Differentials
Fibrocystic changes
SIGNS / SYMPTOMS
Unlike breast cancer, fibrocystic changes are typically symmetric and are associated with cyclic breast pain, which worsens in the luteal phase of menses.[166]
Unlike the incidence of breast cancer, which increases with age, fibrocystic disease usually resolves at menopause.
INVESTIGATIONS
Ultrasound scan can differentiate cysts from solid lesions.
If necessary, biopsy of the involved area will confirm the diagnosis.
Fibroadenoma
SIGNS / SYMPTOMS
Like fibrocystic changes, fibroadenomas tend to worsen during periods of elevated estrogen levels (such as pregnancy) and decline in size during menopause.
Palpation of a fibroadenoma reveals a smooth, well-demarcated and mobile mass.[167]
INVESTIGATIONS
Ultrasound scans may be able to distinguish between a fibroadenoma (defined, oval contour) and a breast carcinoma (which may have ill-defined margins).
Core biopsy provides a pathologic diagnosis.
Excision biopsy reveals fibroadenomas as well-delineated bosselated tumors, easily separated from surrounding breast tissue, and with a shiny and bulging surface on section.
Histologic analysis shows regular epithelial cells lining the duct-like structures, mixed with pale stroma.
Mastitis
SIGNS / SYMPTOMS
Mastitis tends to affect a specific population: lactating women or women who have had a recent breast surgery.
Physical exam finds an erythematous, tender, and swollen breast.
Unlike inflammatory breast cancer, mastitis is also typically associated with systemic signs and symptoms of infection, such as high fevers, chills, and influenza-like symptoms.
Antibiotic treatment of the underlying infection leads to resolution of these signs and symptoms.
INVESTIGATIONS
Imaging studies demonstrate no underlying mass.
The clinical presentation and response to antimicrobial agents will usually sufficiently differentiate these conditions.
Skin biopsy (if needed) will show no evidence of tumor cells within the dermal lymphatics.
Fat necrosis
SIGNS / SYMPTOMS
History of prior breast trauma, surgical reduction, or augmentation.
INVESTIGATIONS
May closely resemble carcinoma on mammographic and ultrasound imaging; biopsy shows fat necrosis.
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