Background: Vascular lesions of the breast are uncommon and include benign and malignant entities that may be incidentally detected on imaging or associated with specific clinical settings. Elements of the patient’s clinical history, such as pregnancy/lactation or history of treated breast cancer, are important when considering a vascular lesion. The imaging features of benign vascular lesions are often nonspecific and may overlap with both other vascular lesions and non-vascular lesions such as lipomas, fat necrosis, fibroadenomas, and cysts. We will review multimodality imaging appearances of benign and malignant vascular lesions in the breast, offer tips for correlation across modalities, review radiologic-pathologic concordance, and review appropriate management recommendations after biopsy reveals a vascular lesion.
Learning Objectives: Review normal breast vascular anatomy.
Review benign and malignant vascular lesions in the breast, including natural history, typical clinical presentation, and associated features.
Review typical imaging features on mammogram, ultrasound, and magnetic resonance imaging (MRI).
Review appropriate radiology-pathology concordance assessment and management recommendations.
Abstract Content/Results: Our content will include a pictorial review of normal breast vascular anatomy and variants. In addition, we will present a pictorial review of breast vascular lesions including at least: Hemangioma Angiolipoma Angiolymphatic malformation and/or AVM Superficial thrombophlebitis/Mondor’s disease Atypical vascular lesion Primary and secondary (radiation-induced) angiosarcoma
Multiple modalities where applicable (ultrasound, mammography, and MRI) will be presented for most vascular lesions with pathology results from both core needle and surgical excisional biopsies, when performed. Key imaging features as well as uncommon presentations will be reviewed. Imaging will be accompanied by pathology findings/slides and review of appropriate next-step management.
Conclusion: Vascular lesions are uncommon in the breast but may cause confusion due to their nonspecific appearance. Breast imagers should be aware of vascular lesions to avoid misinterpretation, especially when correlating findings seen on MRI with MR-directed ultrasound. While definitive diagnosis is often histopathological, a key role of multimodal imaging is to identify potentially malignant features for guidance towards biopsy and to biopsy using the least invasive approach. Familiarity with breast vascular lesions and synthesis of imaging findings with clinical history will also avoid biopsy of benign entities and will allow appropriate rad-path concordance assessment and management of atypical and malignant vascular entities.
