Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Ultrasonography in Breast Cancer

  • Author: Paul R Fisher, MD; Chief Editor: Eugene C Lin, MD  more...
 
Updated: Dec 04, 2014
 

Overview

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. 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. See the image below.

Breast cancer, ultrasonography. Mediolateral obliq 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).

See Breast Lumps in Young Women: Diagnostic Approaches, a Critical Images slideshow, to help manage palpable breast lumps in young women.

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 is also expanding and is under study.

For patient education resources, see the Cancer Center. Also, see the patient education articles Mammogram, Breast Cancer, and Breast Lumps and Pain.

Next

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. 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).[4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28] Kolb et al and Buchberger et al found that, when performed carefully, ultrasonography may be useful in detecting occult breast cancer in dense breasts.[29, 30]

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. 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.

In view of the results of these studies, a prospective, multicenter study was carried out to examine the role of US in breast cancer screening. 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).[31] In this project, a protocol to assess the efficacy of screening breast US was implemented in 14 imaging centers to better define the role of US in breast cancer screening. The study reported higher cancer detection in high-risk women that underwent annual ultrasound screening in addition to mammography compared to those that underwent mammography alone.[32] (More information is available on the ACRIN Web site.) In September 2012, the U.S. Food and Drug Administration approved the first ultrasound system, the somo-v Automated Breast Ultrasound System (ABUS), for breast cancer screening in combination with standard mammographyspecificallyforwomenwith dense breast tissue.[33] ABUS is indicated for women with a negative mammogram, no breast cancer symptoms and no previous breast intervention such as surgery or biopsy.

See the images below of ultrasonography for breast cancer.

Breast cancer, ultrasonography. Mediolateral obliq 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).
Breast cancer, ultrasonography. This mediolateral 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.
Breast cancer, ultrasonography. Craniocaudal scree 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.
Breast cancer, ultrasonography. Radial sonogram sh 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.
Breast cancer, ultrasonography. Digital spot compr 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.
Breast cancer, ultrasonography. This mediolateral 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).
Breast cancer, ultrasonography. Color Doppler sono 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.
Breast cancer, ultrasonography. Spot magnification 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).

A study of the positive predictive value (PPV) of bilateral whole-breast ultrasonography (BWBU) for detection of synchronous breast lesions on initial diagnosis of breast cancer found that BWBU can detect additional synchronous malignancy with a relatively high PPV, especially when mammography findings are correlated with ultrasound findings. In 75 patients who had synchronous lesions, PPV for additional biopsy was 25.7% (18 of 70). The PPV for synchronous lesions detected both on mammography and BWBU was 76.9% (10 of 13) and detected only on BWBU was 14.3% (7 of 49). A mass with calcification on mammography presentation (P < 0.01), presence of calcification among the ultrasonography findings (P < 0.01), and high Breast Imaging Reporting and Data System final assessment (P< 0.01) were imaging factors that were associated with malignancy in the additional synchronous lesion.[34]

In a retrospective study of women younger than 40 years identified with invasive cancer (N = 27) or ductal carcinoma in situ (N = 3), ultrasonography was found to be reliable as the primary imaging modality. Of the 30 women, 28 underwent mammography (graded as uncertain, suspicious, or malignant in the majority), and malignancy was missed in one patient. All 30 patients underwent ultrasonography (reported as uncertain, suspicious, or malignant, an indication for diagnostic core biopsy), and ultrasonography alone did not miss any cancers but did fail to detect multifocal disease in one patient.[35]

Previous
Next

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.[36, 37] More uniform and more clearly understandable examination reports are needed to improve patient care and to facilitate research in the use of breast US.

BI-RADS

Mendelsohn et al published the results of their initial work in creating a standardized breast US lexicon,[38] and the American College of Radiology (ACR) published the Breast Imaging Reporting and Data System (BI-RADS) Atlas.[39] This latter 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.[40]

Previous
Next

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.[41, 42, 43, 44]

Benign, Indeterminate, and Malignant Nodules

In a landmark study, Stavros et al established US criteria for characterizing solid breast masses.[45] 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[45] :

  • Benign
  • Indeterminate
  • Malignant

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:

  • Intense uniform hyperechogenicity
  • Ellipsoid or wider-than-tall (parallel) orientation, along with a thin, echogenic capsule
  • 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
  • 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%.[45] 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.[46] Others who have studied the characteristics of benign and malignant masses by US examination include Zonderland et al and Rahbar et al.[47, 37]

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.[48] 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.[49] 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.[50] 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%.[51] 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.

Previous
Next

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.[52] 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.[53] 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 involving 18 institutions, US-guided or stereotactically guided FNAB yielded a 10% insufficient-sample rate for US-guided FNAB of masses.[54] This finding does not compare favorably with results of US-guided core biopsy or US-guided needle localization.[55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68]

Several investigators have presented preliminary reports on the use of US-guided therapeutic radiofrequency ablation or cryoablation of invasive breast carcinoma.[69, 70, 71]

Previous
Next

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.[52] 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.[72]

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.[73]

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.[74, 75, 76, 77, 78]

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.[79]

Previous
Next

Special Topics

Ultrasonography may be helpful under certain circumstances, such as breast implant rupture, identifying benign breast masses in men, and characterizing lesions in children.

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 Masses

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 Masses

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.[80]

After using US to evaluate breast masses in pediatric and adolescent patients, Weinstein et al reported findings on 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.

Previous
 
Contributor Information and Disclosures
Author

Paul R Fisher, MD Associate Professor of Radiology and Surgery, State University of New York, Stony Brook School of Medicine

Disclosure: Received research grant from: Siemens Corporation.

Coauthor(s)

Joseph P DiPietro, MD Staff Physician, Department of Medicine, Salem Hospital

Disclosure: Nothing to disclose.

Ben Y Young, MD Clinical Assistant Instructor, Staff Physician, Department of Radiology, Stony Brook University Hospital

Ben Y Young, MD is a member of the following medical societies: American College of Radiology

Disclosure: Nothing to disclose.

Sheri L Ford, MD Assistant Professor of Clinical Radiology, State University of New York-Stony Brook School of Medicine; Consulting Staff, Department of Radiology, Section of Breast Imaging, Stony Brook University Hospital

Disclosure: Nothing to disclose.

Barbara Larson RDMS, RDCS, BSRT(R)(M), Staff Sonographer, Section of Breast Imaging, Carol M Baldwin Breast Care Center, Stony Brook University Hospital

Disclosure: Nothing to disclose.

Ajay Malhotra, MD Clinical Assistant Instructor, Consulting Staff, Department of Internal Medicine, Stony Brook University Hospital

Ajay Malhotra, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand

Disclosure: Nothing to disclose.

Edward Azavedo, MD, PhD Director of Clinical Breast Imaging Services, Associate Professor, Department of Radiology, Karolinska University Hospital, Sweden

Edward Azavedo, MD, PhD is a member of the following medical societies: Radiological Society of North America, Swedish Medical Association, Swedish Society of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine

Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, Society of Nuclear Medicine and Molecular Imaging

Disclosure: Nothing to disclose.

Additional Contributors

John M Lewin, MD Section Chief, Breast Imaging, Diversified Radiology of Colorado, PC; Associate Clinical Professor, Department of Preventative Medicine and Biometrics, University of Colorado School of Medicine

John M Lewin, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Radiological Society of North America, Society of Breast Imaging

Disclosure: Received consulting fee from Hologic, Inc. for consulting; Received grant/research funds from Hologic, Inc. for research.

Acknowledgements

Steven Perlmutter, MD, FACR Associate Professor of Clinical Radiology, Stony Brook University School of Medicine; Medical Director of Radiology, Peconic Bay Medical Center

Steven Perlmutter, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, American Medical Association, American Roentgen Ray Society, Association of Program Directors in Radiology, Association of University Radiologists, Medical Society of the State of New York, Radiological Society of North America, Society of Breast Imaging, Society of Nuclear Medicine, andSociety of Uroradiology

Disclosure: Nothing to disclose.

References
  1. Jackson VP, Reynolds HE, Hawes DR. Sonography of the breast. Semin Ultrasound CT MR. 1996 Oct. 17(5):460-75. [Medline].

  2. Sickles EA. Breast imaging: from 1965 to the present. Radiology. 2000 Apr. 215(1):1-16. [Medline]. [Full Text].

  3. Weinstein SP, Conant EF, Orel SG, et al. Spectrum of US findings in pediatric and adolescent patients with palpable breast masses. Radiographics. 2000 Nov-Dec. 20(6):1613-21. [Medline]. [Full Text].

  4. Bassett LW, Ysrael M, Gold RH, Ysrael C. Usefulness of mammography and sonography in women less than 35 years of age. Radiology. 1991 Sep. 180(3):831-5. [Medline].

  5. Bassett LW. Imaging of breast masses. Radiol Clin North Am. 2000 Jul. 38(4):669-91, vii-viii. [Medline].

  6. Beyer T, Moonka R. Normal mammography and ultrasonography in the setting of palpable breast cancer. Am J Surg. 2003 May. 185(5):416-9. [Medline]. [Full Text].

  7. Bosch AM, Kessels AG, Beets GL, et al. Interexamination variation of whole breast ultrasound. Br J Radiol. 2003 May. 76(905):328-31. [Medline]. [Full Text].

  8. 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. 2000 Aug. 21(4):325-36. [Medline].

  9. 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. Ann Intern Med. 2003 Feb 4. 138(3):168-75. [Medline]. [Full Text].

  10. Crystal P, Strano SD, Shcharynski S, Koretz MJ. Using sonography to screen women with mammographically dense breasts. AJR Am J Roentgenol. 2003 Jul. 181(1):177-82. [Medline]. [Full Text].

  11. Georgian-Smith D, Taylor KJ, Madjar H, et al. Sonography of palpable breast cancer. J Clin Ultrasound. 2000 Jun. 28(5):211-6. [Medline]. [Full Text].

  12. Guenin MA. Clip placement during sonographically guided large-core breast biopsy for mammographic-sonographic correlation. AJR Am J Roentgenol. 2000 Oct. 175(4):1053-5. [Medline]. [Full Text].

  13. Hall FM. Screening breast US. Radiology. 2003 May. 227(2):607-8; author reply 608-9. [Medline]. [Full Text].

  14. Hall FM. Screening breast US. Radiology. 2002 Sep. 224(3):930-1; author reply 931-2. [Medline].

  15. 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. AJR Am J Roentgenol. 2003 Apr. 180(4):935-40. [Medline]. [Full Text].

  16. Jackson VP. Management of solid breast nodules: what is the role of sonography?. Radiology. 1995 Jul. 196(1):14-5. [Medline].

  17. Joseph E, Clark R, Berman C, et al. Screening Childhood Cancer Survivors for Breast Cancer. Oncologist. 1997. 2(4):228-234. [Medline]. [Full Text].

  18. Kerlikowske K, Smith-Bindman R, Ljung BM, Grady D. Evaluation of abnormal mammography results and palpable breast abnormalities. Ann Intern Med. 2003 Aug 19. 139(4):274-84. [Medline]. [Full Text].

  19. 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. Radiology. 2002 Oct. 225(1):165-75. [Medline]. [Full Text].

  20. 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. 1997 May-Jun. 47(3):150-3. [Medline].

  21. Leung JW, Sickles EA. Multiple bilateral masses detected on screening mammography: assessment of need for recall imaging. AJR Am J Roentgenol. 2000 Jul. 175(1):23-9. [Medline]. [Full Text].

  22. Mehta TS. Current uses of ultrasound in the evaluation of the breast. Radiol Clin North Am. 2003 Jul. 41(4):841-56. [Medline].

  23. Moy L, Slanetz PJ, Moore R, et al. Specificity of mammography and US in the evaluation of a palpable abnormality: retrospective review. Radiology. 2002 Oct. 225(1):176-81. [Medline]. [Full Text].

  24. 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. 1998 Nov. 209(2):511-8. [Medline].

  25. Sheppard DG, Whitman GJ, Huynh PT, et al. Tubular carcinoma of the breast: mammographic and sonographic features. AJR Am J Roentgenol. 2000 Jan. 174(1):253-7. [Medline]. [Full Text].

  26. Smith RA, Saslow D, Sawyer KA, et al. American Cancer Society guidelines for breast cancer screening: update 2003. CA Cancer J Clin. 2003 May-Jun. 53(3):141-69. [Medline].

  27. 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. 2008 Apr. 59(2):70-6. [Medline].

  28. 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. 2008 May 14. 299(18):2151-63. [Medline]. [Full Text].

  29. Kolb TM, Lichy J, Newhouse JH. Occult cancer in women with dense breasts: detection with screening US--diagnostic yield and tumor characteristics. Radiology. 1998 Apr. 207(1):191-9. [Medline].

  30. 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. 2000 Aug. 21(4):325-36. [Medline].

  31. Berg WA. Rationale for a trial of screening breast ultrasound: American College of Radiology Imaging Network (ACRIN) 6666. AJR Am J Roentgenol. 2003 May. 180(5):1225-8. [Medline]. [Full Text].

  32. Berg WA, Zhang Z, Lehrer D, Jong RA, Pisano ED, Barr RG, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA. 2012 Apr 4. 307(13):1394-404. [Medline].

  33. U.S. Food and Drug Administration (FDA). FDA approves first breast ultrasound imaging system for dense breast tissue. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm319867.htm. Accessed: September 18, 2012.

  34. Kim AH, Kim MJ, Kim EK, Park BW, Moon HJ. Positive predictive value of additional synchronous breast lesions in whole-breast ultrasonography at the diagnosis of breast cancer: clinical and imaging factors. Ultrasonography. 2014 Jul. 33(3):170-7. [Medline]. [Full Text].

  35. Appleton DC, Hackney L, Narayanan S. Ultrasonography alone for diagnosis of breast cancer in women under 40. Ann R Coll Surg Engl. 2014 Apr. 96(3):202-6. [Medline].

  36. Baker JA, Kornguth PJ, Soo MS, et al. Sonography of solid breast lesions: observer variability of lesion description and assessment. AJR Am J Roentgenol. 1999 Jun. 172(6):1621-5. [Medline].

  37. Rahbar G, Sie AC, Hansen GC, et al. Benign versus malignant solid breast masses: US differentiation. Radiology. 1999 Dec. 213(3):889-94. [Medline]. [Full Text].

  38. Mendelson EB, Berg WA, Merritt CR. Toward a standardized breast ultrasound lexicon, BI-RADS: ultrasound. Semin Roentgenol. 2001 Jul. 36(3):217-25. [Medline].

  39. Mendelson EB, Baum JK, Berg WA, et al. ACR Breast imaging and reporting data system ultrasound. ACR Breast Imaging Atlas. 2003.

  40. Liberman L, Menell JH. Breast imaging reporting and data system (BI-RADS). Radiol Clin North Am. 2002 May. 40(3):409-30, v. [Medline].

  41. Evans WP. Breast masses. Appropriate evaluation. Radiol Clin North Am. 1995 Nov. 33(6):1085-108. [Medline].

  42. Gordon PB, Goldenberg SL. Malignant breast masses detected only by ultrasound. A retrospective review. Cancer. 1995 Aug 15. 76(4):626-30. [Medline].

  43. 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. Radiology. 2003 Mar. 226(3):783-90. [Medline]. [Full Text].

  44. Liberman L, Bonaccio E, Hamele-Bena D. Benign and malignant phyllodes tumors: mammographic and sonographic findings. Radiology. 1996. 198:121-124.

  45. Stavros AT, Thickman D, Rapp CL, et al. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 1995 Jul. 196(1):123-34. [Medline].

  46. Skaane P, Engedal K. Analysis of sonographic features in the differentiation of fibroadenoma and invasive ductal carcinoma. AJR Am J Roentgenol. 1998 Jan. 170(1):109-14. [Medline].

  47. Zonderland HM, Coerkamp EG, Hermans J, et al. Diagnosis of breast cancer: contribution of US as an adjunct to mammography. Radiology. 1999 Nov. 213(2):413-22. [Medline]. [Full Text].

  48. 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. 1994 Oct. 163(4):821-4. [Medline].

  49. Butler RS, Venta LA, Wiley EL, et al. Sonographic evaluation of infiltrating lobular carcinoma. AJR Am J Roentgenol. 1999 Feb. 172(2):325-30. [Medline].

  50. Soo MS, Williford ME, Walsh R, et al. Papillary carcinoma of the breast: imaging findings. AJR Am J Roentgenol. 1995 Feb. 164(2):321-6. [Medline].

  51. Taylor KJ, Merritt C, Piccoli C, et al. Ultrasound as a complement to mammography and breast examination to characterize breast masses. Ultrasound Med Biol. 2002 Jan. 28(1):19-26. [Medline].

  52. Berg WA, Campassi CI, Ioffe OB. Cystic lesions of the breast: sonographic-pathologic correlation. Radiology. 2003 Apr. 227(1):183-91. [Medline]. [Full Text].

  53. Parker SH, Jobe WE, Dennis MA, et al. US-guided automated large-core breast biopsy. Radiology. 1993 May. 187(2):507-11. [Medline].

  54. 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. Radiology. 2001 Jun. 219(3):785-92. [Medline]. [Full Text].

  55. Fornage BD, Coan JD, David CL. Ultrasound-guided needle biopsy of the breast and other interventional procedures. Radiol Clin North Am. 1992 Jan. 30(1):167-85. [Medline].

  56. Liberman L, Feng TL, Dershaw DD, et al. US-guided core breast biopsy: use and cost-effectiveness. Radiology. 1998 Sep. 208(3):717-23. [Medline].

  57. Liberman L. Percutaneous image-guided core breast biopsy. Radiol Clin North Am. 2002 May. 40(3):483-500, vi. [Medline].

  58. Liberman L. Centennial dissertation. Percutaneous imaging-guided core breast biopsy: state of the art at the millennium. AJR Am J Roentgenol. 2000 May. 174(5):1191-9. [Medline]. [Full Text].

  59. 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. J Ultrasound Med. 2002 Nov. 21(11):1221-6. [Medline]. [Full Text].

  60. National Cancer Institute. The uniform approach to breast fine-needle aspiration biopsy. National Cancer Institute Fine-Needle Aspiration of Breast Workshop Subcommittees. Diagn Cytopathol. 1997 Apr. 16(4):295-311. [Medline].

  61. Parker SH, Klaus AJ, McWey PJ, et al. Sonographically guided directional vacuum-assisted breast biopsy using a handheld device. AJR Am J Roentgenol. 2001 Aug. 177(2):405-8. [Medline]. [Full Text].

  62. 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. 1998 Feb 15. 82(4):679-88. [Medline].

  63. Rosen EL, Bentley RC, Baker JA, Soo MS. Imaging-guided core needle biopsy of papillary lesions of the breast. AJR Am J Roentgenol. 2002 Nov. 179(5):1185-92. [Medline]. [Full Text].

  64. Smith DN, Kaelin CM, Korbin CD, et al. Impalpable breast cysts: utility of cytologic examination of fluid obtained with radiologically guided aspiration. Radiology. 1997 Jul. 204(1):149-51. [Medline].

  65. Soo MS, Baker JA, Rosen EL. Sonographic detection and sonographically guided biopsy of breast microcalcifications. AJR Am J Roentgenol. 2003 Apr. 180(4):941-8. [Medline]. [Full Text].

  66. 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. 2008 Jun. 60(6):614-7. [Medline].

  67. 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. 2008 Apr 30. 49(2):249-54. [Medline].

  68. Kopans DB. Clip placement during sonographically guided breast biopsy. AJR Am J Roentgenol. 2001 Apr. 176(4):1076-7. [Medline].

  69. Burak WE, Agnese DM, Povoski SP, et al. Radiofrequency ablation of invasive breast carcinoma followed by delayed surgical excision. Cancer. 2003 Oct 1. 98(7):1369-76. [Medline].

  70. Hayashi AH, Silver SF, van der Westhuizen NG, et al. Treatment of invasive breast carcinoma with ultrasound-guided radiofrequency ablation. Am J Surg. 2003 May. 185(5):429-35. [Medline]. [Full Text].

  71. Izzo F, Thomas R, Delrio P, et al. Radiofrequency ablation in patients with primary breast carcinoma: a pilot study in 26 patients. Cancer. 2001 Oct 15. 92(8):2036-44. [Medline]. [Full Text].

  72. 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. 2002 Sep 1. 95(5):982-8. [Medline].

  73. 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. Eur J Cancer. 2003 May. 39(8):1068-73. [Medline]. [Full Text].

  74. Moon WK, Noh DY, Im JG. Multifocal, multicentric, and contralateral breast cancers: bilateral whole-breast US in the preoperative evaluation of patients. Radiology. 2002 Aug. 224(2):569-76. [Medline]. [Full Text].

  75. Venta LA, Kim JP, Pelloski CE, Morrow M. Management of complex breast cysts. AJR Am J Roentgenol. 1999 Nov. 173(5):1331-6. [Medline].

  76. 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. 2008 Jun 9. 8:165. [Medline].

  77. 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. 2008 Apr 23. [Medline].

  78. Berg WA, Gilbreath PL. Multicentric and multifocal cancer: whole-breast US in preoperative evaluation. Radiology. 2000 Jan. 214(1):59-66. [Medline]. [Full Text].

  79. Edeiken BS, Fornage BD, Bedi DG, et al. Recurrence in autogenous myocutaneous flap reconstruction after mastectomy for primary breast cancer: US diagnosis. Radiology. 2003 May. 227(2):542-8. [Medline]. [Full Text].

  80. Kronemer KA, Rhee K, Siegel MJ, et al. Gray scale sonography of breast masses in adolescent girls. J Ultrasound Med. 2001 May. 20(5):491-6; quiz 498. [Medline].

  81. Arger PH, Sehgal CM, Conant EF, et al. Interreader variability and predictive value of US descriptions of solid breast masses: pilot study. Acad Radiol. 2001 Apr. 8(4):335-42. [Medline].

  82. Baker JA, Soo MS. Breast US: assessment of technical quality and image interpretation. Radiology. 2002 Apr. 223(1):229-38. [Medline]. [Full Text].

  83. Baker JA, Soo MS, Rosen EL. Artifacts and pitfalls in sonographic imaging of the breast. AJR Am J Roentgenol. 2001 May. 176(5):1261-6. [Medline]. [Full Text].

  84. Entrekin RR, Porter BA, Sillesen HH, et al. Real-time spatial compound imaging: application to breast, vascular, and musculoskeletal ultrasound. Semin Ultrasound CT MR. 2001 Feb. 22(1):50-64. [Medline].

  85. Garcia CJ, Dinamarca V, Navarro O. Breast US in children and adolescents. Radiographics. 2000. 20:1605-1162. [Medline]. [Full Text].

  86. Kaplan SS. Clinical utility of bilateral whole-breast US in the evaluation of women with dense breast tissue. Radiology. 2001 Dec. 221(3):641-9. [Medline]. [Full Text].

  87. Leconte I, Feger C, Galant C, et al. Mammography and subsequent whole-breast sonography of nonpalpable breast cancers: the importance of radiologic breast density. AJR Am J Roentgenol. 2003 Jun. 180(6):1675-9. [Medline]. [Full Text].

  88. 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. Radiology. 2003 May. 227(2):549-55. [Medline]. [Full Text].

  89. Memis A, Ozdemir N, Parildar M, et al. Mucinous (colloid) breast cancer: mammographic and US features with histologic correlation. Eur J Radiol. 2000 Jul. 35(1):39-43. [Medline].

  90. Moon WK, Myung JS, Lee YJ, et al. US of ductal carcinoma in situ. Radiographics. 2002 Mar-Apr. 22(2):269-80; discussion 280-1. [Medline]. [Full Text].

  91. Perlmutter S, Licht M, Gold BM, et al. Ultrasonic ring down artifact in breast abscess. Journal of Women's Imaging. 2001. 3:108-11.

  92. Rosen EL, Soo MS. Tissue harmonic imaging sonography of breast lesions: improved margin analysis, conspicuity, and image quality compared to conventional ultrasound. Clin Imaging. 2001 Nov-Dec. 25(6):379-84. [Medline].

  93. Szopinski KT, Pajk AM, Wysocki M, et al. Tissue harmonic imaging: utility in breast sonography. J Ultrasound Med. 2003 May. 22(5):479-87; quiz 488-9. [Medline].

  94. Weinstein SP, Conant EF, Acs G. Case 59: Angiolipoma of the breast. Radiology. 2003 Jun. 227(3):773-5. [Medline]. [Full Text].

 
Previous
Next
 
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).
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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).
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.)
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.
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.
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.
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.
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.
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.
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.
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.
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.)
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).
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).
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.
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).
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).
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.
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.