Rationale and Objectives
Adenoid cystic carcinoma (ACC) of the breast is a rare type of breast cancer with
favorable prognosis. There is limited data on the radiological findings of this rare
tumor in literature. The aim of this study is to determine the most common imaging
features and review the literature.
Materials and Methods
Pathological databases of seven institutions from 2009 to 2021 were retrospectively
reviewed, and patients with a diagnosis of ACC of the breast were determined. Thirteen
patients whose imaging studies could be recalled from the picture archiving systems
(PACS) were included in the study. Clinical and pathological findings as well as follow-up
data were recorded. Radiological findings were analyzed and categorized based on BI-RADS
5th edition.
Results
There were 16 mass lesions in 13 patients (two multifocal cases, one case with recurrence).
Mammography demonstrated 14 masses, while ultrasound (US) demonstrated all. MRI was
available in only seven cases, with eight masses. The most common findings were round
or oval shape on all modalities (78.57%–93.75%). Other frequent findings were parallel
orientation (81.25%), isoechoic or hyperechoic echogenicity (62.5%), high T2 signal
(87.5%), restricted diffusion (71.43%), and homogeneous enhancement (62.5%). Mammography,
US and MRI showed circumscribed margins resembling a benign lesion in 35.71%, 37.5%
and 50% of the lesions respectively. Three patients had a cyst-like echogenicty on
US. Half of the lesions were avascular on Doppler US (6/12) and half were soft (2/4)
on strain elastography. Although there were benign features on all imaging modalities
seperately, all lesions could be categorized as BI-RADS 4 or 5 when the findings were
combined. However 9/16 masses were BI-RADS 4A, emphasizing the subtlety of the malignant
features.
Conclusion
ACC of the breast can present with findings resembling a benign lesion on different
imaging modalities. Although combination of all imaging findings correctly indicated
the suspicious nature of the lesions in all cases, final classification was BI-RADS
4A in most of them. Radiologists should be aware of the more frequent findings of
ACC of the breast for early diagnosis. US findings of isoechoic or hyperechoic appearance,
and cyst-like echogenicity have not been reported previously in literature.
Key Words
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Article info
Publication history
Published online: November 07, 2022
Accepted:
October 1,
2022
Received in revised form:
September 25,
2022
Received:
August 16,
2022
Identification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
