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Breast
Lesion Imaging Characteristics
Ultrasound Lesion Characteristics
Lesion Orientation (US)
Lesion Orientation (US)
Uzma Waheed, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Top Differential Diagnoses

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Orientation: Longest axis of mass relative to skin
              • Parallel = "wider-than-tall" = horizontal orientation: Longest axis of mass is parallel to skin
                • Ratio of anteroposterior (AP) to longest horizontal diameter is < 1
                • Seen in both benign and malignant lesions; 78% of biopsied masses; 20% malignant (across series)
              • Vertical = "taller-than-wide" = longest axis of mass is perpendicular to skin (nonparallel)
                • Ratio of AP to horizontal diameters is ≥ 1
                • Includes round masses, i.e., AP and horizontal distances are equal
                • Suspicious for malignancy; 22% of biopsied lesions, 70% malignant (across series)
            • Oval shape: Ellipsoid, includes 2-3 gentle lobulations

          IMAGING

          • General Features

            • Imaging Recommendations

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  CLINICAL ISSUES

                  • Presentation

                    • Natural History & Prognosis

                      DIAGNOSTIC CHECKLIST

                      • Consider

                        • Image Interpretation Pearls

                          • Reporting Tips

                            Selected References

                            1. 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. 53:179-185, 2019
                            2. Javed A et al: Intermediate and long-term outcomes of fibroadenoma excision in adolescent and young adult patients. Breast J. ePub, 2018
                            3. 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):4307-4315, 2017
                            4. Chae EY et al: Association between ultrasound features and the 21-gene recurrence score assays in patients with oestrogen receptor-positive, HER2-negative, invasive breast cancer. PLoS One. 11(6):e0158461, 2016
                            5. Elverici E et al: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol. 21(3):189-94, 2015
                            6. 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
                            7. Zhang L et al: Identifying ultrasound and clinical features of breast cancer molecular subtypes by ensemble decision. Sci Rep. 5:11085, 2015
                            8. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                            9. Hille H et al: The accuracy of BI-RADS classification of breast ultrasound as a first-line imaging method. Ultraschall Med. 33(2):160-3, 2012
                            10. Kim H et al: Comparison of conventional and automated breast volume ultrasound in the description and characterization of solid breast masses based on BI-RADS features. Breast Cancer. Epub ahead of print, 2012
                            11. 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
                            12. Taskin F et al: Sonographic features of histopathologically benign solid breast lesions that have been classified as BI-RADS 4 on sonography. J Clin Ultrasound. 40(5):261-5, 2012
                            13. Zhang J et al: Interobserver agreement for sonograms of breast lesions obtained by an automated breast volume scanner. Eur J Radiol. 81(9):2179-83, 2012
                            14. Shin HJ et al: Automated ultrasound of the breast for diagnosis: interobserver agreement on lesion detection and characterization. AJR Am J Roentgenol. 197(3):747-54, 2011
                            15. Berg WA et al: Cystic breast lesions and the ACRIN 6666 experience. Radiol Clin North Am. 48:931-87, 2010
                            16. Kim JH et al: Noncalcified ductal carcinoma in situ: imaging and histologic findings in 36 tumors. J Ultrasound Med. 28(7):903-10, 2009
                            17. 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
                            18. Kim TH et al: Sonographic differentiation of benign and malignant papillary lesions of the breast. J Ultrasound Med. 27(1):75-82, 2008
                            19. Lee HJ et al: Observer variability of Breast Imaging Reporting and Data System (BI-RADS) for breast ultrasound. Eur J Radiol. 65(2):293-8, 2008
                            20. Costantini M et al: Solid breast mass characterisation: use of the sonographic BI-RADS classification. Radiol Med. 112(6):877-94, 2007
                            21. Park CS et al: Observer agreement using the ACR Breast Imaging Reporting and Data System (BI-RADS)-ultrasound, First Edition (2003). Korean J Radiol. 8(5):397-402, 2007
                            22. Cawson JN: Can sonography be used to help differentiate between radial scars and breast cancers? Breast. 14(5):352-9, 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. Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. Ch 12:45-527, 2004
                            25. Zonderland HM et al: Ultrasound variables and their prognostic value in a population of 1103 patients with 272 breast cancers. Eur Radiol. 10(10):1562-8, 2000
                            26. Skaane P et al: Analysis of sonographic features in the differentiation of fibroadenoma and invasive ductal carcinoma. AJR Am J Roentgenol. 170(1):109-14, 1998
                            27. Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995
                            28. Fornage BD et al: Fibroadenoma of the breast: sonographic appearance. Radiology. 172(3):671-5, 1989
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Top Differential Diagnoses

                                • Pathology

                                  • Clinical Issues

                                    TERMINOLOGY

                                    • Definitions

                                      • Orientation: Longest axis of mass relative to skin
                                        • Parallel = "wider-than-tall" = horizontal orientation: Longest axis of mass is parallel to skin
                                          • Ratio of anteroposterior (AP) to longest horizontal diameter is < 1
                                          • Seen in both benign and malignant lesions; 78% of biopsied masses; 20% malignant (across series)
                                        • Vertical = "taller-than-wide" = longest axis of mass is perpendicular to skin (nonparallel)
                                          • Ratio of AP to horizontal diameters is ≥ 1
                                          • Includes round masses, i.e., AP and horizontal distances are equal
                                          • Suspicious for malignancy; 22% of biopsied lesions, 70% malignant (across series)
                                      • Oval shape: Ellipsoid, includes 2-3 gentle lobulations

                                    IMAGING

                                    • General Features

                                      • Imaging Recommendations

                                        DIFFERENTIAL DIAGNOSIS

                                          PATHOLOGY

                                          • General Features

                                            CLINICAL ISSUES

                                            • Presentation

                                              • Natural History & Prognosis

                                                DIAGNOSTIC CHECKLIST

                                                • Consider

                                                  • Image Interpretation Pearls

                                                    • Reporting Tips

                                                      Selected References

                                                      1. 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. 53:179-185, 2019
                                                      2. Javed A et al: Intermediate and long-term outcomes of fibroadenoma excision in adolescent and young adult patients. Breast J. ePub, 2018
                                                      3. 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):4307-4315, 2017
                                                      4. Chae EY et al: Association between ultrasound features and the 21-gene recurrence score assays in patients with oestrogen receptor-positive, HER2-negative, invasive breast cancer. PLoS One. 11(6):e0158461, 2016
                                                      5. Elverici E et al: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol. 21(3):189-94, 2015
                                                      6. 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
                                                      7. Zhang L et al: Identifying ultrasound and clinical features of breast cancer molecular subtypes by ensemble decision. Sci Rep. 5:11085, 2015
                                                      8. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                                                      9. Hille H et al: The accuracy of BI-RADS classification of breast ultrasound as a first-line imaging method. Ultraschall Med. 33(2):160-3, 2012
                                                      10. Kim H et al: Comparison of conventional and automated breast volume ultrasound in the description and characterization of solid breast masses based on BI-RADS features. Breast Cancer. Epub ahead of print, 2012
                                                      11. 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
                                                      12. Taskin F et al: Sonographic features of histopathologically benign solid breast lesions that have been classified as BI-RADS 4 on sonography. J Clin Ultrasound. 40(5):261-5, 2012
                                                      13. Zhang J et al: Interobserver agreement for sonograms of breast lesions obtained by an automated breast volume scanner. Eur J Radiol. 81(9):2179-83, 2012
                                                      14. Shin HJ et al: Automated ultrasound of the breast for diagnosis: interobserver agreement on lesion detection and characterization. AJR Am J Roentgenol. 197(3):747-54, 2011
                                                      15. Berg WA et al: Cystic breast lesions and the ACRIN 6666 experience. Radiol Clin North Am. 48:931-87, 2010
                                                      16. Kim JH et al: Noncalcified ductal carcinoma in situ: imaging and histologic findings in 36 tumors. J Ultrasound Med. 28(7):903-10, 2009
                                                      17. 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
                                                      18. Kim TH et al: Sonographic differentiation of benign and malignant papillary lesions of the breast. J Ultrasound Med. 27(1):75-82, 2008
                                                      19. Lee HJ et al: Observer variability of Breast Imaging Reporting and Data System (BI-RADS) for breast ultrasound. Eur J Radiol. 65(2):293-8, 2008
                                                      20. Costantini M et al: Solid breast mass characterisation: use of the sonographic BI-RADS classification. Radiol Med. 112(6):877-94, 2007
                                                      21. Park CS et al: Observer agreement using the ACR Breast Imaging Reporting and Data System (BI-RADS)-ultrasound, First Edition (2003). Korean J Radiol. 8(5):397-402, 2007
                                                      22. Cawson JN: Can sonography be used to help differentiate between radial scars and breast cancers? Breast. 14(5):352-9, 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. Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. Ch 12:45-527, 2004
                                                      25. Zonderland HM et al: Ultrasound variables and their prognostic value in a population of 1103 patients with 272 breast cancers. Eur Radiol. 10(10):1562-8, 2000
                                                      26. Skaane P et al: Analysis of sonographic features in the differentiation of fibroadenoma and invasive ductal carcinoma. AJR Am J Roentgenol. 170(1):109-14, 1998
                                                      27. Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995
                                                      28. Fornage BD et al: Fibroadenoma of the breast: sonographic appearance. Radiology. 172(3):671-5, 1989