Hyperechoic breast lesions can be malignant. Poster No.: C-0041 Congress: ECR 2015 Type: Educational Exhibit Authors: G. Babu, R. bradley; Edinburgh/UK Keywords: Breast, Ultrasound, Biopsy, Cancer DOI: 10.1594/ecr2015/C-0041 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 6
Learning objectives This case series reviews malignant hyperechoic breast lesions in our practice. Most hyperechoic lesions are benign but a small proportion are sinister. This series includes biopsy proven malignant hyperechoic lesions including a review of the radiological features. Page 2 of 6
Background At ultrasonography, echogenic breast lesions are usually benign. However, recent data indicated 0.5% of malignant breast lesions appear echogenic. Most malignant breast lesions are hypoechoic. We reviewed ten cases in our series which presented as echogenic malignant lesions. Sonographic findings were evaluated according to the Breast imaging report and the data system lexicon. Further clinical features including follow up and pathological findings were reviewed. Page 3 of 6
Findings and procedure details Patients presented in both the symptomatic and screening setting ( 4:6). The age range was 35 to 71 years. Most symptomatic presented as lumps while one was seen on a long term follow up mammogram. Nine out of ten lesions presented as mammographic opacity, while one was occult. All the lesions were echogenic with either central hypoechoic or cystic areas. Pathology included three patients with Invasive grade 2, two patients with Invasive grade 1, two patients with lobular cancers, one patient with high grade DCIS and one with an intraductal papillary lesion. Page 4 of 6
Conclusion Hyperechoic masses are rare and mostly benign. Most malignant type lesions are not always uniformly hyperechoic and this may be predictor of the malignant nature. Features like shape, vascularity and posterior shadowing help to determine the nature of the lesion. It is posulated that hyperechoic breast cancers reflect the heterogeneity of the tumor. Certain polymorphous histologic patterns eg. cribriform, tubular and those with densely packed tumor cells may be hyperechoic. Although hyperechoic lesions have negative predictive value for malignancy, ultrasound lesion features should be carefully assessed during diagnostic workup and consideration of biopsy. Page 5 of 6
References 1. Echogenic breast lesions at Ultrasound- to biopsy or not to biopsy? Yiming Gao, MD, MM,, Priscilla J. Slanetz, MD, MPH, and, Ronald L. Eisenberg, MD, JD, Radiographics, March-april 2013, Volume 33 2. Hyperechoic lesions of the breast- Radiologic - Histopathologic correlation Beatriz, wun, Yang. - AJR, May 2013, Volume 200 3. Hyperechoic lesions of the breast- not always benign. Anna Linda, Chiriaz Zuanni, AJR, May 2011, Volume 196 4. Wide spectrum of hyperchoic lesions of the breast, Linda Zuanni et.al - Clinical radiology, June 2011 5. Pure lobular carcinoma of the breast - presenting as a hyperchoic mass- Incidence and imaging characteristics. Jones et.al- AJR, Nov 2013 Page 6 of 6