Objective: Our objective was to evaluate the mammographic and sonographic appearances of apocrine metaplasia and correlate imaging and histopathologic findings.
Materials and methods: Retrospective review of 408 lesions in 318 consecutive patients undergoing core needle biopsy (n = 370) or fine needle aspiration (n = 38) revealed 46 cases of apocrine metaplasia. In 17 of these cases, apocrine metaplasia represented more than 50% of the lesion sampled; these 17 lesions formed the basis for analysis.
Results: On mammography, all 17 cases appeared as new or enlarging equal-density (n = 15) or low-density (n = 2) masses with an average size of 12.8 mm. Borders were microlobulated in 59% (10/17), macrolobulated in 29% (5/17), and circumscribed or oval in 12% (2/17). Sonography revealed a lobulated mass containing a cluster of small (2- to 5-mm) anechoic foci and intervening septae in 77% (10/13) of cases. A discrete hypoechoic solid component was seen in 23% of cases (3/13). Posterior acoustic enhancement was seen in 85% of cases (11/13). In 65% of lesions (11/17), we noted a decrease in size or total resolution during biopsy or fine needle aspiration. Histopathologic examination showed the typical appearance of dilated cystic acini lined by apocrine metaplastic epithelium.
Conclusion: On mammography, the combined findings of an equal- or low-density microlobulated or lobulated mass that corresponds on sonography to a cluster of small (2- to 5-mm) anechoic foci with intervening septae should suggest the diagnosis of focal apocrine metaplasia. With radiologists' increasing experience, follow-up, rather than biopsy, of such typical-appearing lesions may be adequate.