HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Baker, J. A. Articles by Soo, M. S. Search for Related Content PubMed PubMed Citation Articles by Baker, J. A. Articles by Soo, M. S.

Breast US: Assessment of Technical Quality and Image Interpretation¹

¹ From the Division of Breast Imaging, Duke University Medical Center, Erwin Rd, Box 3808, Durham, NC 27710. Received June 28, 2001; revision requested July 23; revision received October 2; accepted October 10. Address correspondence to J.A.B. (e-mail: baker013@mc.duke.edu).

View larger version (70K): [in a new window]   Figure 1. Guidelines adapted from the ACR standards for breast US.

View larger version (95K): [in a new window]   Figure 2. Transverse sonogram of the breast obtained in a 42-year-old woman illustrates the inappropriate placement of the focal zone cursor (>). The focal zone is placed at the level of lung tissue, 1.5 cm posterior to the pectoralis muscle (p). Although the breast parenchyma is only 1.0-1.5-cm deep, the depth of field is set at 6 cm, which results in complete attenuation of the posterior 3 cm of the image due to air in the lungs. A 7.0-MHz transducer (arrow) was used for this examination.

View larger version (73K): [in a new window]   Figure 3a. (a) Transverse sonogram of the breast obtained in a 33-year-old woman demonstrates an 8-mm ill-defined hypoechoic mass (calipers). A 7.5-MHz linear transducer was used. Focal zone cursors (arrowheads) were placed 1 and 2 cm deep to the posterior margin of the mass. Depth of field is set at 5 cm. The mass was interpreted as solid and suspicious for malignancy (Breast Imaging Reporting and Data System, or BI-RADS, category 4). (b) Repeat antiradial sonogram demonstrates a homogeneous circumscribed hypoechoic mass (arrow) adjacent to the skin. This mass had been stable at mammography for 2 years and had characteristic features of a sebaceous cyst at physical examination.

View larger version (93K): [in a new window]   Figure 3b. (a) Transverse sonogram of the breast obtained in a 33-year-old woman demonstrates an 8-mm ill-defined hypoechoic mass (calipers). A 7.5-MHz linear transducer was used. Focal zone cursors (arrowheads) were placed 1 and 2 cm deep to the posterior margin of the mass. Depth of field is set at 5 cm. The mass was interpreted as solid and suspicious for malignancy (Breast Imaging Reporting and Data System, or BI-RADS, category 4). (b) Repeat antiradial sonogram demonstrates a homogeneous circumscribed hypoechoic mass (arrow) adjacent to the skin. This mass had been stable at mammography for 2 years and had characteristic features of a sebaceous cyst at physical examination.

View larger version (132K): [in a new window]   Figure 4. Dual-mode sonogram of the breast obtained at an outside referring facility. Transverse (left) and longitudinal (right) projection images obtained in a 49-year-old woman show a 1.0-cm irregularly shaped hypoechoic mass (arrows), which was confirmed at excisional biopsy to represent an infiltrating ductal adenocarcinoma. The surrounding fibroglandular tissue and pectoralis muscle are uniformly markedly hyperechoic and cannot be distinguished, which indicates an inappropriately high setting of the gray-scale gain.

View larger version (116K): [in a new window]   Figure 5a. (a) Mediolateral oblique spot-compression magnification mammogram obtained at an outside facility in a 53-year-old woman with a saline breast implant shows an oval 7-mm mass (arrow) with a central lucency characteristic of an intramammary lymph node. Radiopaque marker indicates the site of a skin mole. (b) Transverse sonogram obtained at an outside facility demonstrates a 7-mm oval hypoechoic mass (arrow) with central hyperechogenicity also characteristic of a lymph node. The mass was interpreted at the referring facility as a solid complex mass suspicious for malignancy (BI-RADS category 4), and biopsy was recommended.

View larger version (84K): [in a new window]   Figure 5b. (a) Mediolateral oblique spot-compression magnification mammogram obtained at an outside facility in a 53-year-old woman with a saline breast implant shows an oval 7-mm mass (arrow) with a central lucency characteristic of an intramammary lymph node. Radiopaque marker indicates the site of a skin mole. (b) Transverse sonogram obtained at an outside facility demonstrates a 7-mm oval hypoechoic mass (arrow) with central hyperechogenicity also characteristic of a lymph node. The mass was interpreted at the referring facility as a solid complex mass suspicious for malignancy (BI-RADS category 4), and biopsy was recommended.

View larger version (91K): [in a new window]   Figure 6a. (a) Mediolateral spot-compression magnification mammogram obtained in a 50-year-old woman with silicone breast implants demonstrates a 10-mm high-density mass (arrow) in the superior right breast. (b) Radial sonogram of the mass shows the characteristic "snowstorm" or "echogenic shadowing" appearance (straight arrows) of extracapsular silicone adjacent to the silicone implant (curved arrow). The mass was reported as highly suspicious (BI-RADS category 5), and biopsy was recommended by an outside imaging facility with no mention of the possibility of extracapsular silicone. Needle biopsy performed at the request of the referring surgeon confirmed foreign body giant cell reaction with abundant silicone.

View larger version (119K): [in a new window]   Figure 6b. (a) Mediolateral spot-compression magnification mammogram obtained in a 50-year-old woman with silicone breast implants demonstrates a 10-mm high-density mass (arrow) in the superior right breast. (b) Radial sonogram of the mass shows the characteristic "snowstorm" or "echogenic shadowing" appearance (straight arrows) of extracapsular silicone adjacent to the silicone implant (curved arrow). The mass was reported as highly suspicious (BI-RADS category 5), and biopsy was recommended by an outside imaging facility with no mention of the possibility of extracapsular silicone. Needle biopsy performed at the request of the referring surgeon confirmed foreign body giant cell reaction with abundant silicone.

View larger version (129K): [in a new window]   Figure 7a. (a) Antiradial sonogram of the breast obtained at an outside referring facility in a 39-year-old woman with white nipple discharge was interpreted at that facility as demonstrating a circumscribed oval hypoechoic mass (calipers). Imaging was performed in the antiradial projection only. (b) Sonogram in the radial projection of the same breast repeated at this facility shows that the structure elongates (arrows) and extends radially toward the nipple (N). A blood vessel was seen wrapping around the structure (arrowhead), which was interpreted at this facility as a dilated lactiferous duct and was confirmed with wire localization and surgical excision at the request of the patient’s surgeon.

View larger version (103K): [in a new window]   Figure 7b. (a) Antiradial sonogram of the breast obtained at an outside referring facility in a 39-year-old woman with white nipple discharge was interpreted at that facility as demonstrating a circumscribed oval hypoechoic mass (calipers). Imaging was performed in the antiradial projection only. (b) Sonogram in the radial projection of the same breast repeated at this facility shows that the structure elongates (arrows) and extends radially toward the nipple (N). A blood vessel was seen wrapping around the structure (arrowhead), which was interpreted at this facility as a dilated lactiferous duct and was confirmed with wire localization and surgical excision at the request of the patient’s surgeon.

View larger version (121K): [in a new window]   Figure 8a. (a) Sagittal and (b) transverse sonograms of the right breast obtained for the evaluation of breast tenderness in a 42-year-old woman. The calipers denote a region of normal-appearing fibroglandular tissue that is identical to the surrounding tissue. The official interpretation from the referring facility was a "1.5-cm solid suspicious mass" for which biopsy was recommended. Normal breast tissue was identified at US-guided core-needle biopsy.

View larger version (128K): [in a new window]   Figure 8b. (a) Sagittal and (b) transverse sonograms of the right breast obtained for the evaluation of breast tenderness in a 42-year-old woman. The calipers denote a region of normal-appearing fibroglandular tissue that is identical to the surrounding tissue. The official interpretation from the referring facility was a "1.5-cm solid suspicious mass" for which biopsy was recommended. Normal breast tissue was identified at US-guided core-needle biopsy.

View larger version (161K): [in a new window]   Figure 9a. (a) Transverse sonogram of a palpable mass in a 44-year-old woman demonstrates two adjacent superficial cysts (calipers) and a large markedly hypoechoic irregularly shaped mass with posterior acoustic shadowing (arrows). Outside interpretation noted only cysts with final BI-RADS assessment of a 2—benign finding. (b) Repeat transverse sonogram obtained at a second outside facility shows a core biopsy needle (curved arrows) entering the large mass (straight arrows). Final histologic finding revealed invasive adenocarcinoma.

View larger version (128K): [in a new window]   Figure 9b. (a) Transverse sonogram of a palpable mass in a 44-year-old woman demonstrates two adjacent superficial cysts (calipers) and a large markedly hypoechoic irregularly shaped mass with posterior acoustic shadowing (arrows). Outside interpretation noted only cysts with final BI-RADS assessment of a 2—benign finding. (b) Repeat transverse sonogram obtained at a second outside facility shows a core biopsy needle (curved arrows) entering the large mass (straight arrows). Final histologic finding revealed invasive adenocarcinoma.

View larger version (132K): [in a new window]   Figure 10. Antiradial sonogram obtained in a 42-year-old woman demonstrates a 9-mm circumscribed hypoechoic mass (calipers) with increased posterior transmission of the sound beam (arrows). The mass was initially interpreted as a simple cyst, and no further evaluation was recommended. The mass was subsequently reinterpreted as either a complex cyst or a solid mass, because internal echoes are evident on the static image. US-guided core-needle biopsy after unsuccessful cyst aspiration revealed fibroadenoma.