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Breast
Lesion Imaging Characteristics
Ultrasound Lesion Characteristics
Echogenicity: Isoechoic (US)
Echogenicity: Isoechoic (US)
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Echogenicity: Echo pattern
              • Isoechoic: Echogenicity equal to subcutaneous fat
                • ↓ conspicuity of isoechoic masses, may be mistaken for fat lobules
                • Distinguish from mildly hypoechoic, markedly hypoechoic, anechoic, and hyperechoic
              • Echogenicity can be homogeneous or heterogeneous (mixed)
                • Mixed echogenicity typically implies both hypo- and hyperechoic areas within mass
                • Complex: Complex cystic and solid mass
              • Oval shape: Ellipsoid, including 2-3 gentle lobulations

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          CLINICAL ISSUES

                          • Presentation

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              • Image Interpretation Pearls

                                Selected References

                                1. Jung J et al: Development of a management algorithm for the diagnosis of cellular fibroepithelial lesions from core needle biopsies. Int J Surg Pathol. 1066896918775525, 2018
                                2. 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):1045-1050, 2018
                                3. Marcon M et al: First ultrasound diagnosis of BI-RADS 3 lesions in young patients: Can 6-months follow-up be sufficient to assess stability? Eur J Radiol. 89:226-233, 2017
                                4. Watanabe T et al: Ultrasound image classification of ductal carcinoma in situ (DCIS) of the breast: analysis of 705 DCIS lesions. Ultrasound Med Biol. 43(5):918-925, 2017
                                5. Wienbeck S et al: Radiological imaging characteristics of intramammary hematological malignancies: results from a German multicenter study. Sci Rep. 7(1):7435, 2017
                                6. Elverici E et al: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol. 21(3):189-94, 2015
                                7. Scoggins ME et al: Correlation between sonographic findings and clinicopathologic and biologic features of pure ductal carcinoma in situ in 691 patients. AJR Am J Roentgenol. 204(4):878-88, 2015
                                8. Song SE et al: Undiagnosed breast cancer: Features at supplemental screening US. Radiology. 277(2):372-80, 2015
                                9. Uematsu T: Ultrasonographic findings of missed breast cancer: pitfalls and pearls. Breast Cancer. 21(1):10-9, 2014
                                10. Kaoku S et al: Sonographic and pathologic image analysis of pure mucinous carcinoma of the breast. Ultrasound Med Biol. 39(7):1158-67, 2013
                                11. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston, American College of Radiology, 2013
                                12. Lee MH et al: Sonographic findings of pure ductal carcinoma in situ. J Clin Ultrasound. 41(8):465-71, 2013
                                13. Tan JZ et al: Mucinous carcinomas of the breast: imaging features and potential for misdiagnosis. J Med Imaging Radiat Oncol. 57(1):25-31, 2013
                                14. Kamitani K et al: Ultrasonographic findings of invasive micropapillary carcinoma of the breast: correlation between internal echogenicity and histological findings. Breast Cancer. 19(4):349-52, 2012
                                15. Kim MJ et al: How to find an isoechoic lesion with breast US. Radiographics. 31(3):663-76, 2011
                                16. Berg WA et al: Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am. 48(5):931-87, 2010
                                17. 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
                                18. Heinig J et al: Accuracy of classification of breast ultrasound findings based on criteria used for BI-RADS. Ultrasound Obstet Gynecol. 32(4):573-8, 2008
                                19. Kim SJ et al: Application of sonographic BI-RADS to synchronous breast nodules detected in patients with breast cancer. AJR Am J Roentgenol. 191(3):653-8, 2008
                                20. Raza S et al: BI-RADS 3, 4, and 5 lesions: value of US in management--follow-up and outcome. Radiology. 248(3):773-81, 2008
                                21. Kim MJ et al: Application of power Doppler vocal fremitus sonography in breast lesions. J Ultrasound Med. 25(7):897-906, 2006
                                22. Bassett LW et al: Diagnosis of Diseases of the Breast. Philadelphia: Elsevier Saunders. 543-49, 2005
                                23. Hong AS et al: BI-RADS for sonography: positive and negative predictive values of sonographic features. AJR Am J Roentgenol. 184(4):1260-5, 2005
                                24. 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
                                25. Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. 115-7, 2004
                                26. Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. 539-41; 571-75, 2004
                                27. Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. 71-5, 2004
                                28. Szopinski KT et al: Tissue harmonic imaging: utility in breast sonography. J Ultrasound Med. 22(5):479-87; quiz 488- 9, 2003
                                29. 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
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Top Differential Diagnoses

                                      • Clinical Issues

                                        • Diagnostic Checklist

                                          TERMINOLOGY

                                          • Definitions

                                            • Echogenicity: Echo pattern
                                            • Isoechoic: Echogenicity equal to subcutaneous fat
                                              • ↓ conspicuity of isoechoic masses, may be mistaken for fat lobules
                                              • Distinguish from mildly hypoechoic, markedly hypoechoic, anechoic, and hyperechoic
                                            • Echogenicity can be homogeneous or heterogeneous (mixed)
                                              • Mixed echogenicity typically implies both hypo- and hyperechoic areas within mass
                                              • Complex: Complex cystic and solid mass
                                            • Oval shape: Ellipsoid, including 2-3 gentle lobulations

                                          IMAGING

                                          • General Features

                                            • Mammographic Findings

                                              • Ultrasonographic Findings

                                                • MR Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          DIAGNOSTIC CHECKLIST

                                                          • Consider

                                                            • Image Interpretation Pearls

                                                              Selected References

                                                              1. Jung J et al: Development of a management algorithm for the diagnosis of cellular fibroepithelial lesions from core needle biopsies. Int J Surg Pathol. 1066896918775525, 2018
                                                              2. 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):1045-1050, 2018
                                                              3. Marcon M et al: First ultrasound diagnosis of BI-RADS 3 lesions in young patients: Can 6-months follow-up be sufficient to assess stability? Eur J Radiol. 89:226-233, 2017
                                                              4. Watanabe T et al: Ultrasound image classification of ductal carcinoma in situ (DCIS) of the breast: analysis of 705 DCIS lesions. Ultrasound Med Biol. 43(5):918-925, 2017
                                                              5. Wienbeck S et al: Radiological imaging characteristics of intramammary hematological malignancies: results from a German multicenter study. Sci Rep. 7(1):7435, 2017
                                                              6. Elverici E et al: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol. 21(3):189-94, 2015
                                                              7. Scoggins ME et al: Correlation between sonographic findings and clinicopathologic and biologic features of pure ductal carcinoma in situ in 691 patients. AJR Am J Roentgenol. 204(4):878-88, 2015
                                                              8. Song SE et al: Undiagnosed breast cancer: Features at supplemental screening US. Radiology. 277(2):372-80, 2015
                                                              9. Uematsu T: Ultrasonographic findings of missed breast cancer: pitfalls and pearls. Breast Cancer. 21(1):10-9, 2014
                                                              10. Kaoku S et al: Sonographic and pathologic image analysis of pure mucinous carcinoma of the breast. Ultrasound Med Biol. 39(7):1158-67, 2013
                                                              11. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston, American College of Radiology, 2013
                                                              12. Lee MH et al: Sonographic findings of pure ductal carcinoma in situ. J Clin Ultrasound. 41(8):465-71, 2013
                                                              13. Tan JZ et al: Mucinous carcinomas of the breast: imaging features and potential for misdiagnosis. J Med Imaging Radiat Oncol. 57(1):25-31, 2013
                                                              14. Kamitani K et al: Ultrasonographic findings of invasive micropapillary carcinoma of the breast: correlation between internal echogenicity and histological findings. Breast Cancer. 19(4):349-52, 2012
                                                              15. Kim MJ et al: How to find an isoechoic lesion with breast US. Radiographics. 31(3):663-76, 2011
                                                              16. Berg WA et al: Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am. 48(5):931-87, 2010
                                                              17. 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
                                                              18. Heinig J et al: Accuracy of classification of breast ultrasound findings based on criteria used for BI-RADS. Ultrasound Obstet Gynecol. 32(4):573-8, 2008
                                                              19. Kim SJ et al: Application of sonographic BI-RADS to synchronous breast nodules detected in patients with breast cancer. AJR Am J Roentgenol. 191(3):653-8, 2008
                                                              20. Raza S et al: BI-RADS 3, 4, and 5 lesions: value of US in management--follow-up and outcome. Radiology. 248(3):773-81, 2008
                                                              21. Kim MJ et al: Application of power Doppler vocal fremitus sonography in breast lesions. J Ultrasound Med. 25(7):897-906, 2006
                                                              22. Bassett LW et al: Diagnosis of Diseases of the Breast. Philadelphia: Elsevier Saunders. 543-49, 2005
                                                              23. Hong AS et al: BI-RADS for sonography: positive and negative predictive values of sonographic features. AJR Am J Roentgenol. 184(4):1260-5, 2005
                                                              24. 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
                                                              25. Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. 115-7, 2004
                                                              26. Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. 539-41; 571-75, 2004
                                                              27. Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. 71-5, 2004
                                                              28. Szopinski KT et al: Tissue harmonic imaging: utility in breast sonography. J Ultrasound Med. 22(5):479-87; quiz 488- 9, 2003
                                                              29. Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995