Sonographic focally thick duct of breast found in screening, why is it concerning? A report of three cases

Abstract

We report three cases of focally thickened ductal lesions found on screening ultrasonography with fine needle aspiration (FNA)-proven benign cytology in order to demonstrate the different fates of this radiographic finding. All three patients, aged 74, 69 and 68 years old, had their first time mammography and concurrent ultrasonography. Their mammograms did not show abnormalities except a focal asymmetry in one case. The sonographic focally thick ducts were the lesions of concern and all the patients had long-term follow-up. One patient had a slightly decreased lesion size on follow-up, likely to be a non-proliferative alteration of the breast. One patient’s FNA revealed a benign papillary lesion whose ductal diameter slightly increased in size with internal echo after two years with repeat FNA demonstrating epithelial papillae consistent with intraductal papilloma. The final patient had an alteration of the imaged ductal lesion in the third year of follow-up and the final specimen after surgical wide excision that was done in the fourth year confirmed cancer. We emphasize the importance of focally thickened ductal lesions found on screening sonography and underscore their need for scrutinized characterization and long term follow-up.