# Clinical-radiologic-pathologic characterization of diabetic mastopathy: an analysis of 21 cases

## TL;DR

This study analyzes 21 cases of diabetic mastopathy to identify unique ultrasound features that can help distinguish it from breast cancer and reduce unnecessary surgeries.

## Contribution

The study highlights the 'absence of space-occupying effect' on ultrasound as a novel diagnostic clue for diabetic mastopathy.

## Key findings

- Ultrasound features of DMP include irregular margins, posterior shadowing, and absence of space-occupying effect.
- Mammography often shows benign findings, while ultrasound appears suspicious, creating a diagnostic paradox.
- Surgical excision was performed in 76.2% of cases, with a 23.1% recurrence rate.

## Abstract

To characterize the clinic-radiologic features of diabetic mastopathy (DMP), with a focus on distinctive ultrasound findings that may aid in differential diagnosis and reduce unnecessary interventions.

A retrospective multicenter analysis was performed on 21 pathologically confirmed DMP lesions from 17 patients (2014–2024). Mammographic and ultrasonographic features were independently assessed by two radiologists according to the Breast Imaging Reporting and Data System (BI-RADS, 5th edition). Clinical data including diabetes history were reviewed.

The median patient age was 58 years, with a median diabetes duration of 23.3 years. Most patients presented with a palpable mass (94.1%). Mammography showed probably benign findings (BI-RADS 3) in 73.7% of lesions, with an additional 10.5% assessed as benign (BI-RADS 2). In contrast, ultrasound revealed suspicious features: all mass-forming lesions had irregular margins (100%), 89.5% showed posterior shadowing, and critically, 78.9% demonstrated an infiltrative growth pattern with an absence of space-occupying effect. One atypical case presented with bilateral ductal dilation. Core needle biopsy yielded a specific DMP diagnosis in only 68.4% of lesions. Surgical excision was performed in 76.2% of lesions, with recurrence in 23.1% during a median follow-up of 33.5 months.

DMP presents a diagnostic paradox of benign mammographic but suspicious sonographic appearances. The characteristic “absence of space-occupying effect” on ultrasound is a key differentiating feature from breast carcinoma. Recognizing this sign, along with atypical patterns like ductal dilation, can increase pre-biopsy diagnostic suspicion in patients with long-standing diabetes, potentially guiding more conservative management. Histopathological confirmation remains essential.