How to Find an Isoechoic Lesion with Breast US

Abstract

Breast ultrasonography (US) is recognized as a useful diagnostic tool for palpable or nonpalpable breast masses, but isoechoic lesions surrounded by fat can be a challenge for radiologists and can result in false-negative interpretations and a delayed diagnosis of breast cancer. Identifying isoechoic lesions surrounded with fat by using breast US requires meticulous evaluation with B-mode US in correlation with mammography. For correlation between mammography and US, the location, surrounding tissue, and lesion characteristics, including size, shape, and internal contents, must be considered. Complementary tools to B-mode US in the evaluation of isoechoic breast lesions include spatial compound imaging, tissue harmonic imaging, US elastography, color or power Doppler imaging, power Doppler vocal fremitus imaging, and contrast agent enhancement. Specimen radiography after breast biopsy can be helpful in evaluating the adequacy of tissue sampling and the appropriateness of lesion targeting and localization, evaluations that increase confidence in the findings from tissue acquisition.

The effectiveness of Power Doppler vocal fremitus imaging in the diagnosis of breast hamartoma

“…The use of PDVF in the differential diagnosis of breast lesions, has been studied by few researchers [6][7][8]15]. Stavros et al [6] suggested that the vibrational defect could be useful for distinguishing benign or malign breast masses, from normal tissues.…”

“…Stavros et al [6] suggested that the vibrational defect could be useful for distinguishing benign or malign breast masses, from normal tissues. Kim et al 7,8] reported that PDVF imaging can be useful in discriminating isoechoic tumors from fatty and isoechoic glandular tissues, and also for detecting multifocal isoechoic disease. They also showed that vibratory defect sizes, of benign and circumscribed malignant lesions on PDVF imaging, could be the same as the lesion sizes on B-mode imaging.…”

“…In the literature, there is a consensus that PDVF imaging can distinguish breast lesions (malign or benign) from normal breast tissue [6][7][8]. PDVF can be a useful imaging method when other better performing ultrasonographic techniques, such as sonoelastography, are not available.…”

Adding Ultrasound to the Evaluation of Patients with Pathologic Nipple Discharge to Diagnose Additional Breast Cancers: Preliminary Data

“…Therefore, for these patients, it is important to search for diagnostic tools that are fairly non-invasive and yet still highly sensitive. The sensitivity of breast US has increased with the evolution of highresolution US systems, development of communication systems such as the BI-RADS (Breast Imaging Reporting and Data System) classification and education that has enhanced US techniques (D'Orsi et al 2003;Kim et al 2011). By performing US on patients with pathologic nipple discharge, we may be able to accurately identify and localize the cause of nipple discharge before surgical intervention.…”

Diagnostic Value Of Mammography And Ultrasonography For Differentiation Of Benign And Malignant Breast Masses

“…The smallest cyst we have detected was 3 mm. Although US is very effective for differentiating cysts from solid lesions, it is not such effective for the differentiation of benign-malign solid masses (16,17). When a solid lesion is detected at US; the dimensions, shape, margins, echogenicity, homogenicity and posterior acoustic properties of the lesion must be evaluated.…”