Breast lumps ultrasound

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]

Overview

Breast ultrasound is the first imaging modality in patients with palpable masses under age 40 years old and is adjunctive modality to mammography for patients older than 40 years. Breast sonography is a type of imaging used to confirm abnormal findings on mammography or MRI. Breast ultrasound improves breast cancer detection rate.

Ultrasound

Indications of breast ultrasonography:^[1]^[2]
- The first imaging modality in patients with palpable masses under age 40 years old
- Adjunctive modality to mammography for patients older than 40 years
- Abnormal findings on mammography or MRI
- Breast implants issues
- Determination of masses with microcalcification and architectural distortion findings on mammography
- Screening method for high risk individuals for breast cance r who have contraindications for breast MRI
- Evaluating axillary lymphadenopathy

Breast ultrasoun d improves breast cancer detection rate.
According to the fact that 11% of palpable breast cancers were detected by ultrasound while these lesions were occult on mammography features.
Combination of mammography and ultrasound increase cancer detection rate to 14%.^[3]

Ultrasonographic finding of common breast lumps^[4]
Types of breast lumps	Characteristic findings
Cyst	Simple cyst: Well-circumscribed, anechoic contents, thin echogenic external capsule, enhanced through-transmission, subtle acoustic shadowing at the ages Complicated cyst: Although not purely anechoic, diffuse echoes of low amplitude Complex cyst: Well-circumscribed anechoic mass with solid components Cysts with sediments: an anechoic mass containing sharp margins and posterior hyperechoic sediment
Abscess	Hypo-anechoic mass with irregular margins and peripheral hypervascularity
Mastitis	Subcutaneous and parenchymal edema with small fluid collection and diffuse hypervascularity
Galactocele	Moderately echogenic contents with fat spreading heterogenously in the liquid component
Seroma	Anechoic or diffuse low-level echoes or thin fibrin septation. Blood presence may result in sediment, pseudonodule, wall-thickening, and coarse septa formation
Liponecrosis	A nodule with same feature as complex cyst
Hemangioma	Based on caliber of blood vessels: Capillary hemangioma: Homogenouesly hyperechoic Cavernous hemangioma: Mixed echotexture
Fibroadenoma	Classic fibroadenoma: Elliptic or lobulated shape, horizontal orientation, isoechoic or mildly hypoechoic echotexture, well-defined curvilinear margin with thin echogenic capsule, unaltered US beam transmission beyond the lesion, and subtle acoustic shadows on both sides of the nodule Complex fibroadenoma: Heterogenous echotexture lesion with microcysts (apocrine metaplasia) or small hyperechoic areas (sclerosing adenosis)
Phyllodes tumor	Moderately hypoechoic nodules with pseudocapsule, without posterior acoustic shadowing, sometimes pseudocystic spaces are so compressed which seem like hyperechoic striations
Hamartoma	Heterogenous appearance with mixture of isoechoic (adipose tissue/glandular lobules) and hyperechoic areas (fibrous tissue)
Papilloma	Intraductal papilloma: Well-circumscribed subareolar duct ectasia with an iscoechoic, microlobulated surface on nodule Intracystic papilloma: A cyst with prominent mass

Ultrasound image of breast abscess – The sonographic feature of breast abscess in lactating mother presenting with right breast lump.There is a lobulated collection with mobile echoes mainly in upper and inner quadrant; extending from 11 o’clock to 3 o’clock. Source: Case courtesy of Dr Maulik S Patel, from Radiopedia

Ultrasound image of breast fibroadenoma -Oval shaped hypodense lesion, no internal vascularities seen on color Doppler. Source: Case courtesy of Dr Hani Salam, from Radiopedia

Ultrasound image of breastinvasive lobular carcinoma -There is a lobulated, hypoechoic lesion involving upper quadrants in the retro-periareolar region. Approximate size of the lesion is 58 x 47 x 25 mm. The lesion abutts pectoralis muscle. There are few tiny echogenic foci in the lesion – calcifications. Lesion shows angular margins. There is no posterior acoustic enhancement/shadowing/ significant vascularity. Rest of the breast shows predominantly fatty parenchymal echopattern. There is no ductal dilatation. There is no axillary or internal mammary adenopathy. Pectoralis muscle is normal. Source: Case courtesy of Dr Maulik S Patel, from Radiopedia

References

↑ Shah R, Rosso K, Nathanson SD (2014). “Pathogenesis, prevention, diagnosis and treatment of breast cancer”. World J Clin Oncol. 5 (3): 283–98. doi:10.5306/wjco.v5.i3.283. PMC 4127601. PMID 25114845.
↑ Lehman CD, Lee AY, Lee CI (2014). “Imaging management of palpable breast abnormalities”. AJR Am J Roentgenol. 203 (5): 1142–53. doi:10.2214/AJR.14.12725. PMID 25341156.
↑ Moss HA, Britton PD, Flower CD, Freeman AH, Lomas DJ, Warren RM (1999). “How reliable is modern breast imaging in differentiating benign from malignant breast lesions in the symptomatic population?”. Clin Radiol. 54 (10): 676–82. PMID 10541394.
↑ Masciadri N, Ferranti C (2011). “Benign breast lesions: Ultrasound”. J Ultrasound. 14 (2): 55–65. doi:10.1016/j.jus.2011.03.002. PMC 3558101. PMID 23396888.

[pmid25114845-1] Shah R, Rosso K, Nathanson SD (2014). “Pathogenesis, prevention, diagnosis and treatment of breast cancer”. World J Clin Oncol. 5 (3): 283–98. doi:10.5306/wjco.v5.i3.283. PMC 4127601. PMID 25114845.

[pmid25341156-2] Lehman CD, Lee AY, Lee CI (2014). “Imaging management of palpable breast abnormalities”. AJR Am J Roentgenol. 203 (5): 1142–53. doi:10.2214/AJR.14.12725. PMID 25341156.

[pmid10541394-3] Moss HA, Britton PD, Flower CD, Freeman AH, Lomas DJ, Warren RM (1999). “How reliable is modern breast imaging in differentiating benign from malignant breast lesions in the symptomatic population?”. Clin Radiol. 54 (10): 676–82. PMID 10541394.

[pmid23396888-4] Masciadri N, Ferranti C (2011). “Benign breast lesions: Ultrasound”. J Ultrasound. 14 (2): 55–65. doi:10.1016/j.jus.2011.03.002. PMC 3558101. PMID 23396888.

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