1/6/2024 0 Comments Benign findings![]() The echo texture of a benign mass will usually be homogeneous with an isoechoic, hyperechoic, to mildly hypoechoic echogenicity. The lesion might also be macrolobulated or with just 2 to 4 mild lobulations.īenign breast lesions also tend to be ovoid or round in shape, and are often ‘wider-than-tall’ (which indicates a parallel orientation to the chest wall). On ultrasound, a benign breast mass will typically be well defined and with smooth margins. But most benign tumors do not usually shadow unless they are calcified. However, posterior acoustic shadowing caused by a desmoplastic reaction can be found in benign breast neoplasms as well.įor example, fibrosis inside a tumor can block ultrasound from passing deeper, causing acoustic shadowing. High grade malignancies in the breast grow too fast for this desmoplastic reaction to occur. That means that dense fibrous and connective tissues are growing around the tumor as a kind of defense mechanism by the body to ‘contain’ the neoplastic growth. What may be happening is that a slow growing breast tumor causes a secondary ‘desmoplastic response’ in the surrounding tissue. Posterior acoustic shadowing is suspicious for malignancy, but tends to be associated with low to intermediate grade breast tumors. If a breast lesion shows posterior acoustic shadowing on ultrasound this means that there is something about the mass or around the mass which attenuates (reduces) the sonic beam strength in comparison to normal adjacent tissues. So, in this case, a biopsy will be necessary. Any apparent growth that is long enough to visibly fill a duct and branch, no matter what direction is goes, will be suspicious for malignancy. A branching pattern tends to indicate a tumor growth advancing away from the nipple. This is different from a ‘branch pattern’ in which multiple extensions arise from the mass but extend away-from the nipple. Sometimes, you will see a duct extensions/projection has developed as a ‘bridge’ between multi-focal malignancies. These projections often occur both within or around breast duct. As the number of these microlobulations increase, the probability that the breast mass is malignant also increases.Ī ‘ duct extension‘ appears on ultrasound as a ‘radially oriented’ projection that seems to arise from the lesions an axis oriented towards the nipple. So, these lobulations will be quite similar to mammogram findings. ‘ Microlobulations‘ on breast ultrasound indicate the presence of lots of very small (1mm to 2 mm) lobulations on the surface of a solid breast nodule. If a mass or part of the mass seems longer in the anteroposterior dimension (tallness) compared to either the sagittal or transverse dimensions (depth and width) then one can conceive that this may be a malignancy ‘aggressive enough’ to overcome normal breast tissue barriers and planes and grow vertically. The textbook may say: when a patient is scanned by ultrasound, they are usually in a supine position, and as a result the normal ’tissue planes’ on the breast will have a horizontal orientation. If a solid breast nodule appears on ultrasound to be ‘ taller-than-wide‘, this is suspicious of malignancy. Angular margins observed on breast ultrasound are highly predictive of malignancy. Angular margins are quite distinct from ‘lobulations’ which tend to be smooth and rounded. Sometimes, specialists refer to these features as ‘jagged’ or ‘irregular’ margins. ![]() ![]() On ultrasound, spiculations will often consist of straight lines that ‘radiate’ in a perpendicular fashion from the surface of the breast mass.Īn ‘ angular margin‘ is an angular configuration at the junction between relatively hypoechoic or isoechoic central portion of a solid mass and surrounding tissue. Spiculations often represent breast tumor ‘ tentacles‘ or desmoplastic reactions.
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