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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Definitions
- Internal echogenicity of mass is assessed relative to subcutaneous fat
- Hypoechoic: Darker gray than subcutaneous fat
- Markedly hypoechoic: One of "malignant" US features with ≥ 50% positive predictive value for malignancy among biopsied masses
- Distinguish from anechoic, isoechoic, hyperechoic
- Anechoic: Absence of internal echoes
- Isoechoic: Echogenicity equal to subcutaneous fat
- May ↓ sensitivity of US, poor conspicuity when surrounded by fat
- Hypo- and isoechoic patterns are common among benign and malignant lesions
- Mildly hypo- to isoechoic solid: 527/625 (84.3%) benign and 38/125 (30.4%) malignant masses (Stavros)
- Markedly hypoechoic solid: 62/625 (9.9%) benign and 86/125 (69%) malignant masses (Stavros)
- Useful only in combination with other features
- Echotexture (echo pattern) can be homogeneous or heterogeneous (mixed)
- Mixed echogenicity typically implies both hypo- and hyperechoic areas within mass
- Complex cystic and solid implies anechoic (cystic) component as well as (usually) hypoechoic solid component
- Oval shape = ellipsoid, includes 2 or 3 gentle lobulations
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Presentation
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Wu T et al: Identification of a correlation between the sonographic appearance and molecular subtype of invasive breast cancer: A review of 311 cases. Clin Imaging. 53:179-85, 2019
- Pistolese CA et al: Probably benign breast nodular lesions (BI-RADS 3): correlation between ultrasound features and histologic findings. Ultrasound Med Biol. 45(1):78-84, 2019
- Koh J et al: Role of elastography for downgrading BI-RADS category 4a breast lesions according to risk factors. Acta Radiol. epub, 2018.
- Koh J et al: Intrinsic subtypes of breast cancers initially assessed as probably benign or of low suspicion on ultrasonography differ according to tumor size. J Ultrasound Med. 37(6):1503-9, 2018
- Moon HJ et al: Follow-up interval for probably benign breast lesions on screening ultrasound in women at average risk for breast cancer with dense breasts. Acta Radiol. 59(9):1045-50, 2018
- Jang JY et al: Clinical significance of interval changes in breast lesions initially categorized as probably benign on breast ultrasound. Medicine (Baltimore). 96(12):e6415, 2017
- Knabben L et al: Breast cancer and pregnancy. Horm Mol Biol Clin Investig. 32(1), 2017
- Stavros AT et al: Ultrasound positive predictive values by BI-RADS categories 3-5 for solid masses: an independent reader study. Eur Radiol. 27(10):4307-15, 2017
- Berg WA et al: Quantitative maximum shear-wave stiffness of breast masses as a predictor of histopathologic severity. AJR Am J Roentgenol. 205(2):448-55, 2015
- Elverici E et al: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol. 21(3):189-94, 2015
- Barr RG et al: Probably benign lesions at screening breast US in a population with elevated risk: prevalence and rate of malignancy in the ACRIN 6666 trial. Radiology. 269(3):701-12, 2013
- Irshad A et al: Assessing the role of ultrasound in predicting the biological behavior of breast cancer. AJR Am J Roentgenol. 200(2):284-90, 2013
- Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston, VA: American College of Radiology, 2013
- Lehman CD et al: Accuracy and value of breast ultrasound for primary imaging evaluation of symptomatic women 30-39 years of age. AJR Am J Roentgenol. 199(5):1169-77, 2012
- Harvey JA et al: Short-term follow-up of palpable breast lesions with benign imaging features: evaluation of 375 lesions in 320 women. AJR Am J Roentgenol. 193(6):1723-30, 2009
- Graf O et al: Follow-up of palpable circumscribed noncalcified solid breast masses at mammography and US: can biopsy be averted? Radiology. 233(3):850-6, 2004
- Stavros AT: Breast Ultrasound. Philadelphia, PA: Lippincott Williams & Wilkins, 2004
- Szopinski KT et al: Tissue harmonic imaging: utility in breast sonography. J Ultrasound Med. 22(5):479-87; quiz 488- 9, 2003
- Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Definitions
- Internal echogenicity of mass is assessed relative to subcutaneous fat
- Hypoechoic: Darker gray than subcutaneous fat
- Markedly hypoechoic: One of "malignant" US features with ≥ 50% positive predictive value for malignancy among biopsied masses
- Distinguish from anechoic, isoechoic, hyperechoic
- Anechoic: Absence of internal echoes
- Isoechoic: Echogenicity equal to subcutaneous fat
- May ↓ sensitivity of US, poor conspicuity when surrounded by fat
- Hypo- and isoechoic patterns are common among benign and malignant lesions
- Mildly hypo- to isoechoic solid: 527/625 (84.3%) benign and 38/125 (30.4%) malignant masses (Stavros)
- Markedly hypoechoic solid: 62/625 (9.9%) benign and 86/125 (69%) malignant masses (Stavros)
- Useful only in combination with other features
- Echotexture (echo pattern) can be homogeneous or heterogeneous (mixed)
- Mixed echogenicity typically implies both hypo- and hyperechoic areas within mass
- Complex cystic and solid implies anechoic (cystic) component as well as (usually) hypoechoic solid component
- Oval shape = ellipsoid, includes 2 or 3 gentle lobulations
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Presentation
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Wu T et al: Identification of a correlation between the sonographic appearance and molecular subtype of invasive breast cancer: A review of 311 cases. Clin Imaging. 53:179-85, 2019
- Pistolese CA et al: Probably benign breast nodular lesions (BI-RADS 3): correlation between ultrasound features and histologic findings. Ultrasound Med Biol. 45(1):78-84, 2019
- Koh J et al: Role of elastography for downgrading BI-RADS category 4a breast lesions according to risk factors. Acta Radiol. epub, 2018.
- Koh J et al: Intrinsic subtypes of breast cancers initially assessed as probably benign or of low suspicion on ultrasonography differ according to tumor size. J Ultrasound Med. 37(6):1503-9, 2018
- Moon HJ et al: Follow-up interval for probably benign breast lesions on screening ultrasound in women at average risk for breast cancer with dense breasts. Acta Radiol. 59(9):1045-50, 2018
- Jang JY et al: Clinical significance of interval changes in breast lesions initially categorized as probably benign on breast ultrasound. Medicine (Baltimore). 96(12):e6415, 2017
- Knabben L et al: Breast cancer and pregnancy. Horm Mol Biol Clin Investig. 32(1), 2017
- Stavros AT et al: Ultrasound positive predictive values by BI-RADS categories 3-5 for solid masses: an independent reader study. Eur Radiol. 27(10):4307-15, 2017
- Berg WA et al: Quantitative maximum shear-wave stiffness of breast masses as a predictor of histopathologic severity. AJR Am J Roentgenol. 205(2):448-55, 2015
- Elverici E et al: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol. 21(3):189-94, 2015
- Barr RG et al: Probably benign lesions at screening breast US in a population with elevated risk: prevalence and rate of malignancy in the ACRIN 6666 trial. Radiology. 269(3):701-12, 2013
- Irshad A et al: Assessing the role of ultrasound in predicting the biological behavior of breast cancer. AJR Am J Roentgenol. 200(2):284-90, 2013
- Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston, VA: American College of Radiology, 2013
- Lehman CD et al: Accuracy and value of breast ultrasound for primary imaging evaluation of symptomatic women 30-39 years of age. AJR Am J Roentgenol. 199(5):1169-77, 2012
- Harvey JA et al: Short-term follow-up of palpable breast lesions with benign imaging features: evaluation of 375 lesions in 320 women. AJR Am J Roentgenol. 193(6):1723-30, 2009
- Graf O et al: Follow-up of palpable circumscribed noncalcified solid breast masses at mammography and US: can biopsy be averted? Radiology. 233(3):850-6, 2004
- Stavros AT: Breast Ultrasound. Philadelphia, PA: Lippincott Williams & Wilkins, 2004
- Szopinski KT et al: Tissue harmonic imaging: utility in breast sonography. J Ultrasound Med. 22(5):479-87; quiz 488- 9, 2003
- Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995
