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Breast Imaging

E2419. Breast Masses on Ultrasound Beyond Cysts and Invasive Cancer

Hwang E,  Sonnenblick E,  Szabo J,  Margolies L. Mount Sinai Hospital, New York, NY

Address correspondence to E. Hwang (esther.hwang@gmail.com)

Background Information: The most easily recognizable breast masses encountered on breast ultrasound examinations are typically invasive breast cancers and benign cysts. However, there is a wide gamut of breast masses that fall under various other categories, including infection, noninvasive tumors, high-risk breast lesions, systemic disease, vascular disease, postoperative changes, fibroepithelial lesions, anatomic variants, and foreign bodies. The purpose of this educational exhibit is to review describing breast lesions using the BI-RADS lexicon, recognize distinguishing features of various breast masses, and to recognize when to consider a neoplastic process despite sonographic findings that appear benign.

Educational Goals/Teaching Points: The goals of this exhibit are to categorize breast ultrasound findings using the BI-RADS lexicon when describing shape, margin, orientation, echo pattern, and posterior acoustic effects; create a differential diagnosis for breast masses that are not typical invasive breast cancers or breast cysts on ultrasound; and recognize when to consider tumors despite benign appearing sonographic features.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: High-risk breast lesions are often occult on ultrasound, but when visible, radial scars and atypical ductal hyperplasia (as well as low-grade ductal carcinoma in situ) may appear sonographically as architectural distortion or a hypoechoic mass with acoustic shadowing. While a circumscribed mass is typically considered a benign feature, circumscribed invasive cancers to be aware of include papillary carcinoma, medullary carcinoma, and mucinous carcinoma. Granular cell tumors can mimic invasive carcinoma, radial scars can mimic and may be a precursor to tubular carcinoma, abscess can mimic invasive carcinoma, and diabetic mastopathy may mimic cancer.

Conclusion: Although the most easily recognizable breast masses encountered on breast ultrasound examinations are typically invasive breast cancers and benign cysts, it is important to recognize the wide gamut of breast masses that fall under various other categories and to create an appropriate differential diagnosis.