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
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
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Synonyms
Posterior enhancement: Increased through transmission
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
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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