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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
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
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
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
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
Wienbeck S et al: Radiological imaging characteristics of intramammary hematological malignancies: results from a German multicenter study. Sci Rep. 7(1):7435, 2017
Elverici E et al: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol. 21(3):189-94, 2015
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
Song SE et al: Undiagnosed breast cancer: Features at supplemental screening US. Radiology. 277(2):372-80, 2015
Uematsu T: Ultrasonographic findings of missed breast cancer: pitfalls and pearls. Breast Cancer. 21(1):10-9, 2014
Kaoku S et al: Sonographic and pathologic image analysis of pure mucinous carcinoma of the breast. Ultrasound Med Biol. 39(7):1158-67, 2013
Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston, American College of Radiology, 2013
Lee MH et al: Sonographic findings of pure ductal carcinoma in situ. J Clin Ultrasound. 41(8):465-71, 2013
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
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
Kim MJ et al: How to find an isoechoic lesion with breast US. Radiographics. 31(3):663-76, 2011
Berg WA et al: Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am. 48(5):931-87, 2010
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
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
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
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
Kim MJ et al: Application of power Doppler vocal fremitus sonography in breast lesions. J Ultrasound Med. 25(7):897-906, 2006
Bassett LW et al: Diagnosis of Diseases of the Breast. Philadelphia: Elsevier Saunders. 543-49, 2005
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
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: Lippincott Williams & Wilkins. 115-7, 2004
Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. 539-41; 571-75, 2004
Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. 71-5, 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
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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
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
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
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
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
Wienbeck S et al: Radiological imaging characteristics of intramammary hematological malignancies: results from a German multicenter study. Sci Rep. 7(1):7435, 2017
Elverici E et al: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol. 21(3):189-94, 2015
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
Song SE et al: Undiagnosed breast cancer: Features at supplemental screening US. Radiology. 277(2):372-80, 2015
Uematsu T: Ultrasonographic findings of missed breast cancer: pitfalls and pearls. Breast Cancer. 21(1):10-9, 2014
Kaoku S et al: Sonographic and pathologic image analysis of pure mucinous carcinoma of the breast. Ultrasound Med Biol. 39(7):1158-67, 2013
Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston, American College of Radiology, 2013
Lee MH et al: Sonographic findings of pure ductal carcinoma in situ. J Clin Ultrasound. 41(8):465-71, 2013
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
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
Kim MJ et al: How to find an isoechoic lesion with breast US. Radiographics. 31(3):663-76, 2011
Berg WA et al: Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am. 48(5):931-87, 2010
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
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
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
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
Kim MJ et al: Application of power Doppler vocal fremitus sonography in breast lesions. J Ultrasound Med. 25(7):897-906, 2006
Bassett LW et al: Diagnosis of Diseases of the Breast. Philadelphia: Elsevier Saunders. 543-49, 2005
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
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: Lippincott Williams & Wilkins. 115-7, 2004
Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. 539-41; 571-75, 2004
Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. 71-5, 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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