Birads US 3 - 5
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Birads US 3 - 5

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Ultrasound of BIRADS 3-5 lesions

Ultrasound of BIRADS 3-5 lesions

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  • Orientation and shape. Solid breast masses on US images may be categorized by orientation and shape. Solid mass orientation is either parallel (b) or not parallel (a, c) to the skin surface. (a) Round shape (arrows), defined as spherical, ball-shaped, circular, or globular, is uncommon but has a relatively high rate of malignancy (60%–100%). Lesions that are not parallel in orientation include those that are round. (b) Oval shape (arrows) is defined as elliptical or egg-shaped (may include two or three undulations [ie, “gently lobulated” or “macrolobulated”]). Approximately 60% of the US-depicted masses that are subjected to biopsy are oval, with a 16% malignancy rate. (c) An irregular mass (arrows) is neither round nor oval in shape. Approximately 40% of sonographically depicted masses that are subsequently subjected to biopsy are irregular, and approximately 60% of these are found to be malignant (10).
  • Orientation and shape. Solid breast masses on US images may be categorized by orientation and shape. Solid mass orientation is either parallel (b) or not parallel (a, c) to the skin surface. (a) Round shape (arrows), defined as spherical, ball-shaped, circular, or globular, is uncommon but has a relatively high rate of malignancy (60%–100%). Lesions that are not parallel in orientation include those that are round. (b) Oval shape (arrows) is defined as elliptical or egg-shaped (may include two or three undulations [ie, “gently lobulated” or “macrolobulated”]). Approximately 60% of the US-depicted masses that are subjected to biopsy are oval, with a 16% malignancy rate. (c) An irregular mass (arrows) is neither round nor oval in shape. Approximately 40% of sonographically depicted masses that are subsequently subjected to biopsy are irregular, and approximately 60% of these are found to be malignant (10).
  • Orientation and shape. Solid breast masses on US images may be categorized by orientation and shape. Solid mass orientation is either parallel (b) or not parallel (a, c) to the skin surface. (a) Round shape (arrows), defined as spherical, ball-shaped, circular, or globular, is uncommon but has a relatively high rate of malignancy (60%–100%). Lesions that are not parallel in orientation include those that are round. (b) Oval shape (arrows) is defined as elliptical or egg-shaped (may include two or three undulations [ie, “gently lobulated” or “macrolobulated”]). Approximately 60% of the US-depicted masses that are subjected to biopsy are oval, with a 16% malignancy rate. (c) An irregular mass (arrows) is neither round nor oval in shape. Approximately 40% of sonographically depicted masses that are subsequently subjected to biopsy are irregular, and approximately 60% of these are found to be malignant (10).
  • Margins. The margins of solid breast masses on US images should be categorized as either circumscribed or noncircumscribed. (a) Circumscribed margins (arrows) are well defined, with an abrupt transition between the lesion and the surrounding tissue. Noncircumscribed margins include microlobulated, indistinct, angular, and spiculated. A mass with noncircumscribed margins should be categorized as either BI-RADS 4 or 5, with a recommendation for biopsy. (b) Microlobulated margins (arrows) have short-cycle undulations (more than three) with a scalloped appearance. (c) Indistinct margins (arrows) have no clear demarcation between the mass and the surrounding tissue. (d) Angular margins have sharp corners (arrows). (e) Spiculated margins appear more as lines projecting from the mass (arrows) (3). Angular margins and spiculated margins are associated with malignancy rates of 60% and 86%, respectively. Lesion boundary, a related feature, can be described as either an abrupt interface (ie, sharp demarcation between the lesion and the surrounding tissue) as seen in a or an echogenic halo (ie, echogenic transition zone without a sharp demarcation from the surrounding tissue) as seen at the arrowheads in e. A lesion with an abrupt interface is more likely to be benign, whereas an echogenic halo or wide transition zone at the boundary is associated with a higher rate of malignancy (70%) (10).
  • Margins. The margins of solid breast masses on US images should be categorized as either circumscribed or noncircumscribed. (a) Circumscribed margins (arrows) are well defined, with an abrupt transition between the lesion and the surrounding tissue. Noncircumscribed margins include microlobulated, indistinct, angular, and spiculated. A mass with noncircumscribed margins should be categorized as either BI-RADS 4 or 5, with a recommendation for biopsy. (b) Microlobulated margins (arrows) have short-cycle undulations (more than three) with a scalloped appearance. (c) Indistinct margins (arrows) have no clear demarcation between the mass and the surrounding tissue. (d) Angular margins have sharp corners (arrows). (e) Spiculated margins appear more as lines projecting from the mass (arrows) (3). Angular margins and spiculated margins are associated with malignancy rates of 60% and 86%, respectively. Lesion boundary, a related feature, can be described as either an abrupt interface (ie, sharp demarcation between the lesion and the surrounding tissue) as seen in a or an echogenic halo (ie, echogenic transition zone without a sharp demarcation from the surrounding tissue) as seen at the arrowheads in e. A lesion with an abrupt interface is more likely to be benign, whereas an echogenic halo or wide transition zone at the boundary is associated with a higher rate of malignancy (70%) (10).
  • Margins. The margins of solid breast masses on US images should be categorized as either circumscribed or noncircumscribed. (a) Circumscribed margins (arrows) are well defined, with an abrupt transition between the lesion and the surrounding tissue. Noncircumscribed margins include microlobulated, indistinct, angular, and spiculated. A mass with noncircumscribed margins should be categorized as either BI-RADS 4 or 5, with a recommendation for biopsy. (b) Microlobulated margins (arrows) have short-cycle undulations (more than three) with a scalloped appearance. (c) Indistinct margins (arrows) have no clear demarcation between the mass and the surrounding tissue. (d) Angular margins have sharp corners (arrows). (e) Spiculated margins appear more as lines projecting from the mass (arrows) (3). Angular margins and spiculated margins are associated with malignancy rates of 60% and 86%, respectively. Lesion boundary, a related feature, can be described as either an abrupt interface (ie, sharp demarcation between the lesion and the surrounding tissue) as seen in a or an echogenic halo (ie, echogenic transition zone without a sharp demarcation from the surrounding tissue) as seen at the arrowheads in e. A lesion with an abrupt interface is more likely to be benign, whereas an echogenic halo or wide transition zone at the boundary is associated with a higher rate of malignancy (70%) (10).
  • Margins. The margins of solid breast masses on US images should be categorized as either circumscribed or noncircumscribed. (a) Circumscribed margins (arrows) are well defined, with an abrupt transition between the lesion and the surrounding tissue. Noncircumscribed margins include microlobulated, indistinct, angular, and spiculated. A mass with noncircumscribed margins should be categorized as either BI-RADS 4 or 5, with a recommendation for biopsy. (b) Microlobulated margins (arrows) have short-cycle undulations (more than three) with a scalloped appearance. (c) Indistinct margins (arrows) have no clear demarcation between the mass and the surrounding tissue. (d) Angular margins have sharp corners (arrows). (e) Spiculated margins appear more as lines projecting from the mass (arrows) (3). Angular margins and spiculated margins are associated with malignancy rates of 60% and 86%, respectively. Lesion boundary, a related feature, can be described as either an abrupt interface (ie, sharp demarcation between the lesion and the surrounding tissue) as seen in a or an echogenic halo (ie, echogenic transition zone without a sharp demarcation from the surrounding tissue) as seen at the arrowheads in e. A lesion with an abrupt interface is more likely to be benign, whereas an echogenic halo or wide transition zone at the boundary is associated with a higher rate of malignancy (70%) (10).
  • Margins. The margins of solid breast masses on US images should be categorized as either circumscribed or noncircumscribed. (a) Circumscribed margins (arrows) are well defined, with an abrupt transition between the lesion and the surrounding tissue. Noncircumscribed margins include microlobulated, indistinct, angular, and spiculated. A mass with noncircumscribed margins should be categorized as either BI-RADS 4 or 5, with a recommendation for biopsy. (b) Microlobulated margins (arrows) have short-cycle undulations (more than three) with a scalloped appearance. (c) Indistinct margins (arrows) have no clear demarcation between the mass and the surrounding tissue. (d) Angular margins have sharp corners (arrows). (e) Spiculated margins appear more as lines projecting from the mass (arrows) (3). Angular margins and spiculated margins are associated with malignancy rates of 60% and 86%, respectively. Lesion boundary, a related feature, can be described as either an abrupt interface (ie, sharp demarcation between the lesion and the surrounding tissue) as seen in a or an echogenic halo (ie, echogenic transition zone without a sharp demarcation from the surrounding tissue) as seen at the arrowheads in e. A lesion with an abrupt interface is more likely to be benign, whereas an echogenic halo or wide transition zone at the boundary is associated with a higher rate of malignancy (70%) (10).
  • Internal echo pattern. The echo pattern, or echotexture, of a lesion on US images is described in reference to the echo pattern of the subcutaneous fat within the breast. The lesion (arrows) is described as hypoechoic (a), isoechoic (b), or hyperechoic (c) relative to the fat (arrowheads). Because most solid breast masses are hypoechoic, including invasive cancers and fibroadenomas, other features, such as margin characteristics, help establish a level of concern.
  • Internal echo pattern. The echo pattern, or echotexture, of a lesion on US images is described in reference to the echo pattern of the subcutaneous fat within the breast. The lesion (arrows) is described as hypoechoic (a), isoechoic (b), or hyperechoic (c) relative to the fat (arrowheads). Because most solid breast masses are hypoechoic, including invasive cancers and fibroadenomas, other features, such as margin characteristics, help establish a level of concern.
  • Internal echo pattern. The echo pattern, or echotexture, of a lesion on US images is described in reference to the echo pattern of the subcutaneous fat within the breast. The lesion (arrows) is described as hypoechoic (a), isoechoic (b), or hyperechoic (c) relative to the fat (arrowheads). Because most solid breast masses are hypoechoic, including invasive cancers and fibroadenomas, other features, such as margin characteristics, help establish a level of concern.
  • Posterior acoustic features. Posterior acoustic features may or may not be a characteristic of solid masses on US images. (a) Posterior acoustic enhancement (arrows) is an indeterminate US finding and in this case is seen with a fibroadenoma. (b) Posterior acoustic shadowing (arrows) is a suspicious finding that is often seen with invasive carcinoma and in this case is depicted with an invasive ductal carcinoma.
  • Posterior acoustic features. Posterior acoustic features may or may not be a characteristic of solid masses on US images. (a) Posterior acoustic enhancement (arrows) is an indeterminate US finding and in this case is seen with a fibroadenoma. (b) Posterior acoustic shadowing (arrows) is a suspicious finding that is often seen with invasive carcinoma and in this case is depicted with an invasive ductal carcinoma.
  • “ Lobulated mass, BI-RADS 3,” in a 40-year-old woman with a circumscribed left breast mass seen at mammography. US image shows the mass (arrows), which was prospectively described as “lobulated,” a term that is not a BI-RADS US descriptor. The lesion has less than three undulations and therefore can be described as having an oval shape. Despite the categorization as BI-RADS 3, a core-needle biopsy was performed because of patient or physician preference. The histologic findings disclosed a fibroadenoma. The recommended BI-RADS description is a hypoechoic mass with an oval shape, circumscribed margins, an abrupt interface, and parallel orientation: BI-RADS 3.
  • Hematoma in a 45-year-old woman with recent trauma to her right breast. (a) Initial US image shows a corresponding mass (arrows). If the site of trauma correlates with the site of a US mass, hematoma should be suspected, and this mass can be assessed as BI-RADS category 3, with short-interval follow-up. (b) On the US image obtained 4 weeks later, the mass has decreased in size (arrows). Although this mass had been prospectively categorized as BI-RADS 4 (when the image in a was obtained), when the patient returned 4 weeks later for biopsy, biopsy was deferred. She was asked to return in 1 month for follow-up. (c) US image obtained at 1-month follow-up obtained shows the lesion (arrows), which was reassessed as BI-RADS 2. The recommended BI-RADS description for findings seen in a is a circumscribed mass with heterogeneous internal echo pattern and parallel orientation at the site of prior trauma: BI-RADS 3, with a recommendation for short-interval follow-up in 4–6 weeks.
  • Hematoma in a 45-year-old woman with recent trauma to her right breast. (a) Initial US image shows a corresponding mass (arrows). If the site of trauma correlates with the site of a US mass, hematoma should be suspected, and this mass can be assessed as BI-RADS category 3, with short-interval follow-up. (b) On the US image obtained 4 weeks later, the mass has decreased in size (arrows). Although this mass had been prospectively categorized as BI-RADS 4 (when the image in a was obtained), when the patient returned 4 weeks later for biopsy, biopsy was deferred. She was asked to return in 1 month for follow-up. (c) US image obtained at 1-month follow-up obtained shows the lesion (arrows), which was reassessed as BI-RADS 2. The recommended BI-RADS description for findings seen in a is a circumscribed mass with heterogeneous internal echo pattern and parallel orientation at the site of prior trauma: BI-RADS 3, with a recommendation for short-interval follow-up in 4–6 weeks.
  • Hematoma in a 45-year-old woman with recent trauma to her right breast. (a) Initial US image shows a corresponding mass (arrows). If the site of trauma correlates with the site of a US mass, hematoma should be suspected, and this mass can be assessed as BI-RADS category 3, with short-interval follow-up. (b) On the US image obtained 4 weeks later, the mass has decreased in size (arrows). Although this mass had been prospectively categorized as BI-RADS 4 (when the image in a was obtained), when the patient returned 4 weeks later for biopsy, biopsy was deferred. She was asked to return in 1 month for follow-up. (c) US image obtained at 1-month follow-up obtained shows the lesion (arrows), which was reassessed as BI-RADS 2. The recommended BI-RADS description for findings seen in a is a circumscribed mass with heterogeneous internal echo pattern and parallel orientation at the site of prior trauma: BI-RADS 3, with a recommendation for short-interval follow-up in 4–6 weeks.
  • Palpable mass in the left breast of a 70-year-old woman. (a) Initial US image shows the mass (arrows), which was prospectively categorized as BI-RADS 3, probably benign. (b) US image obtained at 6-month follow-up. Despite stable findings for the mass (arrows), a different examiner categorized the mass as BI-RADS 4 and recommended biopsy. Histologic examination disclosed a 4-mm invasive ductal carcinoma. Given the patient’s age and the fact that the orientation of the lesion was nonparallel, biopsy should have been recommended at the initial evaluation. The recommended BI-RADS description for the findings seen in a is a hypoechoic mass with an oval shape, circumscribed margins, and nonparallel orientation: BI-RADS 4B.
  • Palpable mass in the left breast of a 70-year-old woman. (a) Initial US image shows the mass (arrows), which was prospectively categorized as BI-RADS 3, probably benign. (b) US image obtained at 6-month follow-up. Despite stable findings for the mass (arrows), a different examiner categorized the mass as BI-RADS 4 and recommended biopsy. Histologic examination disclosed a 4-mm invasive ductal carcinoma. Given the patient’s age and the fact that the orientation of the lesion was nonparallel, biopsy should have been recommended at the initial evaluation. The recommended BI-RADS description for the findings seen in a is a hypoechoic mass with an oval shape, circumscribed margins, and nonparallel orientation: BI-RADS 4B.
  • US image of a 50-year-old woman who presented with a palpable mass (arrows) in the right breast. Although the anterior margins are circumscribed, the posterior margins are angular. A mass must be managed on the basis of its worst features. The histologic findings from excisional biopsy disclosed an invasive ductal carcinoma, with an associated ductal carcinoma in situ. The recommended BI-RADS description is a hypoechoic mass with angular posterior margins, parallel orientation, and no posterior acoustic features: BI-RADS 4B. (Reprinted, with permission, from reference 5.)‏
  • BI-RADS 4A in a 55-year-old woman who presented with a palpable mass and swelling in her left breast. US image shows a corresponding hypoechoic mass (arrows). Subsequent surgical excision revealed a ruptured cyst. The BI-RADS 4 assessment encompasses a wide range of pathologic findings, from benign fibroadenoma to invasive carcinoma. Further subcategorization into 4A, 4B, and 4C is recommended to establish the level of concern and the expectation of what the histologic findings will be. The recommended BI-RADS description is a hypoechoic mass with an oval shape, partially indistinct margins, parallel orientation, and mild posterior acoustic enhancement: BI-RADS 4A.
  • BI-RADS 4B. (a) US image of a 47-year-old woman with a vague right breast density on a screening mammogram (not shown) shows a hypoechoic mass (arrows). Histologic findings from core-needle biopsy disclosed ductal carcinoma in situ. Pathologic concordance is particularly important for category 4B lesions, given that both malignant and benign lesions can be evenly distributed in this group. Recommended BI-RADS description is a hypoechoic irregular mass with indistinct margins, a heterogeneous internal echo pattern, and parallel orientation: BI-RADS 4B. (b) In a 68-year-old woman who had undergone a right lumpectomy and radiation therapy 15 years earlier and who now had an increasing focal asymmetry at mammography (not shown), US image shows a hypoechoic irregular mass (arrows) with indistinct margins and heterogeneous internal echotexture. Histologic findings from a US-guided core-needle biopsy showed fat necrosis, which was considered discordant. Repeat biopsy disclosed the same findings, and the patient had other similar sites shown to be related to fat necrosis. At follow-up, the mass was stable for 18 months. Recommended BI-RADS description is a hypoechoic mass with nonparallel orientation, an oval shape, indistinct margins, and a heterogeneous internal echotexture: BI-RADS 4B. (Fig 9a reprinted, with permission, from reference 5.)‏
  • BI-RADS 5 in a 59-year-old woman with an irregular spiculated mass seen at mammography. US image shows a corresponding mass (arrows). Histologic findings from US-guided core-needle biopsy disclosed a macrocyst with squamous metaplasia, which was discordant. Wire localization of the clip placed at the time of biopsy found a complex sclerosing lesion and sclerosing adenosis. For masses categorized as BI-RADS 5, excision should be recommended regardless of nonmalignant histologic findings from core biopsy. Recommended BI-RADS description is a hypoechoic mass with an irregular shape, indistinct margins, nonparallel orientation, and posterior acoustic shadowing: BI-RADS 5.
  • Importance of correlation in location between US and mammography. (a) Mediolateral oblique screening mammogram of a 69-year-old woman shows a 9-mm focal asymmetry (arrow) in the left breast. US revealed two normal intramammary lymph nodes: one at 2 o’clock 20 cm from the nipple and a second at 3 o’clock 7 cm from the nipple. (b) US image shows a third intramammary lymph node (arrows) at 3 o’clock 20 cm from the nipple. This third node was believed to correspond to the mammographic asymmetry, and 6-month follow-up was recommended. (c) Follow-up mammogram shows that the focal asymmetry had increased in size (arrow). Biopsy was performed with wire localization and surgical excision. Histologic findings disclosed invasive carcinoma with ductal and lobular features. In retrospect, the margins of the mass seen in a were indistinct and not circumscribed, a finding that did not correlate with the lymph node seen in b.
  • Importance of correlation in location between US and mammography. (a) Mediolateral oblique screening mammogram of a 69-year-old woman shows a 9-mm focal asymmetry (arrow) in the left breast. US revealed two normal intramammary lymph nodes: one at 2 o’clock 20 cm from the nipple and a second at 3 o’clock 7 cm from the nipple. (b) US image shows a third intramammary lymph node (arrows) at 3 o’clock 20 cm from the nipple. This third node was believed to correspond to the mammographic asymmetry, and 6-month follow-up was recommended. (c) Follow-up mammogram shows that the focal asymmetry had increased in size (arrow). Biopsy was performed with wire localization and surgical excision. Histologic findings disclosed invasive carcinoma with ductal and lobular features. In retrospect, the margins of the mass seen in a were indistinct and not circumscribed, a finding that did not correlate with the lymph node seen in b.
  • Abscess in a 27-year-old woman with a palpable right subareolar mass that was extremely tender to palpation, who also reported 2 days of fever. (a) US image demonstrates a complex cystic and solid mass (arrows) in the retroareolar region. (b) Doppler US image shows vascularity within the solid components (arrows). Although the US features are suspicious findings, this mass, in the correct clinical setting, is highly suggestive of an abscess. The recommended BI-RADS description is an oval mass with a complex echo pattern, partially indistinct margins, and parallel orientation: BI-RADS 4A, with a recommendation for aspiration in the clinical setting of a probable abscess.
  • Abscess in a 27-year-old woman with a palpable right subareolar mass that was extremely tender to palpation, who also reported 2 days of fever. (a) US image demonstrates a complex cystic and solid mass (arrows) in the retroareolar region. (b) Doppler US image shows vascularity within the solid components (arrows). Although the US features are suspicious findings, this mass, in the correct clinical setting, is highly suggestive of an abscess. The recommended BI-RADS description is an oval mass with a complex echo pattern, partially indistinct margins, and parallel orientation: BI-RADS 4A, with a recommendation for aspiration in the clinical setting of a probable abscess.
  • Fat necrosis. US image shows that in the setting of prior trauma, a mixed hypo- and hyperechoic lesion (arrows) can represent fat necrosis. Variation existed in the BI-RADS assessment and recommendations. The recommended BI-RADS description is an oval circumscribed mass with a heterogeneous internal echo pattern and parallel orientation at the site of prior trauma: BI-RADS 3.
  • Figure 8b.  Confirmation of lesion penetration. (a) Prefire US image shows the relationship of the biopsy needle (arrow) to the lesion. (b) On a postfire US image, the needle (arrow) is seen penetrating through the lesion. (c) Orthogonal US image helps confirm that the needle (arrow) has penetrated the lesion.
  • Figure 8c.  Confirmation of lesion penetration. (a) Prefire US image shows the relationship of the biopsy needle (arrow) to the lesion. (b) On a postfire US image, the needle (arrow) is seen penetrating through the lesion. (c) Orthogonal US image helps confirm that the needle (arrow) has penetrated the lesion.
  • Figure 10a.  Appearance of the specimen in formalin. (a) Photograph shows a core sample that is yellow and floats on the surface of the formalin, findings that indicate that the sample is insufficient for diagnosis. (b) Photograph obtained in a different patient shows a core sample that is predominantly white and sinks in the formalin, findings that indicate that the sample is probably diagnostic.
  • Figure 10b.  Appearance of the specimen in formalin. (a) Photograph shows a core sample that is yellow and floats on the surface of the formalin, findings that indicate that the sample is insufficient for diagnosis. (b) Photograph obtained in a different patient shows a core sample that is predominantly white and sinks in the formalin, findings that indicate that the sample is probably diagnostic.
  • Figure 13a.  Radiologic-histologic discordance in a 41-year-old woman with invasive ductal carcinoma. US-guided 14-gauge core needle biopsy was performed. (a) Prefire US image shows an irregular, spiculated, markedly hypoechoic mass with posterior shadowing in the left breast. The mass was graded as a BI-RADS category 5 lesion. (b) Postfire US image shows the mass. The histologic diagnosis was fibrocystic disease with ductal epithelial hyperplasia and was considered discordant with the US findings. Surgical excision was performed immediately, and the mass was diagnosed as invasive ductal carcinoma.
  • Figure 13b.  Radiologic-histologic discordance in a 41-year-old woman with invasive ductal carcinoma. US-guided 14-gauge core needle biopsy was performed. (a) Prefire US image shows an irregular, spiculated, markedly hypoechoic mass with posterior shadowing in the left breast. The mass was graded as a BI-RADS category 5 lesion. (b) Postfire US image shows the mass. The histologic diagnosis was fibrocystic disease with ductal epithelial hyperplasia and was considered discordant with the US findings. Surgical excision was performed immediately, and the mass was diagnosed as invasive ductal carcinoma.
  • Fibroadenoma. (a) B-mode US image of the left breast shows a lobulated hypoechoic lesion that is taller than wide, with posterior acoustic shadowing. (b) US elastogram, however, shows the lesion to be smaller than on the B-mode image. The findings from biopsy revealed a fibroadenoma.
  • Invasive ductal carcinoma. The breast lesion measures smaller on the B-mode US image (a) than on the US elastogram (b) in the transverse plane. The lesion is too large to measure accurately in the anteroposterior plane; dotted lines indicate measurements of the lesion diameter: 21.9 × 34.2 mm in a and 24.9 × 29.6 mm in b. In addition, the lesion is stiffer than the surrounding tissues. The findings from a US-guided core biopsy revealed invasive ductal carcinoma.

Birads US 3 - 5 Birads US 3 - 5 Presentation Transcript

  • Birads 3-5 Ultrasound
  •  
  • BIRADS
    • 3 - Probably benign: 6,12,(18),24 month
    • 4 - Biopsy (A,B,C) 2-95% risk
    • 5 - Cancer (>95%)
  • Benign Malignant
    • Oval
    • Parallel to skin
    • Circumscribed
    • Sharp boundary
    • Hyper echoic
    • Irregular / round
    • Not parallel
    • Indistinct, angular, spiculated
    • Echogenic halo
    • Mixed echopattern
    • Posterior shadow
  • Orientation and shape. Oval 16% malignant ©2010 by Radiological Society of North America
    • Benign
    • Oval
    • Parallel to skin
    • Circumscribed
    • Sharp boundary
    • Hyper echoic
  • Orientation and shape. Round 60% malignant ©2010 by Radiological Society of North America
    • Malignant
    • Irregular / round
    • Not parallel
    • Indistinct, angular, spiculated
    • Halo
    • Mixed pattern
    • Shadow
  • Orientation and shape. Irregular 60% malignant ©2010 by Radiological Society of North America
    • Malignant
    • Irregular / round
    • Not parallel
    • Indistinct, angular, spiculated
    • Halo
    • Mixed pattern
    • Shadow
  • Margins. Raza S et al. Radiographics 2010;30:1199-1213 ©2010 by Radiological Society of North America
    • Benign
    • Oval
    • Parallel to skin
    • Circumscribed
    • Sharp boundary
    • Hyper echoic
  • Margins. Microlobulated ©2010 by Radiological Society of North America
    • Malignant
    • Irregular / round
    • Not parallel
    • Indistinct, angular, spiculated
    • Halo
    • Mixed pattern
    • Shadow
  • Margins. Indistinct ©2010 by Radiological Society of North America
    • Malignant
    • Irregular / round
    • Not parallel
    • Indistinct, angular, spiculated
    • Halo
    • Mixed pattern
    • Shadow
  • Margins. Angular: 60% malignant ©2010 by Radiological Society of North America
    • Malignant
    • Irregular / round
    • Not parallel
    • Indistinct, angular, spiculated
    • Halo
    • Mixed pattern
    • Shadow
  • Margins. Spiculated: 86% malignant ©2010 by Radiological Society of North America
    • Malignant
    • Irregular / round
    • Not parallel
    • Indistinct, angular, spiculated
    • Halo
    • Mixed pattern
    • Shadow
  • Internal echo pattern. Raza S et al. Radiographics 2010;30:1199-1213 ©2010 by Radiological Society of North America
    • Hypo echoic
    • Most common
    • Compare to fat
  • Internal echo pattern. Raza S et al. Radiographics 2010;30:1199-1213 ©2010 by Radiological Society of North America
    • Iso echoic
    • Compare to fat
  • Internal echo pattern. Raza S et al. Radiographics 2010;30:1199-1213 ©2010 by Radiological Society of North America
    • Hyper echoic
    • Mostly benign
    • Compare to fat
  • Posterior acoustic features. Raza S et al. Radiographics 2010;30:1199-1213 ©2010 by Radiological Society of North America
    • Enhancement
    • Indeterminate
    • SonoCT off
  • Posterior acoustic features. Shadow ©2010 by Radiological Society of North America
    • Malignant
    • Irregular / round
    • Not parallel
    • Indistinct, angular, spiculated
    • Halo
    • Mixed pattern
    • Shadow
  • Benign NPV
    • Oval
    • Parallel to skin
    • Circumscribed
    • Sharp boundary
    • Hyper echoic
    • 84%
    • 78%
    • 90%
  • Malignant PPV
    • Irregular / round
    • Not parallel
    • Indistinct, angular, spiculated
    • Echogenic halo
    • Mixed echopattern
    • Posterior shadow
    62% 69% 86%
  • BIRADS 3
  • “ Lobulated mass, BI-RADS 3,” in a 40-year-old woman with a circumscribed left breast mass seen at mammography. Oval, sharp, parallel, hypo Fibro adenoma ©2010 by Radiological Society of North America
  •  
  • Hematoma in a 45-year-old woman with recent trauma to her right breast. Raza S et al. Radiographics 2010;30:1199-1213 ©2010 by Radiological Society of North America
  • Hematoma in a 45-year-old woman with recent trauma to her right breast. Raza S et al. Radiographics 2010;30:1199-1213 ©2010 by Radiological Society of North America
  • Hematoma in a 45-year-old woman with recent trauma to her right breast. Raza S et al. Radiographics 2010;30:1199-1213 ©2010 by Radiological Society of North America
  • BIRADS 4
  • Palpable mass in the left breast of a 70-year-old woman. 1st visit BIRADS 3 ©2010 by Radiological Society of North America
  • IDC 2nd visit BIRADS 4: circumscribed, hypo, not parallel ©2010 by Radiological Society of North America
  •  
  • US image of a 50-year-old woman who presented with a palpable mass (arrows) in the right breast. BIRADS 4: posterior border indistinct IDC ©2010 by Radiological Society of North America
  • BI-RADS 4A in a 55-year-old woman who presented with a palpable mass and swelling in her left breast. Oval, hypo echoic, partial indistinct, posterior enhancement. Surgery: ruptured cyst ©2010 by Radiological Society of North America
  • BI-RADS 4B. Parallel, hypo echoic, indistinct, mixed echopattern DCIS ©2010 by Radiological Society of North America
  • BIRADS 5
  • BI-RADS 5 in a 59-year-old woman with an irregular spiculated mass seen at mammography. Indistinct, hypo, irregular / spiculated, not parallel, shadow, ©2010 by Radiological Society of North America
  • Technique
  • Importance of correlation in location between US and mammography. Raza S et al. Radiographics 2010;30:1199-1213 ©2010 by Radiological Society of North America
  • Importance of correlation in location between US and mammography. Raza S et al. Radiographics 2010;30:1199-1213 ©2010 by Radiological Society of North America
  • Clinical
  • 27-year-old woman with a palpable right subareolar mass that was extremely tender to palpation, who also reported 2 days of fever. Raza S et al. Radiographics 2010;30:1199-1213 ©2010 by Radiological Society of North America
  • Abscess BIRADS 4a:oval, partly indistinct border, complex echopattern, parallel Aspirate ©2010 by Radiological Society of North America
  • Post traumatic fat necrosis. BIRADS 3: oval, circumscribed, mixed, parallel, at trauma site ©2010 by Radiological Society of North America
  • Negative biopsy
    • Technique
    • Correlation Histology / Radiology
      • Repeat biopsy
      • Follow up 6m / 12m
  • Figure 8b.  Confirmation of lesion penetration. Youk J H et al. Radiographics 2007;27:79-94 ©2007 by Radiological Society of North America
  • Figure 8c.  Confirmation of lesion penetration. Youk J H et al. Radiographics 2007;27:79-94 ©2007 by Radiological Society of North America
  • Figure 10a.  Appearance of the specimen in formalin. Fat ©2007 by Radiological Society of North America
  • Figure 10b.  Appearance of the specimen in formalin. Tissue ©2007 by Radiological Society of North America
  • BIRADS 5: irregular, spiculated, hypo echoid with shadow ©2007 by Radiological Society of North America
  • Figure 13b.  Radiologic-histologic discordance in a 41-year-old woman with invasive ductal carcinoma. Youk J H et al. Radiographics 2007;27:79-94 ©2007 by Radiological Society of North America
  •  
  • Benign Malignant
    • Oval
    • Parallel to skin
    • Circumscribed
    • Sharp boundary
    • Hyper echoic
    • Irregular / round
    • Not parallel
    • Indistinct, angular, spiculated
    • Echogenic halo
    • Mixed echopattern
    • Posterior shadow
  • Other
  • MRI Type 1 6% Type 2 Type 3 >30% t %
  • Elastosonography
  • Fibroadenoma. Smaller on Elastosono ©2009 by Radiological Society of North America
  • Invasive ductal carcinoma. Carcinoma larger on Elastosono ©2009 by Radiological Society of North America
  • Benign Malignant
    • Oval
    • Parallel to skin
    • Circumscribed
    • Sharp boundary
    • Hyper echoic
    • Irregular / round
    • Not parallel
    • Indistinct, angular, spiculated
    • Echogenic halo
    • Mixed echopattern
    • Posterior shadow