What are the characteristic ultrasonography (US) patterns of specific types of breast cancers?

Updated: Feb 01, 2017
  • Author: Paul R Fisher, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

The appearance of specific types of breast carcinoma have been studied. Although appearances vary greatly, some patterns are typical.

Mucin-containing carcinomas are often circumscribed but may have irregular margins. These lesions may be either hypoechoic or isoechoic relative to subcutaneous fat. In a study of these carcinomas by Conant et al involving 8 patients, US showed hypoechoic, solid masses in all of their cases. [51] The lesions demonstrated acoustic shadowing or increased acoustic enhancement. Some lesions had circumscribed margins, and some were not circumscribed.

Tubular carcinoma is usually hypoechoic but is without circumscribed margins and acoustic posterior shadowing. Invasive ductal carcinoma typically appears as an irregularly shaped mass with spiculated margins with shadowing and architectural distortion of adjacent breast tissue. This lesion may contain malignant microcalcifications.

Invasive lobular carcinoma often does not cause a desmoplastic reaction. This type is frequently missed on mammography and may be difficult to see on sonograms. Butler et al reported that these lesions were ultrasonographically occult in 12% of their cases. [52] In approximately 60% of cases, it appeared as a heterogeneous, hypoechoic mass with angular or ill-defined margins and posterior acoustic shadowing. In 15% of cases, US demonstrated focal shadowing without a discrete mass; in 12% of cases, US showed a lobulated, circumscribed mass.

Medullary carcinoma often appears as a hypoechoic mass with acoustic enhancement (increased through transmission). It may be mistaken for a cyst on US.

Soo et al studied papillary carcinoma of the breast; they found that the cystic in situ form may appear as either a solid mass or a complex cystic mass with an internal solid component. [53] In both types, acoustic enhancement tends to be increased. Doppler study may demonstrate intratumoral blood flow. Invasive papillary carcinoma usually appears as a solid mass, although it may also appear as a complex cystic and solid mass.

Ductal carcinoma in situ of the breast often appears as suggestive microcalcifications on mammography. However, it may occasionally appear as a solid mass on ultrasound.


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