What are the breast ultrasonography findings characteristic of solid nodules?

Updated: Jan 24, 2017
  • Author: Durre Sabih, MBBS, MSc, FRCP(Edin); Chief Editor: Mahan Mathur, MD  more...
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Answer

Answer

These are evaluated according to the criteria given in Table 2 (below). To be labeled as benign, the lesion should demonstrate only benign features. The presence of any suspicious finding warrants a biopsy.

Table 2. Ultrasound Features Suggestive of Benign and Malignant Nodules. [12] (Open Table in a new window)

Feature

Benign

Malignant

Shape

Round, wider than tall

Taller than wide

Margins

Smooth

Irregular, angular, spicular

Lobulations

None or up to 3

Multiple

Capsule

Encapsulated

No capsule

Halo

Absent

Echogenic halo

Fixity

None

Fixed to surrounding issue and/or underlying muscles

Shadowing or enhancement

Enhancement, edge shadowing

Shadowing behind lesion

Substance echogenicity

Anechoic (cystic), Hyperechoic

Hypoechoic, calcification

 

Image depicting breast ultrasonography can be seen below.

A normal premenopausal breast ultrasonogram of a 4 A normal premenopausal breast ultrasonogram of a 40-year-old woman. The breast parenchyma is uniformly echogenic with limited ductal visualization.
Same image as the previous, with the color overlay Same image as the previous, with the color overlay following the scheme in the previous image. The skin is brown, premammary fat is yellow, parenchyma is orange, retromammary fat is yellow, chest wall muscles are pink, and the pleural line is yellow. The cooper's ligaments are colored green.
Normal breast ultrasound. This is a younger patien Normal breast ultrasound. This is a younger patient than shown in the previous image. The breast parenchyma is thicker, less premammary and retromammary fat exists. The poorly marginated hypoechoic curvilinear echoes within the parenchyma represent the ducts and periductal stoma.
Normal breast ultrasound. The woman is older than Normal breast ultrasound. The woman is older than the one seen in the first two images. The breast has involuted, the parenchyma has become thinner, and no ductal echoes are seen. Note that the presence of generous premammary and retromammary fat zones.
Normal lactating breast. The parenchyma is thick a Normal lactating breast. The parenchyma is thick and shows reduced echogenicity, in some cases becoming almost isoechoic.
Panoramic imaging allows the seamless joining of v Panoramic imaging allows the seamless joining of very large ultrasound sections as the probe is slid over the area. In this image of a lactating breast, the parenchyma is thick and almost isoechoic. The premammary and retromammary fat zones are not prominent. Multiple dilated ducts are seen as thin walled tubular areas within the parenchyma.
Lactating breasts, like normal nonlactating breast Lactating breasts, like normal nonlactating breasts, can present with a large variety of imaging characteristics. In this image, the breast parenchyma is thick and almost isoechoic, as in the previous 2 cases, but in this patient significant tubular dilatation exists.
The effect of ultrasound focusing. The focal zone, The effect of ultrasound focusing. The focal zone, indicated by the white carrot and red arrow is appropriate in the left pane, showing the anechoic interior of the cyst. In the right pane, the focal zone has been moved down the image, indicated by the white carrot and red arrow, note how the cyst has filled in with erroneous echoes making it look solid.
Images can be appended; the 2 halves can be aligne Images can be appended; the 2 halves can be aligned to double the field of view. Such images, however, cannot be used for measuring across the appending line. In this image, an intraductal mass extends beyond the duct into the surrounding tissue. This is seen on the right side (arrows).
For a laterally located breast lesion, especially For a laterally located breast lesion, especially in a woman with large pendulous breasts, an opposite oblique position, with the ipsilateral arm held over the head, offers the best images.
Breast annotation scheme. The nipple is designated Breast annotation scheme. The nipple is designated "N," the subareolar are "SA," the axilla is "AX." Three concentric, almost equally sized circular zones are designated by the numbers 1, 2, and 3. The clock face is used for radial localization, and the 4 clock times are represented by the blue arrows. The mass given by the black area (M) would be identified as R, 10, 3 (right breast, 10 o'clock, zone 3). Some authors measure the distance from the nipple to the mass (yellow double-sided arrow), which would make the mass R, 10, distance from the nipple (mm or cm). On the hard copies, additional information about the probe direction should also be mentioned. In the diagram, these are represented by the green rectangles and can be horizontal (H), vertical (H), radial (R), or antiradial (AR).
The breast is examined in an overlapping raster pa The breast is examined in an overlapping raster pattern to ensure that the whole organ has been seen. The raster patterns are executed in the horizontal as well as vertical planes. This diagram shows the horizontal raster pattern. The raster pattern is followed by radial scanning, along the direction of the lobes and ducts.
The breast is examined in an overlapping raster pa The breast is examined in an overlapping raster pattern to ensure that the whole organ has been seen. The raster patterns are executed in the horizontal as well as vertical planes. This diagram shows the vertical raster pattern. The raster pattern is followed by radial scanning, along the direction of the lobes and ducts.
The breast is examined in an overlapping raster pa The breast is examined in an overlapping raster pattern to ensure that the whole organ has been seen. The raster patterns are executed in the horizontal as well as vertical planes. The raster pattern is followed by radial scanning, along the direction of the lobes and ducts. This diagram shows the radial scanning pattern.
Scanning the nipple and subareolar region is chall Scanning the nipple and subareolar region is challenging because the nipple pushes into the breast substance, appearing as a vaguely shadowing nodule in the subcutaneous area. The tightly packed ducts in the breast are parallel to the ultrasound beam, making these difficult to see in case of pathology.
With nipple lesions, it is helpful to "roll" the n With nipple lesions, it is helpful to "roll" the nipple, using the probe to scan it along its side. This improves the angle of the ducts to the ultrasound beam making for easier and better visualization.
In some cases, the breast can be supported by the In some cases, the breast can be supported by the other hand to optimize the nipple-probe geometry. This gives the highest quality images of the area but has a learning curve because the nipple tends to slip away.
When biopsying a breast lesion, maintaining an ang When biopsying a breast lesion, maintaining an angle as parallel to the chest wall as possible is important. This minimizes the chance of injuring deeper structures. This is especially important when automatic firing needles are used for core biopsies because the needle extends beyond the sheath when fired. In the diagram, path "A" is steep and likely to injure the underlying muscles. Path "B" is more horizontal and safer to use in deep lesions as the one depicted here.
Trapezoid imaging; the field widens in the far zon Trapezoid imaging; the field widens in the far zone.
Breast cyst, panoramic image. This shows all featu Breast cyst, panoramic image. This shows all features of a simple cyst, including smooth walls, posterior acoustic enhancement, and edge shadowing.
A typical malignant breast mass; intraductal carci A typical malignant breast mass; intraductal carcinoma on biopsy. The mass exhibits irregular pointed margins, hypoechoic interior, posterior shadowing, and a vague hyperechoic rim.
Typical breast carcinoma; an irregular contour exi Typical breast carcinoma; an irregular contour exists, the mass is taller-than-wide, is hypoechoic, and shows posterior shadowing. An echogenic rim exists, and vessels are noted on Doppler.
Breast lesions are not always confined to the pare Breast lesions are not always confined to the parenchyma; this is an image of a lipoma in the premammary fat. This shows typical features of a lipoma, with an ovoid hyperechoic mass in the subcutaneous fat.
Nodes can be seen within the breast as well as in Nodes can be seen within the breast as well as in the axilla. Signs of a benign process involve an ovoid shape and a prominent central echogenic hilum, as seen in this image.
Malignant nodes tend to be round and uniformly hyp Malignant nodes tend to be round and uniformly hypoechoic.

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