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Breast
Lesion Imaging Characteristics
Ultrasound Lesion Characteristics
Margins, Not Circumscribed (US)
Margins, Not Circumscribed (US)
Regina J. Hooley, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Mass shape: Oval (elliptical, includes 2-3 gentle/macro lobulations), round, or irregular
              • Margin: Edge or border of mass
                • Circumscribed: Well-defined, sharp, abrupt transition (margin) between mass and surrounding tissue; usually only seen with oval or round masses
                • Not circumscribed: Used when any portion of mass margin is not sharply defined on US; may have associated echogenic rim
                  • BI-RADS descriptors: Indistinct, angular, microlobulated, spiculated

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    • Image-Guided Biopsy

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            CLINICAL ISSUES

                            • Presentation

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Wen X et al: Correlations between ultrasonographic findings of invasive lobular carcinoma of the breast and intrinsic subtypes. Ultraschall Med. ePub, 2018
                                    2. Au FW et al: Histological grade and immunohistochemical biomarkers of breast cancer: Correlation to ultrasound features. J Ultrasound Med. 36(9):1883-1894, 2017
                                    3. 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
                                    4. Lee J et al: Non-mass lesions on screening breast ultrasound. Med Ultrason. 18(4):446-451, 2016
                                    5. Yoon JH et al: Validation of the fifth edition BI-RADS ultrasound lexicon with comparison of fourth and fifth edition diagnostic performance using video clips. Ultrasonography. 35(4):318-26, 2016
                                    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. Yang Q et al: Ultrasonographic features of triple-negative breast cancer: a comparison with other breast cancer subtypes. Asian Pac J Cancer Prev. 16(8):3229-32, 2015
                                    8. Çelebi F et al: The role of ultrasonographic findings to predict molecular subtype, histologic grade, and hormone receptor status of breast cancer. Diagn Interv Radiol. 21(6):448-53, 2015
                                    9. Cho SH et al: Mimickers of breast malignancy on breast sonography. J Ultrasound Med. 32(11):2029-36, 2013
                                    10. Mendelson EB et al: Breast Imaging Reporting and Data System, BI-RADS: Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                                    11. Berg WA et al: Training the ACRIN 6666 Investigators and effects of feedback on breast ultrasound interpretive performance and agreement in BI-RADS ultrasound feature analysis. AJR Am J Roentgenol. 199(1):224-35, 2012
                                    12. Paulinelli RR et al: Sonobreast: predicting individualized probabilities of malignancy in solid breast masses with echographic expression. Breast J. 17(2):152-9, 2011
                                    13. 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
                                    14. Costantini M et al: Solid breast mass characterisation: use of the sonographic BI-RADS classification. Radiol Med. 112(6):877-94, 2007
                                    15. 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
                                    16. Paulinelli RR et al: Risk of malignancy in solid breast nodules according to their sonographic features. J Ultrasound Med. 24(5):635-41, 2005
                                    17. 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

                                                • Mass shape: Oval (elliptical, includes 2-3 gentle/macro lobulations), round, or irregular
                                                • Margin: Edge or border of mass
                                                  • Circumscribed: Well-defined, sharp, abrupt transition (margin) between mass and surrounding tissue; usually only seen with oval or round masses
                                                  • Not circumscribed: Used when any portion of mass margin is not sharply defined on US; may have associated echogenic rim
                                                    • BI-RADS descriptors: Indistinct, angular, microlobulated, spiculated

                                              IMAGING

                                              • General Features

                                                • Mammographic Findings

                                                  • Ultrasonographic Findings

                                                    • Imaging Recommendations

                                                      • Image-Guided Biopsy

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Staging, Grading, & Classification

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Wen X et al: Correlations between ultrasonographic findings of invasive lobular carcinoma of the breast and intrinsic subtypes. Ultraschall Med. ePub, 2018
                                                                      2. Au FW et al: Histological grade and immunohistochemical biomarkers of breast cancer: Correlation to ultrasound features. J Ultrasound Med. 36(9):1883-1894, 2017
                                                                      3. 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
                                                                      4. Lee J et al: Non-mass lesions on screening breast ultrasound. Med Ultrason. 18(4):446-451, 2016
                                                                      5. Yoon JH et al: Validation of the fifth edition BI-RADS ultrasound lexicon with comparison of fourth and fifth edition diagnostic performance using video clips. Ultrasonography. 35(4):318-26, 2016
                                                                      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. Yang Q et al: Ultrasonographic features of triple-negative breast cancer: a comparison with other breast cancer subtypes. Asian Pac J Cancer Prev. 16(8):3229-32, 2015
                                                                      8. Çelebi F et al: The role of ultrasonographic findings to predict molecular subtype, histologic grade, and hormone receptor status of breast cancer. Diagn Interv Radiol. 21(6):448-53, 2015
                                                                      9. Cho SH et al: Mimickers of breast malignancy on breast sonography. J Ultrasound Med. 32(11):2029-36, 2013
                                                                      10. Mendelson EB et al: Breast Imaging Reporting and Data System, BI-RADS: Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                                                                      11. Berg WA et al: Training the ACRIN 6666 Investigators and effects of feedback on breast ultrasound interpretive performance and agreement in BI-RADS ultrasound feature analysis. AJR Am J Roentgenol. 199(1):224-35, 2012
                                                                      12. Paulinelli RR et al: Sonobreast: predicting individualized probabilities of malignancy in solid breast masses with echographic expression. Breast J. 17(2):152-9, 2011
                                                                      13. 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
                                                                      14. Costantini M et al: Solid breast mass characterisation: use of the sonographic BI-RADS classification. Radiol Med. 112(6):877-94, 2007
                                                                      15. 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
                                                                      16. Paulinelli RR et al: Risk of malignancy in solid breast nodules according to their sonographic features. J Ultrasound Med. 24(5):635-41, 2005
                                                                      17. 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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