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
Related Anatomy
Loading...
Related Differential Diagnoses
Loading...
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)
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
STATdx includes over 200,000 searchable images, including x-ray, CT, MR and ultrasound images. To access all images, please log in or subscribe.