatic edema, usually seen with inflammatory carcinoma (involving ≥ 1/3 of breast)
            • Skin retraction: Skin is abnormally pulled in, tethered, concave, dimpled
            • Skin invasion: Tumor extends into skin, usually directly overlying tumor
              • Usually shows associated skin thickening
              • Skin retraction does not equal skin invasion

          IMAGING

          • Mammographic Findings

            • Ultrasonographic Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Staging, Grading, & Classification

                        CLINICAL ISSUES

                        • Presentation

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Image Interpretation Pearls

                              Selected References

                              1. Hasbahceci M et al: Use of imaging for the diagnosis of idiopathic granulomatous mastitis: A clinician's perspective. J Coll Physicians Surg Pak. 28(11):862-867, 2018
                              2. Kung TA et al: Radiation-induced skin changes after postmastectomy radiation therapy: A pilot study on indicators for timing of delayed breast reconstruction. J Reconstr Microsurg. ePub, 2018
                              3. Bitencourt AGV et al: Breast metastases from extramammary malignancies: multimodality imaging aspects. Br J Radiol. 90(1077):20170197, 2017
                              4. Dabi Y et al: Incidence of inflammatory breast cancer in patients with clinical inflammatory breast symptoms. PLoS One. 12(12):e0189385, 2017
                              5. van Uden DJP et al: Dynamic contrast-enhanced magnetic resonance imaging in the assessment of inflammatory breast cancer prior to and after neoadjuvant treatment. Breast Care (Basel). 12(4):224-229, 2017
                              6. Chesebro AL et al: Radiation-associated angiosarcoma of the breast: What the radiologist needs to know. AJR Am J Roentgenol. 207(1):217-25, 2016
                              7. Torres MA et al: The impact of axillary lymph node surgery on breast skin thickening during and after radiation therapy for breast cancer. Int J Radiat Oncol Biol Phys. 95(2):590-6, 2016
                              8. Morris EA et al: Breast Imaging Reporting and Data System: BI-RADS, Magnetic Resonance Imaging. 2nd ed. Reston: American College of Radiology, 2013
                              9. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                              10. Sickles EA et al: Breast Imaging Reporting and Data System: BI-RADS, Mammography. 5th ed. Reston: American College of Radiology, 2013
                              11. Uematsu T: MRI findings of inflammatory breast cancer, locally advanced breast cancer, and acute mastitis: T2-weighted images can increase the specificity of inflammatory breast cancer. Breast Cancer. 19(4):289-94, 2012
                              12. Kwak JY et al: Unilateral breast edema: spectrum of etiologies and imaging appearances. Yonsei Med J. 46(1):1-7, 2005
                              13. Günhan-Bilgen I et al: Inflammatory breast carcinoma: mammographic, ultrasonographic, clinical, and pathologic findings in 142 cases. Radiology. 223(3):829-38, 2002
                              14. Padhani AR et al: Magnetic resonance imaging of induration in the irradiated breast. Radiother Oncol. 64(2):157-62, 2002
                              15. Harris JR et al: Diseases of the Breast. Philadelphia: Lippincott Williams & Wilkins. 68-9, 1996
                              16. Sickles EA: Practical solutions to common mammographic problems: tailoring the examination. AJR Am J Roentgenol. 151(1):31-9, 1988
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Top Differential Diagnoses

                                    • Pathology

                                      TERMINOLOGY

                                      • Definitions

                                        • Skin thickening: Thickness > 2 mm
                                          • Can be focal or diffuse
                                          • Normal skin thicker in periareolar region, inframammary fold, parasternally, up to 3 mm
                                        • Peau d'orange = skin resembles peel of orange: Thickened, with prominent skin pores, often also erythematous
                                          • Implies lymphatic edema, usually seen with inflammatory carcinoma (involving ≥ 1/3 of breast)
                                        • Skin retraction: Skin is abnormally pulled in, tethered, concave, dimpled
                                        • Skin invasion: Tumor extends into skin, usually directly overlying tumor
                                          • Usually shows associated skin thickening
                                          • Skin retraction does not equal skin invasion

                                      IMAGING

                                      • Mammographic Findings

                                        • Ultrasonographic Findings

                                          • MR Findings

                                            • Imaging Recommendations

                                              DIFFERENTIAL DIAGNOSIS

                                                PATHOLOGY

                                                • General Features

                                                  • Staging, Grading, & Classification

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      • Treatment

                                                        DIAGNOSTIC CHECKLIST

                                                        • Image Interpretation Pearls

                                                          Selected References

                                                          1. Hasbahceci M et al: Use of imaging for the diagnosis of idiopathic granulomatous mastitis: A clinician's perspective. J Coll Physicians Surg Pak. 28(11):862-867, 2018
                                                          2. Kung TA et al: Radiation-induced skin changes after postmastectomy radiation therapy: A pilot study on indicators for timing of delayed breast reconstruction. J Reconstr Microsurg. ePub, 2018
                                                          3. Bitencourt AGV et al: Breast metastases from extramammary malignancies: multimodality imaging aspects. Br J Radiol. 90(1077):20170197, 2017
                                                          4. Dabi Y et al: Incidence of inflammatory breast cancer in patients with clinical inflammatory breast symptoms. PLoS One. 12(12):e0189385, 2017
                                                          5. van Uden DJP et al: Dynamic contrast-enhanced magnetic resonance imaging in the assessment of inflammatory breast cancer prior to and after neoadjuvant treatment. Breast Care (Basel). 12(4):224-229, 2017
                                                          6. Chesebro AL et al: Radiation-associated angiosarcoma of the breast: What the radiologist needs to know. AJR Am J Roentgenol. 207(1):217-25, 2016
                                                          7. Torres MA et al: The impact of axillary lymph node surgery on breast skin thickening during and after radiation therapy for breast cancer. Int J Radiat Oncol Biol Phys. 95(2):590-6, 2016
                                                          8. Morris EA et al: Breast Imaging Reporting and Data System: BI-RADS, Magnetic Resonance Imaging. 2nd ed. Reston: American College of Radiology, 2013
                                                          9. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                                                          10. Sickles EA et al: Breast Imaging Reporting and Data System: BI-RADS, Mammography. 5th ed. Reston: American College of Radiology, 2013
                                                          11. Uematsu T: MRI findings of inflammatory breast cancer, locally advanced breast cancer, and acute mastitis: T2-weighted images can increase the specificity of inflammatory breast cancer. Breast Cancer. 19(4):289-94, 2012
                                                          12. Kwak JY et al: Unilateral breast edema: spectrum of etiologies and imaging appearances. Yonsei Med J. 46(1):1-7, 2005
                                                          13. Günhan-Bilgen I et al: Inflammatory breast carcinoma: mammographic, ultrasonographic, clinical, and pathologic findings in 142 cases. Radiology. 223(3):829-38, 2002
                                                          14. Padhani AR et al: Magnetic resonance imaging of induration in the irradiated breast. Radiother Oncol. 64(2):157-62, 2002
                                                          15. Harris JR et al: Diseases of the Breast. Philadelphia: Lippincott Williams & Wilkins. 68-9, 1996
                                                          16. Sickles EA: Practical solutions to common mammographic problems: tailoring the examination. AJR Am J Roentgenol. 151(1):31-9, 1988