AB195. SOH26AB_0227. The evolving face of fat necrosis in breast radiology—a pictorial review

Background: Fat necrosis is a common entity which poses a significant diagnostic challenge to both clinicians and radiologists. It is a benign pathology that can present as a sequelae of trauma, surgery, or cosmetic procedures. Presenting symptoms and radiological findings depend on the stage of evolution. This pictorial review aims to highlight some of the diagnostic challenges related to the evolving appearance of fat necrosis and provide some practical tips to support safe and accurate radiological assessment.

Methods: We present a comprehensive series of breast imaging demonstrating the temporal evolution of fat necrosis from acute to chronic stages. Common, atypical, and misleading presentations were selected for presentation. Only cases with pathological confirmation via biopsy were chosen for incorporation in the presentation.

Results: Our review demonstrates the varying presentations of fat necrosis from benign patterns like oil cysts or mammographic findings that resemble spiculated masses with architectural distortion. This has allowed the creation of a repository of radiological characteristics that should increase diagnostic certainty and reduce unnecessary biopsies.

Conclusions: Fat necrosis remains a challenging diagnosis due to its variable and evolving radiological and clinical appearance. By developing this pictorial review, we highlight the importance of pattern recognition, clinical history, and correlation of radiographic findings across different modalities. Increased awareness of these characteristics can improve patient care, avoid over-investigation, and ensure safe practice for breast radiologists and patients.

Keywords: Biopsy; breast; fat; necrosis; radiology