Introduction
Ultrasonography (US) has been playing an increasingly important role in the evaluation of breast cancer. US is useful in the evaluation of palpable masses that are mammographically occult, in the evaluation of clinically suspected breast lesions in women younger than 30 years of age, and in the evaluation of many abnormalities seen on mammograms.
Mammography is a well-defined and widely accepted technique for evaluating clinically suspected breast lesions and for screening for breast cancer. The widespread use of physical examination of the breast and of mammography has decreased breast cancer mortality rates. Some breast imagers believe that US is the primary modality for the evaluation of palpable masses in women 30 years of age and older and that mammography plays an adjunctive technique. US is also useful in the guidance of biopsies and therapeutic procedures; research is currently under way to evaluate its role in cancer screening.
Originally, ultrasonography was primarily used as a relatively inexpensive and effective method of differentiating cystic breast masses from solid breast masses. However, it is now well established that US also provides valuable information about the nature and extent of solid masses and other breast lesions.
Ultrasonography does not expose a patient to ionizing radiation — a factor that is particularly important for pregnant patients and young patients. It is believed that in these patients, the breast is more sensitive to radiation; this would mean that in comparison with US, mammography would be associated with a slight increase in the small risk of acquiring radiation-induced neoplasm. Furthermore, young women's breasts tend to appear dense on mammograms — a factor that reduces the diagnostic sensitivity of mammography in this group. In addition, breast US is superior to mammography in the evaluation of breast abscesses.1,2,3
The role of US in the screening of specific groups of patients, such as those with mammographically dense breasts and those at high risk for breast carcinoma, is under investigation. The role of breast magnetic resonance imaging (MRI) is also expanding and is under study.
In many cases, US provides an efficient and effective way to guide interventional procedures.
For excellent patient education resources, visit eMedicine's Imaging Center and Cancer and Tumors Center. Also, see eMedicine's patient education articles Mammogram, Breast Cancer, and Breast Lumps and Pain.
Related eMedicine topics:
Breast Cancer
Breast Cancer Evaluation
Breast Cancer, Mammography
Related Medscape topics:
Specialty Site Radiology
Specialty Site Oncology
CME ASCO 2008: Breast Cancer in Older Women
CME SABCS 2007: Early Stage Breast Cancer
Role of Ultrasonography in Screening
Although mammography is an effective screening tool, data suggest that it is often less sensitive in detecting cancer in mammographically dense breast tissue. Kolb et al and Buchberger et al found that, when performed carefully, ultrasonography may be useful in detecting occult breast cancer in dense breasts.4,5 US is generally acknowledged to be a highly operator dependent modality that requires a skilled practitioner, high-quality examinations, and state-of-the-art equipment. In view of the results of these studies, a prospective, multicenter study is clearly needed to examine the role of US in breast cancer screening (see Images 1, 4, 7, 10, 14, 18, 19, 22, 24, 33, 34, 38).
To meet this need, a large multicenter study supported by the Avon Foundation and the National Institutes of Health was created through the American College of Radiology Imaging Network (ACRIN).6 In this project, a protocol to assess the efficacy of screening breast US is being implemented in 14 imaging centers to better define the role of US in breast cancer screening. (More information is available on the ACRIN Web site.) The results are anticipated to better define the appropriate role of screening US.
Currently, it is recommended that the use of US in screening for breast disease be reserved for special situations, such as for highly anxious patients who request it and for women who have a history of mammographically occult carcinoma.
As of January 2004, the use of US for screening for breast disease has not been generally recommended for high-risk women with dense breasts. Although some research projects have reported reasonable results from US breast screening, a number of serious issues need to be solved before the practice is recommended for general application. Factors include interobserver variability, intraobserver variability, unknown sensitivity, and low specificity (leading to numerous biopsy evaluations of benign lesions). Additional studies are needed before widespread, routine US screening of mammographically dense breasts is recommended.7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31
Breast Imaging Reporting and Data System
As mentioned, ultrasonography is highly operator dependent. Therefore, its efficacy depends on obtaining images that are of high technical quality, on interpreting those images correctly, and on clearly reporting the results.
Baker et al and Rahbar et al demonstrated that observer variability varies considerably in the description and assessment of solid masses demonstrated on sonograms.32,33 More uniform and more clearly understandable examination reports are needed to improve patient care and to facilitate research in the use of breast US.
Mendelsohn et al published the results of their initial work in creating a standardized breast US lexicon.34 In 2003, the American College of Radiology (ACR) published the Breast Imaging Reporting and Data System (BI-RADS) Atlas.35 This document is an extended version of the Third Edition of the BI-RADS lexicon used in mammography. The BI-RADS Atlas includes new sections on breast US (ACR BI-RADS–US) and MRI (ACR BI-RADS–MRI). ACR BI-RADS–US may help standardize the terms used for characterizing and reporting lesions, thereby facilitating patient care, the characterization of lesions, and the development of possible screening applications.
ACR BI-RADS–US provides terms that describe the following features or findings on breast US examinations: shape, orientation, margin, boundary, echo pattern, posterior acoustic features, and surrounding tissue for masses; breast calcifications (which are poorly characterized by US); special cases, such as complicated cysts and intramammary lymph nodes; vascularity; and assessment categories.
ACR BI-RADS–US describes 7 assessment categories. One category is for lesions that are incompletely characterized and for which further imaging is needed for final assessment. The 6 other assessment categories have implications on patient care.36
Distinguishing Benign Masses from Malignant Masses
Originally, ultrasonography was primarily used to distinguish simple cysts, which did not require sampling, from solid masses that were usually examined with biopsy. In many cases, the results of these biopsies were benign. Improving equipment and scanning techniques have helped expand the applications of breast US. Linear-array high-frequency (7.5 MHz or higher center frequency) transducers are generally used. Recent innovations include electronically steered compound imaging and tissue harmonic imaging. Contrast-enhanced Doppler US and 3-dimensional imaging are experimental techniques that are under investigation (see Images 2, 3, 5, 6, 8, 9, 11-13, 15-17, 20, 21, 23, 25, 26-32, 35-37, 39, 40).37,38,39,40
Classification of benign, indeterminate, and malignant nodules
In a landmark study published in 1995, Stavros et al established US criteria for characterizing solid breast masses.41 This work was facilitated by evolving technical improvements in US equipment that provided better resolution and images. They demonstrated that US may be used to accurately classify some solid lesions as benign, allowing follow-up with imaging rather than biopsy. They used high-resolution transducers, which were state-of-the-art at that time, and performed examinations in both radial and antiradial planes. The investigators also focused on the evaluation of suspected areas in the transverse and longitudinal planes.
Stavros et al proposed a US scheme for prospectively classifying breast nodules into 1 of 3 categories: benign, indeterminate, or malignant.41
To be classified as benign, a nodule had to have no malignant characteristics; in addition, 1 of the following 3 combinations of benign characteristics had to be demonstrated: (1) intense uniform hyperechogenicity; (2) ellipsoid or wider-than-tall (parallel) orientation, along with a thin, echogenic capsule; or (3) 2 or 3 gentle lobulations and a thin, echogenic capsule.
A nodule was classified as indeterminate by default if it had no malignant characteristics and none of the 3 benign characteristic combinations listed above.
To be classified as malignant, a mass needed to have any of the following characteristics: spiculated contour, taller-than-wide (not parallel) orientation, angular margins, marked hypoechogenicity, posterior acoustic shadowing, punctate calcifications, duct extension, branch pattern, or microlobulation.
Of the 424 lesions that Stavros et al prospectively classified as benign by means of US, only 2 were found to be malignant at biopsy, resulting in a negative predictive value of 99.5% in a population with a cancer prevalence of 16.7%.41 Of the 125 lesions found to be malignant at biopsy, 123 were classified as malignant or indeterminate with US, yielding a sensitivity of 98.4%. Biopsy is indicated for nodules that are classified on US as either malignant or indeterminate.
Skaane et al found that US could distinguish fibroadenomas from invasive ductal carcinoma.42 Others who have studied the characteristics of benign and malignant masses by US examination include Zonderland et al and Rahbar et al.43,33
Typical US patterns of specific types of breast carcinomas
The appearance of specific types of breast carcinoma have been studied. Although appearances vary greatly, some patterns are typical.
Mucin-containing carcinomas are often circumscribed but may have irregular margins. These lesions may be either hypoechoic or isoechoic relative to subcutaneous fat. In a study of these carcinomas by Conant et al involving 8 patients, US showed hypoechoic, solid masses in all of their cases.44 The lesions demonstrated acoustic shadowing or increased acoustic enhancement. Some lesions had circumscribed margins, and some were not circumscribed.
Tubular carcinoma is usually hypoechoic but is without circumscribed margins and acoustic posterior shadowing. Invasive ductal carcinoma typically appears as an irregularly shaped mass with spiculated margins with shadowing and architectural distortion of adjacent breast tissue. This lesion may contain malignant microcalcifications.
Invasive lobular carcinoma often does not cause a desmoplastic reaction. This type is frequently missed on mammography and may be difficult to see on sonograms. Butler et al reported that these lesions were ultrasonographically occult in 12% of their cases.45 In approximately 60% of cases, it appeared as a heterogeneous, hypoechoic mass with angular or ill-defined margins and posterior acoustic shadowing. In 15% of cases, US demonstrated focal shadowing without a discrete mass; in 12% of cases, US showed a lobulated, circumscribed mass.
Medullary carcinoma often appears as a hypoechoic mass with acoustic enhancement (increased through transmission). It may be mistaken for a cyst on US.
Soo et al studied papillary carcinoma of the breast; they found that the cystic in situ form may appear as either a solid mass or a complex cystic mass with an internal solid component.46 In both types, acoustic enhancement tends to be increased. Doppler study may demonstrate intratumoral blood flow. Invasive papillary carcinoma usually appears as a solid mass, although it may also appear as a complex cystic and solid mass.
Ductal carcinoma in situ of the breast often appears as suggestive microcalcifications on mammography. However, it may occasionally appear as a solid mass on ultrasound.
Characteristic benign masses
Many masses that are demonstrated on mammograms require biopsy to determine whether they are benign. Taylor et al reported that the use of US in conjunction with mammography increased specificity from 51% to 66% in a population with a malignancy prevalence of 31%.47 This improvement could significantly reduce the biopsy rate of benign lesions. Breast US often reveals unexpected benign lesions.
Many benign breast conditions have a nonspecific appearance on US. However, some masses, such as simple cysts, sebaceous cysts, and intramammary lymph nodes, have a characteristic appearance that suggests a specific diagnosis. Almost all highly echogenic masses are benign.
If color Doppler imaging demonstrates blood flow within the contents of a complex cyst or dilated duct, then these contents consist of solid tissue rather then just debris, blood clot, or echogenic fluid. However, we have seen solid tumors that lack demonstrable blood flow on color Doppler imaging. Several investigators reviewed the ability of color Doppler US or contrast-enhanced Doppler US to distinguish benign from malignant lesions. The results were variable; Doppler US is not generally used to distinguish benign from malignant solid breast masses.
Ultrasound-Guided Procedures and Treatments
Ultrasonography is used to guide procedures such as cyst aspiration, percutaneous biopsy, needle localization of masses for surgical excision, abscess drainage in selected cases, and therapeutic radiofrequency or cryoablation.
Ultrasonography is highly accurate in diagnosing a simple cyst, and it is helpful in evaluating some complex cysts. Usually, a simple cyst is not aspirated unless they it is symptomatic or the patient has persistent psychological concerns about it. Complex cysts or suspected abscesses may be aspirated.
Berg et al reviewed their experience with the US-pathologic correlation of cystic lesions and found that all clustered microcysts were benign, but they cautioned that further study is required.48 They recommended that biopsy be performed in cases involving (1) cystic lesions with thick, indistinct walls and/or thick septations (0.5 mm); (2) intracystic masses; and (3) predominantly solid masses with eccentric cystic foci; these recommendations were based on the fact that, in their series, 18 of 79 of such complex cystic lesions proved to be malignant.
If it is uncertain whether a nodule seen on US is a complex cyst or solid mass, US-guided aspiration of the cyst is often performed. This procedure is also performed if the appearance of a complex cyst on US is of concern. The aspirate may be sent for cytologic evaluation, though there is no general consensus about the indications for cytology. Some clinicians send only the fluid for analysis if it is bloody.
Parker et al reported excellent concordance between the results of US-guided automated core biopsy with a 14-gauge needle and surgical resection in 49 lesions.49 US provides effective guidance for percutaneous breast biopsy without ionizing radiation. It also offers the advantages of real-time visualization of the needle and target lesion, multidirectional imaging, and low cost. With US, the patient does not need to undergo mammographic compression; in addition, with US, the examination may usually be performed with the patient recumbent rather than sitting, as is often the case with procedures involving mammographic guidance. However, US is not appropriate for guidance in all situations. For instance, microcalcifications often cannot be localized with US; in addition, not all masses seen on mammography can be seen with US.
Other biopsy devices, such as vacuum-assisted devices, have been developed for use with US guidance. Occasionally, it may be difficult to find the area in the breast where core biopsy was previously performed. This may be a problem if the pathologic results from the biopsy sample and other factors indicate that excisional biopsy or lumpectomy is needed. After a patient receives preoperative neoadjuvant chemotherapy, the tumor may become occult, making it difficult to localize for lumpectomy. For these reasons, various US techniques to mark the biopsy or tumor site have been developed. These include the deployment of coils, clips, or wires.
US-guided fine-needle aspiration biopsy (FNAB) of solid nodules has been used at many centers. Some advantages are that it is relatively easy for a skilled practitioner to perform and that the results are quickly obtained if a cytopathologist is available. For good results, the person performing the FNAB and the cytopathologist must be skilled. Some groups have achieved excellent results. However, in a study by Pisano et al from 2001 involving 18 institutions, US-guided or stereotactically guided FNAB yielded a 10% insufficient-sample rate for US-guided FNAB of masses.50 This finding does not compare favorably with results of US-guided core biopsy or US-guided needle localization.51,52,53,54,55,56,57,58,59,60,61,62,63,64
Several investigators have presented preliminary reports on the use of US-guided therapeutic radiofrequency ablation or cryoablation of invasive breast carcinoma.65,66,67
Ultrasonography in Treatment Planning, Surgery, and Posttreatment Follow-up
Berg et al showed the possible benefit of combining preoperative whole-breast US with mammography when breast-conservation surgery is planned.48 US demonstrated additional sites of multifocal and multicentric carcinoma, facilitating preoperative planning.
Several investigators have studied the role of US in the assessment of axillary lymph nodes for tumor involvement. Normal lymph nodes usually have a prominent echogenic fatty hilum and a thin hypoechoic cortex. Lymph nodes that lack a fatty echogenic hilum or are heterogeneous are considered suspicious. The appearances on US of benign and malignant lymph nodes overlap; therefore, US-guided fine-needle aspiration biopsy (FNAB) of suspicious lymph nodes has been advocated. Krishnamurthy et al found that in approximately 12% of cases, false-negative results occur with US-guided axillary lymph node FNAB.68
Deurloo et al showed that US-guided axillary lymph node FNAB reduces the number of the more time-consuming sentinel-node biopsy procedures that are needed.69
Intraoperative US may be used to localize breast masses. It obviates the need for preoperative needle localization, offers more flexibility in choosing the incision site than preoperative needle localization, and may allow assessment of the tumor's extent. However, intraoperative US is operator dependent, and as with breast needle localization, it may not help in localizing the carcinoma.70,71,72,73,74
US plays a role in the postoperative assessment of patients with breast cancer. It may be helpful in evaluating both postoperative breast masses and breast infections. Edeiken et al showed that US offers a benefit in the detection of recurrent cancer on breasts reconstructed with autogenous myocutaneous flaps.75
Special Topics
Breast implants
Although MRI is accurate in evaluating silicone implants for rupture, MRI is not readily available or cannot be used in a number of circumstances.
For instance, rupture of implants may be evaluated with ultrasonography. On US, an intact implant has an echogenic wall, and its contents are anechoic. Normal folds in the implant wall may be seen. US may demonstrate the stepladder sign, consisting of multiple lines in the implant when an intracapsular rupture occurs or when an extracapsular rupture occurs, producing the snowstorm sign of increased echogenicity. US can provide additional information about implants, and it may also help in evaluating breast masses that are unrelated to the implant.
Male breast In the male patient, US may help in distinguishing benign conditions, such as gynecomastia, from breast carcinoma. Many believe that the addition of US to mammography increases diagnostic accuracy. However, US findings of malignancy in the male breast may be subtle, and the appearances of benign disease and malignant disease overlap.
Pediatric breast
US is particularly helpful in characterizing cystic, inflammatory, and neoplastic lesions in children. Fibroadenomas are the most common breast tumors in adolescent girls and may become large. Although most masses that occur in the pediatric breast are benign, phyllodes tumors may be benign or malignant. In adolescents, cystosarcoma phyllodes are rare, but they are still the most common malignant breast tumors. Phyllodes tumors are usually well-circumscribed, oval, or lobulated tumors, and they may have cystic areas.
In a study involving female adolescents, Kronemer et al found that sonograms demonstrated 36 fibroadenomas, 12 cysts, 7 abscesses, 1 lactating adenoma, and 1 phyllodes tumor.76
After using US to evaluate breast masses in pediatric and adolescent patients, Weinstein et al reported the following findings: gynecomastia, cyst, fibroadenoma, lymph node, galactocele, duct ectasia, and infection.3 They had no patients with malignancy, but they cautioned that, in rare cases, rhabdomyosarcoma, non-Hodgkin lymphoma, and leukemia may metastasize to the breast; they also reported that in patients of this age group, these diseases are more likely to be found than a primary breast cancer is.
Multimedia
 | Media file 1: Breast cancer, ultrasonography. Mediolateral oblique digital mammogram of the right breast in a 66-year-old woman with a new, opaque, irregular mass approximately 1 cm in diameter. The mass has spiculated margins in the middle third of the right breast at the 10-o'clock position. Image demonstrates both the spiculated mass (black arrow) and separate anterior focal asymmetry (white arrow). |
 | Media file 2: Breast cancer, ultrasonography. Antiradial sonogram of the spiculated mass shown in Image 1 demonstrates a hypoechoic mass with angular margins (black arrows). Cursors on the margins of the mass were used to electronically measure its dimensions of the mass, which was 0.9 X 0.8 cm. |
 | Media file 3: Breast cancer, ultrasonography. Magnified view of the mass in Image 2 is in the radial plane and perpendicular to the plane in Image 2. The 2 cursors indicate the margins of the mass, which was an infiltrating carcinoma with mixed ductal and lobular features. Sonography-guided core biopsy with a 14-gauge needle was used to initially diagnose the malignancy. A radiologist performed sonography-guided needle localization to assist the surgeon in localizing the tumor. The area of anterior focal asymmetry noted in Image 1 was also excised; this had fibrocystic changes with a 0.5-mm focus of lobular carcinoma in situ and atypical hyperplasia. |
 | Media file 4: Breast cancer, ultrasonography. This mediolateral mammogram was obtained in a 74-year-old woman with 2-week history of spontaneous discharge from the right nipple. A metal BB marker was placed on a possible lump at the 2-o'clock position. The breast is heterogeneously dense, which may decrease the sensitivity of mammography. |
 | Media file 5: Breast cancer, ultrasonography. Antiradial sonogram of the right breast (patient in Image 4) reveals a 2.2-cm-long, palpable, heterogeneous mass (horizontal arrows) at the 2-o'clock position. The mass is 3 cm from the nipple in the posterior third of the breast. It has a parallel, wider-than-tall orientation and an angular margin on its anterior edge (vertical arrow). |
 | Media file 6: Breast cancer, ultrasonography. Radial view of the sonogram in Image 5 confirms the angular anterior margin of the mass (vertical arrow) and its other angulated margins (upper horizontal arrows). Note that a portion of the margin is indistinct (question mark). The pathologic result of initial sonography-guided core biopsy with a 14-gauge needle was predominantly dense fibrosis and focal papillomatosis with evidence of prior hemorrhage. Because of the suspicious sonographic appearance, a sonography-guided needle localization and excisional biopsy was performed. It revealed invasive and intraductal papillary carcinoma. |
 | Media file 7: Breast cancer, ultrasonography. Craniocaudal screening digital mammogram in a 46-year-old woman shows a new mass (arrow) at the 7- to 8-o'clock position in the right breast. Diagnostic mammography and sonography were then requested. |
 | Media file 8: Breast cancer, ultrasonography. Radial sonogram shows a mass that is nearly isoechoic relative to breast fat. The mass has angulated and spiculated margins surrounded by echogenic fibrous tissue. The margins are marked with white electronic calipers. Its largest dimension is 0.8 cm. |
 | Media file 9: Breast cancer, ultrasonography. Color Doppler sonogram in the same orientation as Image 8 without the calipers. No blood flow is demonstrated within the mass. Sonography-guided core biopsy with a 14-gauge needle revealed predominantly fatty tissue. Because of the discordance between the imaging and pathologic findings, stereotactically guided core biopsy was performed and demonstrated invasive breast carcinoma. Partial mastectomy revealed a 0.8-cm, invasive, poorly differentiated ductal carcinoma and adjacent high-grade in situ carcinoma. In addition, 2 of 6 lymph nodes were positive for metastases. |
 | Media file 10: Breast cancer, ultrasonography. Digital spot compression view of the left breast in a 79-year-old woman who presented with a palpable lump in the upper outer quadrant of the left breast. Image shows a BB marker over the palpable high-density mass, which is approximately 2 cm in diameter and has obscured margins. |
 | Media file 11: Breast cancer, ultrasonography. Sonogram of the mass in Image 10 shows a suspicious, irregularly shaped, hypoechoic mass (arrows) that does not have a parallel taller-than-wide orientation. It has partially microlobulated and partially spiculated margins. Core biopsy revealed invasive, poorly differentiated ductal carcinoma. |
 | Media file 12: Breast cancer, ultrasonography. Right-breast mammogram in a 52-year-old woman who underwent previous left mastectomy shows clusters of microcalcification and a small mass with strong posterior acoustic shadowing. The patient was receiving heparin, which was stopped several hours prior to sonography-guided core biopsy with a 14-gauge needle. |
 | Media file 13: Breast cancer, ultrasonography. Magnified and annotated view of Image 12 shows the isoechoic mass with spiculated margins (arrows) that are made conspicuous by the prominent posterior acoustic shadowing (asterisks) deep to the mass. Core biopsy demonstrated a moderately differentiated infiltrating ductal carcinoma with focal microcalcifications. |
 | Media file 14: Breast cancer, ultrasonography. This mediolateral oblique digital mammogram of the left breast was obtained in a 48-year-old woman with a several-month history of bloody discharge from the left nipple. Image demonstrates dilated ducts extending from the nipple into the lateral aspect of the breast (asterisks) with a calcification in 1 of the dilated ducts (arrowhead). |
 | Media file 15: Breast cancer, ultrasonography. Radial sonogram of the area demonstrated in Image 14 shows dilated ducts (asterisks) extending from the nipple into the superior lateral quadrant of the left breast; these are filled with echogenic tissue. (This image and Images 16-17 are oriented with the nipple near the lower right corner to facilitate comparison with the mammogram in Image 14.) |
 | Media file 16: Breast cancer, ultrasonography. Sonogram of the same quadrant of the left breast reveals a dilated tumor filled duct with a single calcification in a duct. |
 | Media file 17: Breast cancer, ultrasonography. Color Doppler sonogram (displayed in black and white in the Doppler color box) from the same quadrant of the left breast demonstrates blood flow in the tumor within the ducts. The white oval areas (with central asterisks) represent blood flow within the intraductal tissue and thus confirms that the echogenic material within the ducts is tumor and not just intraluminal debris, blood clot, or secretions. |
 | Media file 18: Breast cancer, ultrasonography. This galactogram of the upper outer quadrant of the left breast was obtained in the patient shown in Images 14-17 before biopsy. Although unusual, this study demonstrated only normal, nondilated arborizing ducts and not the dilated ducts that contained tumor. Presumably, the orifice of the wrong duct was cannulated and injected with contrast agent, though cannulation of the ductal orifice expressing bloody nipple discharge was attempted. Incidentally noted is extravasation of contrast agent into the breast parenchyma. Cytologic results from the discharge indicated atypia with hyperplastic ductal groups, and Ian intraductal papillary lesion could not be excluded. Subsequent excisional biopsy revealed ductal carcinoma in situ with lobular extension and no invasive carcinoma. A few microcalcifications were present. |
 | Media file 19: Breast cancer, ultrasonography. Spot mammogram in a 37-year-old woman with a superficial mass of the right breast. A BB metal marker was placed on the mass, which is oval and well circumscribed. |
 | Media file 20: Breast cancer, ultrasonography. Sonogram of the mass in Image 19 demonstrates a superficial, well-circumscribed mass that was pathologically a dermatofibrosarcoma. It has a wider-than-tall orientation that parallels the skin surface. |
 | Media file 21: Breast cancer, ultrasonography. Color flow Doppler image (displayed in black and white) shows blood flow in vessels within the mass (arrows). The internal blood flow is consistent with a solid mass, such as this patient's dermatofibrosarcoma, but not with a superficial sebaceous cyst, protein-containing cyst, or hematoma. |
 | Media file 22: Breast cancer, ultrasonography. Craniocaudal spot compression view was obtained in a 60-year-old woman in whom a mass was detected on screening mammography. Image demonstrates a high-density mass (arrow), the margins of which are partly obscured by adjacent breast tissue. |
 | Media file 23: Breast cancer, ultrasonography. Sonogram of the mass in Image 22 defines a 2-cm-long, complex, oval cystic mass (arrow) that contains a 0.9-cm, solid, central mass (marginated by calipers). The margin of the mass is well circumscribed and the long axis of the mass is parallel to the chest wall. This is a benign intracystic papilloma. An intracystic papillary carcinoma could have an identical sonographic appearance. |
 | Media file 24: Breast cancer, ultrasonography. This craniocaudal digital mammogram was obtained in a 45-year-old woman who underwent 5 previous surgical biopsy procedures for fibroadenomas and who presented with a new palpable mass at the 6-o'clock position in the right breast. Image demonstrates the palpable, large, oval mass that has well-circumscribed margins (arrow). Note the linear white lines created by wire markers placed on the skin surface and overlying 2 scars from previous surgery. (Images 25-29 are all from this patient.) |
 | Media file 25: Breast cancer, ultrasonography. Sonogram of the mass in Image 24 shows the well-circumscribed, oval mass (cursors) with internal echoes. The mass was 36 mm long. The anterior edge of this palpable mass (cursor 2) extends near the skin surface. Although it has internal echoes and was found to be solid, the mass has slight posterior acoustic enhancement, or increased through transmission deep to it (arrow). This finding may be due to a homogenous population of tumor cells in the mass that have few acoustic interfaces, which would facilitate the transmission rather than the reflection of ultrasound. |
 | Media file 26: Breast cancer, ultrasonography. Color Doppler image (shown in black and white) of the same mass as in Image 25 shows blood flow in a portion of the mass (arrows). This finding indicates that the mass is solid and not a protein-containing cyst with internal echoes, though slight enhancement of the ultrasound deep to the mass is suggested. On the basis of the appearance and size of the mass, the possibility of a phyllodes tumor was suspected; therefore, surgical excision rather that a core biopsy was recommended. Surgical pathology confirmed a phyllodes tumor. |
 | Media file 27: Breast cancer, ultrasonography. One of the several other breast masses found in the patient in Image 26includes a probable fibroadenoma (cursors). This mass is oval and circumscribed and has a wider-than-tall orientation parallel to the skin line (anterior margin of the image). Note the posterior acoustic enhancement (arrows) suggesting the presence of a relatively homogenous population of cells within the mass with few acoustic interfaces. |
 | Media file 28: Breast cancer, ultrasonography. Sonogram shows another breast mass (cursor) in the patient in Images 26-27. This mass is typical of a fibroadenoma, though its sonographic appearance is not pathognomonic. The mass has a well-circumscribed margin and oval shape, as well as a parallel, wider-than-tall orientation. Note that it has no enhancement deep to the mass compared with adjacent tissue. The white surrounding tissue is echogenic fibrous tissue, which obscured the mass on mammography. |
 | Media file 29: Breast cancer, ultrasonography. The patient in Images 26-28 also had a 7-mm-diameter cyst at the 10-o'clock position in the right breast (black central structure). Note the well-circumscribed margins, thin wall, lack of internal echoes, and posterior acoustic enhancement (increased through transmission) deep to the cyst. |
 | Media file 30: Breast cancer, ultrasonography. This 49-year-old woman was found to have a mass in the right breast on screening mammography (not shown). Sonography demonstrated a well-circumscribed, oval mass with internal echoes and equivocal posterior acoustic enhancement (arrow) beneath it. To determine if this was a solid mass or complex cyst containing echogenic debris, sonography-guided aspiration was performed with an 18-gauge needle. Nonbloody fluid was aspirated. The cyst completely disappeared on aspiration; this finding was consistent with a benign cyst. It is a benign cyst. In rare cases, a carcinoma can have an identical sonographic appearance, though it would not resolve after aspiration. |
 | Media file 31: Breast cancer, ultrasonography. This 43-year-old woman had a subcentimetric lesion in her left breast, as noted on a mammogram obtained at another facility (not shown); as a result, biopsy was requested. This sonogram demonstrates a 0.6-cm, hyperechoic, well-circumscribed mass (arrow) made more conspicuous by the surrounding hypoechoic fatty tissue. The layers of echogenic skin, hypoechoic fat (which contains the echogenic, thin, linear Cooper ligaments), and the posterior echogenic fascia and pectoralis muscle are labeled. The patient and her family insisted on biopsy even though entirely echogenic breast masses are usually benign. |
 | Media file 32: Breast cancer, ultrasonography. Sonography-guided core biopsy (of the echogenic lesion in Image 31) was performed with an 18-gauge core-biopsy needle (arrows), which is shown entering the mass. Pathologic evaluation of the core samples demonstrated an angiolipoma within predominantly fatty breast tissue. |
 | Media file 33: Breast cancer, ultrasonography. Right breast craniocaudal projection from a mammogram in a 73-year-old woman who underwent a contralateral mastectomy 14 years ago shows a mass (asterisks) in the right breast that is unchanged from a mammogram obtained 3 years earlier. |
 | Media file 34: Breast cancer, ultrasonography. Spot magnification 90° mediolateral view of the mass in Image 33 demonstrates that it is heterogeneous, with a thin rim of subcapsular radiolucent fat (arrows). |
 | Media file 35: Breast cancer, ultrasonography. Sonogram of the nonpalpable mass in Image 33 demonstrates a heterogeneous mass that resembles the appearance of a "breast within a breast" and is typical for a hamartoma (arrows). |
 | Media file 36: Breast cancer, ultrasonography. The sonogram was obtained through the long axis of a normal intramammary lymph node in a woman's right breast (arrow). The normal lymph node is oval, not round, and has a normal relatively thin, peripheral, hypoechoic cortex and a prominent normal hyperechoic hilus. This appearance has been compared to the sonographic appearance of a normal kidney. |
 | Media file 37: Breast cancer, ultrasonography. This sonogram was obtained though the short axis of the intramammary lymph node shown in Image 36. The relatively hypoechoic cortex (white arrow) surrounds the lymph node except at the hilum (black arrow). |
 | Media file 38: Breast cancer, ultrasonography. Craniocaudal digital spot compression view of the lateral aspect of the left breast in a 39-year-old woman with a 3-week history of a palpable, tender, cordlike swelling in this area. A metallic BB marker is placed over the palpable, cordlike mass (arrow). |
 | Media file 39: Breast cancer, ultrasonography. Radial sonogram demonstrates the palpable mass at the 3-o'clock position shown in Image 38 and reveals a hypoechoic tubular mass with fine internal echoes. Electronic calipers are placed on this obstructed noncompressible vein, which measures 0.4 cm in diameter. |
 | Media file 40: Breast cancer, ultrasonography. Antiradial sonogram of the mass shown in Images 38-39 is a cross-section through the dilated, thrombosed, and tender vein. No blood flow was demonstrated in the mass during color flow Doppler sonography (not shown). The patient had Mondor disease. |
Keywords
breast cancer breast cancer ultrasonography, breast cancer diagnosis, breast cancer imaging, breast cancer ultrasound, breast ultrasound, breast US, breast sonography, mammography, breast cancer screening, breast imaging, breast cancer detection, BI-RADS, American College of Radiology Imaging Network, ACRIN
More on Breast Cancer, Ultrasonography |
| References |
References
Jackson VP, Reynolds HE, Hawes DR. Sonography of the breast. Semin Ultrasound CT MR. Oct 1996;17(5):460-75. [Medline].
Sickles EA. Breast imaging: from 1965 to the present. Available at: http://radiology.rsnajnls.org/cgi/content/full/215/1/1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1062430769079_1221&stored_search=&FIRSTINDEX=0&volume=215&firstpage=1&resourcetype=1. Radiology. Apr 2000;215(1):1-16. [Medline]. [Full Text].
Weinstein SP, Conant EF, Orel SG, et al. Spectrum of US findings in pediatric and adolescent patients with palpable breast masses. Available at: http://radiographics.rsnajnls.org/cgi/content/full/20/6/1613. Radiographics. Nov-Dec 2000;20(6):1613-21. [Medline]. [Full Text].
Kolb TM, Lichy J, Newhouse JH. Occult cancer in women with dense breasts: detection with screening US--diagnostic yield and tumor characteristics. Radiology. Apr 1998;207(1):191-9. [Medline].
Buchberger W, Niehoff A, Obrist P, et al. Clinically and mammographically occult breast lesions: detection and classification with high-resolution sonography. Semin Ultrasound CT MR. Aug 2000;21(4):325-36. [Medline].
Berg WA. Rationale for a trial of screening breast ultrasound: American College of Radiology Imaging Network (ACRIN) 6666. Available at: http://www.ajronline.org/cgi/content/full/180/5/1225. AJR Am J Roentgenol. May 2003;180(5):1225-8. [Medline]. [Full Text].
Bassett LW, Ysrael M, Gold RH, Ysrael C. Usefulness of mammography and sonography in women less than 35 years of age. Radiology. Sep 1991;180(3):831-5. [Medline].
Bassett LW. Imaging of breast masses. Radiol Clin North Am. Jul 2000;38(4):669-91, vii-viii. [Medline].
Beyer T, Moonka R. Normal mammography and ultrasonography in the setting of palpable breast cancer. Available at: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHS-48FDP9S-. Am J Surg. May 2003;185(5):416-9. [Medline]. [Full Text].
Bosch AM, Kessels AG, Beets GL, et al. Interexamination variation of whole breast ultrasound. Available at: http://bjr.birjournals.org/cgi/content/full/76/905/328. Br J Radiol. May 2003;76(905):328-31. [Medline]. [Full Text].
Buchberger W, Niehoff A, Obrist P, et al. Clinically and mammographically occult breast lesions: detection and classification with high-resolution sonography. Semin Ultrasound CT MR. Aug 2000;21(4):325-36. [Medline].
Carney PA, Miglioretti DL, Yankaskas BC, et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Available at: http://www.annals.org/cgi/content/full/138/3/168. Ann Intern Med. Feb 4 2003;138(3):168-75. [Medline]. [Full Text].
Crystal P, Strano SD, Shcharynski S, Koretz MJ. Using sonography to screen women with mammographically dense breasts. Available at: http://www.ajronline.org/cgi/content/full/181/1/177. AJR Am J Roentgenol. Jul 2003;181(1):177-82. [Medline]. [Full Text].
Georgian-Smith D, Taylor KJ, Madjar H, et al. Sonography of palpable breast cancer. Available at: http://www3.interscience.wiley.com/cgi-bin/fulltext/72500269/PDFSTART. J Clin Ultrasound. Jun 2000;28(5):211-6. [Medline]. [Full Text].
Guenin MA. Clip placement during sonographically guided large-core breast biopsy for mammographic-sonographic correlation. Available at: http://www.ajronline.org/cgi/content/full/175/4/1053. AJR Am J Roentgenol. Oct 2000;175(4):1053-5. [Medline]. [Full Text].
Hall FM. Screening breast US. Available at: http://radiology.rsnajnls.org/cgi/content/full/227/2/607. Radiology. May 2003;227(2):607-8; author reply 608-9. [Medline]. [Full Text].
Hall FM. Screening breast US. Radiology. Sep 2002;224(3):930-1; author reply 931-2. [Medline].
Houssami N, Irwig L, Simpson JM, et al. Sydney Breast Imaging Accuracy Study: Comparative sensitivity and specificity of mammography and sonography in young women with symptoms. Available at: http://www.ajronline.org/cgi/content/full/180/4/935. AJR Am J Roentgenol. Apr 2003;180(4):935-40. [Medline]. [Full Text].
Jackson VP. Management of solid breast nodules: what is the role of sonography?. Radiology. Jul 1995;196(1):14-5. [Medline].
Joseph E, Clark R, Berman C, et al. Screening Childhood Cancer Survivors for Breast Cancer. Available at: http://theoncologist.alphamedpress.org/cgi/content/full/2/4/228. Oncologist. 1997;2(4):228-234. [Medline]. [Full Text].
Kerlikowske K, Smith-Bindman R, Ljung BM, Grady D. Evaluation of abnormal mammography results and palpable breast abnormalities. Available at: http://www.annals.org/cgi/content/full/139/4/274. Ann Intern Med. Aug 19 2003;139(4):274-84. [Medline]. [Full Text].
Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Available at: http://radiology.rsnajnls.org/cgi/content/abstract/225/1/1. Radiology. Oct 2002;225(1):165-75. [Medline]. [Full Text].
Leitch AM, Dodd GD, Costanza M, et al. American Cancer Society guidelines for the early detection of breast cancer: update 1997. CA Cancer J Clin. May-Jun 1997;47(3):150-3. [Medline].
Leung JW, Sickles EA. Multiple bilateral masses detected on screening mammography: assessment of need for recall imaging. Available at: http://www.ajronline.org/cgi/content/full/175/1/23. AJR Am J Roentgenol. Jul 2000;175(1):23-9. [Medline]. [Full Text].
Mehta TS. Current uses of ultrasound in the evaluation of the breast. Radiol Clin North Am. Jul 2003;41(4):841-56. [Medline].
Moy L, Slanetz PJ, Moore R, et al. Specificity of mammography and US in the evaluation of a palpable abnormality: retrospective review. Available at: http://radiology.rsnajnls.org/cgi/content/full/225/1/176. Radiology. Oct 2002;225(1):176-81. [Medline]. [Full Text].
Rosenberg RD, Hunt WC, Williamson MR, et al. Effects of age, breast density, ethnicity, and estrogen replacement therapy on screening mammographic sensitivity and cancer stage at diagnosis: review of 183,134 screening mammograms in Albuquerque, New Mexico. Radiology. Nov 1998;209(2):511-8. [Medline].
Sheppard DG, Whitman GJ, Huynh PT, et al. Tubular carcinoma of the breast: mammographic and sonographic features. Available at: http://www.ajronline.org/cgi/content/full/174/1/253. AJR Am J Roentgenol. Jan 2000;174(1):253-7. [Medline]. [Full Text].
Smith RA, Saslow D, Sawyer KA, et al. American Cancer Society guidelines for breast cancer screening: update 2003. Available at: http://caonline.amcancersoc.org/cgi/content/full/53/3/141. CA Cancer J Clin. May-Jun 2003;53(3):141-69. [Medline]. [Full Text].
Simpson WL Jr, Hermann G, Rausch DR, Sherman J, Feig SA, Bleiweiss IJ, et al. Ultrasound detection of nonpalpable mammographically occult malignancy. Can Assoc Radiol J. Apr 2008;59(2):70-6. [Medline].
Berg WA, Blume JD, Cormack JB, Mendelson EB, Lehrer D, Böhm-Vélez M, et al. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA. May 14 2008;299(18):2151-63. [Medline].
Baker JA, Kornguth PJ, Soo MS, et al. Sonography of solid breast lesions: observer variability of lesion description and assessment. AJR Am J Roentgenol. Jun 1999;172(6):1621-5. [Medline].
Rahbar G, Sie AC, Hansen GC, et al. Benign versus malignant solid breast masses: US differentiation. Available at: http://radiology.rsnajnls.org/cgi/content/full/213/3/889. Radiology. Dec 1999;213(3):889-94. [Medline]. [Full Text].
Mendelson EB, Berg WA, Merritt CR. Toward a standardized breast ultrasound lexicon, BI-RADS: ultrasound. Semin Roentgenol. Jul 2001;36(3):217-25. [Medline].
Mendelson EB, Baum JK, Berg WA, et al. ACR Breast imaging and reporting data system ultrasound. ACR Breast Imaging Atlas. 2003.
Liberman L, Menell JH. Breast imaging reporting and data system (BI-RADS). Radiol Clin North Am. May 2002;40(3):409-30, v. [Medline].
Evans WP. Breast masses. Appropriate evaluation. Radiol Clin North Am. Nov 1995;33(6):1085-108. [Medline].
Gordon PB, Goldenberg SL. Malignant breast masses detected only by ultrasound. A retrospective review. Cancer. Aug 15 1995;76(4):626-30. [Medline].
Huber S, Wagner M, Medl M, Czembirek H. Benign breast lesions: minimally invasive vacuum-assisted biopsy with 11-gauge needles patient acceptance and effect on follow-up imaging findings. Available at: http://radiology.rsnajnls.org/cgi/content/full/226/3/783. Radiology. Mar 2003;226(3):783-90. [Medline]. [Full Text].
Liberman L, Bonaccio E, Hamele-Bena D. Benign and malignant phyllodes tumors: mammographic and sonographic findings. Radiology. 1996;198:121-124.
Stavros AT, Thickman D, Rapp CL, et al. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. Jul 1995;196(1):123-34. [Medline].
Skaane P, Engedal K. Analysis of sonographic features in the differentiation of fibroadenoma and invasive ductal carcinoma. AJR Am J Roentgenol. Jan 1998;170(1):109-14. [Medline].
Zonderland HM, Coerkamp EG, Hermans J, et al. Diagnosis of breast cancer: contribution of US as an adjunct to mammography. Available at: http://radiology.rsnajnls.org/cgi/content/full/213/2/413. Radiology. Nov 1999;213(2):413-22. [Medline]. [Full Text].
Conant EF, Dillon RL, Palazzo J, et al. Imaging findings in mucin-containing carcinomas of the breast: correlation with pathologic features. AJR Am J Roentgenol. Oct 1994;163(4):821-4. [Medline].
Butler RS, Venta LA, Wiley EL, et al. Sonographic evaluation of infiltrating lobular carcinoma. AJR Am J Roentgenol. Feb 1999;172(2):325-30. [Medline].
Soo MS, Williford ME, Walsh R, et al. Papillary carcinoma of the breast: imaging findings. AJR Am J Roentgenol. Feb 1995;164(2):321-6. [Medline].
Taylor KJ, Merritt C, Piccoli C, et al. Ultrasound as a complement to mammography and breast examination to characterize breast masses. Ultrasound Med Biol. Jan 2002;28(1):19-26. [Medline].
Berg WA, Campassi CI, Ioffe OB. Cystic lesions of the breast: sonographic-pathologic correlation. Available at: http://radiology.rsnajnls.org/cgi/content/full/227/1/183. Radiology. Apr 2003;227(1):183-91. [Medline]. [Full Text].
Parker SH, Jobe WE, Dennis MA, et al. US-guided automated large-core breast biopsy. Radiology. May 1993;187(2):507-11. [Medline].
Pisano ED, Fajardo LL, Caudry DJ, et al. Fine-needle aspiration biopsy of nonpalpable breast lesions in a multicenter clinical trial: results from the radiologic diagnostic oncology group V. Available at: http://radiology.rsnajnls.org/cgi/content/full/219/3/785. Radiology. Jun 2001;219(3):785-92. [Medline]. [Full Text].
Fornage BD, Coan JD, David CL. Ultrasound-guided needle biopsy of the breast and other interventional procedures. Radiol Clin North Am. Jan 1992;30(1):167-85. [Medline].
Liberman L, Feng TL, Dershaw DD, et al. US-guided core breast biopsy: use and cost-effectiveness. Radiology. Sep 1998;208(3):717-23. [Medline].
Liberman L. Percutaneous image-guided core breast biopsy. Radiol Clin North Am. May 2002;40(3):483-500, vi. [Medline].
Liberman L. Centennial dissertation. Percutaneous imaging-guided core breast biopsy: state of the art at the millennium. Available at: http://www.ajronline.org/cgi/content/full/174/5/1191. AJR Am J Roentgenol. May 2000;174(5):1191-9. [Medline]. [Full Text].
Mainiero MB, Gareen IF, Bird CE, et al. Preferential use of sonographically guided biopsy to minimize patient discomfort and procedure time in a percutaneous image-guided breast biopsy program. Available at: http://www.jultrasoundmed.org/cgi/content/full/21/11/1221. J Ultrasound Med. Nov 2002;21(11):1221-6. [Medline]. [Full Text].
National Cancer Institute. The uniform approach to breast fine-needle aspiration biopsy. National Cancer Institute Fine-Needle Aspiration of Breast Workshop Subcommittees. Diagn Cytopathol. Apr 1997;16(4):295-311. [Medline].
Parker SH, Klaus AJ, McWey PJ, et al. Sonographically guided directional vacuum-assisted breast biopsy using a handheld device. Available at: http://www.ajronline.org/cgi/content/full/177/2/405. AJR Am J Roentgenol. Aug 2001;177(2):405-8. [Medline]. [Full Text].
Pisano ED, Fajardo LL, Tsimikas J, et al. Rate of insufficient samples for fine-needle aspiration for nonpalpable breast lesions in a multicenter clinical trial: The Radiologic Diagnostic Oncology Group 5 Study. The RDOG5 investigators. Cancer. Feb 15 1998;82(4):679-88. [Medline].
Rosen EL, Bentley RC, Baker JA, Soo MS. Imaging-guided core needle biopsy of papillary lesions of the breast. Available at: http://www.ajronline.org/cgi/content/full/179/5/1185. AJR Am J Roentgenol. Nov 2002;179(5):1185-92. [Medline]. [Full Text].
Smith DN, Kaelin CM, Korbin CD, et al. Impalpable breast cysts: utility of cytologic examination of fluid obtained with radiologically guided aspiration. Radiology. Jul 1997;204(1):149-51. [Medline].
Soo MS, Baker JA, Rosen EL. Sonographic detection and sonographically guided biopsy of breast microcalcifications. Available at: http://www.ajronline.org/cgi/content/full/180/4/941. AJR Am J Roentgenol. Apr 2003;180(4):941-8. [Medline]. [Full Text].
Caterson SA, Tobias AM, Slavin SA, Lee BT. Ultrasound-assisted liposuction as a treatment of fat necrosis after deep inferior epigastric perforator flap breast reconstruction: a case report. Ann Plast Surg. Jun 2008;60(6):614-7. [Medline].
Kim KH, Son EJ, Kim EK, Ko KH, Kang H, Oh KK. The safety and efficiency of the ultrasound-guided large needle core biopsy of axilla lymph nodes. Yonsei Med J. Apr 30 2008;49(2):249-54. [Medline].
Kopans DB. Clip placement during sonographically guided breast biopsy. AJR Am J Roentgenol. Apr 2001;176(4):1076-7. [Medline].
Burak WE, Agnese DM, Povoski SP, et al. Radiofrequency ablation of invasive breast carcinoma followed by delayed surgical excision. Cancer. Oct 1 2003;98(7):1369-76. [Medline].
Hayashi AH, Silver SF, van der Westhuizen NG, et al. Treatment of invasive breast carcinoma with ultrasound-guided radiofrequency ablation. Available at: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHS-48FDP9S-. Am J Surg. May 2003;185(5):429-35. [Medline]. [Full Text].
Izzo F, Thomas R, Delrio P, et al. Radiofrequency ablation in patients with primary breast carcinoma: a pilot study in 26 patients. Available at: http://www3.interscience.wiley.com/cgi-bin/fulltext/85515600/HTMLSTART. Cancer. Oct 15 2001;92(8):2036-44. [Medline]. [Full Text].
Krishnamurthy S, Sneige N, Bedi DG, et al. Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer. Sep 1 2002;95(5):982-8. [Medline].
Deurloo EE, Tanis PJ, Gilhuijs KG, et al. Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer. Available at: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T68-47RBDNM-. Eur J Cancer. May 2003;39(8):1068-73. [Medline]. [Full Text].
Moon WK, Noh DY, Im JG. Multifocal, multicentric, and contralateral breast cancers: bilateral whole-breast US in the preoperative evaluation of patients. Available at: http://radiology.rsnajnls.org/cgi/content/full/224/2/569. Radiology. Aug 2002;224(2):569-76. [Medline]. [Full Text].
Venta LA, Kim JP, Pelloski CE, Morrow M. Management of complex breast cysts. AJR Am J Roentgenol. Nov 1999;173(5):1331-6. [Medline].
Ueda S, Tsuda H, Asakawa H, Omata J, Fukatsu K, Kondo N, et al. Utility of 18F-fluoro-deoxyglucose emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in combination with ultrasonography for axillary staging in primary breast cancer. BMC Cancer. Jun 9 2008;8:165. [Medline].
Vercauteren LD, Kessels AG, van der Weijden T, Koster D, Severens JL, van Engelshoven JM, et al. Clinical impact of the use of additional ultrasonography in diagnostic breast imaging. Eur Radiol. Apr 23 2008;[Medline].
Berg WA, Gilbreath PL. Multicentric and multifocal cancer: whole-breast US in preoperative evaluation. Available at: http://radiology.rsnajnls.org/cgi/content/full/214/1/59. Radiology. Jan 2000;214(1):59-66. [Medline]. [Full Text].
Edeiken BS, Fornage BD, Bedi DG, et al. Recurrence in autogenous myocutaneous flap reconstruction after mastectomy for primary breast cancer: US diagnosis. Available at: http://radiology.rsnajnls.org/cgi/content/full/227/2/542. Radiology. May 2003;227(2):542-8. [Medline]. [Full Text].
Kronemer KA, Rhee K, Siegel MJ, et al. Gray scale sonography of breast masses in adolescent girls. J Ultrasound Med. May 2001;20(5):491-6; quiz 498. [Medline].
Arger PH, Sehgal CM, Conant EF, et al. Interreader variability and predictive value of US descriptions of solid breast masses: pilot study. Acad Radiol. Apr 2001;8(4):335-42. [Medline].
Baker JA, Soo MS. Breast US: assessment of technical quality and image interpretation. Available at: http://radiology.rsnajnls.org/cgi/reprint/223/1/229. Radiology. Apr 2002;223(1):229-38. [Medline]. [Full Text].
Baker JA, Soo MS, Rosen EL. Artifacts and pitfalls in sonographic imaging of the breast. Available at: http://www.ajronline.org/cgi/content/full/176/5/1261. AJR Am J Roentgenol. May 2001;176(5):1261-6. [Medline]. [Full Text].
Entrekin RR, Porter BA, Sillesen HH, et al. Real-time spatial compound imaging: application to breast, vascular, and musculoskeletal ultrasound. Semin Ultrasound CT MR. Feb 2001;22(1):50-64. [Medline].
Garcia CJ, Dinamarca V, Navarro O. Breast US in children and adolescents. Radiographics. 2000;20:1605-1162. [Medline]. [Full Text].
Kaplan SS. Clinical utility of bilateral whole-breast US in the evaluation of women with dense breast tissue. Available at: http://radiology.rsnajnls.org/cgi/content/abstract/221/3/641?ijkey=8727cb645e0115be79d3691fc684f96923f7911a&keytype2=tf_ipsecsha. Radiology. Dec 2001;221(3):641-9. [Medline]. [Full Text].
Leconte I, Feger C, Galant C, et al. Mammography and subsequent whole-breast sonography of nonpalpable breast cancers: the importance of radiologic breast density. Available at: http://www.ajronline.org/cgi/content/full/180/6/1675. AJR Am J Roentgenol. Jun 2003;180(6):1675-9. [Medline]. [Full Text].
March DE, Coughlin BF, Barham RB, et al. Breast masses: removal of all US evidence during biopsy by using a handheld vacuum-assisted device--initial experience. Available at: http://radiology.rsnajnls.org/cgi/content/full/227/2/549. Radiology. May 2003;227(2):549-55. [Medline]. [Full Text].
Memis A, Ozdemir N, Parildar M, et al. Mucinous (colloid) breast cancer: mammographic and US features with histologic correlation. Eur J Radiol. Jul 2000;35(1):39-43. [Medline].
Moon WK, Myung JS, Lee YJ, et al. US of ductal carcinoma in situ. Available at: http://radiographics.rsnajnls.org/cgi/content/full/22/2/269. Radiographics. Mar-Apr 2002;22(2):269-80; discussion 280-1. [Medline]. [Full Text].
Perlmutter S, Licht M, Gold BM, et al. Ultrasonic ring down artifact in breast abscess. Journal of Women's Imaging. 2001;3:108-11.
Rosen EL, Soo MS. Tissue harmonic imaging sonography of breast lesions: improved margin analysis, conspicuity, and image quality compared to conventional ultrasound. Clin Imaging. Nov-Dec 2001;25(6):379-84. [Medline].
Szopinski KT, Pajk AM, Wysocki M, et al. Tissue harmonic imaging: utility in breast sonography. J Ultrasound Med. May 2003;22(5):479-87; quiz 488-9. [Medline].
Weinstein SP, Conant EF, Acs G. Case 59: Angiolipoma of the breast. Available at: http://radiology.rsnajnls.org/cgi/content/full/227/3/773. Radiology. Jun 2003;227(3):773-5. [Medline]. [Full Text].
Further Reading
Keywords
breast cancer breast cancer ultrasonography, breast cancer diagnosis, breast cancer imaging, breast cancer ultrasound, breast ultrasound, breast US, breast sonography, mammography, breast cancer screening, breast imaging, breast cancer detection, BI-RADS, American College of Radiology Imaging Network, ACRIN
