The Significance of Computed Tomography–Detected Breast Lesions

Introduction:With ever-increasing computed tomography (CT) utilisation, more breast lesions are incidentally detected.We sought to investigate the yield of undiagnosed cancers from incidental CT-detected breast lesions.Imaging features were compared with the pathological diagnoses.Methods: A retrospective analysis of CT examinations in a regional hospital in Hong Kong between January 2018 and December 2020 was performed.Patients without a history of breast diseases whose CT reports contained the keyword 'breast' and who were referred for a formal breast examination were included.Two radiologists reviewed the CT reports and lesion characteristics were recorded.The diagnostic accuracy of different CT features was evaluated.Results: A total of 219 breast lesions were included.Forty-eight lesions (21.9%) were malignant.Patients with malignant diagnoses were older in age than those with benign diagnoses (mean age: 67.58 vs. 56.60 years; p = 0.05).Spiculation, irregularity, rim and heterogeneous enhancement, as well as the presence of abnormal lymph nodes were useful in predicting malignancy.Lesion size and presence of calcifications were not useful for predicting the pathological diagnosis.Conclusion: More than 20% of breast lesions detected incidentally in CT examinations were malignant.The presence of spiculation and irregularity were positive predictive factors.A careful review of the breasts on CT studies including the chest should always be part of routine practice.