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The sonographic appearances of ten breast carcinomas associated with microcalcifications were reviewed. None of the clusters of microcalcifications were visualized sonographically. All of the tumors were seen on sonomammography as either solid mass lesions or areas of acoustical shadowing.

The current classification of mammary carcinoma divides tumors into two groups, those that appear to develop from ducts and those that arise from lobules. Lobular carcinomas account for 14%-20% of invasive breast tumors.' A second tumor in the ipsilateral and/or contralateral breast is quite common. Later development of a carcinoma in the contralateral breast is also quite high, therefore follow-up of the contralateral breast is very important. We have noted on several occasions lobular carcinomas which have not been picked up on xeromammography. In our department, ultrasound whole breast water-path scanning is used as an additive and complementary means of evaluating the obscure tumor. CASE HISTORYA 45-year-old female was admitted to the hospital for biopsy of a right breast mass. She first noted the mass in her right breast 2 weeks earlier while bathing. Upon consulting her physician the mass was confirmed on physical examination to lie in the lower outer quadrant of the right breast. It measured approximately 1 cm in diameter and was moderately firm. An attempted needle aspiration failed to reveal fluid and she was referred to our department for further evaluation. A xeromammogram failed to demonstrate the palpable mass in either the cephalocaudad or lateral views (Figs. 1, 2). Sonographic mammography was then performed. The scans were obtained using an automated whole breast water-path scanner, SMV-50, developed by Technicare (Englewood, Colo. Figure 3 is a sagittal scan of the right breast made 5.6 cm lateral to the nipple. Approximately 2 cm below the level of the nipple there was a hypoechoic mass, 1.3 cm in diameter, with irregular borders and a few internal echoes. Highly reflective stroma was noted anterior to the mass and distal shadowing was noted posterior t o the mass causing a keyhole configuration. A transverse scan confirmed the presence of the mass (Fig. 4). These findings were consistent with a solid mass and highly suspicious for malign a n~y .~>~ The patient was then taken to surgery at which time a right breast mass was excised and found to be an infiltrating lobular carcinoma, 1 cm in diameter. Right axillary node dissection showed reactive histiocytic and follicular hyperplasia, but no evidence of carcinoma. A mirror image biopsy of the left breast showed no evidence of carcinoma. The patient declined a mastectomy and was referred for radiation therapy and systemic chemotherapy. DISCUSSIONThe axiom that early detection is the best cure for carcinoma of the breast still holds true today. It is important that we use all means to detect these tumors. Our patient had dense mammary parenchyma on xeromammography obscuring the palpable tumor. Most cases of lobular carcinoma, in situ or invasive, are found in breast tissue that contains fibrocystic d i~e a s e .~ Therefore, it is not surprising that a small lobular carcinoma can go undetected on plain film mammography or xeromammography .Patients with infiltrating lobular carcinoma have a high incidence of co-existing lesions in the ipsilateral a...

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