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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Synonyms
- Posterior enhancement: Increased through transmission
- Posterior shadowing: Posterior attenuation, acoustic shadowing
Definitions
- Posterior (acoustic) enhancement
- Sound travels better through lesion than surrounding tissue → ↑ echoes (brighter) in tissues posterior to lesion relative to adjacent tissues at comparable depth
- No posterior features: No shadowing or enhancement
- Echogenicity of tissue immediately behind mass is not different from that of adjacent tissue at same depth
- Posterior (acoustic) shadowing
- Attenuation of US beam → ↓ echoes in tissue posterior to lesion relative to adjacent tissue at comparable depth
- Calcifications > 1-2 mm can cause shadowing
- Does not include refractive edge shadowing
- Refraction of sound waves occurs at edges of curved mass or ligaments perpendicular to US beam → ↓ echoes in tissue directly deep to curved surface
- Thin (1-2 mm) stripe of shadowing tangential to surface of mass, perpendicular to beam
- Essentially eliminated with spatial compounding (multiple off-angle beams)
- Mixed pattern: Some portions of lesion cause posterior enhancement, and others cause posterior shadowing
- Spatial compounding: Use of multiple off-angle US beams
- Improves margin assessment on sides of mass
- Posterior features less apparent
- Posterior (acoustic) enhancement
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
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
- Wen X et al: Correlations between ultrasonographic findings of invasive lobular carcinoma of the breast and intrinsic subtypes. Ultraschall Med. ePub, 2018
- Au FW et al: Histological grade and immunohistochemical biomarkers of breast cancer: correlation to ultrasound features. J Ultrasound Med. 36(9):1883-1894, 2017
- Elverici E et al: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol. 21(3):189-94, 2015
- Zhang L et al: Identifying ultrasound and clinical features of breast cancer molecular subtypes by ensemble decision. Sci Rep. 5:11085, 2015
- 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
- Aho M et al: Correlation of sonographic features of invasive ductal mammary carcinoma with age, tumor grade, and hormone-receptor status. J Clin Ultrasound. 41(1):10-7, 2013
- Irshad A et al: Assessing the role of ultrasound in predicting the biological behavior of breast cancer. AJR Am J Roentgenol. 200(2):284-90, 2013
- Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology. 2013
- Sickles EA et al: Breast Imaging Reporting and Data System, BI-RADS: Mammography. 5th ed. Reston: American College of Radiology, 2013
- Blaichman J et al: Sonographic appearance of invasive ductal carcinoma of the breast according to histologic grade. AJR Am J Roentgenol. 199(3):W402-8, 2012
- Linda A et al: Nonsurgical management of high-risk lesions diagnosed at core needle biopsy: can malignancy be ruled out safely with breast MRI? AJR Am J Roentgenol. 198(2):272-80, 2012
- Barr RG and Lackey AE: The utility of the "bull's-eye" artifact on breast elasticity imaging in reducing breast lesion biopsy rate. Ultrasound Q. 27:151-5, 2011
- Hsu HH et al: Complex cystic lesions of the breast on ultrasonography: feature analysis and BI-RADS assessment. Eur J Radiol. 79(1):73-9, 2011
- Berg WA et al: Cystic breast lesions and the ACRIN 6666 experience. Radiol Clin North Am. 48:931-87, 2010
- Lopez JK et al: Invasive lobular carcinoma of the breast: spectrum of mammographic, US, and MR imaging findings. Radiographics. 29(1):165-76, 2009
- Kim SH et al: Correlation of ultrasound findings with histology, tumor grade, and biological markers in breast cancer. Acta Oncol. 47(8):1531-8, 2008
- Berg WA et al: Operator dependence of physician-performed whole-breast US: lesion detection and characterization. Radiology. 241:355-65, 2006
- Costantini M et al: Characterization of solid breast masses: use of the sonographic breast imaging reporting and data system lexicon. J Ultrasound Med. 25(5):649-59; quiz 661, 2006
- 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
- Paulinelli RR et al: Risk of malignancy in solid breast nodules according to their sonographic features. J Ultrasound Med. 24(5):635-41, 2005
- Watermann DO et al: Ultrasound morphology of invasive lobular breast cancer is different compared with other types of breast cancer. Ultrasound Med Biol. 31(2):167-74, 2005
- Selinko VL et al: Role of sonography in diagnosing and staging invasive lobular carcinoma. J Clin Ultrasound. 32(7):323-32, 2004
- Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. 641-8, 2004
- Weinstein SP et al: Posterior acoustic shadowing in benign breast lesions: sonographic-pathologic correlation. J Ultrasound Med. 23(1):73-83, 2004
- Ahn BY et al: Pregnancy- and lactation-associated breast cancer: mammographic and sonographic findings. J Ultrasound Med. 22(5):491-7; quiz 498-9, 2003
- Berg WA et al: Cystic lesions of the breast: sonographic-pathologic correlation. Radiology 227:183-191, 2003
- Memis A et al: Granulomatous mastitis: imaging findings with histopathologic correlation. Clin Radiol. 57(11):1001-6, 2002
- Samardar P et al: Focal asymmetric densities seen at mammography: US and pathologic correlation. Radiographics. 22(1):19-33, 2002
- Seo BK et al: Sonographic evaluation of breast nodules: comparison of conventional, real-time compound, and pulse-inversion harmonic images. Korean J Radiol. 3(1):38-44, 2002
- Wong KT et al: Ultrasound and MR imaging of diabetic mastopathy. Clin Radiol. 57(8):730-5, 2002
- Woo KM et al: US of ductal carcinoma in situ. Radiographics. 22:269-81, 2002
- Lamb PM et al: Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast. Clin Radiol. 55(1):40-4, 2000
- Revelon G et al: Focal fibrosis of the breast: imaging characteristics and histopathologic correlation. Radiology. 216(1):255-9, 2000
- Butler RS et al: Sonographic evaluation of infiltrating lobular carcinoma. AJR Am J Roentgenol. 172(2):325-30, 1999
- Georgian-Smith D et al: From the RSNA refresher courses. Freehand interventional sonography in the breast: basic principles and clinical applications. Radiographics. 16(1):149-61, 1996
- Paramagul CP et al: Invasive lobular carcinoma: sonographic appearance and role of sonography in improving diagnostic sensitivity. Radiology. 195(1):231-4, 1995
- Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995
- Hilton SV et al: Real-time breast sonography: application in 300 consecutive patients. AJR Am J Roentgenol. 147(3):479-86, 1986
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References
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Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Synonyms
- Posterior enhancement: Increased through transmission
- Posterior shadowing: Posterior attenuation, acoustic shadowing
Definitions
- Posterior (acoustic) enhancement
- Sound travels better through lesion than surrounding tissue → ↑ echoes (brighter) in tissues posterior to lesion relative to adjacent tissues at comparable depth
- No posterior features: No shadowing or enhancement
- Echogenicity of tissue immediately behind mass is not different from that of adjacent tissue at same depth
- Posterior (acoustic) shadowing
- Attenuation of US beam → ↓ echoes in tissue posterior to lesion relative to adjacent tissue at comparable depth
- Calcifications > 1-2 mm can cause shadowing
- Does not include refractive edge shadowing
- Refraction of sound waves occurs at edges of curved mass or ligaments perpendicular to US beam → ↓ echoes in tissue directly deep to curved surface
- Thin (1-2 mm) stripe of shadowing tangential to surface of mass, perpendicular to beam
- Essentially eliminated with spatial compounding (multiple off-angle beams)
- Mixed pattern: Some portions of lesion cause posterior enhancement, and others cause posterior shadowing
- Spatial compounding: Use of multiple off-angle US beams
- Improves margin assessment on sides of mass
- Posterior features less apparent
- Posterior (acoustic) enhancement
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
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
- Wen X et al: Correlations between ultrasonographic findings of invasive lobular carcinoma of the breast and intrinsic subtypes. Ultraschall Med. ePub, 2018
- Au FW et al: Histological grade and immunohistochemical biomarkers of breast cancer: correlation to ultrasound features. J Ultrasound Med. 36(9):1883-1894, 2017
- Elverici E et al: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol. 21(3):189-94, 2015
- Zhang L et al: Identifying ultrasound and clinical features of breast cancer molecular subtypes by ensemble decision. Sci Rep. 5:11085, 2015
- 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
- Aho M et al: Correlation of sonographic features of invasive ductal mammary carcinoma with age, tumor grade, and hormone-receptor status. J Clin Ultrasound. 41(1):10-7, 2013
- Irshad A et al: Assessing the role of ultrasound in predicting the biological behavior of breast cancer. AJR Am J Roentgenol. 200(2):284-90, 2013
- Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology. 2013
- Sickles EA et al: Breast Imaging Reporting and Data System, BI-RADS: Mammography. 5th ed. Reston: American College of Radiology, 2013
- Blaichman J et al: Sonographic appearance of invasive ductal carcinoma of the breast according to histologic grade. AJR Am J Roentgenol. 199(3):W402-8, 2012
- Linda A et al: Nonsurgical management of high-risk lesions diagnosed at core needle biopsy: can malignancy be ruled out safely with breast MRI? AJR Am J Roentgenol. 198(2):272-80, 2012
- Barr RG and Lackey AE: The utility of the "bull's-eye" artifact on breast elasticity imaging in reducing breast lesion biopsy rate. Ultrasound Q. 27:151-5, 2011
- Hsu HH et al: Complex cystic lesions of the breast on ultrasonography: feature analysis and BI-RADS assessment. Eur J Radiol. 79(1):73-9, 2011
- Berg WA et al: Cystic breast lesions and the ACRIN 6666 experience. Radiol Clin North Am. 48:931-87, 2010
- Lopez JK et al: Invasive lobular carcinoma of the breast: spectrum of mammographic, US, and MR imaging findings. Radiographics. 29(1):165-76, 2009
- Kim SH et al: Correlation of ultrasound findings with histology, tumor grade, and biological markers in breast cancer. Acta Oncol. 47(8):1531-8, 2008
- Berg WA et al: Operator dependence of physician-performed whole-breast US: lesion detection and characterization. Radiology. 241:355-65, 2006
- Costantini M et al: Characterization of solid breast masses: use of the sonographic breast imaging reporting and data system lexicon. J Ultrasound Med. 25(5):649-59; quiz 661, 2006
- 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
- Paulinelli RR et al: Risk of malignancy in solid breast nodules according to their sonographic features. J Ultrasound Med. 24(5):635-41, 2005
- Watermann DO et al: Ultrasound morphology of invasive lobular breast cancer is different compared with other types of breast cancer. Ultrasound Med Biol. 31(2):167-74, 2005
- Selinko VL et al: Role of sonography in diagnosing and staging invasive lobular carcinoma. J Clin Ultrasound. 32(7):323-32, 2004
- Stavros AT: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins. 641-8, 2004
- Weinstein SP et al: Posterior acoustic shadowing in benign breast lesions: sonographic-pathologic correlation. J Ultrasound Med. 23(1):73-83, 2004
- Ahn BY et al: Pregnancy- and lactation-associated breast cancer: mammographic and sonographic findings. J Ultrasound Med. 22(5):491-7; quiz 498-9, 2003
- Berg WA et al: Cystic lesions of the breast: sonographic-pathologic correlation. Radiology 227:183-191, 2003
- Memis A et al: Granulomatous mastitis: imaging findings with histopathologic correlation. Clin Radiol. 57(11):1001-6, 2002
- Samardar P et al: Focal asymmetric densities seen at mammography: US and pathologic correlation. Radiographics. 22(1):19-33, 2002
- Seo BK et al: Sonographic evaluation of breast nodules: comparison of conventional, real-time compound, and pulse-inversion harmonic images. Korean J Radiol. 3(1):38-44, 2002
- Wong KT et al: Ultrasound and MR imaging of diabetic mastopathy. Clin Radiol. 57(8):730-5, 2002
- Woo KM et al: US of ductal carcinoma in situ. Radiographics. 22:269-81, 2002
- Lamb PM et al: Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast. Clin Radiol. 55(1):40-4, 2000
- Revelon G et al: Focal fibrosis of the breast: imaging characteristics and histopathologic correlation. Radiology. 216(1):255-9, 2000
- Butler RS et al: Sonographic evaluation of infiltrating lobular carcinoma. AJR Am J Roentgenol. 172(2):325-30, 1999
- Georgian-Smith D et al: From the RSNA refresher courses. Freehand interventional sonography in the breast: basic principles and clinical applications. Radiographics. 16(1):149-61, 1996
- Paramagul CP et al: Invasive lobular carcinoma: sonographic appearance and role of sonography in improving diagnostic sensitivity. Radiology. 195(1):231-4, 1995
- Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995
- Hilton SV et al: Real-time breast sonography: application in 300 consecutive patients. AJR Am J Roentgenol. 147(3):479-86, 1986
