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
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
Javed A et al: Intermediate and long-term outcomes of fibroadenoma excision in adolescent and young adult patients. Breast J. ePub, 2018
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
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
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
Zhang L et al: Identifying ultrasound and clinical features of breast cancer molecular subtypes by ensemble decision. Sci Rep. 5:11085, 2015
Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
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
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
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
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
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
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
Berg WA et al: Cystic breast lesions and the ACRIN 6666 experience. Radiol Clin North Am. 48:931-87, 2010
Kim JH et al: Noncalcified ductal carcinoma in situ: imaging and histologic findings in 36 tumors. J Ultrasound Med. 28(7):903-10, 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 TH et al: Sonographic differentiation of benign and malignant papillary lesions of the breast. J Ultrasound Med. 27(1):75-82, 2008
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
Costantini M et al: Solid breast mass characterisation: use of the sonographic BI-RADS classification. Radiol Med. 112(6):877-94, 2007
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
Cawson JN: Can sonography be used to help differentiate between radial scars and breast cancers? Breast. 14(5):352-9, 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
Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. Ch 12:45-527, 2004
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
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
Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995
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
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
Javed A et al: Intermediate and long-term outcomes of fibroadenoma excision in adolescent and young adult patients. Breast J. ePub, 2018
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
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
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
Zhang L et al: Identifying ultrasound and clinical features of breast cancer molecular subtypes by ensemble decision. Sci Rep. 5:11085, 2015
Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
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
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
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
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
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
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
Berg WA et al: Cystic breast lesions and the ACRIN 6666 experience. Radiol Clin North Am. 48:931-87, 2010
Kim JH et al: Noncalcified ductal carcinoma in situ: imaging and histologic findings in 36 tumors. J Ultrasound Med. 28(7):903-10, 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 TH et al: Sonographic differentiation of benign and malignant papillary lesions of the breast. J Ultrasound Med. 27(1):75-82, 2008
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
Costantini M et al: Solid breast mass characterisation: use of the sonographic BI-RADS classification. Radiol Med. 112(6):877-94, 2007
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
Cawson JN: Can sonography be used to help differentiate between radial scars and breast cancers? Breast. 14(5):352-9, 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
Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. Ch 12:45-527, 2004
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
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
Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995
Fornage BD et al: Fibroadenoma of the breast: sonographic appearance. Radiology. 172(3):671-5, 1989
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